Spina Bifida

Hydrocephalus occurs in about 90% of infants with Spina Bifida Myelomeningocele due to the blocked flow of cerebrospinal fluid.

Consuming folic acid during pregnancy has been found to reduce the risk of Spina Bifida Myelomeningocele by up to 70%.

Ventriculoperitoneal Shunt placement is a common procedure used to manage hydrocephalus by directing the excess fluid from the brain ventricles to the peritoneal cavity.

Spinal Bifida Myelomeningocele primarily affects the sacral region of the spine, which is the lowest part of the back.

Congenital anomaly. Hydrocephalus is most commonly caused by a congenital anomaly in infants, such as a neural tube defect or brain malformation.

Ventriculoperitoneal shunt. In infants, hydrocephalus is usually treated by surgically implanting a ventriculoperitoneal shunt to drain excess CSF from the brain, as it can cause brain damage if left untreated.

Frequent repositioning helps to relieve pressure on bony prominences and prevent skin breakdown. This is especially important for clients with spina bifida who have limited mobility and may be restricted to a wheelchair or bed-bound.

Timed voiding is a structured approach to toilet training that involves establishing a regular schedule of bathroom breaks. This helps to promote bladder control and reduce the risk of incontinence. Pelvic floor muscle exercises and the use of catheters may also be helpful interventions, but timed voiding is the most effective strategy for managing bowel and bladder incontinence in clients with spina bifida.

The priority nursing intervention for a newborn with myelomeningocele is assessing for signs of infection, such as fever, drainage, redness, or swelling around the sac. This is important to prevent meningitis, which is a common complication associated with this condition. Administering IV antibiotics would be appropriate if an infection were present.

A neonate born with myelomeningocele (spina bifida) has a protruding spinal cord and the best position for the neonate is prone. This is to prevent any pressure on the myelomeningocele and reduce the risk of damage or rupture. The supine position increases pressure on the myelomeningocele, which can lead to complications such as hydrocephalus, respiratory distress or cardiac problems. The lateral position also puts pressure on the myelomeningocele and can worsen the condition, while the right lateral position does not offer any advantage over the other lateral positions. Thus, placing the neonate in a prone position with proper support can prevent complications and improve outcomes.

The decerebrate position is characterized by extension of the upper extremities, pronation of the hands, and extension of the lower extremities. This abnormal positioning is indicative of damage to the brainstem, particularly the midbrain or pons. The patient may exhibit other signs such as altered consciousness, abnormal breathing patterns, and decreased motor function. It is important for the nurse to recognize this position as it indicates a serious neurological issue and immediate intervention is required to prevent further damage. Assessing and monitoring the patient's level of consciousness, respiratory status, and neurological responses are critical nursing interventions when observing decerebrate position.

Decorticate position is a postural abnormality that indicates damage to the corticospinal tract. The position is characterized by upper extremity flexion and lower extremity extension. The arms are adducted and internally rotated, while the wrists are flexed and the fingers are flexed into a fist. The legs are internally rotated and extended. The decorticate position is caused by damage to the midbrain or upper pons and is often associated with anoxic brain injury, stroke, or traumatic brain injury.