Hydrocephalus

HYDROCEPHALUS HYDROCEPHALUS •

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Condition caused by an imbalance in the production and absorption of CSF in the ventricular system. When production is greater than absorption, CSF accumulates within the ventricular system, usually under increased pressure, producing dilation of the ventricles.

PATHOPHYSIOLOGY • • • •

Congenital – Abnormal development at birth – premature are at increased risk Acquired – Tumor, infection, hemorrhage Impaired absorption of CSF within the subarachnoid space (communicating hydrocephalous) o Obstruction flow is most common in adults Obstruction to the flow of CSF through the ventricular system o Noncommunicating hydrocephalous

CLINICAL MANIFESTATIONS • • • •

Infants o Rapid head growth, bulging fontanels, separated sutures, “setting sun” sign Later o Irritability, lethargy, change in LOC Childhood o Headache on awakening, papilledema, ataxia, irritability, lethargy Adult >60 o Wet, wobble, weird (incontinent, problem with gait, behavior change)

DIAGNOSTIC TESTS • • •

Infants Head circumference CT Scan MRI: Enlarge ventricle – Children should be sedated

SURGICAL MANAGEMENT • •

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Direct removal of obstruction (tumor) by a crainotomy Ventriculoperitoneal Shunt o Placed in ventricle to drain fluid away. Control but not a cure o Problem with infection – Massive antibiotics o If kinked, may have headache Endoscopic third ventriculostomy o Small hole on the floor of ventricles allows fluids to drain / bypass obstruction ½ of children with this usually have a neurological deficit

NURSING MANAGEMENT • •

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CP: Increased ICP Routine craniotomy care o Position dictated by surgeon o Observe for infection o Abdominal distention Knowledge deficit-Family education

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Infection Deficits