Spina Bifida and Osteoporosis - Sep. 5 @ 7_53 pm

docx

School

Boise State University *

*We aren’t endorsed by this school

Course

408

Subject

Medicine

Date

Apr 3, 2024

Type

docx

Pages

Uploaded by DukePorcupine4053

1 Spina Bifida and Osteoporosis Scenario A  Spina Bifida – An ultrasound of a nineteen-week gestation fetus demonstrates spina bifida. Answer the following questions:  What is the etiology for this disorder? Spina bifida is a birth defect of the neural tube (when the spine and spinal cord don't form properly). The neural tube is the structure in a developing embryo that eventually becomes the baby's brain, spinal cord and the tissues that enclose them. Normally, the neural tube forms early in pregnancy, and it closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube doesn't close or develop properly, causing problems in the spinal cord and in the bones of the spine. The medical community theorizes what causes spina bifida. The cause of spina bifida is thought to result from a combination of genetic, nutritional and environmental risk factors, such as a family history of neural tube defects and folate (vitamin B-9) deficiency ( Spina Bifida , 2022)  What are the steps that can be taken toward potential prevention of this disorder? Doctors recommend taking folic acid (in supplement form) starting at least one month before conception and continuing through the first trimester of pregnancy, greatly reduces the risk of spina bifida and other neural tube defects ( Spina Bifida , 2022). Having enough folic acid in your system by the early weeks of pregnancy is critical to prevent spina bifida. Because many women don't discover that they're pregnant until this time, experts recommend that all women of childbearing age take a daily supplement of 400 micrograms (mcg) of folic acid. Examples of foods containing 400 mcg of folic acid per

2 serving, include: enriched bread, pasta, rice, and some breakfast cereals ( Spina Bifida , 2022).  Why are these effective? The human body doesn't absorb folate as easily as it absorbs synthetic folic acid, and most women don't get the recommended amount of folate through diet alone, so vitamin supplements are necessary to prevent spina bifida. Adult women who are planning pregnancy or who could become pregnant should be advised to get 400 to 800 mcg of folic acid a day ( Spina Bifida , 2022). Also, folic acid will also help reduce the risk of other birth defects, including cleft lip, cleft palate and some congenital heart defects ( Spina Bifida , 2022). It's also a good idea to eat a healthy diet, including foods rich in folate or enriched with folic acid / vitamin B. vitamin B is present naturally in many foods, including: beans and peas, citrus fruits and juices, egg yolks, milk, avocados, and dark green vegetables, such as broccoli and spinach ( Spina Bifida , 2022).  What are long term considerations for this child? In other words, what complications might be associated with this disorder? Children with spina bifida (neural tube defects) have varying degrees of central nervous system problems as well as difficulties with bladder and bowel control and lower limb movement ("Spina Bifida," 2022, p. 1628). A person suffering from spina bifida can move around in different ways. This may include walking without any aids or assistance; walking with braces, crutches or walkers; and using wheelchairs ( Spina Bifida , 2023). People with spina bifida that occurs higher on the spine (near the head) might have paralyzed legs and use wheelchairs. Those with spina bifida lower on the spine (near the hips) might have more use of their legs and use crutches, braces, or walkers, or they might be able to walk without these devices

