Spina Bifida Nursing Care Plans
Use this nursing care plan and management guide to help care for patients
with spina bifida. Learn about the nursing assessment, nursing interventions,
goals and nursing diagnosis for spina bifida in this guide.
Table of Contents
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What is Spina Bifida?
Nursing Care Plans and Management
 Nursing Problem Priorities
 Nursing Assessment
 Nursing Diagnosis
 Nursing Goals
 Nursing Interventions and Actions
 1. Managing Hypothermia
 2. Promoting Effective Urinary Elimination
 3. Restoring Bowel Function
 4. Promoting Positive Self-Body Image
 5. Promoting Effective Coping
 6. Preventing Infections and Injuries
 7. Initiating Patient Education and Health
Teachings
 8. Administer Medications and Provide
Pharmacologic Support
Recommended Resources
See also
What is Spina Bifida?
Spina bifida involves the failure of the neural tube to develop or close during
embryonic development causing defects in the spinal cord and in the bones of
the spine. There are two types of spina bifida: spina bifida occulta is the most
common and is a defect in the closure without the herniation and exposure of
the spinal cord or meninges at the surface of the skin in the lumbosacral area.
While spina bifida cystica (meningocele or myelomeningocele) is a defect in the
closure of a sac and herniated protrusion of meninges, spinal fluid and possibly
some part of the spinal cord and nerves at the surface of the skin in the
lumbosacral or sacral area.
Hydrocephalus is often related with spina bifida cystica. The extent of neurologic
impairment are associated to the location and nerves involved in the defect and
range from varying degrees of sensory deficits, to partial or total loss of motor
function resulting in flaccidity, partial paralysis of lower extremities, and bowel
and urinary incontinence.
There are several different treatments that can be used to manage symptoms or
conditions associated with spina bifida such as surgery to close the opening in
the spine which may be done during infancy or later, physiotherapy, speech and
occupational therapy, use of assistive devices and mobility equipment, such as a
wheelchair, or walking aids, and urinary and bowel management.
Nursing Care Plans and Management
Nursing care plans and management for clients with spina bifida include
preventing infection, maintaining skin integrity, preventing trauma related to
disuse, increasing family coping skills, education about the condition, and
support.
Nursing Problem Priorities
The following are the nursing priorities for patients with spina bifida:
Infection control
 Manage neurogenic bladder and bowel dysfunction
 Monitor for signs of 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 referrals to specialists as
needed
 Ensure regular follow-up and monitoring of growth and
development.
Nursing Assessment
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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 present with signs of increased
intracranial pressure such as enlarged head size, vomiting, irritability,
or changes in consciousness
 Developmental delays, including motor, cognitive, or speech delays
 Difficulty walking or using assistive devices
 Vision or hearing problems
 Latex allergy or sensitivity
Nursing Diagnosis
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Following a thorough assessment, a nursing diagnosis is formulated to
specifically address the challenges associated with spina bifida based on
the nurse’s clinical judgment and understanding of the patient’s unique health
condition. While nursing diagnoses serve as a framework for organizing care,
their usefulness may vary in different clinical situations. In real-life clinical
settings, it is important to note that the use of specific nursing diagnostic labels
may not be as prominent or commonly utilized as other components of the care
plan. It is ultimately the nurse’s clinical expertise and judgment that shape the
care plan to meet the unique needs of each patient, prioritizing their health
concerns and priorities.
Nursing Goals
Goals and expected outcomes may include:
The child’s temperature will remain above (97.8°F).
 The child will have improved urinary elimination by school age.
 The child will participate in a bowel control regimen.
 The child will be able to control elimination.
Nursing Interventions and Actions
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Therapeutic interventions and nursing actions for patients with spina bifida may
include:
1. Managing Hypothermia
Hypothermia is a condition where the body temperature drops below normal
levels in patients with spina bifida. Due to impaired thermoregulation and
reduced mobility, individuals with spina bifida may be more susceptible to
hypothermia, as they may have difficulty generating or conserving body heat.
Hypothermia can lead to various complications and requires prompt intervention
to restore normal body temperature and prevent further deterioration.
Monitor temperature pattern every 2 to 4 hours; Assess the temperature of
extremity present.
Gives data as to the source of changes in temperature which may be below the
normal if an infection is.
