Causing the spinal cord and its protective membrane

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causing the spinal cord and its protective membrane to protrude through a sac-like opening in the back. 29. NEURAL TUBE DEFECTS A. Spina Bifida (myelodysplasia): midline defects involving failure of the bony spine to close B. Spina bifida occulta: defect not visible externally; often no treatment needed C. Spina bifida cystica: visible defect with external saclike protrusion ccxcv. Meningocele (encased meninges and spinal fluid) ccxcvi. Myelomeningocele (encased meninges, spinal fluid, and spinal cord/nerves) D. Causes ccxcvii. Drugs, radiation, maternal malnutrition, chemicals, genetic mutation in folate pathways E. Can be anywhere along spinal column
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ccxcviii. Degree of dysfunction depends on where sac protrudes and amount of nerve tissue involved F. Usually in lumbar or lumbosacral area G. Clinical manifestations ccxcix. Hydrocephalus in 80-90% of cases ccc. Chiari II malformation 80% H. Prevention ccci. Folic acid in pregnancy can prevent up to 80% cccii. Minimize exposures during pregnancy (drugs, chemicals, radiation) 30. MYELOMENIGOCELE A. Nursing considerations ccciii. Prevention education (folic acid) ccciv. Diagnosis prenatally: 1. Alpha-fetoprotein 2. Ultrasound 3. Amniocentesis 4. MRI cccv. Assessment of degree of neurologic involvement 5. Movement of extremities 6. Urinary output 7. Anal reflex 8. Head circumference cccvi. Care of the sac 9. Keep moist and clean until surgical repair 10. Change dressing frequently—q 2 hrs cccvii. Prevention of complications 11. Infection 12. Positioning (pre-op: prone, hips flexed, legs abducted) 31. TREATMENT/COMPLICATIONS cccviii. Orthopedic 1. Common problems include clubfoot, scoliosis, other malformations cccix. Genitourinary 2. Bladder dysfunction 3. Incontinence 4. Need for stoma 5. Catheterization cccx. Bowel
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6. Bowel plan to avoid constipation cccxi. Increased ICP 7. Shunt malfunction 8. Hydrocephalus cccxii. Latex allergies 9. High risk for latex allergies 10. Identify exposure 11. Monitor for s/sx 12. Treatment (epi pen) cccxiii. Skin 13. Monitor for pressure ulcers & skin breakdown 32. HYDROCEPHALUS A. Pathophysiology cccxiv. Non obstructive (malfunction) cccxv. Obstructive (malformation, like Arnold-Chiari, myelomeningocele) B. Clinical Manifestations cccxvi. Infants: 1. Increased head circumference (rapid) 2. Bulging fontanel 3. Vomiting 4. Sleepiness 5. Irritability 6. Poor feeding 7. Seizure 8. Sunsetting 9. Deficits in muscle tone cccxvii. Older children: 10. Headache 11. Blurred vision 12. Sleepiness 13. Nnausea/vomitin g 14. Unstable balance 15. Appetite 16. Irritability 17. Personality change 18. Decline in memory
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C. Therapeutic management cccxviii. Ventriculoperitoneal (VP) shunt 1. External ventricular drainage system 2. Drains cerebral spinal fluid from the ventricles to the peritoneal cavity (it then absorbs into the bloodstream) 3. Can be adjustable using valves 4. Shunts are under the skin 5. May need to be replaced as the child grows 6. **Complications: a. Obstruction (s/sx of hydrocephalus will return) b. Infection (redness and swelling along length of shunt, fever) c. Excess drainage (fluid draining too quickly) cccxix. Surgery 7. Hydrocephalus a. Ventriculostomy used to remove CSF 8. Craniotomy a. Open brain to remove clot or tumor 9. Craniectomy a. Removes a piece of bone to allow brain to expand
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