hydrocephalus 9

Time Specific objective

Content Teaching learning activity

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Evaluat-ion

Introduce the topic

Define the condition

Enlist the incidence

Discuss the related Anatomy

HYDROCEPHALUS

Introduction “Hydrocephalus is a condition in which there is excessive fluid accumulation in the brain.” The word Hydrocephalus derived from two words -hydro means water, cephalus means headDefinition:-

“is a condition in which portion of the entire ventricular system is abnormally dilated & the CSF has been under increased pressure.”Incidence Sex

Bickers adam syndrome NPH

Age Infancy Adulthood (40%)

Mortality and morbidity Due to brain herniation and resp. arrest

Related anatomyCSF circulation & pathway

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male

Identify the etiology

Enumerate the classification

Discuss the pathophysiology

Classification and etiology:A. Depending on the type of block Non communicating (block is intraventricular) ¾ Mal development of the aqueduct¾ Obstruction due to mass lesions¾ Obstruction secondary to exudate , haemorrhage or paracsites¾ Obstruction of the fourth ventricle outlet foramina- dandy Walker malformation Communicating type(block is extra ventricular)¾ Post infectious, post hemorrhagic, or developmental adhesions of basal cisterns

or surface arachnoid space¾ Commonly after neonatal meningitis or intra ventricular haemorrhage¾ Arachnoid villi obstruction by erythrocytes, exudates¾ Skeletal defects- achondroplasia

B ) depending on the time of presentation Congenital hydrocephalus¾ Intra utrerine infections- TORCH¾ Congenital malformations of the aqueduct¾ Congenital midline tumors of CNS Acquired hydrocephalus¾ TB/ Bacterial meningitis¾ Posterior fossa tumors

Pathophysiology : internal

External hydrocephalus



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Discuss the pathophysiology

Identify the clinical features

Enlist the diagnostic measures

Clinical features¾ Enlargement of the head(speed of enlargement proportional to ICP ) & small

face¾ Sunsetting eye sign¾ Separation of the sutures & ¾ widening , fullness of ant. Frontanelle¾ Prominent scalp vein¾ Wasting is common with progression of hydro cephalus¾ CRACK POT RESONANCE(Macewen sign)¾ Epileptic attack

Diagnosis ¾ Head circumference¾ Radiographs¾ CT¾ USG¾ MRI

Management :



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Discuss the goals of medical management

Discss the medical management

Goals¾ To reduce the CSF pressure ¾ To reduce irritability¾ To prevent infection¾ To improve nutrition¾ To improve the skin integrity

Medical management¾ Osmotic diuretic: cerebral edema¾ Carbonic anhydrase inhibitors: Acetazolamide¾ Antibiotics¾ Slightly elevate the head end of the bed to 15º

Stationary or arrested type¾ No surgical intervention is needed

Progressive type¾ Site of block should be localised¾ Repeated lumbar puncture¾ Use of Acetazolamine 50-75 mg/kg/day

Expanding lesion¾ Excision of the tumor¾ Ventricular tapping¾ Endoscopic 3rd ventriculostomy¾ Cauterisation of the choroid plexes¾ Surgical intervention required¾ Ventriculoatrial shunt¾ Ventriculoperitoneal shunt¾ Ventriculogallbladder shunt¾ Ventriculoureteric shunt

Complications of shunt Outgrows tube length Subdural haematoma Mechanical failure Obstruction Over/ under drainage Failure of the valve



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Enlist the complications of shunt

Discuss the nursing management

Perforation Infections Collapse of the ventricular valve Other Complications like Physical injury, Delayed growth and development and

Decreased intracranial adaptive capacityNursing Nursing ManagementAssessment

Increased HC , usually increases during infancy Full ,tense , bulging frontanels Widening suture lines Distended scalp vein Irritability , or lethargy , decreased attention span High pitched cry Sunset sign Inability to support the head when upright Cracked pot

Nursing diagnosis1. Disturbance in comfort , irritability r/t disaese condition2. High risk for respiratory arrest related to increased ICP3. Risk for blockage of the shunt4. Risk for infection related to the presence of shunt5. Risk for impaired nutrition r/t poor feeding6. Risk for complication(seizures)7. Anxiety8. Knowledge deficit9. Altered parental coping

