HYDROCEPHALUS

A case study presented to the faculty of

College of Nursing

Pamantasan ng Lungsod ng Marikina

In partial fulfillment of the requirements for

NCM 109 (RLE)

Jane Mae P. Jesoro

2BSN2
 TABLE OF CONTENTS

I. Introduction
II. Anatomy and Physiology
III. Pathophysiology
IV. Laboratory and Diagnostic Examinations
V. Medical and Surgical Management
VI. Drug Study
VII. Nursing Care Plan
VIII. Current trends/ Innovations/ Clinical Management
IX. References
INTRODUCTION
ANATOMY AND PHYSIOLOGY
 Brain- It is a complex organ
that controls thought, memory,
emotion, touch, motor skills,
vision, breathing, temperature,
hunger and every process that
regulates our body. Together,
the brain and spinal cord that
extends from it make up the
central nervous system, or
CNS.
 Skull- Encloses and protects
the brain and meninges in its
cavity and special senses (eyes
and ears) within the skull bones and cavities bounded by them.
 Cerebrum- It is the principal and most anterior part of the brain in
vertebrates, located in the front area of the skull and consisting of two
hemispheres, left and right, separated by a fissure. It is responsible for the
integration of complex sensory and neural functions and the initiation and
coordination of voluntary activity in the body.
 Lateral ventricle- these are the two c-shaped cavities one on each side of
the cerebral hemisphere. It consists of a central part called body and three
extensions: anterior (frontal horn), posterior (occipital horn), and inferior
(temporal horn).
 Choroid plexus- It is a plexus of cells that arises from the teal choro idea
in each of the ventricles of the brain. It produces most of the
cerebrospinal fluid (CSF) of the central nervous system.

 Fourth ventricle- It protects the human brain from trauma (via a

cushioning effect) and to help form the central canal, which runs the
length of the spinal cord.
 Cerebellum- It is important for making postural adjustments in order to
maintain balance. Through its input from vestibular receptors and
proprioceptors, it modulates commands to motor neurons to compensate
for shifts in body position or changes in load upon muscles.
PATHOPHYSIOLOGY
 LABORATORY AND DIAGNOSTIC EXAMINATIONS

Laboratory and Normal Purpose/Indication Nursing Responsibilities

Diagnostic values
Examinations

Computed    It is used to  Expect the child to be

Tomography (CT) evaluate for the transported out of the
presence area for the study. 
of hydrocephalus
 Accompany the child to
and can also aid in
provide continued
identifying the
observation and
cause of
management, especially
hydrocephalus.
if the child's condition
 Rapid evaluation of is unstable.
tissues and skeletal
areas Superior test
for the evaluation
of internal bleeding.

Magnetic Resonance  Used to evaluate for  Administer sedation as

Imaging (MRI) a congenital ordered.
abnormality or
 Assist child in
alterations in the
remaining still; MRI
brain tissue that
requires child to remain
may lead to
still for a longer period
developmental
than for a CT.
delay.
 Assist the conscious
 Superior test for the
child to deal with fear
evaluation of the
related to loud banging
spinal cord and the
noise of the machine.
cerebrospinal fluid
spaces; less useful
in emergency
situations.
Skull x-ray studies
(may reveal
separation of
sutures)

Skull radiography To detect erosion of sella  Review the patient's

turcica, or “beaten copper clinical record to
cranium” (or “beaten determine the reason
silver cranium”)—the (purpose) for the
latter can also be seen in specific scheduled skull
craniosynostosis; (after x-rays.
shunt insertion) to
 Explain to the parent or
confirm correct
guardian of the infant.
positioning of installed
the specific purpose of
hardware.
the skull x-rays in
his/her situation.
Explain purpose in a
manner consistent with
that offered by the
physician to avoid
confusion
 Patient will be placed in
a supine position on a
radiographic table
 Reassure the patient
that the procedure will
cause no discomfort.
 Films will be developed
and checked before the
patient leaves the x-ray
department.

Diffusion tensor To detect differences in

imaging (DTI) fractional anisotropy and
 mean diffusivity of the
brain parenchyma
surrounding the
ventricles; allows
recognition of
microstructural changes in
periventricular white
matter region that may be
too subtle on conventional
MRI.

