4. Neural Tube Defects

how does a Chiari malformation affect CSF flow?

parts of the brain sit too low and block normal CSF flow

what’s hydrocephalus?

excess CSF in the brain’s ventricles

what factors can interfere with normal neural tube development?

drugs, malnutrition, chemicals, and genetics

what supplement can prevent neural tube defects? *

0.4mg of folic acid

• should be taken by all people capable of getting pregnant

how does preconception folic acid supplementation affect neural tube defects? *

decreases their incidence by 50%

what’s an encephalocele?

protrusion of the brain and meninges through a skull defect, usually in the occipital region

what determines the prognosis of an encephalocele?

size, location, and involvement of other brain structures

what should the nurse assess in a child with an encephalocele?

• neurologic status

• whether the sac is intact/infected

if the sac in encephalocele is not in tact, it is a _____ *

medical emergency

how should the nurse protect an encephalocele sac? *

cover it with a wet, non-adherent dressing to help prevent rupture and infection

• notify provider if it breaks

what ongoing monitoring is needed for a child with an encephalocele?

head circumference and signs of increased intracranial pressure

what’s spina bifida occulta?

a vertebral defect without protrusion of the spinal cord or meninges

• the defect isn’t visible externally

what skin findings may indicate spina bifida occulta?

dimpling, abnormal patches of hair, or discoloration at the defect site

how is spina bifida occulta usually managed?

no immediate interventio

• nursing care focused on family education

• surgery is occasionally needed for complications

what’s a meningocele?

meninges herniate through a vertebral defect, forming a visible spinal sac that’s usually covered with skin

• usually surgically corrected, but not asap

how does a meningocele usually affect neurologic function?

the spinal cord is usually normal, with minor or no neurologic deficits

when can meningocele surgery be delayed?

when the skin is intact and neurologic functioning is normal

what findings require immediate surgical correction of a meningocele?

thin skin over the sac or leaking CSF

what should the nurse monitor in a child with a meningocele?

• constipation

• bladder dysfunction

• head circumference

• signs of increased intracranial pressure