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Polish up on client care 657 no neurologic

  • Kean University
  • NURS 3400
  • JusticeOxideTurtle429
  • 835
  • 94% (17) 16 out of 17 people found this document helpful

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Polish up on client care657• No neurologic dysfunction (usually),except occasional foot weakness or bowel andbladder disturbances• Port wine nevi (commonly found on theskin over the spinal defect)• Soft fatty deposits (commonly found on theskin over the spinal defect)• Trophic skin disturbances (ulcerations,cyanosis)Meningocele• No neurologic dysfunction (usually)• Saclike structure protruding over the spineMyelomeningocele• Saclike structure protruding over the spine• Hydrocephalus• Permanent neurologic dysfunction (paral-ysis, bowel and bladder incontinence)• Possible mental retardation• Knee contractures• Clubfoot• Arnold-Chiari syndrome• Curvature of the spineDIAGNOSTIC TEST RESULTS• Elevated alpha-fetoprotein levels in themother’s blood may indicate the presence of aneural tube defect.• Amniocentesis reveals neural tube defect.• Acetylcholinesterase measurement can beused to confirm the diagnosis.After birth, spinal X-ray can show the bonedefect.• Fetal karyotype should be done in additionto the biochemical tests because of theassociation of neural tube defects with chro-mosomal abnormalities.• Myelography can differentiate spina bifidafrom other spinal abnormalities, especiallyspinal cord tumors.• Ultrasound may identify the open neuraltube or ventral wall defect.NURSING DIAGNOSES• Delayed growth and development• Impaired physical mobility• Impaired adjustment• Pad the crib or bedto prevent injury.• Monitor serum levels of anticonvulsantmedications, such as phenytoin,to ensuretherapeutic levels and prevent toxicity or sub-therapeutic levels.Teaching topics• Explanation of the disorder and treatmentplan• Medication use and possible adverse effects• Importance of follow-up care• Instituting safety measures during seizureactivitySpina bifidaSpina bifida is exposure of the spinal cordresulting from a defect of the back bone andspinal cord. It has two main forms. Spinabifida occulta, the more common and lesssevere form, is characterized by incompleteclosure of one or more vertebrae withoutprotrusion of the spinal cord or meninges(membranes covering the spinal cord). Spinabifida cystica, the more severe form, is distin-guished by incomplete closure of one or morevertebrae that causes protrusion of the spinalcontents in an external sac or cystic lesion.Spina bifida cystica has two classifications:myelomeningocele: an external sac thatcontains meninges, CSF, and a portion of thespinal cord or nerve rootsmeningocele: an external sac that containsmeninges and CSF.CAUSES• Combination of genetic and environmentalfactors• Exposure to a teratogen• Part of a multiple malformation syndrome(for example, chromosomal abnormalitiessuch as trisomy 18 or 13 syndrome)Low intake of folic acid by the mother dur-ing pregnancyASSESSMENT FINDINGSSpina bifida occultaDimple or tuft of hair on the skin over thespinal defectHmmm. Spinabifida occulta andmeningocele rarelycause neurologicdysfunction. However,myelomeningocelemay causepermanent problems.

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Term
Fall
Professor
N/A
Tags
Nursing, Samantha T Marino

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