Hydrocephalus
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Study Tools For Hydrocephalus
Hydrocephalus Pathochart (Cheatsheet)
Hydrocephalus Effect on Brain (Image)
Hydrocesphalus (Image)
im-peds-075-sunsetting_eyes (Image)
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Outline
Overview
- Abnormal accumulation of CSF with the brain
- Imbalance of production and absorption
- Causes increased intracranial pressure and head enlargement
Nursing Points
General
- Types
- Communicating
- Flow of CSF is blocked after it exits the ventricles not being absorbed into the subarachnoid space
- Non-communicating “Obstructive”
- Flow of CSF is blocked along one of the passageways connecting the ventricles
- Communicating
- Causes
- Tumor
- Hemorrhage
- Infection
- Congenital
Assessment
- Infant
- Increasing head circumference
- Bulging fontanels
- “Sunsetting” eyes
- Downward deviation of eyes
- Vomiting
- Sleeplessness
- Irritability
- Seizures
- Shrill, high pitched cry
- Child
- Headache on waking
- Nausea and vomiting
- Vision changes
- Strabismus
- Poor balance and coordination
- “Sunsetting” eyes
- Lethargy, change in level of consciousness
Therapeutic Management
- Ventriculoperitoneal shunt (VP shunt)
- Shunt is placed into the ventricle and run to the abdominal cavity where CSF can be reabsorbed
- Endoscopic Third Ventriculostomy (ETV)
- Opening is made in the 3rd ventricle allowing CSF to drain and be reabsorbed
- Post Operative Care
- Patient positioning and activity
- Detailed instructions should be provided by surgeon
- Often child is placed on unoperated side
- Measure head circumference daily
- Assess neuro status frequently
- Shunt may become obstructed causing increased ICP
- Assess for infection
- CNS infection
- Peritonitis
- Patient positioning and activity
Nursing Concepts
- Intracranial Regulation
- Cognition
Patient Education
- Educate caregivers on recognizing:
- Neuro status changes
- Signs of possible Shunt obstruction (increasing ICP)
- Signs of infection
- Neuro status changes
- Emphasize the importance of follow-up care and re-evaluation
- As child grows, length of shunt should be checked
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Hydrocephalus
Transcript
Hey everybody, in this lesson we are going to be talking about the diagnosis hydrocephalus.
The name hydrocephalus actually just tells you straightaway what the diagnosis means. You have hydro which means water and cephalus which refers to the head. So, there’s an excess amount of fluid, Cerebral Spinal Fluid to be exact, in the brain.
There are two different types of hydrocephalus the first is the communicating hydrocephalus and this just means that there is no obstruction to the flow of CSF in the brain. So the excess is being caused by overproduction or poor absorption. Problems that may cause this are infections like meningitis, or a hemorrhage. Non-communicating hydrocephalus is caused by something blocking the flow of CSF. Diagnoses that may cause this are tumors and congenital anomalies like Chiari malformations. These account for most cases of hydrocephalus in babies. Where in older kids the cause is likely to be infection or trauma.
Your assessment of a child with hydrocephalus is really all about looking for signs of increased intracranial. pressure.
The head may be visibly enlarged or it may just be slightly enlarged and you’ve noticed this from daily head circumference measurements. Remember, head circumference is measured and monitored until children are 2-3 years of age to keep an eye out for even small variations that could indicate hydrocephalus.
Another classic symptoms associated with hydrocephalus something called sunsetting eyes. The pressure in the brain is actually pushing the eyes down, causing there to be a lot of white or sclera at the visible at the top. We’ve included a picture of this in the resources so take a look at it so you know exactly what you are looking for.
Other classic symptoms of increased and cranial pressure in older children are nausea and vomiting, headache, changes in gate or poor coordination, decreased level of consciousness, and vision changes (so things like for a photophobia, strabismus and blurred vision). In babies and young kids, you are very unlikely to see these classic symptoms, mostly because they can’t tell you about them. So symptoms that may indicate increased ICP for them are poor feeding, a shrill or high-pitched cry and bulging fontanels.