Provide a radiant warmer or place the infant in an incubator (isolette) based
on hypothermia evaluation keeping the sac moist postoperatively.
Provides a controlled warmth and lessens the heat loss causing hypothermia.
Offer warm fluids frequently such as warm formula, breast milk, or warm
water, and monitor fluid intake and output.
Warm fluids help raise the internal body temperature. This will ensure adequate
fluid intake to prevent dehydration, as dehydration can exacerbate hypothermia.
Provide a warm environment by adjusting the room temperature, using
warm blankets or clothing, and ensuring proper insulation.
Spina bifida have decreased sensation or impaired thermoregulation due to the
spinal cord defect. This can make them more vulnerable to developing
hypothermia, as they may have difficulty perceiving or responding to cold
temperatures. These interventions help maintain body temperature within a
normal range and prevent the risk of hypothermia.
Educate parents on how to take temperature and notify of any changes.
Early recognition of temperature fluctuations will lead to early intervention.
Educate parents regarding the appropriate amount of clothing and room
temperature suitable for the infant/child.
Provides optimal environmental temperature.
2. Promoting Effective Urinary Elimination
Urinary elimination for patients with spina bifida can be affected due to
neurogenic bladder dysfunction. The condition can lead to issues such as urinary
retention, incontinence, or difficulties with voluntary control of urination.
Management of urinary elimination in patients with spina bifida may involve
interventions such as intermittent catheterization, medication to promote bladder
function, and implementing a regular voiding schedule to maintain bladder
health and prevent urinary tract complications.
Assess urine for color, amount, odor, and turbidity.
Cloudy, dark, bloody, or strange-smelling urine indicates a urinary bladder
infection caused by urinary retention.
Assess the presence of neurogenic bladder, the degree of incontinence, the
potential for rehabilitation, and the age of the child.
Provides information about the condition for use in the plan of establishing a
urinary elimination routine.
Keep the genital and anal area clean after each elimination episode or as
needed if incontinent.
Prevents the introduction of microorganisms into the urethra and urinary bladder.
Encourage adequate fluid intake of 30 ml/1lb/day including acid-containing
beverages and the addition of foods high in acid content in the diet.
Promotes renal blood flow and acidifies urine to prevent infection.
Encourage parents to use pads and water-proof undergarments instead of
the use of diapers for a child over 3 years of age.
Prevents embarrassment for the child.
Perform the scheduled rehabilitation program of placing the child on the
toilet or potty chair at the same times each day.
Establishes a routine for urinary elimination if this is a possibility.
Perform intermittent catheterization every 3 to 4 hours if indicated to
resolve incontinence.
Ensures emptying of the bladder to prevent incontinence and infection.
Perform Crede’s maneuver if indicated.
This is done by exerting manual pressure on the abdomen at the location of the
bladder that promotes emptying of the bladder.
Educate parents and age-dependent child in the use of external urinary
devices or procedures for intermittent self-catheterization; demonstrate and
provide a return demonstration.
Provides a method for emptying the bladder routinely or managing incontinence
by use of a collecting device connected to a closed system.
Administer anticholinergic, and antispasmodic medications as indicated.
See Pharmacologic Management
Advise parents on alternative procedures to control incontinence such as
implantation of an artificial sphincter, creation of an artificial reservoir, or
creation of a urinary diversion.
Provides information about other methods that can be performed if intermittent
catheterization is not attained.
Educate parents and child about changes in urine characteristics indicating
bladder infection and measures to take to prevent this complication.
Allows for early interventions to control infection and eventual renal
complications.
Advice to keep a record of fluid intake/day and weight and report changes;
Avoid foods and fluids that are acidic including meat, poultry, fish, citrus
fruits, pasta, dairy, eggs, and grains.
Maintains a monitoring system to ensure control of possible complications.
3. Restoring Bowel Function
Bowel function for patients with spina bifida can be affected due to neurogenic
bowel dysfunction. This can result in issues such as constipation, fecal
incontinence, or difficulties with bowel control. Management of bowel function in
patients with spina bifida may involve interventions such as dietary modifications,
bowel training programs, medication to promote regular bowel movements, and
the use of assistive devices like stool softeners or laxatives to ensure adequate
bowel elimination and prevent complications such as bowel impaction.
