Spina bifida ppt

Spina bifida ppt

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  SPINA BIFIDA  SUB: PEDIATRIC NURSING  UNIT : V CHILD WITH CONGENITAL DISORDERS  TOPIC : SPINA BIFIDA BY  P.THIRUNAGALINGA PANDIYAN M.Sc.,(Child Health Nursing)
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  Introduction  Spina bifidais a condition that the 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.
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  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
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  Causes  The exactcause is unknown Risk factors are  Consanguinity marriage  Drugs (valproate)  Folic acid deficiency  Exposure to chemicals and radiation during antenatal period
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  Pathophysiology  The neuralplate 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
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  Pathophysiology
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  CLASSIFICATION OF SPINABIFIDA  1. Spina Bifida Occulta  2. Spina Bifida Cystica a. Meningocoele b. Myelomeningocele
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  CLASSIFICATION OF SPINABIFIDA  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.
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  SPINA BIFIDA OCCULTA
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  CLASSIFICATION OF SPINABIFIDA 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
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  CLASSIFICATION OF SPINABIFIDA  SPINA BIFIDA CYSTICA Spina bifida cystica classified into two a . Meningocele b. Meningomyelocele
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  CLASSIFICATION OF SPINABIFIDA 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
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  MENINGOCOELE
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  CLASSIFICATION OF SPINABIFIDA  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
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  MYELOMENINGOCELE
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  CLASSIFICATION OF SPINABIFIDA
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  CLASSIFICATION OF SPINABIFIDA
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  CLINICAL MANIFESTATIONS Spina BifidaOcculta  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
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  CLINICAL MANIFESTATIONS  SpinaBifida Cystica  Sensory disturbances  Flaccid (weakness)  Partial paralysis of lower extremities  Overflow incontinence with constant dribbling of urine  Hydrocephalus, lack of bowel control
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  Diagnosis  Maternal serumalpha-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.
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  MANAGEMENT  Surgical correction Thespinal 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
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  MANAGEMENT
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  PREVENTION  Folic acidsupplementation 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.
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  NURSING MANAGEMENT  PREOPERATIVECARE  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.
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  NURSING MANAGEMENT  Emptyingthe 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.
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  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
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  NURSING DIAGNOSES  Impairedphysical 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