3 ( Spina Bifida , 2023). People with spina bifida often cannot control when they go to the bathroom. They also can develop urinary tract infections ( Spina Bifida , 2023). It is important to develop a plan for going to the bathroom that works and is as simple as possible. This can lead to increased health, participation, and independence, and avoid embarrassment for people with spina bifida. Healthcare providers can help develop a plan for each person. A tube (catheter) inserted in the bladder can help drain urine. In some cases, extra fiber can be added to the diet to keep bowel movements regular. Surgery also might be recommended ( Spina Bifida , 2023). Throughout this newborn’s whole life (childhood through adulthood) living with spina bifida, this person may have limited feeling in some areas of their body, leaving them unable to feel cuts, bruises, sores, and dry skin. Since a child/adult with spina bifida may not know they have been hurt, they may be unable to tell a parent or caregiver that they need help ( Spina Bifida , 2023). Pressure sores occur when there is prolonged pressure on soft tissue, skin, and muscle. Healthcare professionals report skin wounds as one of the primary diagnoses associated with the hospitalization1 of people with spina bifida. Pressure sores can lead to infection, amputation, or even death ( Spina Bifida , 2023). By checking skin regularly for redness including under braces, people with spina bifida, along with their parents and caregivers, can identify skin problems before they become pressure sores ( Spina Bifida , 2023).  What are the potential treatment options? Why might these be necessary? I work at Yale New Haven Health where, in conjunction with the Yale School of Medicine, have one of the leading Fetal Care Centers and Pediatric Spina Bifida programs in the world. Treatment for spina bifida depends on the type and severity of the condition ( Pediatric Spina Bifida Program , 2023). At Yale, fetal surgery for spina bifida usually occurs in the

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

4 26th week of pregnancy. The neonatal surgeon will perform a comprehensive evaluation to determine if fetal surgery is feasible. For example, myelomeningocele may involve surgery prior to or right after birth to repair the opening in the spine or to treat other complications that can occur ( Pediatric Spina Bifida Program , 2023). After birth, children with spina bifida often require care from multiple specialties such as neurology, physical therapy and orthopedics. If patients are not eligible for fetal surgery or decide it is not the best option for them, surgical repair takes place after the baby is born ( Pediatric Spina Bifida Program , 2023 ). At Yale, the surgeon will operate on the baby within a few days after birth to close the opening in the spine to prevent infection and prevent further injury to the spinal cord and nerves. A baby’s prognosis after surgical repair depends on many factors, including the location of their spinal defect. Some children may require minimal ongoing care, while others may require medical and educational support for many years after birth ( Pediatric Spina Bifida Program , 2023). Surgery is needed for myelomeningocele, the most severe form of spina bifida. For infants born with a myelomeningocele, the spinal cord does not form properly and a portion of the undeveloped cord protrudes through the back ( Pediatric Spina Bifida Program , 2023). A sac containing cerebrospinal fluid and blood vessels surrounds the protruding cord, which is usually not covered by skin so that the nerves and tissues are exposed. Between 70% and 90% of infants born with myelomeningocele also experience hydrocephalus due to a defect at the base of the skull (Chiari malformation) ( Pediatric Spina Bifida Program , 2023). Hydrocephalus is an excess buildup of spinal fluid on the brain that will cause brain damage, seizures or blindness if it is left untreated. To avoid this, plastic shunts must be surgically inserted beneath the skin to drain off excess fluid into the abdominal

5 cavity ( Pediatric Spina Bifida Program , 2023). Infants born with myelomeningocele often have paralysis or weakness below the level of the spinal lesion. This affects the lower limbs along with problems with bladder and bowel function. In extreme cases, the trunk and upper extremities are involved ( Pediatric Spina Bifida Program , 2023). Scenario B  Osteoporosis – Eighty-six-year-old Sarah O'Connor presents today a hip fracture. The radiologist’s report states there is significant cortical bone loss consistent with osteoporosis.  What are the surgical considerations with the osteoporotic changes in the proximal femur? It’s imperative that Ms. O’Connor have surgery. A hip fracture is a serious injury, with complications that can be life-threatening ( Hip Fracture , 2021). The risk of hip fracture rises with age and being 86 years old, puts Ms. O’Connor in a very high risk group. Her risk increases because bones tend to weaken with age (osteoporosis). A hip fracture almost always requires surgical repair or replacement, followed by physical therapy. Taking steps to maintain bone density and avoid falls could’ve help to prevent a hip fracture. A hip fracture can reduce independence and sometimes shorten life ( Hip Fracture , 2021). About half the people who have a hip fracture aren't able to regain the ability to live independently. When hip fractures prevent movement for a long time, complications can include:blood clots in the legs or lungs, bedsores, pneumonia, further loss of muscle mass, increasing the risk of falls and injuries, and even death ( Hip Fracture , 2021).  Who is most generally affected by osteoporosis? Why?

