A 12-year-old patient with spina bifida occulta presents with mild lower back pain but no neurological deficits. What is the most appropriate nursing intervention to help manage her condition?

B) Educate the patient and family about maintaining an active lifestyle

A) Encourage complete bed rest until the pain subsides

B) Educate the patient and family about maintaining an active lifestyle

C) Restrict all physical activities to prevent further pain

D) Advise the use of a back brace to support the lumbar region

What is the primary nursing intervention for a 12-year-old patient with spina bifida occulta experiencing mild lower back pain?

B) Encourage regular physical activity tailored to her condition

A) Administer prescribed analgesics as needed

B) Encourage regular physical activity tailored to her condition

C) Suggest complete bed rest until the pain subsides

D) Recommend the use of a back brace to prevent further pain

What is the primary focus of the nursing care plan for a patient diagnosed with spina bifida occulta?

C) Educating the patient and family on lifestyle modifications

A) Administering scheduled pain medication

B) Preventing infection at the site of the defect

C) Educating the patient and family on lifestyle modifications

D) Monitoring for signs of increased intracranial pressure

What is the primary purpose of providing patient education to the family of a child with spina bifida occulta?

B) To promote the child's recovery and prevent complications

A) To ensure the family can independently perform diagnostic tests at home

B) To promote the child's recovery and prevent complications

C) To diagnose new conditions related to spina bifida occulta

D) To eliminate the need for future medical follow-up appointments

What is the primary reason for scheduling regular follow-up appointments for a patient after spinal surgery?

B) To monitor for any new neurological deficits

A) To ensure the patient is adhering to their medication regimen

B) To monitor for any new neurological deficits

C) To provide nutritional counseling

D) To routinely change the surgical dressing

What is the most appropriate nursing intervention for a patient who reports mild, intermittent back discomfort that is manageable with prescribed physical therapy exercises?

B) Encourage continuation of the current exercise regimen

A) Increase the frequency of physical therapy sessions

B) Encourage continuation of the current exercise regimen

C) Recommend over-the-counter pain medication

D) Advise complete bed rest until the discomfort subsides

What is the primary reason the nursing team emphasizes adherence to physical therapy exercises for this patient?

B) To maintain range of motion and prevent complications

A) To promote social interaction

B) To maintain range of motion and prevent complications

C) To reduce the need for future surgical interventions

D) To decrease the frequency of routine follow-up visits

During the patient's routine follow-up appointment, which aspect of her assessment most directly indicates effective management of her condition?

B) Her ability to maintain a steady gait without muscle weakness

A) Her cheerful demeanor and active engagement with her parents

B) Her ability to maintain a steady gait without muscle weakness

C) The absence of redness or swelling at the surgical incision site

D) Her participation in physical activities such as swimming and cycling

Which of the following assessments would be most important for the nurse to perform regularly in a patient with a suspected tethered cord syndrome?

B) Assess muscle strength and gait for changes

A) Monitor the surgical incision site for signs of infection

B) Assess muscle strength and gait for changes

C) Record daily fluid intake and output

D) Measure blood glucose levels

What is the primary purpose of including physical therapy in the revised care plan for this patient with tethered cord syndrome?

B) To improve muscle strength and balance

A) To prevent infection at the surgical site

B) To improve muscle strength and balance

C) To increase flexibility in the upper extremities

D) To provide psychological support

spina bifida - Nursing Case Study

Pathophysiology

• Primary mechanism: Spina bifida occurs due to incomplete closure of the neural tube during embryonic development, leading to defects in the spine and spinal cord. This typically happens in the first month of pregnancy when the neural tube fails to close completely.

• Secondary mechanism: The defect allows parts of the spinal cord and nerves to protrude through the gap in the spine, potentially damaging these structures and impairing their function.

• Key complication: This can result in minor complications like weakness or numbness in the legs, bladder or bowel issues, and learning difficulties, emphasizing the need for early detection and intervention.

