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(Clinical Manifestations (Irritability, lethargy, vomiting, Dramatic head…
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Clinical Manifestations
Irritability, lethargy, vomiting
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Apathy, inattentiveness, and indifference
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Diagnostics
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Head Circumference - measured regularly in infancy to determine whether the head is enlarging to rapidly, the patient is referred for imaging first then, if needed, to neurosurgery for further evaluation.
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MRI Brain enlarged vs normal Ventricles
Pathophysiology
Hydrocephalus is characterized by an increase in the Intracranial pressure, causing compression of white matter
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Although rare, a papilloma (epithelial tumor) may cause overproduction of CSF
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Nursing Care
Monitoring for infections of the shunt/surgical site. The greatest risk for shunt infections occurs within the first three months following surgery. Patients receive perioperative intravenous antibiotics to help prevent the development of infection
Signs of shunt infection include: fever, lethargy, irritability, redness along shunt device system, abdominal discomfort, or apnea. The physician will obtain CSF cultures if a patient develops symptoms of infection
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Immediate post-operative assessments include frequent neurological checks and monitoring for signs of infection and proper functioning of shunt.
(Chiafery, 2006)
Complications of both the LP and the VP shunt include infection and blockages of the shunt (Vajpeyi, 2013)
The 5 yr. survival rate with follow-up tx. is usually greater than 80% (McCance & Huether, 2014)
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Treatments
Shunt Placement:
Surgical placement of shunt from ventricle to another area of the body, to divert the excess CSF from the ventricular cavity to other of the body
The main objective of any shunt system is to decrease ICP (Intracranial Pressure) and preserve neuronal function.
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Lumbar-peritoneal (LP) shunt is placed to transport CSF from the lumbar thecal sac to the peritoneal cavity
Endoscopic Ventriculoscopy with Choroid plexus cauterization, a new procedure that hopes to avoid shunts which can malfunction and increase risk of infection
Ventriculoatrial (VA) shunts are provided to transfer cerebrospinal fluid from the cerebral ventricle into the right atrium of the heart
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Pharmacological treatments would include anti-seizure medications, antibiotics in cases of meningitis
