Alterations in

Nervous System
Presented By: Carim, Cairoden, Dalidig
 Hydrocephalus
- The term hydrocephalus is derived from the Greek words
“hydro” meaning water and “cephalus” meaning head. As the
name implies, it is a condition in which the primary
characteristic is excessive accumulation of fluid in the brain.
- Hydrocephalus is an excess of CSF in the ventricles or the
subarachnoid space (Moe, Benke, & Bernard, 2008).
- it is also classified regarding whether it occurs at birth
(congenital) or from an incident later in life (acquired).
 Etiology
- The cause of congenital hydrocephalus is
unknown, although maternal infection such as
toxoplasmosis or infant meningitis may be
factors (Smith & Henderson, 2007).
- The most common causes of acquired
hydrocephalus are: Head
trauma. Stroke. Brain or spinal cord tumors.
 SIGNS AND SYMPTOMS
- The signs and symptoms of hydrocephalus vary somewhat
by age of onset.

• Infants show symptoms of increased intracranial pressure,

such as decreased pulse and respirations, increased
temperature and blood pressure, hyperactive reflexes,
strabismus, and optic atrophy.
• Changes in the head
• Eyes fixed downward (sunsetting of the eyes)
• Sleepiness or sluggishness (lethargy)
• Nausea and vomiting
 Risk Factors
Newborns
Hydrocephalus present at birth (congenital) or
shortly after birth can occur because of any of
the following:
• Abnormal development of the central
nervous system that can obstruct the flow of
cerebrospinal fluid
• Bleeding within the ventricles, a possible
complication of premature birth
• Infection in the uterus — such as rubella or
syphilis — during pregnancy, which can cause
inflammation in fetal brain tissues.
Other Contributing factors
Other factors that can contribute to hydrocephalus
among any age group include:
• Lesions or tumors of the brain or spinal
cord
• Central nervous system infections, such
as bacterial meningitis or mumps
• Bleeding in the brain from a stroke or
head injury
• Other traumatic injury to the brain
 Laboratory and Diagnostic Procedure
Lumbar Puncture
A procedure where a sample of cerebrospinal
fluid is taken from your lower spine. The
pressure of the CSF sample is then checked.
Removing some CSF during a lumbar puncture
may help improve your symptoms. If it does, you
may benefit from having surgery (see treating
hydrocephalus to find out more).
CT Scan, MRI, Ultrasonography
through anterior fontanelle in
infants, skull radiography, MRI
cine, diffusion tensor imaging
(DTI), and Radionuclide
cisternography (in NPH).
To confirm enlargement of
the ventricles and determine
the cause of the
hydrocephalus.
 Nursing Diagnosis
Risk for ineffective cerebral tissue perfusion related to increased
intracranial pressure as evidenced by impaired brain blood flow.

ASSESSMENT:
• Assess vital signs hourly, noting for any irregularity in breathing and heart rate, and
rhythm, and measure the pulse pressure.
• Assess neurological status (such as mental status, motor, and balance, reflexes (for
newborns and infants), and cranial nerves.
• Examine the pupils by noting the size, shape, equality, and position of the pupils,
and their response to light.
• Measure the client’s head circumference and appearance of the anterior fontanelle.
 Medical Management
DIURETICS Anticonvulsants Antibiotic

- Acetazolamide and Phenobarbital to treat

furosemide treat neonatal seizures.
posthemorrhagic
hydrocephalus in
neonates
 Surgical Management

SHUNT
A surgical insertion of a
drainage system. A shunt
drains excess cerebrospinal
fluid from the brain to
another part of the body,
such as the abdomen, where
it can be more easily
absorbed.
 Surgical Management
Endoscopic third
ventriculostomy

is a surgical procedure that

can be used for some people.
The surgeon uses a small
video camera see inside the
brain. Your surgeon makes a
hole in the bottom of one of
the ventricles or between the
ventricles to enable
cerebrospinal fluid to flow
out of the brain.
Nursing Interventions
• Provide a non-stimulating environment and adequate rest
periods.
• Elevate the head of the bed gradually about 15-45 degrees
as indicated. Maintain the client’s head in a neutral position.
• Provide oxygen therapy as needed.
• Administer diuretics, carbonic hydrase, corticosteroids as
ordered.
 Febrile Seizures
- Seizures associated with high fever (102° to 104° F [38.9° to 40.0° C]) are
the most common type seen in preschool children (5 months to 5 years),
although these can occur as early as 3 months or as late as 7 years of age.

Simple Febrile Seizures

This most common type lasts from a few seconds to 15 minutes.
Simple febrile seizures do not recur within a 24-hour period and
are not specific to one part of the body.

Complex febrile Seizures

This type lasts longer than 15 minutes, occurs more
than once within 24 hours or is confined to one side
of your child's body.
Etiology
- The fever that trigger febrile seizure are
usually cause by a viral infection, and less
commonly by a bacterial infection.
- Post-vaccination seizures
 SIGNS AND SYMPTOMS
- Usually, a child having a febrile seizure shakes all over
and loses consciousness. Sometimes, the child may get
very stiff or twitch in just one area of the body.
• A child having a febrile seizure may:
• Have a fever higher than 100.4 F (38.0 C)
• Lose consciousness
• Shake or jerk the arms and legs
 Risk Factors
Young age Family history

- Most febrile seizures occur in children - Some children inherit a family's tendency to
between 6 months and 5 years of age, have seizures with a fever. Additionally,
with the greatest risk between 12 and 18 researchers have linked several genes to a
months of age susceptibility to febrile seizures.
 Nursing Diagnosis
Hyperthermia related to antigens or microorganisms that cause
inflammation, as evidenced by high body temperature (102°F to
104°F [38.9°C to 40°C])

ASSESSMENT
• Monitor the child’s temperature (tympanic or rectal temperature).
• Assess for hydration status.
Medical Management
• Benzodiazepine.
• Antipyretics.
• Giving your child infants' or children's
acetaminophen (Tylenol, others) or ibuprofen
(Advil, Motrin, others) at the beginning of a fever
may make your child more comfortable, but it
won't prevent a seizure.
Surgical Management

- No surgical procedure is needed.