Patient Profile

Demographics:

12-year-old female, student

History:

• Key past medical history: Diagnosed with spina bifida occulta at birth, no prior surgeries

• Current medications: None

• Allergies: None known

Current Presentation:

• Chief complaint: Mild lower back pain

• Key symptoms: Occasional back discomfort, no neurological deficits, no bowel or bladder issues

• Vital signs: Blood pressure 110/70 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

Upon further assessment, the nursing team conducted a comprehensive physical examination to better understand the extent of the 12-year-old patient's condition. The examination revealed mild tenderness in the lower lumbar region, correlating with her chief complaint of mild lower back pain. There were no visible abnormalities such as swelling or discoloration, and the skin overlying the spine appeared intact. Neurological assessment showed no signs of sensory loss or motor deficits; the patient demonstrated full strength and range of motion in both lower extremities, and reflexes were within normal limits. She was able to ambulate independently without any assistive devices, and her gait was steady and coordinated.

In addition to the physical examination, the nursing team conducted a thorough review of the patient's functional status. The patient reported attending school regularly and participating in physical activities with her peers, although she occasionally experienced fatigue. She denied any difficulties with bladder or bowel function, and her academic performance was noted to be satisfactory, with no reported learning difficulties. The patient's parents expressed understanding of her diagnosis and were proactive in seeking guidance on managing her condition and preventing potential complications.

These findings suggest that the patient with spina bifida occulta is currently experiencing a stable and manageable condition. With no significant neurological symptoms present, the focus remains on monitoring for any changes in her status and providing education on lifestyle modifications that may help alleviate her mild back discomfort. The nursing team plans to collaborate with the patient's healthcare provider to develop a tailored care plan emphasizing routine follow-ups, physical activity encouragement, and potential physical therapy for strengthening exercises to maintain her current level of function and quality of life.

Section 2

Following the initial assessment, the healthcare team decided to order a set of baseline diagnostic tests to further evaluate the patient's condition and ensure comprehensive monitoring. An MRI of the lumbar spine was conducted, which confirmed the presence of spina bifida occulta, characterized by a small defect in the bony encasement of the spinal cord, without any involvement of the spinal cord itself. This finding aligned with the absence of significant neurological symptoms and supported the clinical impression of a stable condition. Routine blood tests, including a complete blood count and basic metabolic panel, were within normal limits, providing reassurance that there were no underlying systemic concerns contributing to her mild back pain.

In light of the diagnostic results, the nursing team continued to focus on preventive care and patient education. They provided the patient and her parents with information on maintaining proper posture and ergonomics, especially during school activities and physical play, to minimize strain on the lower back. Additionally, the importance of maintaining a healthy weight and engaging in regular physical activity was emphasized to support overall musculoskeletal health. The patient was encouraged to participate in a tailored physical therapy program, which included core strengthening and flexibility exercises designed to support spinal stability and alleviate discomfort.

The nursing team scheduled a follow-up appointment in three months to reassess the patient's condition and adjust the care plan as needed. They also encouraged the family to reach out promptly if any changes in symptoms occurred, such as increased pain or any new neurological signs. With a well-established routine and proactive management strategies in place, the patient and her family felt confident in their ability to manage her condition effectively, laying a solid foundation for continuing her active and fulfilling lifestyle.

Section 3

Three months later, the patient returned for her scheduled follow-up appointment. During the initial assessment, the nursing team noted that the patient appeared well-nourished and in no acute distress. Her vital signs were stable, with a blood pressure of 110/70 mmHg, heart rate of 78 beats per minute, respiratory rate of 16 breaths per minute, and a temperature of 98.6°F. The patient reported mild, intermittent back discomfort that was manageable with the prescribed physical therapy exercises. Her parents confirmed that she had been adhering to the exercise program regularly and had not experienced any significant episodes of pain or discomfort since the last visit.

