neural tube defects Flashcards
what is spina bifida?
- group of birth defect called neural tube defect
- caused by defect in neural arch (lumbosacral area)
- failure of the posterior lamina of vertebra to close (back bone that protects spinal cord doesn’t form and close as it should)
- may leave an opening through which spinal meninges and spinal cord may protrude
what are the types of spina bifida?
1) spina bifica occulta
2) spinal bifida cystica
- meningocele
- myelomeningocele
what is the pathophysiology of spina bifida?
CNS start to develop in wk 5, by wk 6 all opening on the tube should be closed
what is spina bifida occulta?
- “hidden”/bony defect: soft tissue involvment
- lubosacral are (L5 and S1)
- 1 or more vertebrae is malformed
small gap in spine but no opening or sac
usually not discovered till late childhood
what is spina bifida w meningocele?
- part of spinal meninges and spinal fluid protrudes through bony defect and forms a cystic sac
- little/no nerve damage -> minor disabilities
- can have complete paralysis w bladder and bowel dyfnx
- tx: surgery to close sac
what is spina bifida w myelomeningocele?
- protrusion of spinal cord and meninges w nerve roots embedded in wall of cyst
- moderate/severe diabilities
- affect how person goes to bathroom
- loss of feeling in legs or feet
- not being bale to move legs
risk factors?
- low folic acid intake (0.4mg/day at leats 1 mo before pregnancy, dont take w multivitamins, doesnt help epileptic women on antiepileptics)
- genetics
- diabetes
- obesity
- low maternal vit b12
- hx of ntd
- radiation
- meds
diagnostic tests?
PRE NATALLY:
- fetal ultrasound (16-18wks)
- amniocentesis
- fetoscopy (18wk)
- folic acid blood lvls
- Chorionic villus sampling (CVS) is a test you may be offered during pregnancy to check if your baby has a genetic or chromosomal condition
- afp lvl (high mat alpha fetoprotein lvls in amniotic fluid indicates probability of cns abnormalities)
- ultrasound
POST NATALLY:
- MRI
- CT
- MYOLOGRAPHY
post natal assessments?
- examine protruding meningocele or myelomeningocele (prevent taruma)
- neuro assessment:
- determine extent of involvement of bowel and
bladder fx
- determine extent of involvement of lower
extremity neuromuscular fx
- determine neurosegmental lvl of lesion
- spasticity and paralysis
- decreased sensataion -> prevent skin
breakdown
what are the goals?
- early closure of sac
- prevent infection
- minimize effects of abnormalities on fanily dynamics
what area to focus on in your HTT?
- hydrocephalus
- paralysis
- orthopeadic deformities
- genitourinary abnormaliities
prenatal management of spinis bifida?
surgical closure of sac in utero
complications include: oliohydroaminos (low amniotic fluid), preterm delivery, small birth wt
post natal management of spina bifida?
- incubator/warmer to keep BB warm and maintain temp (clothing can irritate skin)
- sterile non adherent NS drsg on sac
- avoid ruputre/ skin breakdown:
- gentle care of sac
- positioning = prone w legs flexed
- avoid pressure to site
- avoid diaper till repair - early surgically intervention (12-18h after birth)
- closure of sac
- more than one sx needed
- shunt procedure
- orthopaedic management: prev joint
contracture (orthoses: special walking device,
wheelchair, crutches) - ROM exercises
- preserve renal fx
- urologic care, tx of uti
- clean intermittent catherization
- meds to improve continence - bowel control
- diet mod
- reg toilet habits
- prevent constipation
post op and intra op care?
intra op:
- latex allergy (hypersensitivity) -> medic alert bracelet
post op:
- V, I and O, pain, infcetion
- op site: as per surgeons orders
- prone position, side laying at times unless it aggravates hip flexors
- measure head circumference q day
- assess fontanels
- assess urinary ret
- neuro: mov, sensation, behavior
