8 Spina Bifida Nursing Care Plans

Your spina bifida patient is usually an infant, and your job sorts into a handful of fronts: protect the open sac before surgery, prevent infection, manage a neurogenic bladder and bowel, watch for hydrocephalus, and keep an overwhelmed family functioning. The defect itself you can't fix at the bedside. What you can do is keep the sac intact, catch infection early, and set up the bladder, bowel, and skin routines this child will live with for years.

What is Spina Bifida?

Spina bifida is a failure of the neural tube to close during embryonic development, leaving defects in the spinal cord and the bones of the spine. Two forms matter on the floor. Spina bifida occulta is the common, mild one: a closure defect in the lumbosacral area with no herniation and no exposed cord or meninges. Spina bifida cystica (meningocele or myelomeningocele) is the one you nurse aggressively: a sac herniates through the defect carrying meninges, spinal fluid, and sometimes cord and nerves, exposed at the skin surface in the lumbosacral or sacral area.

Hydrocephalus often comes with spina bifida cystica, so watch for it. Neurologic impairment tracks with the location of the defect and the nerves involved, ranging from sensory deficits to partial or total loss of motor function, flaccidity, partial paralysis of the lower extremities, and bowel and urinary incontinence.

Treatment combines surgery to close the spinal opening (in infancy or later), physiotherapy, speech and occupational therapy, assistive devices and mobility equipment such as wheelchairs or walking aids, and ongoing urinary and bowel management.

Nursing Care Plans and Management

Care centers on preventing infection, protecting skin integrity, preventing trauma from disuse, building family coping, and teaching the family the condition and its long-term management.

Nursing Problem Priorities

• Control infection, especially at the sac and in the urinary tract.
• Manage neurogenic bladder and bowel dysfunction.
• Monitor for hydrocephalus and manage ventricular shunts.
• Assist with mobility and positioning.
• Promote optimal nutrition and weight management.
• Promote self-care and independence as appropriate.
• Coordinate multidisciplinary care and specialist referrals.
• Ensure regular followup and monitoring of growth and development.

Nursing Assessment

Assess for the following subjective and objective data:

• Visible defect on the back, such as a sac or opening in the spine
• Weakness or paralysis in the legs
• Sensory deficits, such as numbness or loss of sensation in the legs or feet
• Bowel and bladder problems, such as urinary or fecal incontinence
• Orthopedic issues, including joint deformities or scoliosis
• Hydrocephalus, which may show signs of increased intracranial pressure such as enlarged head size, vomiting, irritability, or changes in consciousness
• Developmental delays in motor, cognitive, or speech function
• Difficulty walking or using assistive devices
• Vision or hearing problems
• Latex allergy or sensitivity

Nursing Diagnosis

Form your nursing diagnoses from the assessment and your clinical judgment of this child's specific needs, prioritizing the most pressing health concerns.

Nursing Goals

• The child's temperature stays at or above 97.8°F.
• The child shows improved urinary elimination by school age.
• The child participates in a bowel control regimen and gains control over elimination.

Nursing Interventions and Actions

1. Managing Hypothermia

Impaired thermoregulation and reduced mobility make these infants prone to hypothermia, and they may not generate or conserve heat well. Catch a dropping temperature early and restore it before it causes problems.

Monitor temperature every 2 to 4 hours and assess the temperature of the extremities. A temperature below normal can be your first clue to an infection.

Place the infant in a radiant warmer or incubator based on the hypothermia evaluation, keeping the sac moist postoperatively. This gives controlled warmth and cuts heat loss.

Offer warm fluids often (warm formula, breast milk, or warm water) and monitor intake and output. Warm fluids raise core temperature, and adequate intake prevents the dehydration that worsens hypothermia.

Warm the environment: adjust room temperature, use warm blankets or clothing, and ensure good insulation. A child with decreased sensation may not perceive or respond to cold, so you control it for them.

Teach parents to take a temperature and report changes. Early recognition means early intervention.

Teach parents the right amount of clothing and room temperature for the infant. This keeps the environment in a safe range.

2. Promoting Effective Urinary Elimination

A neurogenic bladder brings retention, incontinence, and loss of voluntary control. You manage it with intermittent catheterization, bladder medications, and a regular voiding schedule to protect the bladder and prevent infection.

Assess urine for color, amount, odor, and turbidity. Cloudy, dark, bloody, or foul-smelling urine points to a bladder infection from retention.

Assess for neurogenic bladder, the degree of incontinence, the rehabilitation potential, and the child's age. This shapes the elimination routine you build.

Keep the genital and anal area clean after each elimination episode or as needed. This keeps microorganisms out of the urethra and bladder.

Encourage fluid intake of 30 mL/lb/day, including acid-containing beverages and acidic foods. This promotes renal blood flow and acidifies the urine to prevent infection.

For a child over 3 years of age, have parents use pads and waterproof undergarments instead of diapers. This spares the child embarrassment.

