10.3 Hydrocephalus

Question 1

Hydrocephalus

Answer 1

1. Excessive amount of CSF accumulate with cerebral ventricles and or subarachnoid space
2. Ventricular dilation
3. Increased ICP
4. Damage brain tissue

Question 2

CSF
ICP

Answer 2

Cerebrospinal fluid
Intracranial pressure

Question 3

Type of hydrocephalus

Answer 3

Congenital (mal-development, intra-uterine infection)
Acquired

Question 4

Type,
Cause and Pathophysiology of hydrocephalus

Answer 4

1. Communicating (non-obstructive)
   - impaired absorption of CSF
   - eg post-naemorragic in preterm, subarachnoid haemorrhage
2. Non-communicating (obstructive)
   - obstruction to flow of CSF
   - eg post-intracranial infection, congenital malformations

Question 5

Most common cause of congenital hydrocephalus

Answer 5

Myelomeningocele (spinal bifida)

Question 6

Clinical manifestations of hydrocephalus
General, specific

Answer 6

• General: irritability and lethargy, decreased HR RR, increase BP, temp, projectile vomiting,
  lower extremities spasticity,
  change LOC, seizure,
  poor feeding, high-pitch cry
• specific (early signs ):
  Abnormal rapid head growth (increase circumference)
  Bulging fontanels
  Separated sutures
• specific (late signs):
  Setting-sun sign
  Pupil sluggish, unequal response to light

Question 7

Diagnosis of hydrocephalus
Assessment

Answer 7

Head circumference measurement
CT, MRI
EEG Echoencephalography

Obverse general appearance:
- Size of skull and symmetry,
- daily measurements of occipitofrontal circumference
- gently palpate fontanels and suture line (size, signs of bulging, tenseness)

Question 8

Nursing care for hydrocephalus

Answer 8

1. Positioning
   - Change position frequently (prevent hypostatic pneumonia and PI
   - well support head (prevent extra strain in neck)
2. Feeding
   - small, frequent, extra time feeding

Question 9

Therapeutic management for hydrocephalus

Answer 9

1. CSF shunt
   VP shunt, VA shunt
2. ETV Endoscopic third ventriculostomy (create opening in third ventricule)

Question 10

Shunt complication

Answer 10

1. Shunt infection
   - On operative site (wound infection)/ along shunt tract (sepsis, inflammt)
   -PV infection Symptoms: peritonitis, fever, abd pain, anorexia
   Most occur first 6 months
2. Mechanical shunt failure
   Obstruction of catheter
   - symptoms: headache, n/v, vomiting, irritability, lethargy
3. Overdrainage of CSF
   - symptoms: postural headaches, nausea

Question 11

Hydrocephalus post-op assessment
Post-op care

Answer 11

VS
Hydration status
Neurological status
Signs of Increase ICP
Abdominal girth
Sign of infection
Incision site and test drainage of glucose (CSF leakage)

1. Positioning (to unoperated side, keep flat, elevated head of bed if increase ICP
2. Wound management
   (Test drainage for glucose)
3. Meticulous skin care
4. Pain management
5. Fluid replacement