Upon physical examination, the nursing team observed no new neurological deficits. The patient demonstrated a full range of motion in her lower extremities and maintained good posture. Her gait was normal, and there were no signs of muscle weakness or atrophy. The incision site from her previous spinal surgery appeared well-healed, with no signs of infection or irritation. The patient's BMI was within healthy limits, indicating effective weight management and adherence to dietary recommendations. Routine blood tests were repeated, and results remained within normal limits, further supporting her stable condition.

The nursing team was pleased with the patient's progress and response to interventions. They praised the patient and her family for their commitment to the care plan, particularly in maintaining an active lifestyle and participating in physical therapy. Based on these positive findings, the team decided to continue the current management plan, with another follow-up scheduled in six months. They reinforced the importance of ongoing monitoring and adherence to lifestyle modifications, while also encouraging the family to remain vigilant for any changes in symptoms. This proactive approach ensured that the patient could continue her daily activities comfortably and confidently, with the support of her healthcare team.

Section 4

Six months later, the patient returned for her routine follow-up appointment. During the initial assessment, the nursing team noted that she appeared cheerful and was engaging actively with her parents. Her vital signs were stable: blood pressure was 112/72 mmHg, heart rate was 76 beats per minute, respiratory rate was 17 breaths per minute, and temperature was 98.7°F. The patient reported that her back discomfort had become less frequent and was easily managed with simple stretching exercises. Her parents remarked on her enthusiasm for participating in physical activities, including swimming and cycling, which she enjoyed immensely.

The physical examination revealed that the patient continued to demonstrate a full range of motion in her lower extremities, with no new neurological deficits. Her posture remained excellent, and she displayed a steady gait with no signs of muscle weakness or imbalance. The incision site from her spinal surgery looked healthy, with no redness or swelling. Encouragingly, the patient had maintained her BMI within healthy limits, and her dietary habits remained consistent with the nutritional guidelines provided by the healthcare team. Routine laboratory tests, including a complete blood count and metabolic panel, returned within normal ranges, further confirming her stable health status.

The nursing team commended the patient and her family for their diligence in following the care plan and incorporating lifestyle changes. They emphasized the importance of continuing this active lifestyle and adhering to physical therapy exercises, as these had clearly contributed to the patient's improved quality of life. The team scheduled another follow-up in six months and advised the family to stay attentive to any new or unusual symptoms. This consistent, structured approach to care would help ensure that the patient maintained her current level of health and wellbeing, allowing her to thrive in her daily activities.

Section 5

Six months later, during the next routine follow-up appointment, the nursing team noted some changes in the patient's status that warranted further evaluation. The patient appeared slightly fatigued, although she remained cheerful and interactive with her parents. Her vital signs were mostly stable, with a blood pressure of 110/70 mmHg, heart rate of 80 beats per minute, respiratory rate of 18 breaths per minute, and temperature of 98.4°F. However, her parents mentioned that she had been experiencing occasional mild headaches and a slight increase in back discomfort, particularly after more intense physical activities.

The physical examination revealed that while the patient retained a full range of motion in her lower extremities, there was a slight reduction in muscle strength in her right leg. Her gait remained steady, but the nursing team noted a mild imbalance when she was asked to perform tandem walking. The surgical incision site remained healthy, with no signs of infection. However, these subtle changes prompted the healthcare team to order an MRI to assess for any potential underlying issues such as tethered cord syndrome or other spinal changes that might explain the recent symptoms.

The results of the MRI indicated a small area of tethering at the surgical site, which could be contributing to her new symptoms. The healthcare team discussed these findings with the family, emphasizing that while the tethering was a concern, it was in its early stages and could be managed effectively with close monitoring and possibly an adjustment in her physical therapy regimen. The team outlined a revised care plan that included more focused physical therapy exercises to address muscle strength and balance, and they scheduled a follow-up appointment in three months to closely monitor her progress. This proactive approach aimed to address the new complication and support the patient in maintaining her active lifestyle without significant interruption.