Hydrocephalus

Hydrocephalus is a buildup of fluid inside the skull that leads to brain swelling. Hydrocephalus means "water on the brain."

Causes
Hydrocephalus is due to a problem with the flow of the fluid that surrounds the brain. This fluid is called the cerebrospinal fluid, or CSF. It surrounds the brain and spinal cord, and helps cushion the brain. CSF normally moves through the brain and the spinal cord, and is soaked into the bloodstream. CSF levels in the brain can rise if: The flow of CSF is blocked It does not get absorbed into the blood properly Your brain makes too much of it

Too much CSF puts pressure on the brain. This pushes the brain up against the skull and damage brain tissue. Hydrocephalus may begin while the baby is growing in the womb. It is common in babies who have amyelomeningocele, a birth defect in which the spinal column does not close properly. Hydrocephalus may also be due to: Genetic defects Certain infections during pregnancy

In young children, hydrocephalus may be due to: Infections that affect the central nervous system (such as meningitis or encephalitis), especially in infants Bleeding in the brain during or soon after delivery (especially in premature babies) Injury before, during, or after childbirth, including subarachnoid hemorrhage Tumors of the central nervous system, including the brain or spinal cord Injury or trauma

Hydrocephalus most often occurs in children. Another type, called normal pressure hydrocephalus, may occur in adults and the elderly.

Symptoms
Symptoms of hydrocephalus depend on: Age Amount of brain damage What is causing the buildup of CSF fluid In infants with hydrocephalus, it causes the fontanels (soft spot) to bulge and the head to be larger than expected. Early symptoms may also include: Eyes that appear to gaze downward Irritability Seizures Separated sutures Sleepiness Vomiting

Symptoms that may occur in older children can include: Brief, shrill, high-pitched cry Changes in personality, memory, or the ability to reason or think Changes in facial appearance and eye spacing Crossed eyes or uncontrolled eye movements Difficulty feeding Excessive sleepiness Headache Irritability, poor temper control Loss of bladder control (urinary incontinence) Loss of coordination and trouble walking Muscle spasticity (spasm) Slow growth (child 0 - 5 years) Slow or restricted movement Vomiting

Exams and Tests The doctor or nurse will examine the baby. This may show: Stretched or swollen veins on the baby's scalp Abnormal sounds when the health care provider taps lightly on the skull, suggesting a problem with the skull bones All or part of the head may be larger than normal, usually in the front part Eyes that look "sunken in" White part of the eye appears over the colored area, making it look like a "setting sun" Reflexes may be normal Head circumference measurements, repeated over time, may show that the head is getting bigger. A head CT scan is one of the best tests for identifying hydrocephalus. Other tests that may be done include: Arteriography Brain scan using radioisotopes Cranial ultrasound (an ultrasound of the brain) Lumbar puncture and examination of the cerebrospinal fluid (rarely done) Skull x-rays

Treatment The goal of treatment is to reduce or prevent brain damage by improving the flow of CSF. Surgery may be done to remove a blockage, if possible.

If not, a flexible tube called a shunt may be placed in the brain to re-route the flow of CSF. The shunt sends CSF to another part of the body, such as the belly area, where it can be absorbed. Other treatments may include: Antibiotics are given if there are signs of infection. Severe infections may require the shunt to be removed. A procedure called endoscopic third ventriculostomy (ETV), which relieves pressure without replacing the shunt. Removing or burning away (cauterizing) the parts of the brain that produce CSF.