Most children who have hydrocephalus are going to need to have surgery. About 75% are going to have a shunt placed to help drain the CSF out of the brain where it is causing problems.
There are two different types of shunts. The first is a ventriculoperitoneal shunt and the second is a endoscopic third ventriculostomy. The VP shunt is going to drain cerebrospinal fluid from the ventricle, through a tube that goes down into the abdomen. You can see in the photo here with that looks like. The ETV creates an opening in the third ventricle that allows the fluid to drain out
For post-op care, one of the most important things is to make sure that you have an order from the provider that gives very specific guidelines on how to position the patient and how much activity they are allowed to have. Often, the orders are to have the child lay on the unoperated side to prevent occlusion of the shunt. And activity is limited and the child is kept flat for a while to prevent rapid draining of CSF.
The two biggest complications after placement of a shunt are infection and obstruction. So, it’s really important to be on the lookout for signs of infection and then also signs of increased intracranial pressure which indicate that the shunt isn’t working.
Your priority nursing concepts for pediatric patient with hydrocephalus are intracranial regulation, cognition and infection control.
Let’s go over your key points for this lesson! Hydrocephalus is when there is an excessive amount of CSF in the brain. This can either be from excessive formation, decreased absorption or obstructed flow. Possible causes of this are things like meningitis, trauma and hemorrhage, tumors and congenital anomalies. The primary things to be on the lookout for are signs of increased intracranial pressure, head circumference and sunsetting eyes are key findings. Keep in mind that babies can’t report a lot of the classic symptoms so they may present with poor feeding, high pitched cry and bulging fontanels.
In most cases patients are going to need to have a shunt placed, either the VP shunt or the ETV shunt. Post-op care is all about monitoring position and activity and looking for signs of infection and increased intracranial pressure that could indicate the shunt isn’t working.
That’s it for our lesson on hydrocephalus. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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Study Plan Lessons
Abdomen (Abdominal) Assessment
ABG (Arterial Blood Gas) Interpretation-The Basics
ABG (Arterial Blood Gas) Oxygenation
ABGs Nursing Normal Lab Values
ABGs Tic-Tac-Toe interpretation Method
Acetaminophen (Tylenol) Nursing Considerations
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Appendicitis – Assessment Nursing Mnemonic (PAINS)
Appendicitis Case Study (Peds) (30 min)
Appendicitis for Certified Emergency Nursing (CEN)
Assessment of a Burn Nursing Mnemonic (SCALD)
Asthma
Asthma Concept Map
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Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorders
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Bronchiolitis and Respiratory Syncytial Virus (RSV)
Bronchodilators
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Burn Injuries
Burn Injury Case Study (60 min)
Burns for Certified Emergency Nursing (CEN)
Cardiac Glycosides
Care of the Pediatric Patient
Casting & Splinting
Cefaclor (Ceclor) Nursing Considerations
Celiac Disease
Cerebral Palsy (CP)
Cimetidine (Tagamet) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Cleft Lip and Palate
Cleft Lip Repair – Post Op Care Nursing Mnemonic (CLEFT LIP)
Clubfoot
Congenital Heart Defects (CHD)
Conjunctivitis
Constipation and Encopresis (Incontinence)
Corticosteroids
Coumarins
Cyanotic Defects Nursing Mnemonic (The 4 T’s)
Cystic Fibrosis (CF)
Day in the Life of a NICU Nurse
Day in the Life of a Peds (Pediatric) Nurse
Defects of Decreased Pulmonary Blood Flow
Defects of Increased Pulmonary Blood Flow
Dehydration
Diarrhea – Treatment Nursing Mnemonic (BRAT)
Digoxin (Lanoxin) Nursing Considerations
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Diphenoxylate-Atropine (Lomotil) Nursing Considerations
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EENT Assessment
Enuresis
Epiglottitis
Epiglottitis – Signs and Symptoms Nursing Mnemonic (AIR RAID)
Epispadias and Hypospadias
Famotidine (Pepcid) Nursing Considerations
Fever
Fever Case Study (Pediatric) (30 min)
Flu Symptoms Nursing Mnemonic (FACTS)
Fluid Compartments
Fluid Pressures
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Fluid Volume Deficit
Fluticasone (Flonase) Nursing Considerations
Gas Exchange
