HYDROCEPHALUS And Nursing Care Plan

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HYDROCEPHALUS

Definition: diverse group of conditions which result from impaired circulation and reabsorption  of CSF.

CSF is formed by the choroid plexus. Normal csf production: 20 ml/h.

Types of hydrocephalus

Hydrocephalus may be congenital or acquired. Congenital hydrocephalus is present at birth and may be caused by either environmental influences during fetal development or genetic predisposition. Acquired hydrocephalus develops at the time of birth or at some point afterward. This type of hydrocephalus can affect individuals of all ages and may be caused by injury or disease.

Hydrocephalus may also be communicating or non-communicating.

Communicating hydrocephalus

occurs when the flow of CSF is blocked after it exits from the ventricles. This form is called communicating because the CSF can still flow between the ventricles, which remain open. Noncommunicating hydrocephalus – also called “obstructive” hydrocephalus – occurs when the flow of CSF is blocked along one or more of the narrow pathways connecting the ventricles. One of the most common causes of hydrocephalus is “aqueductal stenosis.” In this case, hydrocephalus results from a narrowing of the aqueduct of Sylvius, a small passageway between the third and fourth ventricles in the middle of the brain.

There are two other forms of hydrocephalus which do not fit distinctly into the categories mentioned above and primarily affect adults: hydrocephalus ex-vacuo and normal pressure hydrocephalus.

Hydrocephalus ex-vacuo occurs when there is damage to the brain caused by stroke or traumatic injury. In these cases, there may be actual shrinkage (atrophy or wasting) of brain tissue. Normal pressure hydrocephalus can occur in people of any age, but it is most common in the elderly population. It may result from a subarachnoid hemorrhage, head trauma, infection, tumor, or complications of surgery.

However, many people develop normal pressure hydrocephalus even when none of these factors are present. In these cases the cause of the disorder is unknown.

Causes of hydrocephalus

•Lesions or malformations of the posterior fossa

–Chiari malformation

–Dandy- walker syndrome

–Tumors

•Ivh

•Meningitis: pneumococcal, tb

•Intrauterine infections

Clinical manifestations:

Symptoms:

–Irritability

–Poor feed

–Lethargy

–Vomiting

–In older patients:

•Headache

•Changes in personality

•Academic deterioration

Signs:

–Anterior fontanel wide open and bulging, increased head circ.

–Dilated scalp veins

–Setting sun sign

–Brisk tendon reflexes, spasticity

–Clonus, babinsky

–Macewen sign “cracked pot”

–Prominent occiput (dandy-walker)

Imaging studies

•X-ray plain films:

–Separation of sutures

•Ultrasound

•CT scan, MRI

Therapy

•Medical:

–Acetazolamide

–Furosemide

Surgical:

–V-P shunt placement

Prognosis

•Increased risk for developmental disabilities

•Mean IQ is reduced compared to general population

•Abnormalities in memory

•Some patients show aggressive or delinquent behavior.

•Visual problems:

–Strabismus

–Visuospatial abnormalities

–Decreased visual acuity

–Visual field defects

•Patients require long term follow up (multidisciplinary)

Nursing diagnosis

•Potential for injury r/t increased ICP

•Potential for infection r/t presence of mechanical drainage system.

•Altered family process r/t child with chronic defect.

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Posted in Neurology, Nursing Care Plans, Nursing Intervention, Pediatrics

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