HYDROCEPHALUS CASE STUDY

I.

Introduction:

Hydrocephalus is the most common congenital abnormality of the central nervous system in infants. Many cases of hydrocephalic children are described since ancient times. It is characterized by excessive accumulation of cerebrospinal fluid in the ventricles of the brain. Its symptomatology during infanthood or early childhood is characterized by swelling of the head, protrusion of the forehead and brain atrophy. All these symptoms appear due to increased cerebrospinal fluid volume, increased intracranial pressure and dilatation of the ventricular walls. Hydrocephalus, characterized by enlargement of the head, bulge in the forehead, brain atrophy, and mental disorders - caused by the failure of the circulation of cerebrospinal fluid (CSF) which flows from the ventricles of the brain. Obstruction or disruption resulting in increased cerebrospinal fluid absorption and an increase in intracranial pressure (ICP), which if not relieved, can lead to brain damage and died. Hydrocephalus can occur because of congenital or due to a tumor, infection, or bleeding. Treatment includes surgery with placement of a shunt to reduce ICP. Possible complications include infection, blockage, or subdural hematoma. II. Anatomy and Physiology

The central nervous system (CNS) consists of the brain and spinal cord. The brain is an important organ that controls thought, memory, emotion, touch, motor skills, vision, respirations, temperature, hunger, and every process that regulates our body. The brain can be divided into the cerebrum, the brainstem, and the cerebellum:

CEREBROSPINAL FLUID CSF bathes the brain and spinal cord, providing a protective cushion around the CNS. It is produced by the choroid plexuses, specialized structures made of ependymal cells, which are located in the ventricles.

FLOW OF CSF 1. The CSF flows from the lateral ventricles into the third ventricle and then through the cerebral aqueduct into the fourth ventricle. 2. A small amount of CSF enters the central canal of the spinal cord. 3. CSF flows through the subarachnoid space to the arachnoid granulations (masses of arachnoid tissues, penetrate into the superior sagittal sinus, a dural venous sinus in the longitudinal fissure) in the superior sagittal sinus, where it enters the venous circulation FLOW OF CSF IN THE BRAIN

III.

Physical Assessment A. Mental Status Comatose B. Skin Moist, with good skin turgor C. Hair With white hair evenly distributed D. Nails With good capillary refill approximately 2-3 seconds E. Musculoskeletal Edema on both upper and lower extremeties

IV. V.

DX EXAM Course in the Ward a. January 6, 2014 - Continue oral feeding - Continue IVF - Request for CBC with platelet; Na, K, Cl - VS q1 b. January 7, 2014 - Continue Paracetamol - Tepid Sponge Bath q30 minutes - VS q1 c. January 8, 2014 - VS: BP: 120/80 T: 36.7 RR: 24 PR: 115

VI.

Patients Profile Name: EA Age: 47 yrs old Address: Brgy. Gayagayaan Gumaca, Quezon Birthday: 02/12/66 Date of Admission: 12/23/2013 Admitting Diagnosis: Hydrocephalus Past and Present History 3 weeks prior to admission, patient experienced dizziness, headache followed by vomiting. There was also noted slurring of speech. 1 week prior to admission, patient was referred from a local hospital for further evaluation and management.

VII.

VIII.

Nursing Care Plan

IX.

Drug Study a. Tramadol Brand Name: TRAMADOL CLASSIFICATIONS Therapeutic: Analgesics (centrally acting) ACTIONS Physiologic Mechanism Decreased pain. Pharmacologic Mechanism Binds to mu-opioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS. INDICATION Moderate to moderately severe pain NURSING CONSIDERATIONS Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration.

 Assess BP & RR before and periodically during administration. Respiratorydepression has not occurred with recommended doses. b. Mannitol

Brand
Name: Osmitrol, Resectisol

Classification: Osmotic Diuretic Action Summary Half-life 100 minutes Indications

1. 2. 3. Acute oliguric renal failure Toxic overdose Edema

Onset 30-60 minutes

Peak 1 hour

Duration 6-8 hours

4. Increased intracranial pressure (ICP) 5. Intraocular pressure (IOP) Action 1. In the oliguric phase of acute renal failure, Mannitol increases osmotic pressure (pressure needed to stop the absorption of something or osmosis) of the glumerular filtrate, thereby,promoting diuresis (treating the oliguric phase of renal failure) and excretes toxic materials(management for toxic overdose). Contraindications 1. Susceptibility 2. Dehydration Adverse reactions 1. 2. 3. 4. Dehydration Anuria Intracranial bleeding Headache

Dosage

Adult Oliguria: 50-100 g as a 5-25% solution.