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Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
Hematocrit (Hct) Lab Values
Hemoglobin (Hbg) Lab Values
Hemophilia
Hierarchy of O2 Delivery
Hydrocephalus
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Ibuprofen (Motrin) Nursing Considerations
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Imperforate Anus
Impetigo
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Iron Deficiency Anemia
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Levetiracetam (Keppra) Nursing Considerations
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Marfan Syndrome
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Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Meningitis for Certified Emergency Nursing (CEN)
Methylphenidate (Concerta) Nursing Considerations
Mixed (Cardiac) Heart Defects
Mumps
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Nephrotic Syndrome Case Study (Peds) (45 min)
Neuro Assessment
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Nursing Care Plan (NCP) for Celiac Disease
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Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate
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Nursing Care Plan (NCP) for Fluid Volume Deficit
Nursing Care Plan (NCP) for Hemophilia
Nursing Care Plan (NCP) for Hydrocephalus
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Nursing Care Plan (NCP) for Impetigo
Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
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Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Care Plan (NCP) for Meningitis
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Nursing Case Study for Pediatric Asthma
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Ocular Infections (Conjunctivitis, Iritis) for Certified Emergency Nursing (CEN)
Omphalocele
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Pediatric Oncology Basics
Pediatrics Course Introduction
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Pneumonia
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Pulmonary Function Test
Red Blood Cell (RBC) Lab Values
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Reye’s Syndrome
Reyes Syndrome Case Study (Peds) (45 min)
Rheumatic Fever
ROME – ABG (Arterial Blood Gas) Interpretation
Rubeola – Measles
Salmeterol (Serevent) Nursing Considerations
Scoliosis
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Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Umbilical Hernia
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Varicella – Chickenpox
Varicella Case Study (Peds) (30 min)
Vitals (VS) and Assessment
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White Blood Cell (WBC) Lab Values
X-Ray (Xray)
05.03 Jaundice for CCRN Review
Abortion in Nursing: Spontaneous, Induced, and Missed
Abruptio Placenta for Certified Emergency Nursing (CEN)
Abruptio Placentae (Placental abruption)
Acyclovir (Zovirax) Nursing Considerations
Addicted Newborn
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Alpha-fetoprotein (AFP) Lab Values
Ampicillin (Omnipen) Nursing Considerations
Anemia in Pregnancy
Antepartum Testing
Antepartum Testing Case Study (45 min)
Anti-Infective – Aminoglycosides
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Aspiration for Certified Emergency Nursing (CEN)
Babies by Term
Behind The Red Line – Live Tutoring Archive
Betamethasone and Dexamethasone
Betamethasone and Dexamethasone in Pregnancy
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Breastfeeding
Butorphanol (Stadol) Nursing Considerations
Cardiac (Heart) Disease in Pregnancy
Causes of Chorioamnionitis Nursing Mnemonic (Pregnancies Are Very Interesting)
Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
Causes of Postpartum Hemorrhage Nursing Mnemonic (4 T’s)
Certified Nurse Midwife
Chorioamnionitis
Clindamycin (Cleocin) Nursing Considerations
Congestive Heart Failure (CHF) Labs
Day in the Life of a Labor Nurse
Day in the Life of a Postpartum Nurse
Dexamethasone (Decadron) Nursing Considerations
Direct Bilirubin (Conjugated) Lab Values
Discomforts of Pregnancy
Disseminated Intravascular Coagulation (DIC)
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Dystocia
Ectopic Pregnancy
Ectopic Pregnancy Case Study (30 min)
Ectopic Pregnancy for Certified Emergency Nursing (CEN)
Emergent Delivery (OB) (30 min)
Emergent Delivery for Certified Emergency Nursing (CEN)
Epidural
Episiotomy – Evaluation of Healing Nursing Mnemonic (REEDA)
Erythroblastosis Fetalis
Eye Prophylaxis for Newborn
Eye Prophylaxis for Newborn (Erythromycin)
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Family Planning & Contraception
Family Planning & Signs of Pregnancy – Live Tutoring Archive
