T3-Hydrocephalus/Spina bifida

Question 1

Abnormal accumulation of fluid within ventricles

Answer 1

Hydrocephalus

Question 2

What is the primary cause of hydrocephalus?

Answer 2

Blockage or obstruction somewhere along the circulatory pathway of CSF

Question 3

What is the primary cause of hydrocephalus?

Answer 3

Arnold Chiari Syndrome

Question 4

What is the secondary cause of hydrocephalus?

Answer 4

Acquired

Question 5

What are S&S of hydrocephalus?

Answer 5

• Sunset sign
• Inc head circumference (??)
• HIGH pitched cry!
• Poor feeding if ICP is too high

Question 6

Surgical treatment with shunt placement=?

Answer 6

Biggest complication is infection

Question 7

Obstruction is one cause of hydrocephalus. What kind of obstruction is there with hydrocephalus?

Answer 7

Aqueductal obstruction

• the long narrow pathway between the 3rd and 4th ventricle
• can be due to infection, hemorrhage, tumor

Question 8

What are the 5 other causes of hydrocephalus on top of obstruction?

Answer 8

• Myleomeningocele
• Intraventricular hemorrhage
• Meningitis
• Head trauma
• Tumors

Question 9

For intraventicular hemorrhage cause. What causes the blockage?

Answer 9

Blood

Question 10

For meningitis cause, what may restrict flow?

Answer 10

Meningitis

Question 11

FOr tumors, what does it do to the ventricle?

Answer 11

Compression on the ventricle

Question 12

How do we diagnosis hydrocephalus?

Answer 12

• Fetal ultrasound
• CT scan of head
• MRI
• Physical assessment

Question 13

What does a CT scan reveal?

Answer 13

Enlarged ventricles

Question 14

What are the two types of shunts?

Answer 14

Ventricular peritoneal & ventricular atrial

Question 15

What does ventricular peritoneal shunt do?

Answer 15

Drains fluid from brain ventricles into peritoneum

Question 16

What does ventricular atrial shunt do?

Answer 16

Drains fluid from brain ventricles into atria of the heart

Question 17

What shunt is preferred?

Answer 17

Longer tubing can be inserted for VP than VA shunts, which allows for growth

Question 18

When is ventricular atrial shunt usually used?

Answer 18

When abdominal surgery has been done

Question 19

When is a ventriculoperitoneal shunt placed?

Answer 19

3-4 months of age–however it may be placed at any age as needed to treat secondary hydrocephalus (from conditions like meningitis or tumors)

Question 20

What are 4 prts to ventriculoperitoneal shunt?

Answer 20

• Ventricular catheter
• Pumping chamber/reservoir
• One way pressure valve
• Distal catheter

Question 21

What does the tubing drains of ventriculoperitoneal shunt do?

Answer 21

Drains excess CSF fluid from ventricles to abdomen

Question 22

What is the main goal of treatment for ventriculoperitoneal shunt?

Answer 22

Reduce the ICP and to preserve CNS function

Question 23

Surgery pre-op. Observe for signs of ICP. What are those signs?

Answer 23

• Bulging fontanel
• Take daily head circumference
• Behavior changes
• Irritability

Question 24

Children being discharged after hydrocephalus: What should we teach parents?

Answer 24

• Child needs to avoid contact sports

- Need to wear protective helmets

Question 25

Surgery post op: What should the child be placed..what position? Bed flat or elevated?

Answer 25

Unaffected side; flat

Question 26

Why should they be placed on unaffected side and why should the bed be flat?

Answer 26

To avoid overdrainage

Question 27

What are the complications of hydrocephalus?

Answer 27

Shunt malfunction---common causes are shunt obstruction and infection

Question 28

When are shunt revisions needed?

Answer 28

As child grows

Question 29

Shunt infection frequently results in ____ and may produce ___ or ___ along the shunt tract

Answer 29

Fever; reddening or swelling

Question 30

What does shunt obstruction proceed?

Answer 30

Recurrent symptoms of hydrocephalus, increased ICP, or fluid along the shunt tract