A patient with spina bifida presents with increased lower back pain and difficulty walking. MRI results indicate tethered cord syndrome, and a urinalysis confirms a urinary tract infection. The patient also has mild anemia. Considering these findings, which nursing intervention should be prioritized to address the patient's immediate medical needs?

A) Administer prescribed antibiotics to treat the UTI

B) Educate the patient on exercises to improve mobility

C) Refer the patient to a nutritionist for anemia management

D) Schedule a surgical consultation for tethered cord syndrome

A patient with spina bifida has been diagnosed with tethered cord syndrome and a urinary tract infection. She also exhibits mild anemia. Which nursing intervention should be prioritized to address the patient's current symptoms and complications effectively?

C) Arrange for a surgical consultation to address the tethered cord syndrome.

A) Encourage the patient to increase oral fluid intake to help manage the urinary tract infection.

B) Initiate a high-protein diet to address the patient's anemia and fatigue.

C) Arrange for a surgical consultation to address the tethered cord syndrome.

D) Educate the patient on performing intermittent self-catheterization to manage urinary incontinence.

A nurse is planning the care for a patient with tethered cord syndrome who is scheduled for surgical intervention. Considering the patient's concurrent urinary tract infection and mild anemia, which nursing action is the highest priority preoperatively?

D) Coordinating with the cardiac team for a comprehensive preoperative cardiac evaluation.

A) Ensuring the patient receives the prescribed nitrofurantoin to manage the urinary tract infection.

B) Educating the patient on dietary modifications to increase folate intake to address mild anemia.

C) Monitoring the patient's vital signs and urinary output to assess the effectiveness of the current treatment plan.

D) Coordinating with the cardiac team for a comprehensive preoperative cardiac evaluation.

A nurse is caring for a patient with tethered cord syndrome who is scheduled for surgical intervention. The patient has a history of urinary tract infections and mild anemia. Which of the following nursing interventions is most important to implement preoperatively to minimize the risk of complications?

C) Arrange for a preoperative cardiac evaluation.

A) Encourage the patient to increase intake of folate-rich foods.

B) Monitor the patient's urine output and clarity daily.

C) Arrange for a preoperative cardiac evaluation.

D) Administer nitrofurantoin as prescribed.

A patient with a history of tethered cord syndrome and anemia is receiving antibiotic therapy for a urinary tract infection and folic acid supplementation. The patient now presents with increased lower extremity weakness, spasticity, and moderate hypertension. Which nursing intervention is most appropriate to address the immediate neurological concerns?

C) Prepare the patient for a neurosurgical consultation.

A) Administer antihypertensive medication as prescribed.

B) Elevate the lower extremities to improve circulation.

C) Prepare the patient for a neurosurgical consultation.

D) Educate the patient on dietary modifications for hypertension.

A patient with a history of tethered cord syndrome is showing signs of neurological deterioration and moderate hypertension. Which nursing intervention is most appropriate to prioritize in this scenario?

B) Conduct frequent neurological assessments to monitor changes in lower extremity strength.

A) Administer the prescribed low-dose ACE inhibitor to manage blood pressure.

B) Conduct frequent neurological assessments to monitor changes in lower extremity strength.

C) Educate the patient on dietary changes to support improved anemia management.

D) Coordinate with the pharmacy to ensure timely administration of folic acid supplementation.

A patient with a history of spina bifida presents with severe headaches, visual disturbances, and an MRI showing ventriculomegaly. The nursing team is preparing for a shunt revision surgery. Which nursing intervention is the priority to address the patient's current condition?

B) Monitor neurological status closely for changes in consciousness and pupil response.

A) Administer prescribed antihypertensive medications to manage blood pressure preoperatively.

B) Monitor neurological status closely for changes in consciousness and pupil response.

C) Educate the patient and family about the upcoming surgical procedure and postoperative care.

D) Ensure the patient is adequately hydrated to prevent postoperative complications.

A patient with spina bifida and a history of hydrocephalus presents with severe headaches and visual disturbances. An MRI confirms ventriculomegaly. What is the nurse's priority intervention in this scenario?

B) Prepare the patient for surgical intervention to revise the ventricular shunt.

A) Administer antihypertensive medications to manage blood pressure.

B) Prepare the patient for surgical intervention to revise the ventricular shunt.

C) Encourage the patient to rest in a dark room to relieve photophobia.

D) Educate the patient about the importance of regular neurological assessments.

A patient with a history of spina bifida and recent shunt revision for hydrocephalus is on the second postoperative day and presents with new onset nausea and vomiting. Which of the following is the most appropriate initial nursing action?

C) Assess the patient's neurological status and vital signs.

A) Administer prescribed antiemetic medication.

B) Notify the neurosurgeon immediately.

C) Assess the patient's neurological status and vital signs.

D) Encourage the patient to increase fluid intake.