Radionuclide To assess the prognosis

cisternography (in with regard to possible
NPH) shunting

Results: 

I. MEDICAL AND SURGICAL MANAGEMENT

Medical Management
  Carbonic anhydrase inhibitors like Acetazolamide (Diamox) in doses of
50mg/kg/day to reduce CSF production in slow progressive
hydrocephalus.  
 Oral glycerol and Isosorbide are also used to reduce CSF production.

Surgical Management
Ventriculoperitoneal shunt procedure is performed to the infant, to relieve
pressure on the brain caused by fluid accumulation. It is a placement of shunt that
provides primary drainage of the CSF from the ventricles to an extracranial
compartment. These consist of ventricular catheter, flush pump, unidirectional
flow valve, and a distal catheter. 

Health teaching 
 Hydrocephalus is a serious and chronic illness. It will require lifelong
follow-up and regular evaluations. It requires early recognition of
complications to prevent neurologic damage. Children will require future
surgeries and hospitalizations, which can place a strain on the family and its
finances. Potential growth and developmental disabilities are an additional
strain. 
 Tell them that the support of the family in establishing realistic goals and
helping the child to achieve his or her developmental and educational
potential is important.
 The family should be involved in the child’s care from the time of diagnosis.
Initially parents may be frightened because shunt placement involves
entering the brain. 
 Provide parents with accurate information regarding the procedure, and be
available to listen to parents’ concerns and to answer questions that arise. 
Ongoing education about the illness and its treatment are important,
including signs and symptoms of shunt complications. As the family
becomes more comfortable with the diagnosis, treatment, and signs and
symptoms of complications, they will become experts on the child’s care
and will often recognize subtle changes in him or her that may be indicative
of shunt complications. 
  Referral to support groups can be helpful for both the family and the child.
 To prepare for the child’s discharge and home care, the parents are
instructed on how to recognize signs that indicate shunt malfunction or
infection. Active children may have injuries such as a fall that can damage
the shunt, and the tubing may pull out of the distal insertion site or become
disconnected during normal growth. 
 Contact sports should be avoided, and a helmet should be worn when
outside play is vigorous.
 The management of hydrocephalus in a child is a demanding task for both
family and health care providers, and helping a family cope with the child’s
difficulties is an important nursing responsibility. 
 Children with hydrocephalus have lifelong special health care needs and
requires evaluation on a regular basis. The overall aim is to establish realistic
goals and an appropriate educational program that will help the child to
achieve his or her optimal potential.
 Families can be referred to community agencies for support and guidance.
The National Hydrocephalus Foundation* and the Hydrocephalus
Association† provide information on the condition for families and help
interested groups establish local organizations.

RUG STUDY/THERAPY

THERAPY CLASSIFICATIO INDICATIONS AND SIDE NURSING

 NS AND MODE CONTRAINDICATIO EFFECTS / RESPONSIBILITI
OF ACTION NS ADVERSE ES
REACTION
Acetazolamide  Promote the excretion Hypersensitivity to CNS: confusion, Monitor blood tests
Diamox of excess fluid. acetazolamide and dizziness, during acetazolamide
sulfonamides or its disorientation, therapy to detect
Pharmacologic  In the kidneys, it components. drowsiness, electrolyte imbalance.
class: Carbonic increases bicarbonate fatigue, fever,
anhydrase excretion, which headache. -Monitor fluid intake
inhibitor carries out water, and output, and weight
potassium, and GI: anorexia, to detect excessive
Therapeutic class: sodium, inducing constipation, fluid loss.
Diuretic diuresis. diarrhea
-Use acetazolamide
SKIN: cautiously with
photosensitivity, patients with
rash respiratory
impairment.
Other: acidosis,
hypokalemia, -Use the drug within
weight loss 12 hours because the
drug has no
preservatives, unless
refrigerated. (Use
within 3 days)

NURSING DIAGNOSIS

Assessment Cues/ signs and symptoms usually Nursing Diagnosis

 presents

High pitched cry, tachypnea, lethargy, weakness Risk for ineffective cerebral tissue
perfusion related to increased intracranial
pressure

Poor sucking reflex, vomiting Risk for imbalanced nutrition, less than
body requirements related to increased
cranial pressure

Poor sucking reflex, less interactive Risk for delayed growth and development
related to potential neurologic challenge

Deficient knowledge related to home care

needs of child with hydrocephalus

Immunological deficit, Impaired circulation Risk for impaired skin integrity related to
extra weight and immobility of the head.

