Week 10 - Hydrocephalus Flashcards
what is hydrocephalus
- imbalance in production and absorption of CSF =accumulation in ventricles
= dilation of ventricles & enlargement of skull (if it occurs when young & prior to cranial suture lines closing)
= +++CSF in brain = increased pressure
what causes hydrocephalus (4)
- congenital
- trauma
- infection
- tumours
what are 2 types of hydrocephalus
- communicating
2. non-communicating
what is communicating hydrocephalus
- impaired absorption of CSF
what is non-communicating hydrocephalus
- obstruction of flow of CSF thru ventricles
what are S&S of hydrocephalus (8)
- rapid head growth
- bulging fontanels
- NV
- HA
- blurry vision
- changes in LOC
- irritability
- pupils sluggish (late)
all caused by IICP
what diagnostics are used for hydrocephalus (3)
- CT
- MRI
- fetal US
what is the goal of mngmt for hydrocephalus (2)
- reduce hydrocephalus & pressure
- prevent brain damage
what is included in mngmt of hydrocephalus
- surgery
what type of surgery may be done for hydrocephalus (2)
- removal of obstruction (ex. tumour) –> for non-communicating
- ventriculoperitoneal (VP) shunt –> for communicating
what is a VP shunt
- placement of a shunt that drains CSF to an extracranial compartment, usually the peritoneum
what is included in pre-op care for surgery r/t hydrocephalus (7)
- neurovitals & monitor for signs of IICP
- assess head, palpate head, head circumferene daily
- NPO prior to surgery
- prep for diagnostic tests
- assist w LP (ventricular tap)
- assess for seizure activity
- assess LOC, change in behaviors
why is LP (ventircular tap) done w hydrocephalus (2)
- to relieve pressure
- for sample
(sedation may be required)
what complications should you monitor for post-VP shunt (2)
- monitor for mechanical obstructions (kinking, plugging)
- monitor for infection –> septicemia, wound infection, meningitis
what is a sign of mechanical obstruction of the VP shunt
- rapid onset of symptom recurrence (signs of IICP)
what may be required w VP shunt
- revisions
at what point is the pt at the highest risk of infection post-hydrocephalus
- within the first 1-2 months after insertion
what is the treatment for infection of VP shunt (2)
- IV or intrathecal antibiotics
- if antibiotics ineffective, shunt removed until infection clears
if the shunt is removed d/t infection, what is used (2)
- EVD –> flows by gravity into collection device
- used until CSF is sterile or runs clear
what education is required to parents r/t VP shunt (2)
- risks (infection, obstruction)
- revision is typically required more than once
what is included in postop care for VP shunt (10)
- bedrest
- vitals
- neurovitals
- manage pain
- monitor for signs of IICP (d/t shunt malfunction)
- watch for signs of infection
- monitor ins and outs
- monitor BS
- monitor for signs of peritonitits
- monitor skin (r/o pressure ulcers d/t bedrest)
- IV fluids
describe pt positioning post-op VP shunt (3)
- lie on opposite side of shunt
- flat first (to avoid symptoms of too rapid fluid reduction)
- increase HOB slowly (as per orders)
describe pt’s diet post-op VP shunt
- NPO –> diet progression
what should you educate parents on r/t prognosis (7)
depends on:
- rate that hydrocephalus develops
- cause of hydrocephalus
- signif of postop / later complications
- post op survival 80%
- 1/3 pts neurologically normal long-term
- mortality in 1st year if it does happen
describe general caregiver education r/t VP shunt (7)
- shunt at highest risk of infection in first few months
- S&S of infection
- repeated/untreated infection can = signif brain damage or death
- issue causing hydrocephally is most likely a lifetime problem that requires lifetime care and maintenance
- shunt malfunction = decreased LOC
- S&S of IICP
- supportive emotional care for child & parents
