1. The client/caregiver can define spina bifida.
    1. It is a neural tube defect involving incomplete development of the brain, spinal cord, and/or the protective coverings.
    2. It is caused by the failure of the fetus’s spine to close properly during the first month of pregnancy.
    3. The three types of spina bifida are
      1. Myelomeningocele (most severe)—the spinal cord and its protective covering protrude from an opening in the spine.
      2. Meningocele—the spinal cord develops normally but the meninges protrude from a spinal opening.
      3. Occulta—one or more vertebrae are malformed and covered by a layer of skin.
    4. Spina bifida can cause bowel and bladder complications.
    5. Spina bifida is often associated with hydrocephalus (excessive accumulation of cerebrospinal fluid in the brain).
  2. The client/caregiver can list risk factors for spina bifida.
    1. Spina bifida is more common among Hispanics and whites of European descent.
    2. Family history of neural tube defects
    3. Folic acid deficiency
    4. Some medications (antiseizure medications) taken during pregnancy can increase risk for neural tube defects.
    5. Diabetes and poor blood sugar control during early pregnancy
    6. Obesity and prepregnancy obesity
    7. Increased body temperature in the early months of pregnancy
  3. The client/caregiver can list methods to screen and diagnose spina bifida.
    1. Maternal serum alpha-fetoprotein (MSAFP) test. This is a blood test performed during weeks 16 and 18 of pregnancy.
    2. Based on the results of this test, the physician may suggest amniocentesis or high-resolution ultrasonography.
  4. The client/caregiver can list current treatment considerations for SB.
    1. The treatment depends on the severity of the condition.
    2. Often a caesarean birth is planned for the safety of the baby, and it can provide for quick and skilled intervention after birth.
    3. Research is promising regarding prenatal surgery to correct defects before birth.
    4. Treatment can include multiple surgeries and a multidisciplinary team of health care providers.
  5. The client/caregiver can list prevention tips and measures to manage this condition.
    1. Folic acid supplements taken at least 1 month before conception and during the first trimester of pregnancy will greatly reduce the risk of neural tube defects.
    2. March of Dimes, the Centers for Disease Control and Prevention, and the Institute of Medicine recommend that women of childbearing age take folic acid supple- ments of 400 micrograms daily.
    3. Be informed. Develop realistic goals.
    4. There is a need for periodic and ongoing medical evaluations and treatment.
    5. Understand medications and treatments.
    6. Prevent infection and injury.
    7. More than 70% of people with spina bifida have a latex allergy. Check Latex allergy information in Chapter 2. The Spina Bifida Association offers a latex update list (2006).
    8. Promote family coping. Seek counseling, education, emotional support, and financial assistance as needed.

Resources

March of Dimeswww.marchofdimes.com/
National PKU Newswww.pkunews.org/
National Institute of Child Health and Human Developmentwww.nichd.nih.gov/
Dietician
Support groups

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.Canobbio, M. M. (2006). Mosby’s handbook of patient teaching. St. Louis: Mosby Inc.Lutz, C., & Przytulski, K. (2001). Nutrition and diet therapy. Philadelphia: F. A. Davis Company.Maternal-neonatal nursing: Lippincott manual of nursing practice pocket guides. (2007). Philadelphia: Lippincott Williams & Wilkins.Muscari, M. E. (2005). Pediatric nursing. Philadelphia: Lippincott Williams & Wilkins.Novak, J. C., & Broom, B. L. (1999). Maternal and child health nursing. St. Louis: Mosby, Inc.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com

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