Assess the presence of neurogenic bowel, the degree of incontinence, and
the potential for rehabilitation.
Provides information about the condition for use in the plan of establishing a
bowel elimination routine.
Place the child on a toilet or potty chair at the same time each day; use
stimulation and suppository if needed.
Establishes a routine for elimination to empty bowel.
Teach parents to correct cleansing and diapering techniques for
infants/toddlers.
Promotes understanding to maintain good skin integrity.
Change diapers as quickly as feasible; cleanse the perianal area carefully.
Dry, clean skin resist breakdown.
Apply barrier creams as prescribed to the perianal area during diapering.
Prevents skin breakdown.
Suggest clothing and undergarments to protect from staining accidents.
Promotes self-image and prevents embarrassing incidents.
Apply padding in waterproof undergarments but avoid the use of diapers.
Prevents embarrassment for the child if bowel elimination is not controlled.
Encourage fluid intake of up to 2,000 ml/day depending on age; include
fiber and roughage in the diet.
Promotes bulk for easier and more manageable passage.
Teach parents and child about program for control of bowel
incontinence (fluids, diet, routine toileting, use of stimulation).
Promotes success in bowel training.
Teach about behavior modification as a method to be used for bowel
rehabilitation.
Promotes compliance with the routine to control bowel incontinence.
Administer stool softeners, laxatives, or fiber supplements as indicated.
See Pharmacologic Management
4. Promoting Positive Self-Body Image
Self-body image for patients with spina bifida can be influenced by physical
differences and functional limitations associated with the condition. These
individuals may face challenges in accepting and embracing their unique body
characteristics, which can impact their self-esteem and overall body image.
Supporting a positive self-body image involves providing emotional support,
promoting self-acceptance, and encouraging the development of personal
identity beyond physical appearance to foster a sense of empowerment and wellbeing.
Assess child for feelings about strengths and weaknesses in performing
ADL, social interaction, and effect on self-concept.
Provides information about the potential for independence in thinking and
functioning.
Encourage expression of feelings and concerns and support communication
of the child with parents and peers.
Provides an opportunity to vent feelings to reduce anxiety and negative feelings.
Encourage parents to sustain support and care for the child.
Encourages acceptance of the child.
Encourage independence and maximize functioning with the use of aids for
dressing, bathing, grooming, eating, mobility, toileting, and acknowledge
on attempts at self-care activities.
Promotes ADL capability by use of assistive aids as needed depending on the
disability.
Advise parents to maintain consistent behavior rules for the child as other
children in the family and to integrate care and activities into the family
routine.
Provides a sense of belonging to the family.
Notice any positive achievements and avoid mentioning negative
comments.
Enhances body image and confidence.
Provide touching and hugging, age-appropriate activities with other
children.
Conveys caring and concern for the child and enhances socialization.
Encourage and teach the use of assistive aids for ADL.
Promotes independence and enhances body image.
5. Promoting Effective Coping
Families of patients with spina bifida may experience various emotional,
psychological, and practical challenges as they adapt to their child’s condition.
Coping strategies can involve seeking emotional support from healthcare
professionals, support groups, and other families facing similar situations, as well
as engaging in education about spina bifida to enhance their understanding and
ability to manage the condition.
Assess the anxiety level of family and child, perception of crisis situation,
coping and problem-solving methods used, and effectiveness.
Identifies the need to develop new coping skills and realistic behaviors in goal
setting and interventions necessary for family and child to adapt to crisis.
Assess the family’s ability to cope with the child, developmental level of the
family, stress on family relationships, the response of siblings, knowledge of
health practices, family role behavior and attitude about long-term care,
economic burdens, resources to care for long-term condition
and grieving process, signs of depression, feelings
of powerlessness and hopelessness.
Provides information about family attitudes and coping abilities that directly
affect the child’s health and feeling of well-being; chronic conditions affecting a
child in a family may strengthen or strain relationships and members may
develop emotional problems when the family is stressed.
Encourage family members to vent feelings and reactions to the appearance
and condition of the infant/child.
Relieves anxiety and concern and allows a show of acceptance for their
responses.
Encourage expression of feelings and provide accurate, honest information
about care with or without surgical repair, abilities, and disabilities.
