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CONGENITAL CONDITIONS-HYDROCEPHALUS (Health Education (Give your child…
CONGENITAL CONDITIONS-HYDROCEPHALUS
Definition
is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain.
Signs and Symptoms
Infants
An unusually large head
A rapid increase in the size of the head
A bulging or tense soft spot (fontanel) on the top of the head
Vomitting
Sleeplessness
Irritability
Poor feeding
Seizures
Toddlers and older children
Eyes fixed downward (sunsetting of eyes)
Headache
Blurred or double vision
Unstable balance
Poor co-ordination
Risk Factors
Newborns
Abnormal development of the central nervous system that can obstruct the flow of cerebrospinal fluid
Bleeding within the ventricles, a possible complication of premature birth
Infection in the uterus during a pregnancy, such as rubella or syphilis, that can cause inflammation in fetal brain tissues
Any age group
Lesions or tumors of the brain or spinal cord
Central nervous system infections, such as bacterial meningitis or mumps
Bleeding in the brain from a stroke or head injury
Causes
Hydrocephalus is caused by an imbalance between how much cerebrospinal fluid is produced and how much is absorbed into the bloodstream.
Diagnostic Procedures
Ultrasound
CT Scan
MRI
Surgical Management
Ventriculostomy
the surgeon makes a hole in the bottom of a ventricle so that the excess fluid flows towards the base of the brain. Normal absorption occurs at the base of the brain. This procedure is sometimes performed when the flow of fluids between ventricles is obstructed.
Shunt
is the surgical insertion of a drainage system. A catheter (a thin tube with a valve) is placed in the brain to drain away excess fluid from the brain into another part of the body, such as the abdomen, the chest cavity, or a chamber of the heart. Usually, this is all that is needed, and no further treatment is required.
Endoscopic third ventriculostomy (ETV
a small hole is made in the deep part of the brain so that the fluid in the brain can flow freely.
Pathophysiology
The cerebrospinal fluid accumulates within the cranial cavity ventricles of the brain causing an increase in the cranial cavity
Types
Communicating Hydrocephalus
Communicating hydrocephalus, also known as nonobstructive hydrocephalus, is caused by impaired CSF reabsorption in the absence of any CSF-flow obstruction between the ventricles and subarachnoid space.
Non-Communicating Hydrocephalus
Non-communicating hydrocephalus - also called obstructive hydrocephalus - occurs when the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles.
Medical Management
Acetazolamide (ACZ) and furosemide (FUR) treat posthemorrhagic hydrocephalus in neonates. Both are diuretics that also appear to decrease secretion of CSF at the level of the choroid plexus. ACZ can be used alone or in conjunction with FUR.
Nursing Mangement
Nursing Assessment
Head circumference. Measurement of the newborn‘s head is essential.
Neurologic and vital signs. Obtaining accurate vital and neurologic signs is necessary before and after surgery.
Check the fontanelles. If the fontanelles are not closed, carefully observe them for any signs of bulging.
Monitor increase in intracranial pressure. Observe, report, and document all signs of IICP.
History taking. If the child has returned for revision of an existing shunt, obtain a complete history before surgery from the family caregiver to provide a baseline of the child’s behavior.
Nursing Intervention
Preventing injury. At least every 2 to 4 hours, monitor the newborn’s level of consciousness; check the pupils for equality and reaction; monitor the neurologic status, and observe for a shrill cry, lethargy, or irritability; measure and record the head circumference daily, and keep suction and oxygen equipment convenient at the bedside.
Promoting skin integrity. After a shunting procedure, keep the newborn’s head turned away from the operative site until the physician allows a change in position; reposition the newborn at least every 2 hours, as permitted; inspect the dressings over the shunt site immediately after the surgery, every hour for the first 3 to 4 hours, and then at least every 4 hours.
Preventing infection. Closely observe for and promptly report any signs of infection; perform wound care thoroughly as ordered, and administer antibiotics as prescribed.
Nursing Care Plan
Risk Of Injury
Goals and Outcomes
Patient remains free of injuries.
Patient explains methods to prevent injury.
Patient identifies factors that increase risk for injury.
Patient relates intent to practice selected prevention measures.
Patient increases daily activity, if feasible.
Nursing Assessments
Assess general status of the patient.
Assess mood coping abilities, personality style that may result in carelessnes.
Thoroughly conform patient to surroundings. Put call light within reach and teach how to call for assistance; respond to call light immediately.
Health Education
Give your child pain medicines as your healthcare provider directs.
Feed your child his or her regular diet.
Wash your child’s incision each day with mild soap. Rinse the incision with water and gently pat it dry.
Don’t allow your child to soak in water (in the bathtub or swimming pool) until the incision is completely healed.