A patient with a history of hydrocephalus and tethered cord syndrome has undergone a shunt revision surgery. On the second postoperative day, she develops nausea and vomiting. Which nursing intervention is the priority?

B) Assess the patient's neurological status

A) Administer antiemetic medication as prescribed

B) Assess the patient's neurological status

C) Encourage the patient to ambulate to alleviate symptoms

D) Increase fluid intake to prevent dehydration

SPINA BIFIDA - Nursing Case Study

Pathophysiology

• Primary mechanism: Spina bifida is primarily caused by the incomplete closure of the neural tube during embryonic development, which typically occurs by the fourth week of pregnancy. This defect results in the vertebrae not fully enclosing the spinal cord, leaving portions of it exposed.

• Secondary mechanism: A deficiency in folic acid during early pregnancy significantly increases the risk of neural tube defects like spina bifida. Folic acid is crucial for DNA synthesis and cell division, which are vital for the proper formation of the neural tube.

• Key complication: This defect can lead to neurological impairments such as paralysis or loss of sensation below the affected area due to damage to the exposed spinal cord and nerves. This can affect mobility, bladder and bowel control, and overall quality of life.

Patient Profile

Demographics:

28-year-old female, office administrator

History:

• Key past medical history: Diagnosed with spina bifida at birth, history of recurrent urinary tract infections, mild scoliosis

• Current medications: Folic acid supplement, oxybutynin, ibuprofen as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increased lower back pain and difficulty walking

• Key symptoms: Numbness and tingling in legs, urinary incontinence, fatigue

• Vital signs: Blood pressure 145/90 mmHg, heart rate 95 bpm, respiratory rate 18 breaths per minute, temperature 37.2°C

Section 1

New Diagnostic Results:

Following the initial assessment, the patient underwent a series of diagnostic tests to further evaluate her current symptoms and complications related to spina bifida. An MRI of the lumbar spine revealed tethered cord syndrome, a condition where the spinal cord is abnormally attached within the spinal canal, restricting its movement and leading to neurological symptoms. This finding correlates with her increased lower back pain and difficulty walking. In addition, a urinalysis confirmed the presence of a urinary tract infection (UTI), indicated by elevated white blood cells and nitrites, likely contributing to her urinary incontinence and recurrent fatigue.

Laboratory results also revealed a mild anemia with a hemoglobin level of 10.5 g/dL, perhaps explaining her fatigue and contributing to her overall decreased energy levels. This anemia could be linked to her chronic health condition and possible nutritional deficiencies. These results underscore the need for a multidisciplinary approach to manage her symptoms effectively. The medical team must address the tethered cord syndrome, likely through surgical consultation, while also treating the UTI with antibiotics that are not penicillin-based due to her allergy. Additionally, a nutritional assessment may be warranted to optimize her folic acid intake and address any other deficiencies contributing to her anemia.

These new diagnostic findings provide a clearer picture of the complexity of her condition and highlight the importance of ongoing monitoring and interdisciplinary care. The patient’s next steps will involve collaboration between neurology, urology, and nutrition specialists to develop a comprehensive treatment plan that addresses both her immediate medical needs and long-term quality of life.

Section 2

Upon receiving the new diagnostic results, the medical team initiated a comprehensive treatment plan addressing the patient's tethered cord syndrome, urinary tract infection, and mild anemia. A neurosurgical consultation was promptly arranged to discuss potential surgical intervention for the tethered cord syndrome. The neurosurgeon recommended a surgical procedure to release the tethered cord, aiming to alleviate her back pain and improve her mobility. In preparation for surgery, the patient was advised to undergo preoperative assessments, including a thorough cardiac evaluation due to her chronic condition and potential for perioperative complications.

In parallel, the urology team initiated treatment for the urinary tract infection with a course of nitrofurantoin, an antibiotic suitable given her penicillin allergy. The team also reviewed her current bladder management plan, considering the potential need for intermittent catheterization to prevent further infections and manage urinary incontinence. Daily monitoring of her vital signs and urinary output was implemented, revealing a gradual reduction in fever and improvement in urine clarity. Her vital signs showed stabilization, with blood pressure at 110/70 mmHg, heart rate at 88 bpm, and temperature returning to 98.6°F.

The nutritional team conducted a detailed assessment and identified a potential deficiency in folic acid, contributing to her mild anemia. They recommended dietary modifications to increase her intake of folate-rich foods, alongside a folic acid supplement to address the deficiency. Follow-up laboratory tests were scheduled to monitor her hemoglobin levels and evaluate the effectiveness of the nutritional intervention. The collaborative efforts of the multidisciplinary team aim to stabilize her condition and enhance her quality of life, setting the stage for the next phase of her treatment journey.

