Spina bifida ppt

Pediatric nursing

1. SPINA BIFIDA SUB : PEDIATRIC NURSING UNIT : V CHILD WITH CONGENITAL DISORDERS TOPIC : SPINA BIFIDA BY P.THIRUNAGALINGA PANDIYAN M.Sc .,(Child Health Nursing )

2. Introduction Spina bifida is a condition that t he backbone that protects the spinal cord does not form and close properly. This often results in damage to the spinal cord and nerves. Spina bifida might cause physical and intellectual disabilities that range from mild to severe.

3. Definition Spina bifida (Latin: "split spine") is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube . Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD). Incidence is 1-5 per 1000 live births

4. Causes The exact cause is unknown Risk factors are Consanguinity marriage Drugs (valproate) Folic acid deficiency Exposure to chemicals and radiation during antenatal period

5. Pathophysiology The neural plate folds along its central axis to form a neural groove lined on each side by a neural fold.   The two neural folds fuse together and pinch off to become the neural tube. Fusion of the neural folds begins in the middle of the embryo and moves cranially and caudally and form neural tube closure during 3 -5 weeks of gestation Risk factors like folic acid deficiency ,drugs, radiation causes genetic mutation which may results in abnormal development and end in neural tube defects

6. Pathophysiology

7. CLASSIFICATION OF SPINA BIFIDA 1. Spina Bifida Occulta 2. Spina Bifida Cystica a . Meningocoele b. Myelomeningocele

8. CLASSIFICATION OF SPINA BIFIDA SPINA BIFIDA OCCULTA Spina bifida occulta is the mildest type of spina bifida. It is sometimes called “hidden” spina bifida. With it, there is a small gap in the spine, but no opening or sac on the back . The spinal cord and the nerves usually are normal.

9. SPINA BIFIDA OCCULTA

10. CLASSIFICATION OF SPINA BIFIDA Spina Bifida Occulta Isolated laminar defects are seen The defects is not visible externally It occurs most frequently in the lumbosacral area The spinal cord is usually normal

11. CLASSIFICATION OF SPINA BIFIDA SPINA BIFIDA CYSTICA Spina bifida cystica classified into two a . Meningocele b. Meningomyelocele

12. CLASSIFICATION OF SPINA BIFIDA A.MENINGOCOELE It is condition that the meninges herniates through the gap in the spine. This creates a sac filled with fluid (called a Meningocoele ) on the baby’s back. There’s usually little or no nerve damage The sac containing meninges and CSF

13. MENINGOCOELE

14. CLASSIFICATION OF SPINA BIFIDA B.MYELOMENINGOCELE It is condition that the meninges herniates through the gap in the spine with nerves. There’s usually with nerve damage The sac containing meninges and CSF and nerves

15. MYELOMENINGOCELE

16. CLASSIFICATION OF SPINA BIFIDA

17. CLASSIFICATION OF SPINA BIFIDA

18. CLINICAL MANIFESTATIONS Spina Bifida Occulta Frequently no observable manifestations May be associated with one or more cutaneous manifestations Skin depression, port wine angiomatous nevi,dark tufts of hair ,soft subcutaneous lyphoma Foot weakness Bowel and bladder sphincter disturbances

19. CLINICAL MANIFESTATIONS Spina Bifida Cystica Sensory disturbances Flaccid (weakness) Partial paralysis of lower extremities Overflow incontinence with constant dribbling of urine Hydrocephalus, lack of bowel control

20. Diagnosis Maternal serum alpha-fetoprotein (MSAFP) test . a sample of the mother's blood is drawn and tested for alpha-fetoprotein abnormally high levels of AFP suggest that the baby has a neural tube defect. Ultrasound Fetal ultrasound is the most accurate method to diagnose spina bifida Investigations such as X-ray, MRI, or CT, to get a clearer view of the baby’s spine and the bones in the back.

21. MANAGEMENT Surgical correction The spinal cord and its nerve roots are put back inside the spine and covered with meninges. • Management is complicated and should involve a multidisciplinary team • Team should include pediatrician, orthopaedic surgeon, neurologist, physiotherapist etc

22. MANAGEMENT

23. PREVENTION Folic acid supplementation Dietary supplementation with folic acid has been shown to be helpful in preventing spina bifida . Sources of folic acid include whole grains, fortified breakfast cereals, dried beans, leaf vegetables and fruits.

24. NURSING MANAGEMENT PREOPERATIVE CARE Kept flat on his abdomen with a single layer of sterile gauze. The genitalia and buttocks must be kept clean. The ankles to be supported with foam rubber pads Antibiotics must be given as order if infection is suspected.

25. NURSING MANAGEMENT Emptying the infant’s bladder every 2 hours during the day and once at night If evidence of urinary infection occurs culture should be done to determine the antibiotics. The infant to be feeding properly . Records the activity of the legs and the degree of continence All the vital signs should be taken and recorded.

26. NURSING MANAGEMENT POSTOPERATIVE CARE The nurse is responsible for observing Temperature, Pulse, Respiration, symptoms of shock, abdominal distention. Head circumference of the infant must be measured frequently. Surgical dressing should be kept clean . Fluid and electrolyte management

27. NURSING DIAGNOSES Impaired physical mobility related to neuromuscular impairment Bowel incontinence related to neuromuscular impairment Impaired urinary elimination related to neuromuscular impairment Body image disturbances related to biophysical factors of child Altered family process related to situational crisis of long term condition of child Impaired skin integrity related to skeletal prominence