6 Bone density and muscle mass tend to decrease with age. Older people can also have problems with vision and balance, which can increase the risk of falling (Kim & Koh, 2017). Hip fractures occur in women about three times more often than they do in men. Women lose bone density faster than men do, in part because the drop in estrogen levels that occurs with menopause accelerates bone loss (Kim & Koh, 2017).  What are the treatment options and are they effective? Why? In terms of the hip fracture, the treatment option is hip surgery/replacement as stated above. If we’re discussing how to treat the osteoporosis, Ms. O’Connor needs to slow down the osteoporosis (bone loss) and reduce the risk of fall, which could lead to another fracture (Kim & Koh, 2017). A doctor could recommend proper nutrition (increase calcium and vitamin D) to slow down bone loss, quit smoking and no alcohol consumption, exercise to increase muscle mass (bone mass can no longer be improved at her age), follow fall prevention guidelines to help prevent future fractures, and potentially prescribe one or more of the following medications for treating osteoporosis: bisphosphonates, calcitonin, estrogen/hormone therapy, and rankl inhibitors (Kim & Koh, 2017). Due to Ms. O’Connor advanced age of 86, the primary focus is to slow down the rate of bone loss and damage fall risk.  What are the long-term considerations and potential prognosis for Mrs. O'Connor? Why? Most hip fractures in older adults require surgery to restore mobility and to manage pain. Ms. O’Connor is at risk for a range of post-surgical complications, including infection, blood clots in the lungs or legs, bedsores, urinary tract infection and pneumonia ( Hip Fracture , 2021). Recovery for adults like Ms. O’Connor, who are older or frail, can take months. Her age of 86 years which will delay her body from physically

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

7 recovering from the hip fracture can often lead to further loss of muscle mass, which then increases the risk of a subsequent fall. Due to the length of recovery, a hip fracture also often leads to a decrease in independence for Ms. O’Connor. One factor that can go overlooked, particularly among older adults, is pain management. It’s crucial to an optimal recovery. Ms. O’Connor needs to communicate her pain levels clearly and that her health care providers are responding appropriately (Kim & Koh, 2017). Unfortunately, many older adults won’t return to their same level of activity and independence following a hip fracture. If Ms. O’Connor has family, they should be prepared to make arrangements to get her the future help (convalescent / assisted living) that she will need (Kim & Koh, 2017). References Hip fracture . (2021, December 8). Mayo Clinic. Retrieved September 5, 2023, from https://www.mayoclinic.org/diseases-conditions/hip-fracture/symptoms-causes/syc- 20373468 Kim, J.-H., & Koh, K.-H. (2017). Risk factors including age, gender, osteoporosis in spine or hip, and local osteoporosis for more severe pattern of fracture in proximal humerus fracture. Osteoporosis and Sarcopenia , 3 (3), S37. Retrieved September 5, 2023, from https://doi.org/10.1016/j.afos.2017.08.068 Pediatric spina bifida program . (2023, June 24). Yale New Haven Health. Retrieved September 5, 2023, from https://www.ynhh.org/childrens-hospital/services/fetal-care

8 Spina bifida . (2020, January 28). Cleveland Clinic. Retrieved September 5, 2023, from https://my.clevelandclinic.org/health/diseases/8719-spina-bifida Spina bifida. (2022). New England Journal of Medicine , 387 (17), 1628–1628. Retrieved September 5, 2023, from https://doi.org/10.1056/nejmc2211513 Spina bifida . (2022, January 2). Mayo Clinic. Retrieved September 5, 2023, from https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc- 20377860 Spina bifida . (2023, January 27). National institute for neurological disorders and stroke. Retrieved September 5, 2023, from https://www.ninds.nih.gov/health-information/disorders/spina-bifida

Spina Bifida and Osteoporosis - Sep. 5 @ 7_53 pm

Related Documents