Week 10 - Neural Tube Defects Flashcards
what is the neural tube
- an embryonic structure that ultimately forms the spinal cord and brain
what is a neural tube defect
- group of abnormalities resulting from abnormal development of the brain, spine and/or spinal column
- during the development of an affected embryo, the neural tube does not close completely as it should, resulting in a hole somewhere along the spinal column
- causes varying degrees of defect
what are 2 types of neural tube defects
- spina bifida occulta
2. spina bifida cystica
what is spina bifida occulta
- neural tube defect that affects the lumbar sacral area: L5-S1
what are symptoms of spina bifida occulta (5)
- less visible abnormalities
- skin manifestations instead:
- port wine mark
- soft lipomas
- dimples in the lumbar region
what are signs & symptoms of spina bifida cystica
- has an external saclike protrusion
what are 2 types of spina bifida cystica
- meningocele
2. myelomeningocele
what is meningocele
- includes an external saclike protrusion of meninges and spinal fluid
what is myelomeningocele
- includes an external saclike protrusion of meninges, spinal fluid, and nerves
what are signs of myelomeningocele (i think that’s what she’s referring to in the lecture?? either this or spina bifida cystica in general) (4)
- neuromuscular defects
- impacts bowel & bladder function
- lower limb paralysis
- associated deformities
what are associated deformities r/t myelomeningocele (5)
- scoliosis
- hip dislocation
- lower limb paralysis
- hydrocephaly
- VS –> inability to control & regulate temp, cardiac, and resp function
what is the cause of neural tube defects (5)
- unknown but can be related to:
- prenatal meds
- radiation
- maternal malnutrition (decreased FA)
- genes
what diagnostic studies are used for neural tube defects (5)
- MRI
- CT
- US (prenatally)
- neuro assessment
- assess meningeal sac
what disciplines are involved in nursing care for myelomeningocele (5)
- neuro
- neurosurgery
- peds
- urology
- ortho
what is included in nursing care for myelomeningocele(2)
- manage associated deformities (ex. hydrocephalus, limb paralysis)
- manage bowel & urinary malformations (lumbar & sacral area)
what are pts w myelomeningocele at risk for (2)
- meningitis
- hypoxia
what is treatment for myelomeningocele
- surgery to close the sac
when is surgery for myelomeningocele done (3)
- sometimes pre-natal
- otherwise within 72 hrs
- within 24hr if sac leaking CSF
what is included in myelomeningocele pre-op nursing care (5)
- assess & care for sac
- neuro & motor assessments
- ROM exercises
- u/o monitoring
- monitor for & prevent pressure sores/skin care (esp. bc may not be diapered)
how should a pt w myelomeningocele be fed
- prone
what is included in care for the sac (4)
- prevent trauma to the sac (caution: rupture of sac during transport)
- regulate temp
- prevent from drying out/keep moist
- prevent infection
how is trauma to the sac prevented (5)
- prone position
- no pressure on the sac
- don’t bump
- diapering may be contraindicated
- no blankets, clothes
describe how temp may be regulated in a pt w myelomeningocele
- isolette/warmer (bc no clothes or covers)
describe how the sac is left from drying out/kept moist (2)
- keep moist w NS soaked dressing
- change dressings often
describe how to prevent infection in a pt w myelomeningocele (2)
- antibiotics
- cleanse sac
what is u/o monitoring imp for a pt w myelomeningocele (3)
- risk of bladder dysfunction
- risk for UTI
- foleys
- etc.
describe post-op care for a pt w myelomeningocele (6)
- same as pre-op
- watch for signs of CSF leakage at site
- monitor for bleeding
- monitor for infections
- VS
- ABCs
describe prognosis of myelomeningocele (3)
- varying degrees of impairment (including motor & GU)
- intelligence not typically effected
- many can have a degree of independent living