 Laboratory Test/Procedure
01 Blood Test

02 Urine Test

A spinal tap (lumbar

03 puncture)
to find out if your child has a central
nervous system infection, such as
meningitis.
NURSING INTERVENTIONS
1. Eliminate excess clothing.

2. Administer a tepid sponge bath.

3. Advise the mother to avoid applying cold

water or alcohol to the child.

4. Administer antipyretic as indicated:

• 4.1. Acetaminophen (Tylenol)
• 4.2. Ibuprofen (Advil)
ANENCEPHALY
Anencephaly is a serious birth defect in which a
baby is born without parts of the brain and skull. It
is a type of neural tube defect (NTD).
 ETIOLOGY
Anencephaly happens if the upper part of the neural tube
does not close all the way. This often results in a baby
being born without the front part of the brain (forebrain)
and the thinking and coordinating part of the brain
(cerebrum). The remaining parts of the brain are often not
covered by bone or skin.
SIGNS AND SYMPTOMS
• Absence of bony covering over the back of the head
• Missing bones around the front and sides of the head
• Folding of the ears
• Cleft palate. A condition in which the roof of the child's mouth
does not completely close, leaving an opening that can extend into
the nasal cavity.
• Congenital heart defects
• Some basic reflexes, but without the cerebrum, there can be no
consciousness and the baby cannot survive
RISK FACTOR (maternal)
diabetes mellitus

obesity

exposure to high heat (such as a fever

or use of a hot tub or sauna) in early
pregnancy

use of certain anti-seizure

medications during pregnancy.
Nursing Diagnosis
Grieving related to Death of infant as evidenced by
crying, verbal expression of distress, anger, loss,
guilt.
 Nursing Interventions
1. Assess the client’s/couple’s information and understanding of events surrounding the death of the fetus/infant.
Provide more accurate information and correct misconceptions based on the couple’s readiness and ability to listen
effectively. Emotional reactions may prevent the couple’s ability to process information and interpret the significance of
events.
2. Communicate therapeutically with patients and family members and allow them to verbalize feelings. Sharing feelings
with a healthcare provider may help the patient find significance in the experience of loss.
3. Support patients and significant others who share mutual fears, concerns, plans, and hopes for each other. Keeping
secrets won’t help during this time. These times of stress can be used as an opportunity for growth and family
development.
4. Encourage significant others to manage their own self-care needs for rest, sleep, nutrition, leisure activities, and time
away from the patient. Alteration in normal activities is evident during this time of stress. Care should be taken to treat
these symptoms so that emotional reconstitution is not complicated by illness.
5. Strengthen the patient’s efforts to go on with his or her life and normal routine. Allow the patient and family to feel
that they are enabled to do this by supporting them.
6. Consider the patient’s or family’s denial about the loss for it is part of the grieving process. The nurse needs to
recognize and understand these events as a time during which an individual or family member incorporates his or her
strength to go on to the next stage of grief.
 DIAGNOSTIC PROCEDURE

Alpha-fetoprotein. Amniocentesis

Ultrasound (also called

Blood tests
sonography).
 MANAGEMENTS
SURGICAL MANAGEMENT

No surgical intervention has been reported in the

management of anencephaly.

MEDICAL MANAGEMENT

There is no medical treatment for anencephaly.

BACTERIAL MENINGITIS
- Meningitis is, as the name implies, infection of the cerebral
meninges. It tends to occur most frequently in children
younger than 24 months of age and most often in winter.
 Etiology
- Meningitis can be caused by infectious and
non-infectious processes. The infectious
etiologic agents of meningitis include bacteria,
viruses, fungi, and less commonly parasites.
 SIGNS AND SYMPTOMS
Symptoms of meningitis develop suddenly and
can include:
- a high temperature (fever)
- being sick
- a headache
- a rash that does not fade when a glass is rolled
over it (but a rash will not always develop)
- a stiff neck
- a dislike of bright lights
- drowsiness or unresponsiveness
- seizures (fits)
 Risk Factors
infants under 1 year of Certain medical
age and people ages 16 conditions
to 21.
 Nursing Diagnosis
Risk for Infection Transmission related to
contagious nature of organism.
 Nursing Interventions
1. Assess neurologic status and vital signs constantly. Determine oxygenation
from arterial blood gas values and pulse oximetry.
2. Insert cuffed endotracheal tube (or tracheostomy), and position patient on
mechanical ventilation as prescribed.
3. Assess blood pressure (usually monitored using an arterial line) for incipient
shock, which precedes cardiac or respiratory failure.
4. Rapid IV fluid replacement may be prescribed but take care not to overhydrate
patient because of risk of cerebral edema.
5. Reduce high fever to decrease load on heart and brain from oxygen demands.
6. Protect the patient from injury secondary to seizure activity or altered level of
consciousness (LOC).
DIAGNOSTIC PROCEDURE
- Lumbar puncture.
- CT scan.
- Blood studies.
- Chest radiography.
- Cultures and bacterial antigen
testing.
- Serum procalcitonin testing.
 MANAGEMENT
MEDICAL MANAGEMENT
- Crystalloid infusion.
- Seizure precautions.
- IVT and oxygen
administration

SURGICAL MANAGEMENT

- No surgical Management
needed
Thanks!

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