NURSING CARE PLAN

ASSESSMEN DIAGNOSIS RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION
T

Subjective: Risk for Intracranial Short Term: Independent: Short Term:

ineffective pressure
cerebral tissue reduces the Within 30 -Monitor vital To recognize Within 30
perfusion blood flow in minutes of signs early signs of minutes of
related to the brain nursing increased nursing
increased interventions, the intracranial interventions, the
intracranial client will: pressure such as client was able to
pressure shallow
Objective: -Have a normal breathing, -Have a normal
respiratory rate tachycardia, and respiratory rate
-High pitched fluctuating blood
cry Long Term: pressure. Long Term:
-Tachypnea -
Lethargy Within duration -High-pitched cry Within duration
-Weakness of the nursing -Note the tone of is caused by of the nursing
interventions, the the cry increased interventions, the
client will: intracranial client was able to
pressure.
-Demonstrate -Demonstrate
improved brain -To reduce improved brain
function, -Elevate the head arterial pressure function,
evidenced by about 15-45 and enhancing evidenced by
normal vital signs degrees while cerebral perfusion normal vital sign
and improvement maintaining the and improvemen
of alertness and head in neutral of alertness and
cry position. cry
-Activity and
-Provide adequate stimulation
rest and a non- increase
stimulating intracranial
environment. pressure.

Dependent:

-Administer -To decrease

oxygen therapy as hypoxemia, thus
ordered. improves cerebral
vasodilation.

-Diuretics reduce
-Administer production of
diuretics and fluid and
corticosteroids as corticosteroids
ordered. reduce
inflammation.

Collaborative: -To determine

data about the
Monitor condition and if
laboratory and intervention is
diagnostic results successful.
frequently
CURRENT TRENDS / INNOVATIONS / CLINICAL
MANAGEMENT
A smarter device to treat pediatric
hydrocephalus and ease parents’ worry
Startup specializes in sensor technology for
the first “smart” system seen as a boon for
patients. A prototype of the implantable
device that provides micro-sensing
technology for hydrocephalus shunts.

USC researchers have invented a device

that could significantly improve care for
people with hydrocephalus, a chronic
condition that causes excessive fluid in the
brain. One in every 500 children is born
with pediatric hydrocephalus. In these
children, the pressure from the fluid can bring on splitting headaches and, if left
untreated, can cause brain damage or death.

In these patients doctors impact shunts, a type of tube that acts as plumbing to
drain excess cerebrospinal fluid from the brain into the patient’s stomach, where it
is reabsorbed. But sometimes shunts develop problems, and it’s difficult to detect
hydrocephalus shunt failure before it causes a patient to suffer which is a potential
nightmare for a parent.
So, USC Viterbi School of Engineering professors Ellis Meng and Tuan Hoang
created a device that could tip off doctors about problems with the shunts, in real
time. Today their startup, Sen seer, has patented technologies, developed at USC,
for a “smart” shunt system that can sense trouble.
For pediatric hydrocephalus, A ‘self-aware’ solution
The team developed a suite of sensors to measure three different parameters
in the shunt: pressure, flow and blockage all of which could alert a clinician prior
to shunt failure. Senseer’s Eugene Yoon, also a biomedical engineering PhD
student, is working to make the pressure sensor more accurate and up to physician
standards. The flow and blockage sensors are now being validated in tests at
CHLA.
“Having all these sensors adds a lot of redundancy and gives patients peace of
mind,” Yoon said.
Senseer’s vision is to store clinical data from the device in a database cloud
where the data will be analyzed. If the self-diagnosis detects one or more
parameters going too far out of whack, doctors may be alerted to assess the data
and follow up with patients as necessary. “People have tried over the course of
many decades to make shunts that don’t fail, but because there’s no data from the
body to inform the designs, no one has succeeded,” said Meng, who holds the
Dwight C. and Hildagarde E. Baum Chair. “I’m hoping we can provide doctors
with data on when the shunts fail and that some of this data will be useful in
designing shunts that don’t fail at all in the future.”
The research team collaborated with Gordon McComb, Mark Krieger and
Eisha Christian of the clinical neurosurgery department at CHLA and Frances
Richmond and Michael Jamieson from the USC Regulatory Science Program. 
 
REFERENCES