Allow reduction in anxiety and enhances family understanding of the condition
and child’s needs.
Encourage to maintain the health of family members and social contacts.
Prevents adverse effects of chronic anxiety, fatigue, and isolation on the health
and care capabilities of the family.
Communicate empathy for the client and family.
Promotes coping and positive adjustment to illness.
Support and encourage parental and family caretaking efforts.
Provides positive reinforcement of roles and reduces stress in family members.
Provide anticipatory guidance for crisis resolution.
Assists the family to adapt to the situation and develop a new coping mechanism.
Be aware of cultural differences in coping behaviors; need differs according
to cultural and ethnic backgrounds.
Promotes cultural and developmental normalcy.
Assist to discuss family dynamics and the need to tolerate conflict and
individual behaviors.
Assists to understand the family members leading to resolution.
Assist to identify helpful techniques to use to problem solve and cope with
the problem and gain control over the situation.
Provides support for problem-solving and management of the situation.
Assist the family with identifying the realities of disabilities and suggest
contact with community agencies, clergy, social services, and physical and
occupational therapy.
Provides support, information, and assistance.
Teach that overprotective behavior may hinder growth and development,
and that child should have limits and rules to live by.
Enhances the family’s understanding of the condition and the need for the
integration of the child into family activities.
Reinforce positive coping behaviors.
Promotes behavior change and adaptation to care for the child.
If hospitalization is frequent, assign the same personnel to care for the child
if appropriate.
Promotes trust and communication with family members.
Explain causes, treatment, and prognosis of the condition; inform parents
that they are not at fault for the development of the congenital defect.
Reduces guilt and provides information about the condition.
Advise parents that surgery may be performed within 48 hours after birth or
be postponed to the age of 3 months or until a further neurologic function
is assessed, to allow for better epithelialization to occur, and to reduce the
possibility of the development of hydrocephalus; use this information as
reinforcement of physician information.
Provides information to assist the family in the decision about the surgical
procedure.
Inform the need for follow-up appointments with physician and therapists.
Ensures compliance with the medical regimen.
6. Preventing Infections and Injuries
Patients with spina bifida are prone to infection due to the increased risk of
urinary tract infections and the presence of exposed neural tissue, which can
serve as a potential entry point for pathogens. Additionally, their reduced
mobility and sensory deficits can make them more susceptible to injuries, such as
falls or pressure sores. The combination of these factors underscores the
importance of infection control measures, proper hygiene, and injury prevention
strategies to mitigate the risks and promote the well-being of individuals with
spina bifida.
Assess neural tube sac for breaks or leakage of CSF, irritation of sac,
redness, swelling, and purulent drainage at or around sac area; Assess
for fever, irritability, nuchal rigidity, cloudy foul-smelling urine.
Gives information about the potential infection of the sac site, and meningitis if
the sac is ruptured, or is present.
Do handwashing before or after procedures involving the site and maintain
sterile technique when caring for the client.
Avoids the proliferation of microorganisms on the site.
Use sterile saline or antibiotic solution as prescribed to make sure a moist
sterile dressing is applied over the sac.
Avoids the sac membrane to be dried which could result in sac breakage and
contamination.
Reinforce moist dressing with dry sterile dressing and change as needed;
Remove moist dressing after it has dried to avoid damage to the sac.
Prevents contamination by capillary action through moisture.
Apply a shield over the sac dressing and tape a plastic sheet below the
defect; following surgical closure on the defect, apply a transparent
occlusive dressing over the area below the sac site.
Protects the sac from urine or fecal contamination.
Keep anal area clean and apply a sterile shield between anus and sac.
Prevent fecal contamination caused by poor anal sphincter control which allows
for dribbling and incontinence of stool.
Avoid ureteral contamination with stool, and perform thorough perianal
hygiene as needed.
Prevents urinary tract infection.
Alter routine nursing care activities such as feedings, changing linens, and
comforting as needed.
Prevents trauma to the sac.
Following surgical repair of the defect, observe any changes in wound
including redness, swelling, warmth, drainage, or fever.
Indicates wound infection.
Following surgery, cleanse wound with antiseptic as ordered and change
dressings when needed using sterile technique for at least 24 hours.
Promotes cleanliness of wound and prevents infection.
