Spina Bifida on the NCLEX
Occulta vs meningocele vs myelomeningocele, pre-op sac care, the latex allergy link, and folic acid prevention.
Spina bifida questions cluster around three moments: protecting the sac at birth, the lifelong latex precaution, and the folic acid teaching that prevents the defect.
The three types
Occulta: vertebrae fail to close but nothing protrudes. Often just a dimple, hair tuft, or birthmark over the lower spine; may be found incidentally. Meningocele: sac contains meninges and CSF, no cord - deficits are minimal or absent. Myelomeningocele: sac contains meninges, CSF, and spinal cord/nerves. Deficits below the lesion: motor and sensory loss, neurogenic bladder and bowel. Strongly associated with hydrocephalus (Chiari II malformation), so monitor head circumference.
Protect the sac before surgery
Priority at birth with myelomeningocele: prevent rupture and infection. Cover the sac with a sterile, moist, non-adherent saline dressing and keep it from drying out. Position prone (or side-lying per orders) with hips slightly flexed; keep diapering below the defect so stool never contaminates the sac. No pressure on the sac, no rectal temperatures. Watch for CSF leak and infection signs. Closure is done early, typically within the first days of life.
Latex, bladder, and prevention
High risk of latex allergy from repeated exposure during procedures and catheterizations: latex-free environment from birth, for life. Teach families about cross-reactions (banana, avocado, kiwi, chestnut). Neurogenic bladder: clean intermittent catheterization, taught to parents and eventually the child, prevents infection and kidney damage. Bowel programs for continence. Prevention: folic acid 400 mcg daily for anyone who can become pregnant, started before conception; a 4 mg dose is used after a previously affected pregnancy, by prescription.
Frequently asked
First nursing action for a newborn with myelomeningocele?
Cover the sac with a sterile moist saline dressing and position prone. Protecting the sac from rupture and infection outranks everything else.
Why the latex allergy connection?
Repeated latex exposure from birth (surgeries, catheters) sensitizes these children at very high rates. Latex-free gloves and supplies from day one.
When should folic acid start?
Before conception. The neural tube closes in the first weeks of pregnancy, often before the person knows they are pregnant.
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