Section 3

As the patient progressed through the treatment plan, her response to interventions was closely monitored by the multidisciplinary team. In the days following the initiation of antibiotic therapy and nutritional supplementation, the patient displayed noticeable improvements in several areas. Her urinary tract infection showed marked signs of resolution, with urinalysis indicating a significant decrease in leukocyte esterase and nitrites, suggesting effective clearance of the bacterial infection. The patient's anemia also showed improvement, with a follow-up complete blood count revealing a rise in hemoglobin levels from 10.5 g/dL to 11.8 g/dL, reflecting a positive response to the folic acid supplementation and dietary adjustments.

However, new complications emerged that required immediate attention. The patient began experiencing increased lower extremity weakness and difficulty ambulating, which raised concerns about potential worsening of her tethered cord syndrome. A repeat neurological examination revealed diminished strength in her lower limbs, with a decrease in muscle power from 4/5 to 3/5 bilaterally. Reflexes remained brisk, and there was an increase in spasticity, indicating potential neurological deterioration. These findings prompted an urgent review by the neurosurgical team, who emphasized the need to expedite surgical intervention to prevent further decline in her neurological status.

The patient's case was further complicated by the emergence of moderate hypertension, with blood pressure readings fluctuating between 140/90 mmHg and 150/95 mmHg. This change necessitated a reevaluation of her cardiac status in light of her chronic condition and the upcoming surgical procedure. The medical team decided to initiate antihypertensive therapy, starting with a low-dose ACE inhibitor, while closely monitoring her renal function and electrolyte levels. This development underscored the need for ongoing vigilance and adaptability in managing her complex medical needs, as the team worked to stabilize her condition and prepare her for the crucial neurosurgical intervention.

Section 4

Despite the multidisciplinary team's diligent efforts, the patient's condition developed further complications that warranted immediate attention. During a routine follow-up, the patient reported experiencing severe headaches and visual disturbances, including blurred vision and photophobia. These symptoms prompted an urgent ophthalmological and neurological evaluation to explore potential etiologies, such as increased intracranial pressure or hydrocephalus, which are known concerns in patients with spina bifida. The ophthalmologist's examination revealed bilateral papilledema, a clear indication of increased intracranial pressure, necessitating an urgent neuroimaging study.

The MRI results confirmed the presence of ventriculomegaly, suggesting a worsening of her hydrocephalus. This finding necessitated a discussion about possible interventions, including the revision of her ventricular shunt to alleviate the pressure and prevent further neurological compromise. The case was promptly reviewed by the neurosurgical team, who emphasized the critical nature of timely intervention to address the hydrocephalus and prevent irreversible damage.

These developments further complicated the patient's clinical picture, as her hypertension and tethered cord syndrome required simultaneous management. The team carefully balanced the need for surgical intervention with the optimization of her blood pressure control. They adjusted her antihypertensive regimen to achieve better stabilization prior to the surgical procedures. This complex interplay of conditions required continued interdisciplinary collaboration, emphasizing the importance of comprehensive care to address each facet of her health challenges effectively. As the team prepared for the surgical intervention, they remained vigilant in monitoring her neurological status and managing her systemic complications to ensure the best possible outcome.

Section 5

As the team prepared for the surgical intervention to address the patient's hydrocephalus, they conducted a thorough preoperative assessment to establish a clear baseline of her current status. The patient presented with a blood pressure of 160/95 mmHg, heart rate of 88 beats per minute, and respiratory rate of 18 breaths per minute. Her oxygen saturation was stable at 97% on room air, but she appeared visibly uncomfortable and reported persistent headaches. On neurological examination, she was alert and oriented but demonstrated difficulty with coordination and balance, consistent with her known tethered cord syndrome. Sensory examination revealed decreased sensation in the lower extremities, and reflex testing showed hyperreflexia, suggestive of ongoing spinal cord tension.

Laboratory investigations revealed mild anemia with a hemoglobin level of 11.0 g/dL and a slight elevation in serum creatinine at 1.3 mg/dL, raising concerns about potential renal involvement in her hypertension. Electrolytes were within normal limits, and a coagulation profile showed no abnormalities, deeming her suitable for surgery from a hematological standpoint. In light of these findings, the multidisciplinary team prioritized optimizing her blood pressure, adjusting her antihypertensive medications to include a calcium channel blocker, which was expected to provide more effective control of her systemic hypertension and reduce perioperative risks.

The neurosurgical team proceeded with the shunt revision to relieve the increased intracranial pressure. Postoperatively, the patient was closely monitored in the intensive care unit. Her vital signs remained stable, and she reported a significant reduction in headache severity. However, on the second postoperative day, the patient developed new onset of nausea and vomiting, raising concerns about possible shunt malfunction or infection. An urgent CT scan was ordered to assess the shunt function and identify any potential complications. This situation underscored the complexity of managing spina bifida-related complications and the necessity for continued vigilance and prompt response to any changes in her clinical status. The team prepared to address these new symptoms while maintaining a focus on her overall recovery and long-term management of her multifaceted condition.