HYDROCEPHALUS

Jed Ray G. Montayre, RN, MSN

HYDROCEPHALUS
characterized by an increased in the amount of CSF within the ventricle of the brain.
Types: 1.Communicating 2.Non-communicating

Pathophysiology
CAUSES: > tumor or fibrosis from infection or inflammation > congenital malformation > tumor at the choroid plexus > Meningitis, severe CHF, subarachnoid hemorrhage venous sinus thrombosis > Spinal cord tumor > GBS (producing a High CHON CSF) flow of CSF is plugged or impeded by the protein & cellular & molecular debris Alteration in the absorption of CSF at the arachnoid granulation Distention of the ventricles with the corresponding thinning of the white matter

pathways for the circulation of CSF is blocked or narrowed obstruction of CSF

oversecretion of CSF

Signs and Symptoms ( Assessment Nursing Process )

increase head circumference cranial suture separation downward rotation of eyes Macewens Sign Focal Neurologic Deficits Increased ICP *

Medical Management
Diagnostic Tests: 1. Serial Transilluminations 2. CT Scan Management: Shunting (Ventriculoperitoneal & Ventriculoatrial) > insertion of a flexible tube into the lateral ventricle of the brain (peritoneum or right atrium)

NURSING RESPONSIBILITIES
1. Pre-op care 2. Check neuro status 3. Post-op care DO NOT flex neck on the side where the shunt is placed Observe for signs of infection Observe for signs of ICP H-ead of bed (not more than 30 ) E-valuate A-irway D-rainage S-afety 4. Parental teaching

Care of Client with Increased ICP

-Maintain patent airway and adequate ventilation - Prevent hypoxia and hypercabia - Principles of suctioning - Assist with mechanical hyperventilation V/S and Neuro Check HOB- 30 45 degrees

Care of Client with Increased ICP

-Prevent further Increased in ICP -provide quite environment -avoid straining, vomiting, excessive coughing - avoid sharp and disturbing sensory stimulants ( light).

Care of Client with Increased ICP

Medication Hyperosmotic agents- ( Mannitol)decrease cerebral edema Corticosteroid- ( Dexamethasone)- antiinflammatory effect Anticonvulsant Analgesic ( Strong opiates are contraindicated)

Care of Client with Increased ICP

ICP monitoring Barbiturate and Paralyzing agent Treatment - Constant monitoring of ICP, Laboratory results - Appropriate nursing care to patients with ventilator

Nursing Care Plan

Assessment- S/S and Laboratory Results Nursing Diagnosis - Ineffective Airway and breathing pattern - Decrease Cerebral Perfusion - Impaired Sensory perception - Immobility - Risk for Injury

Nursing Care Plan

Nursing Goal To prevent further brain injury Sustain the bodys vital organ functioning Provide comfort and avoid complications

Nursing Care Plan

Nursing Interventions - Monitoring ABCs and providing safe and comfort - Measures to prevent increase in ICP - Collaborative nursing responsibilities in assisting the doctor in special procedures - Parental teaching

Nursing Care Plan

Evaluation - Based on the results of the nursing measures - Outcomes in ICP monitoring - Manifestation of the clients - Parental understanding about the measures to avoid the increase of ICP.

Thank You!
Jed Ray G. Montayre, RN, MN-MSN