Maintain the infant in a prone position or side-lying, as permitted, with
head lower than buttocks or hips slightly flexed with a pad between the
knees; anchor position with sandbags.
Reduces pressure on the sac to prevent possible rupture and prevents rolling on
the side or back.
Administer antibiotics as ordered.
See Pharmacologic Management
14. Handle infant gently, hold and support back above the defect, or place
on a pillow in a prone position to move from place to place.
Prevents pressure on the sac area.
Recognize children with latex allergies and make them wear a medical id
alert bracelet.
Promote usefulness during treatment; May prevent an allergic reaction to
happen.
Inquire all clients admitted about reactions to latex allergy during all initial
interviews.
Promotes screening of all clients which may prevent severe allergic reactions in
otherwise low-risk clients.
Keep a latex-free environment, especially with high-risk populations
(children with spina bifida). Discourage the use of latex balloons in the
healthcare facility.
Prevents the development of latex allergy; prevents an allergic reaction in those
who are already sensitized.
Have emergency equipment ready, making sure the availability of supplies
required to manage an anaphylactic reaction.
Promote immediate emergency treatment.
7. Initiating Patient Education and Health Teachings
Patient health teachings for spina bifida include educating patients and their
families about the disease condition, as well as providing guidance on self-care
tasks such as bowel and bladder management, skincare, and proper use of
assistive devices. Moreover, teaching infection prevention strategies, injury
prevention techniques, and promoting psychological well-being are vital
components of patient education for spina bifida.
Educate patients with spina bifida and their family about the condition, its
implications, and potential complications.
This is to enhance a better understanding of the condition, empower them to
actively participate in the care, and promote informed decision-making for better
management.
Provide teachings on injury prevention, including safe mobility techniques,
and fall prevention.
Injury prevention for patients with spina bifida involves teaching safe mobility
techniques, such as proper body mechanics, transfers, and using mobility aids
like wheelchairs or braces. Fall prevention strategies include assessing the home
environment for hazards, recommending modifications or adaptive equipment,
and teaching patients and families about the importance of maintaining balance
and stability.
Educate patients and families about infection prevention strategies, such as
proper hand hygiene, clean intermittent catheterization techniques, and
regular skin care.
Proper hand hygiene helps minimize the transmission of pathogens and reduces
the risk of urinary tract and respiratory infections. Educating on clean intermittent
catheterization techniques ensures the proper management of neurogenic
bladder, minimizing the risk of urinary tract infections. Regular skin care,
including cleaning and inspection, helps prevent skin breakdown and potential
infections, particularly in areas prone to pressure sores.
Teach parents to cleanse the sac gently with moist cotton balls if soiled, and
avoid diapering the infant until after surgery and healing has taken place.
Protects sac from contaminants and maintains cleanliness.
Teach parents about the proper positioning of infant and the application of
protection around sac such as foam rubber doughnut.
Prevents damage to the sac and possible infection.
Teach parents about signs and symptoms of infection on the surgical site,
and notify the health care provider accordingly.
Promotes early detection of an infectious process for early treatment.
Stress the importance of handwashing, dressing change, and use of clean or
sterile linens, gloves, supplies when caring for the sac area.
Prevents transmission of infectious organisms; sterile technique may not be
needed in giving care after surgery is performed.
8. Administer Medications and Provide Pharmacologic Support
Medications involved in the management of spina bifida can include antibiotics
to prevent or treat urinary tract infections, antispasmodics to control bladder
dysfunction, and stool softeners, laxatives, or fiber supplements to manage bowel
dysfunction. The specific medications prescribed depend on the individual’s
needs and may vary to address the various aspects of spina bifida-related
complications such as neurogenic bladder and bowel dysfunction.
Antibiotics
Antibiotics may be prescribed to prevent or treat urinary tract infections (UTIs)
that are common in individuals with spina bifida due to neurogenic bladder
dysfunction.
Anticholinergic; Antispasmodic
These medications can help control bladder spasms, increase bladder capacity,
and improve bladder emptying.
Stool softeners; laxatives
These medications and supplements help promote regular bowel movements,
prevent constipation, and alleviate discomfort associated with bowel
irregularities.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
These medications are used to alleviate pain associated with musculoskeletal
issues, surgical procedures, or complications such as pressure sores.