Nursing interventionDisturbance in comfort , irritability r/t disaese condition-Provide a quiet environment with less stimuli.-Advice to use zero watt bulbs to minimize photosensitivity.-Avoid too much neck flexion or manipulation.-Sit near the child and speak in a low ,modulated voice-Minimal handling of the baby is advised-Elevate head end to 300 to reduce cerebral oedema


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-Monitor TPR every two hourlyHigh risk for respiratory arrest related to increased ICP

Check signs of increased ICP Assess the respiratory status Monitor vital signs every 2 hrly Support the child’s head when the child is upright

Risk for blockage of the shunt Measure HC to aid in diagnosis of hydrocephalus Monitor vital signs and intake and out put Assess neurologic status Don’t allow the child to lie on the same side of shunt Instruct to lay flat to avoid rapid decompression Signs of ICP Teach parents signs of increasing ICP

Risk for infection related to the presence of shunt Observe signs of infection Provide proper skin care to the head , turn it frequently Monitor signs of infection like elevated W.B.C, E.S.R Follow strict aseptic techniques to minimize infection Maintain fluid volume through IV therapy

Risk for impaired nutrition r/t poor feeding-Maintain fluid volume through IV therapy-Give expressed breast milk-Provide ryles tube feeding-Provide soft diet to avoid too much difficulty by mastication

Risk for complication(seizures) Educate seizure precautions Administer anticonvulsants as prescribed. Raise the padded side rails of bed to prevent any falls Ensure that injurious toys and instruments are kept at a safer place. Monitor the pattern of seizures Teach the parents how to use padded spoons to clench between teeth during

seizures Provide side-lying position after seizures to prevent aspiration.

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Avoid overcrowding during seizure episode. Administer O2 and do suction in case of status epileptics

Anxiety-provide psychological support to parents-Be with the child and speak in a low and calm voice-Ensure the safety of the child in the absence of his parents-Support family members while explaining about the child’s prognosis-Provide play articles or transitional objects to the child to avoid boredom and to make him feel comfortable

Knowledge deficit- Teach parents signs of increasing ICP-Educate the family about need calm environment-Provide them a copy of immunization protocol-Educate the need for HiB vaccine for unimmunized siblings at home-Encourage them to clarify their doubts-Teach them about the disease ,its prognosis and management

Altered parental coping provide psychological support encourage them to verbalise feelings advise about supporting agencies

BIBLIOGRAPHY:1. Wong D.L etal . Essentials Of Paediatric Nursing. 6th edition. Missouri:

Mosby;20012. Marlow D.R. Redding B. Textbook of Paediatric nursing. 1st edition.Singapore:

Harwourt Brace & company; 19983. Dr.Chaudari KC. Indian Journa of Paediatrics. Nov22 20074. Parthasarathy IAP textbook of Paediatrics. 2nd edition. jaypee: NewDelhi; 2002

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LESSON PLAN

TOPIC : HYDROCEPHALUS

SUBJECT : PAEDIATRIC NURSING

GROUP : II YEAR MSc NSG STUDENTS

METHODS : LECTURE CUM DISCUSSION

VENUE : MSc NSG CLASS ROOM

DATE : 23. 06. 2010

STUDENTR TEACHER: Ms. SHESLY P. JOSE

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PREVIOUS KNOWLEDGE:

Students have had classes on convulsion in children in their BSc nsg course

General Objective

On completion of the class the students will be able to understand the disease condition hydrocephalus so as to apply this knowledge in their future practice with a positive attitude.

Specific objective:

On completion of the class the students will be able to;

1. Define the condition2. Enlist the incidence3. Discuss the related Anatomy4. Identify the etiology5. Enumerate the classification6. Discuss the pathophysiology7. Identify the clinical features8. Enlist the diagnostic measures9. Discuss the goals of medical management10. Discss the medical management11. Enlist the complications of shunt12. Discuss the nursing management

Lesson plan on

HydrocephalusSubmitted to: Submitted by:

Ms. G. Laviga Ms. Shesly P . Jose

Lecturer II MSc (N)

NUINS NUINS

hydrocephalus 9

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