The child will need regular check-ups to make sure there are no further problems. Tests are regularly done to check the child's developmental and for intellectual, neurological, or physical problems. Visiting nurses, social services, support groups, and local agencies can provide emotional support and assist with the care of a child with hydrocephalus who has significant brain damage. Outlook (Prognosis) Without treatment, up to 6 in 10 people with hydrocephalus will die. Those who survive have different amounts of intellectual, physical, and neurological disabilities. The outlook depends on the cause. Hydrocephalus that is not due to an infection has the best outlook. Persons with hydrocephalus caused by tumors usually do very poorly. Most children with hydrocephalus that survive for 1 year will have a fairly normal life span. Possible Complications The shunt may become blocked. Symptoms of such a blockage include headache and vomiting. Surgeons may be able to help the shunt open without having to replace it. There may be other problems with the shunt, such as kinking, tube separation, or infection in the area of the shunt. Other complications may include: Complications of surgery Infections such as meningitis or encephalitis Intellectual impairment Nerve damage (decrease in movement, sensation, function) Physical disabilities

When to Contact a Medical Professional Seek immediate medical care if your child has any symptoms of this disorder. Go to the emergency room or call 911 if emergency symptoms occur, which include: Breathing problems Extreme drowsiness or sleepiness Feeding difficulties Fever High-pitched cry No pulse (heart beat) Seizures Severe headache Stiff neck Vomiting

You should also call your health care provider if the child has been diagnosed with hydrocephalus and the condition gets worse and you are unable to care for him or her at home.

Nursing Diagnosis 1. :
Ineffective Cerebral Tissue Perfusion increased intracranial pressure. Interventions: 1. Observe evidence of increased ICP (a change of consciousness, vomiting, headache, increased blood pressure, seizures, bradycardia, slow and irregular breathing), report immediately if any. R /: It is very important in preventing dangerous or life-threatening complications. 2. Observation of vital signs (BP, pulse, respiration and temperature) R /: Changes in the clients vital signs can provide an overview of post surgical complications, poor prognosis disease.

3. Monitor post-surgical drainage of cerebrospinal fluid by a bulge the size monitors crown, measure the circumference of the head per day R /: Drainage of cerebrospinal fluid overload can be suspected occurrence of a progressive brain damage and assist in taking further action. 4. Place the head in an elevated position of 15-30 degrees R /: Lowering the arterial pressure and improve drainage and circulation / cerebral perfusion. 5. Help prevent straining during defecation and respiratory pressure (persistent cough) R /: Valsalva maneuver may increase the ICT and increase the risk of hemorrhage. 6. Create a calm environment. Provide periodic breaks between maintenance activities, and limit the duration of each procedure. R /: Activities / continuous stimulation may Increasing ICT. 7. Management of luminal appropriate therapy medical program. R /: Therapy luminal sedatives contain substances that can help reduce seizure activity.

Nursing Diagnosis 2:
Imbalanced Nutrition Less Than Body Requirements related to inadequate food intake Intervention: 1. Assess the childs preferred foods and foods that do not induce vomiting R /: so easy choosing and serving food 2. Give the food a little but often R / to maintain a stable weight in order not to fall dramatically and also no nausea 3. Serving food while warm R / with serving food while warm add the patients appetite 4. Assist and accompany clients during meal R /: to give support and encouragement to the client. 5. Collaboration to provide IV fluid line R / infusion of fluids through an IV to add nutrients and fluids for patients with nausea and vomiting

Nursing Diagnosis 3 :
Risk for injury related to increased intracranial pressure. intervention: 1. With careful observation for signs of increased ICP (a change of consciousness, vomiting, headache, increased blood pressure, seizures, bradycardia, breathing slow and irregular) R /: action to prevent delays. 2. Perform assessment on preoperative neurological basis. R /: as a guideline for postoperative assessment and evaluation of shunt function. 3. Avoid intravenous infusion in the vein of the scalp when the surgery will be performed. R /: because the procedure will affect the IV. 4. Position the child in accordance with (placed on the side that is not in operation). R /: to prevent pressure on the shunt valve. 5. Elevate head of bed if instructed. R /: to increase the gravity flow through the shunt. 6. Avoid sedation R /: because the level of awareness is an important indicator of increased intracranial pressure. 7. Teach the patients family about the signs of increased ICP and when to inform practitioners of nursing. R /: action to prevent delays.

Prepared by: Arnelle Hachero Michael Ong Ann Margareth Manuel