Spina bifida involves the failure of the neural tube to develop or close during embryonic development causing defects in the spinal cord and in the bones of the spine. There are two types of spina bifida: spina bifida occulta is the most common and is a defect in the closure without the herniation and exposure of the spinal cord or meninges at the surface of the skin in the lumbosacral area. While spina bifida cystica (meningocele or myelomeningocele) is a defect in the closure of a sac and herniated protrusion of meninges, spinal fluid and possibly some part of the spinal cord and nerves at the surface of the skin in the lumbosacral or sacral area.
Hydrocephalus is often related with spina bifida cystica. The extent of neurologic impairment are associated to the location and nerves involved in the defect and range from varying degrees of sensory deficits, to partial or total loss of motor function resulting in flaccidity, partial paralysis of lower extremities, and bowel and urinary incontinence.
There are several different treatments that can be used to manage symptoms or conditions associated with spina bifida such as surgery to close the opening in the spine which may be done during infancy or later, physiotherapy, speech and occupational therapy, use of assistive devices and mobility equipment, such as a wheelchair, or walking aids, and urinary and bowel management.
Nursing Care Plans
Nursing care planning goals for clients with spina bifida include prevent infection, maintain skin integrity, prevent trauma related to disuse, increase family coping skills, education about the condition, and support.
Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for spina bifida:
Impaired Urinary Elimination
Disturbed Body Image
Interrupted Family Processes
Risk for Infection
Risk for Injury
Hypothermia: Body temperature below normal range.
May be related to
Possibly evidenced by
Loss of heat and fluid from large area of exposed sac
Body temperature lower than normal range
Child’s temperature will remain above (97.8°F)
Nursing Interventions Rationale
Monitor temperature pattern every 2 to 4 hours; Assess temperature of extremity present. Gives data as to the source of changes in temperature which may be below the normal if an infection is.
Provide radiant warmer or place infant in an incubator (isolette) based on hypothermia evaluation keeping sac moist postoperatively. Provides a controlled warmth and lessens the heat loss causing hypothermia.
Educate parents on how to take temperature and notify of any changes. Early recognition of temperature fluctuations will lead to early intervention.
Educate parents regarding the appropriate amount of clothing and room temperature suitable for the infant/child. Provides optimal environmental temperature.