ENCEPHALOCELE, Nursing Intervention and Care Plan

– It is a protrusion of the brain substance through a congenital defect in the skull .It is essential that no pressure be brought upon the sac. The infant should also be observed for normal developmental mile stones.
It is a condition characterized by an increase of C.S.F in the ventricles of the brain which causes an increase in the size of the head and pressure changes in the brain.
Etiology :
1- Obstruction in the flow of C.S.F (obstructive).
2- Non obstruction (communicating):normal communication between the ventricles and the subarachnoid space at the base of the brain.
Clinical features :
1- Increase in head size(O.F.C).
2- The sutures fail to close and bone of the skull become thin.
3- The fontanels are tense and wider.
4- The eyes seems to be pushed downward and protrude slightly, the sclera are visible above the iris.
5- Irritability ,anorexia and vomiting.
6- High pitched cry.
7- Convulsion may occur.
1- Head O.F.C is measured daily.
2- Ventriculogram , pneumoencephalogram.
3- U.S of brain.
4- C.A.T scan ,M.R.I .
Treatment :
– Several shunting procedure are now in use :-
1- Ventriculovenostomy (shunting from the ventricle through the internal jugular vein to the right atrium of the heart).
2- Ventriculoperitoneostomy.
Nurse responsibility (preoperatively) :
1) Observe the degree of irritability and changing vital sign.
2) Must keep the infant clean and dry.
3) Nutrition :
a- The feeding schedule must be arranged to avoid vomiting.
b- Avoid moving the infant after he has been fed.
c- If the head is very large the infant can not be bubbled.
d- Elevate his shoulder and head during feeding.
e- Place on his right side to prevent aspiration.
4) Change the position frequently to prevent hypostatic pneumonia and prevent bed sore. pong rubber may be placed under his head. When the child is lifted from his crib his head must be carefully supported.
Nurse responsibility (postoperatively):
1) Note the vital signs every 15 minutes during the first day then every hour for several days.
2) Observe signs of increase intracrainial (lethargy,vomiting,irritability,bulging fontanel).
3) If temperature is elevated use cold sponge.
4) I.V fluid slowly until the infant can be fed orally.
5) Mucus from the nose and throat should be aspirated.
6) Cotton may be placed behind the ear ,over the ear, and under the head dressing.
7) Change position at least every 2 hours.
8) The nurse and parents should know the location of the valve to observe it.
9) Elevate the head and shoulder according to rate of drainage, if the anterior fontanel is depressed the infant should be placed flat in the bed with the head slightly lower than the body. When anterior fontanel is normal his head should be slightly elevated or flat.
10) In ventriculoperitonial shunt :nothing by mouth.
11) If the infant’s mouth become dry ,mouth care is necessary.
12) Observe :
– sign of infection
– tenderness of the anterior fontanel.
– vomiting(sign of increase intracrainial pressure).
– signs of dehydration.
– state of consciousness.
– signs of paralysis.
13) Sodium replacement.
Teaching the parent:
1- Signs of increase intracrainial pressure and signs of dehydration.
2- Exercise to strengthen the infant’s muscle ,lift his head.
3- Skillful in handling him.
4- Site of the valve.
5- Passive exercise, frequent turning and cleanliness.
6- The infant should lead as normal life as possible and given toys.

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