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Fetal Alcohol Syndrome (FAS)
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Fetal Environment
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Fetal Heart Monitoring Like A Pro – Live Tutoring Archive
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Fetal Wellbeing Assessment Tests Nursing Mnemonic (ALONE)
Fundal Height Assessment for Nurses
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Gestation & Nägele’s Rule: Estimating Due Dates
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Gestational Diabetes and Why YOU Should Know About It – Live Tutoring Archive
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HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
Hemodynamics
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Hemorrhage (Postpartum Bleeding) for Certified Emergency Nursing (CEN)
Hepatitis B Vaccine for Newborns
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Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Hyperbilirubinemia (Jaundice)
Hyperemesis Gravidarum
Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypovolemic Shock Case Study (OB sim) (60 min)
Incompetent Cervix
Infections in Pregnancy
Initial Care of the Newborn (APGAR)
Inserting a Foley (Urinary Catheter) – Female
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Isotonic Solutions (IV solutions)
Labor Progression Case Study (45 min)
Leopold Maneuvers
Lung Surfactant
Lung Surfactant for Newborns
Magnesium Sulfate
Magnesium Sulfate
Magnesium Sulfate (MgSO4) Nursing Considerations
Magnesium Sulfate in Pregnancy
Mastitis
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Mechanisms of Labor
Meconium Aspiration
Meds for Postpartum Hemorrhage (PPH)
Meds for PPH (postpartum hemorrhage)
Menstrual Cycle
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Newborn of HIV+ Mother
Newborn Physical Exam
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Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
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Nursing Care Plan (NCP) for Chorioamnionitis
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Dystocia
Nursing Care Plan (NCP) for Ectopic Pregnancy
Nursing Care Plan (NCP) for Gestational Diabetes (GDM)
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for Hyperemesis Gravidarum
Nursing Care Plan (NCP) for Hypertension (HTN)
Nursing Care Plan (NCP) for Incompetent Cervix
Nursing Care Plan (NCP) for Mastitis
Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Meconium Aspiration
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Newborns
Nursing Care Plan (NCP) for Placenta Previa
Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH)
Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)
Nursing Care Plan (NCP) for Preterm Labor / Premature Labor
Nursing Care Plan (NCP) for Process of Labor
Nursing Care Plan (NCP) for Transient Tachypnea of Newborn
Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)
Nursing Care Plan for Newborn Reflexes
Nursing Case Study for Maternal Newborn
Nutrition Assessments
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OB (Labor) Nurse Report to OB (Postpartum) Nurses
OB Course Introduction
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Pediatric Vital Signs (VS)
Physiological Changes
Phytonadione (Vitamin K)
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Postpartum Discomforts
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Preeclampsia, Eclampsia, and HELLP Syndrome for Certified Emergency Nursing (CEN)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Labs
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Preload and Afterload
Premature Rupture of the Membranes (PROM)
Preterm Labor
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Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Process of Labor – Live Tutoring Archive
Process of Labor 2 – Live Tutoring Archive
Prolapsed Umbilical Cord
Promethazine (Phenergan) Nursing Considerations
Prostaglandins
Prostaglandins in Pregnancy
Protein (PROT) Lab Values
Retinopathy of Prematurity (ROP)
Rh Immune Globulin (Rhogam)
Rh Immune Globulin in Pregnancy
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Signs of Pregnancy (Presumptive, Probable, Positive)
Spironolactone (Aldactone) Nursing Considerations
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Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Tips & Advice for Newborns (Neonatal IV Insertion)
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Tocolytics
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Transient Tachypnea of Newborn
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