Run a scheduled toileting program, placing the child on the toilet or potty chair at the same times each day. This builds a routine when continence is achievable.

Perform intermittent catheterization every 3 to 4 hours if indicated. Emptying the bladder prevents incontinence and infection.

Perform Crede's maneuver if indicated by applying manual pressure over the bladder to promote emptying.

Teach parents and the age-appropriate child to use external urinary devices or clean intermittent self-catheterization, with a return demonstration. This gives them a reliable way to empty the bladder or manage incontinence with a closed collecting system.

Administer anticholinergic and antispasmodic medications as indicated. See Pharmacologic Management.

Tell parents about alternatives if intermittent catheterization fails: an artificial sphincter, an artificial reservoir, or a urinary diversion.

Teach parents and child the urine changes that signal a bladder infection and the steps to prevent it. This catches infection early and heads off renal complications.

Have them keep a record of daily fluid intake and weight and report changes. This monitoring keeps complications in check.

3. Restoring Bowel Function

A neurogenic bowel brings constipation, fecal incontinence, and loss of bowel control. Manage it with diet, a bowel training program, and medications to keep stool moving and prevent impaction.

Assess for neurogenic bowel, the degree of incontinence, and the rehabilitation potential. This shapes the bowel routine you build.

Place the child on a toilet or potty chair at the same time each day, using stimulation and a suppository if needed. This empties the bowel on a schedule.

Teach parents correct cleansing and diapering for infants and toddlers. Clean, dry skin resists breakdown.

Change diapers as quickly as feasible and cleanse the perianal area carefully.

Apply barrier creams to the perianal area during diapering as prescribed. This prevents skin breakdown.

Suggest clothing and undergarments that protect against staining accidents. This protects the child's self-image.

Use padding in waterproof undergarments rather than diapers. This spares an older child embarrassment when bowel control isn't there.

Encourage fluid intake up to 2,000 mL/day depending on age, with fiber and roughage in the diet. This adds bulk for easier passage.

Teach parents and child the bowel-control program: fluids, diet, routine toileting, and stimulation. Pair it with behavior modification to build compliance with the routine.

Administer stool softeners, laxatives, or fiber supplements as indicated. See Pharmacologic Management.

4. Promoting Positive Self-Body Image

Physical differences and functional limits can wear on a child's self-esteem. Support a positive body image by providing emotional support, encouraging self-acceptance, and building identity beyond physical appearance.

Assess the child's feelings about strengths and weaknesses in ADLs, social interaction, and self-concept. This tells you the potential for independent thinking and functioning.

Encourage the child to express feelings and concerns, and support communication with parents and peers. Venting reduces anxiety and negative feelings.

Encourage parents to sustain their support and care, which signals acceptance of the child.

Maximize independence with aids for dressing, bathing, grooming, eating, mobility, and toileting, and acknowledge every attempt at self-care. Assistive aids build ADL capability around the disability.

Advise parents to hold the child to the same behavior rules as their other children and to fold care and activities into the family routine. This gives the child a sense of belonging.

Notice positive achievements and skip negative comments. This builds body image and confidence.

Provide touch, hugging, and age-appropriate activities with other children. This conveys caring and builds socialization.

5. Promoting Effective Coping

Families face emotional, psychological, and practical strain adapting to this diagnosis. Help them cope by connecting them with professional support, support groups, other families, and education about the condition.

Assess the anxiety level of the family and child, their read on the crisis, the coping and problem-solving methods they use, and how well those work. This shows you where they need new coping skills and realistic goals.

Assess the family's broader picture: developmental level, strain on relationships, the siblings' response, knowledge of health practices, role behavior and attitude about long-term care, economic burdens, available resources, the grieving process, and any signs of depression, powerlessness, or hopelessness. Family attitudes and coping directly affect the child's health and wellbeing, and a chronic condition can either strengthen or strain a family.

Encourage family members to vent their feelings and reactions to the infant's appearance and condition. This relieves anxiety and shows you accept their responses.

Give accurate, honest information about care with or without surgical repair, and about the child's abilities and disabilities. This reduces anxiety and builds understanding of the child's needs.

Encourage the family to protect their own health and social contacts. This guards against the chronic anxiety, fatigue, and isolation that erode their ability to care for the child.

Communicate empathy for the child and family, and reinforce their caretaking efforts. This supports coping and positive adjustment and reduces stress.

Provide anticipatory guidance for crisis resolution so the family can adapt and build new coping mechanisms.

Be aware of cultural differences in coping; needs differ by cultural and ethnic background.

Help the family discuss its dynamics and tolerate conflict and individual differences, and help them identify techniques to problem-solve and regain control of the situation.

Help the family face the realities of the disabilities and connect with community agencies, clergy, social services, and physical and occupational therapy.

Teach that overprotection can hinder growth and development, and that the child needs limits and rules to live by. Reinforce positive coping behaviors as they appear.

