SPINA BIFIDA
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| What is s/b? | congenital neural tube defect, affects head and spinal column, most common developmental disorder of the CNS, can occur anywhere along the spinal column
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| 2 types of s/b | spina bifida occulta, and spina bifida cystica
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| S/B Occulta | failure of the posterior vertebra to fuse, most commonly at L5/S1
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| diabilities of S/B Occulta | usually not detected until child begins to walk when abnormal gait is noted, later may be difficulty with toilet training
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| S/B Cystica? | defect in the closure of the posterior vertebral arch with varying degrees of protrusion thru the BONY spine, further classified as: meningocele, and myelomeningocele
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| meingocele | sac like protrusion thru the bony defect containing meninges and cerebrospinal fluid , sac covering the defect may be thin and translucent or membranous
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| myelomeningocele | sac like HERNIATION thru the bony defect containing meninges, CSF, and a portion of the spinal cord or nerve roots, fluid leadkage is likely to occur, lesion is poorly covered with imperfect tissue
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| disabilities of S/B Cystica | depend on the location of the lesion, the higher the deformity the more neurologic dysfunction will be present. Partial or complete paralysis, bowel and or bladder may or may not be affected, renal fx may be affected due to poor kidney innervation
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| Associated complications | orthopedic, hydrocephalus, chronic UTI due to poor or absent bladder control, risk of skin freakdoun, shunt infection in children with associated hydrocephalus
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| incidence | develops in the 1st 28 days of gestation, incidence increase with family hx
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| etiology | unknown but associated with: environmental, nutritional and genetics
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| environmental exposure | radiation, maternal hyperthermia, chemical, maternal medications
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| nutritional | folic acid= 400mcg esp if family hx of s/b. at least one month before conception thru 1st trimester
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| dx | prenatal dx; ultrasound, AFP, Postnatal dx: neonal physical exam, tranilumination, CTs or MRI and flat plate films
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| neuro eval | baseline evals, motor response, strenghth, sensory response, reflexes, ongoing evaluation
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| tx | multidisciplinary approach
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| goal of tx | prevent infection, preserve or enhance whatever neurological or urological fx is present, promote opimal physiological & psychological development, support the family
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| preop care | POSITION: prone, towel roll bt the knees, hips slightly flexed and legs abducted to decrease pressure on the sac and maintain hip alignment, place isolette to maintain temp, keep sac covered with sterile moist N/S dressings to prevent drying and cracking,
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| focus of nursing assess | observe sac closely and assess it integrity, note any s/s of infection: fever, irritability and / or lethargy, nuchal rigidity, and s/s of ICP
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| Post op care | prone position until incision has healed, wound careand sterile dressing changes, antibiotic, analgesics, iv fluids for hydration, ob for s/s of infection, monitior for development of hydrocephalus, and management of bowel and bladder incontinence and pre
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| potential for mobility | assistive devices: lesion at L2 to L5, Lesions at L2 or above: customized wheel chairs
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| bladder fx | neurogenic, prone to urenary retention, freq bladder infection
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Created by:
meinmethoo
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