Ward Class

An Online Resource Site For Student Nurses

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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Neurologic Disorders: Hydrocephalus


  • excessive amounts of CSF within ventricles of the brain
  • may be caused by obstruction, overproduction, or inadequate reabsorption of CSF
  • may be congenital, or a result of injury, infection, or tumor
  • fairly common, 1 in 500 children are born with the disorder
  • may be non-communicating (flow of CSF is obstructed) or communicating (no obstruction is present but CSF is inadequately reabsorbed or is excessively produced)
Assessment Findings
  • infant to 2 years:
    • an unusually large head
    • a rapid increase in the size of the head
    • bulging , non-pulsating fontanels
    • separation of cranial sutures
    • vomiting
    • sleepiness
    • irritability
    • seizures
    • eyes fixed downward (sunsetting of the eyes)
    • poor feeding
    • high-pitched cry
    • Developmental delay
  • older children:
    • changes in head size less common
    • nausea, vomiting, headache (increased ICP)
    • ataxia (incoordination and irregularity of voluntary movements)
    • blurred or double vision
    • alterations in consciousness-->late sign
    • papilledema (swelling of the optic disc)-->late sign
  • diagnostic tests:
    • serial transilluminations--> done by holding a flashlight against the skull with the child in a darkened room; will reveal a skull filled with fluid rather than brain substance
    • CT scans-->shows dilated ventricles as well as presence of mass
Surgical Management
  1. shunting-->a tube is inserted into the lateral ventricles of the brain so that the CSF is drained from the ventricles and then channeled to the peritoneum or the right atrium for reabsorption
  2. ventriculostomy-->sometimes used when there's an obstruction of flow between ventricles; a hole is made at the bottom of one of the ventricles to allow the cerebrospinal fluid to flow toward the base of the brain where normal absorption takes place
Nursing Management
  1. provide routine pre-op care for patient prior to shunting
  2. monitor neurologic status
  3. post-shunting:
    • maintain shunt patency
      1. position patient off operative site
      2. pump shunt as ordered
      3. observe site for signs of infection (increased drainage, swelling, opening of incision line,increased redness and warmth along incision line)
      4. observe for signs of increased ICP: inc BP, inc T, dec RR, dec PR, headache, nausea, vomiting
      5. position patient with head slightly elevated as ordered
  4. instruct parents of patient on:
      • wound care
      • positioning of patient
      • pumping of shunt
      • signs of infection
      • signs of increased ICP
      • need for shunt revisions
      • expected level of developmental functioning--there may be some developmental problems
      • availability of government-sponsored health care and other support services
Prognosis

The prognosis for patients with hydrocephalus is difficult to predict but timely diagnosis and effective treatment lessens the risk of developmental delays, both cognitive and physical. Educational interventions and rehabilitation therapies help patients lead normal lives with few limitations.

Prevention

To prevent hydrocephalus, mothers should get regular prenatal care to reduce risk of premature labor as there is a high incidence of hydrocephalus among premature infants. It is also important to protect infant or child from head injuries. Also, a child's immunizations must be up-to-date to prevent hydrocephalus secondary to infections.

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