If hospitalization is frequent, assign the same staff to the child when possible. This builds trust and communication with the family.

Explain the causes, treatment, and prognosis, and tell parents they are not at fault for a congenital defect. This reduces guilt.

Tell parents that surgery may be done within 48 hours after birth or postponed to about 3 months of age, allowing better epithelialization and a lower chance of hydrocephalus while neurologic function is assessed. Use this to reinforce the physician's information for their decision.

Stress the need for followup appointments with the physician and therapists to keep the medical regimen on track.

6. Preventing Infections and Injuries

These children are prone to urinary tract infections and, before closure, to infection of the exposed neural tissue, which is a direct entry point for pathogens. Reduced mobility and sensory deficits add risk of falls and pressure sores. Infection control, hygiene, and injury prevention carry this section.

Assess the neural tube sac for breaks, CSF leakage, irritation, redness, swelling, and purulent drainage, and watch for fever, irritability, nuchal rigidity, and cloudy foul-smelling urine. These signal infection of the sac site, or meningitis if the sac has ruptured.

Wash your hands before and after any procedure involving the site, and use sterile technique when caring for the sac. This keeps microorganisms off the site.

Keep a moist sterile dressing over the sac using sterile saline or antibiotic solution as prescribed. A dry sac membrane can break and become contaminated.

Reinforce the moist dressing with dry sterile dressing and change it as needed, removing the moist dressing after it dries to avoid damaging the sac. This prevents contamination through capillary action.

Apply a shield over the sac dressing and tape a plastic sheet below the defect. After surgical closure, apply a transparent occlusive dressing over the area below the sac site. This protects the sac from urine and fecal contamination.

Keep the anal area clean and place a sterile shield between the anus and the sac. This blocks fecal contamination from poor anal sphincter control.

Avoid contaminating the urinary tract with stool, and perform thorough perianal hygiene as needed.

Adapt routine care (feedings, linen changes, comforting) to avoid trauma to the sac.

After surgical repair, watch the wound for redness, swelling, warmth, drainage, or fever, all signs of wound infection. Cleanse the wound with antiseptic as ordered and change dressings using sterile technique for at least 24 hours.

Position the infant prone or side-lying as permitted, with the head lower than the buttocks or the hips slightly flexed with a pad between the knees, and anchor the position with sandbags. This keeps pressure off the sac and prevents rolling onto the side or back.

Handle the infant gently, supporting the back above the defect, or move the infant on a pillow in a prone position. This keeps pressure off the sac.

Administer antibiotics as ordered. See Pharmacologic Management.

Identify children with latex allergy and have them wear a medical ID alert bracelet. Ask every admitted patient about latex reactions during the initial interview to screen out even otherwise low-risk children.

Keep a latex-free environment for high-risk populations like children with spina bifida, and keep latex balloons out of the facility. This prevents both the development of latex sensitivity and reactions in those already sensitized.

Keep emergency equipment and anaphylaxis supplies ready for immediate treatment.

7. Initiating Patient Education and Health Teachings

Teach the family the condition and the self-care it demands: bowel and bladder management, skin care, proper use of assistive devices, infection and injury prevention, and protecting the child's psychological wellbeing.

Educate the patient and family on the condition, its implications, and its potential complications. Understanding lets them participate in care and make informed decisions.

Teach injury prevention: safe mobility and proper body mechanics, transfers, and use of mobility aids like wheelchairs or braces. Assess the home for hazards, recommend modifications or adaptive equipment, and stress balance and stability.

Teach infection prevention: proper hand hygiene, clean intermittent catheterization, and regular skin care. Hand hygiene cuts transmission and lowers urinary and respiratory infection risk, clean catheterization protects the neurogenic bladder, and regular skin cleaning and inspection prevent breakdown over pressure-prone areas.

Teach parents to cleanse the sac gently with moist cotton balls if soiled, and to avoid diapering the infant until after surgery and healing. This protects the sac from contaminants.

Teach parents how to position the infant and apply protection around the sac, such as a foam rubber doughnut, to prevent damage and infection.

Teach parents the signs of infection at the surgical site and to notify the provider. This catches an infectious process early.

Stress handwashing, dressing changes, and the use of clean or sterile linens, gloves, and supplies when caring for the sac area. Sterile technique may not be needed once surgical healing is underway.

8. Administer Medications and Provide Pharmacologic Support

Medications target the complications: urinary tract infections, bladder dysfunction, and bowel dysfunction. The specific drugs depend on the child's needs.

Antibiotics prevent or treat the urinary tract infections common with neurogenic bladder dysfunction.

Anticholinergics and antispasmodics control bladder spasms, increase bladder capacity, and improve bladder emptying.

Stool softeners and laxatives promote regular bowel movements, prevent constipation, and ease the discomfort of bowel irregularity.

Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain from musculoskeletal issues, surgical procedures, or complications such as pressure sores.