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Hydrocephalus (Picmonic)
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This is the nursing care plan for hydrocephalus. So hydrocephalus is a condition where the CSF is not absorbed by the brain, or it's unable to drain and builds up inside or around the brain. This progressively increases the pressure on the brain without treatment to relieve this pressure. The patient can suffer growth in developmental abnormalities, infants and toddlers with this condition may develop abnormally large head circumference. So some nursing considerations that we want to be mindful of is we want to do frequent neuro checks. These patients are at risk for seizures. So we also want to make sure that we initiate seizure precautions. We want to administer any medications that are ordered as assess and monitor the intracranial regulation. We want to maintain safety and prevent injury, and we want to maintain fluid balance. The desired outcome for this patient is that this patient will have optimal brain function without developmental delays. And the patient will be free from injury. This patient will also be free from infection. So this patient comes in and this parent tells us, Hey, my child has hydrocephalus. What is some subjective data that you think this parent will tell us? Well, I do think that this parent will say that there was a rapid increase in their child's head circumference. Maybe they'll say that the child has a poor appetite, Headaches, personality changes, And they may have some difficulty concentrating. So when we see this, this child, what are we going to notice? Well, we're going to notice a large or oddly shaped head.
And we're going to notice the bulging fontanelles. Remember the fontanelles are those soft spots on the head where the skull is closing and fusing. So those should not be bulging. So we're going to have bulging fontanelles. We're going to also see infants are fussy and that's for infants. They're going to be very fussy. Remember infants tend to communicate by fussing if they have something that's going wrong with them, there'll be some excessive drowsiness. And some vomiting. Remember this patient is at risk for seizures. So you may see some seizures and eyes fixed downward, or sunsetting, and we call that sunsetting. So let's take a look at some of the nursing interventions that we can do. Well, the first thing we want to do when the patient arrives at the hospital is we want to assess their neurological status and examine their pupils. Remember we see these patients and we want to monitor for changes in their mental status and their motor function changes with their pupil reaction may indicate the altered brainstem functioning
All right. The next thing we want to do is we want to assess their head circumference and their fontanelles. Remember, we should not see fontanelle bulgy. We shouldn't see a rapid increase in head circumference. If, and if the head size is increasing, this is indicating excessive fluid buildup.
We want to initiate safety as seizure precautions. So these patients are at high risk for a seizure, and we want them to be protected and safe. So we want to monitor the intracranial pressure. We want to protect them from seizures. They may need some oxygen supplementation because of those seizures, but also may need suctioning. So we want to make sure that that is set up at the bedside as well, so we can clear the airway. Okay. The next thing that we want to do is to administer medication. Some medications that we may give the patient are diuretics or water pills. They want to remove the water and we want to administer steroids. Okay? The steroids control the production of CSF. In the case of nonobstructive hydrocephalus, if they are blocked because of any type of inflammation, those corticosteroids are going to help reduce that inflammation. We want to prepare this patient for surgery. This patient, if it is not going to be managed with the medications for the diabetes and the corticosteroids, they are going to prepare for surgery.
This patient needs to be NPO. So nothing by mouth, nothing by mouth two to four hours prior to the surgery; we want to make sure that we administer IV fluids once they're NPO. And we want to realize that they may undergo surgery to put a VP drain or ventriculoperitoneal shunt. That's going to drain fluid from the brain into the stomach. Okay. Let's look at the key points. So cerebral spinal fluid is not absorbed by the brain. That's when it's a nonobstructive hydrocephalus or it's unable to drain at all. That's obstructive hydrocephalus that builds up inside or around the brain. Remember some other subjective data that they're going to present with is they aren't going to present as poor feeders. They're going to have rapid rise in the head circumference. Some of the things that we are going to monitor, and we're going to assess and observe is the objective data that they're going to be fussy.
When they're infants, they're going to be vomiting. We may observe some seizures. We're going to see those sunset eyes, those low eyes when they're focusing downward, and we may see some falls in functionality, what are we going to do for these patients? Well, first we're going to do frequent neuro checks. So we're going to do frequent neuro exams, and we're going to pay close attention to their pupils. Remember any changes with the pupils can indicate that the brainstem has been compromised with this. We're also going to prepare for surgery. We're going to keep the patient NPO. We're going to monitor their EVD or their external ventricular drain. And we're going to monitor for post op infection and to ensure that the drain is draining properly. We love you guys; go out and be your best self today. And, as always, happy nursing.
And we're going to notice the bulging fontanelles. Remember the fontanelles are those soft spots on the head where the skull is closing and fusing. So those should not be bulging. So we're going to have bulging fontanelles. We're going to also see infants are fussy and that's for infants. They're going to be very fussy. Remember infants tend to communicate by fussing if they have something that's going wrong with them, there'll be some excessive drowsiness. And some vomiting. Remember this patient is at risk for seizures. So you may see some seizures and eyes fixed downward, or sunsetting, and we call that sunsetting. So let's take a look at some of the nursing interventions that we can do. Well, the first thing we want to do when the patient arrives at the hospital is we want to assess their neurological status and examine their pupils. Remember we see these patients and we want to monitor for changes in their mental status and their motor function changes with their pupil reaction may indicate the altered brainstem functioning
All right. The next thing we want to do is we want to assess their head circumference and their fontanelles. Remember, we should not see fontanelle bulgy. We shouldn't see a rapid increase in head circumference. If, and if the head size is increasing, this is indicating excessive fluid buildup.
We want to initiate safety as seizure precautions. So these patients are at high risk for a seizure, and we want them to be protected and safe. So we want to monitor the intracranial pressure. We want to protect them from seizures. They may need some oxygen supplementation because of those seizures, but also may need suctioning. So we want to make sure that that is set up at the bedside as well, so we can clear the airway. Okay. The next thing that we want to do is to administer medication. Some medications that we may give the patient are diuretics or water pills. They want to remove the water and we want to administer steroids. Okay? The steroids control the production of CSF. In the case of nonobstructive hydrocephalus, if they are blocked because of any type of inflammation, those corticosteroids are going to help reduce that inflammation. We want to prepare this patient for surgery. This patient, if it is not going to be managed with the medications for the diabetes and the corticosteroids, they are going to prepare for surgery.
This patient needs to be NPO. So nothing by mouth, nothing by mouth two to four hours prior to the surgery; we want to make sure that we administer IV fluids once they're NPO. And we want to realize that they may undergo surgery to put a VP drain or ventriculoperitoneal shunt. That's going to drain fluid from the brain into the stomach. Okay. Let's look at the key points. So cerebral spinal fluid is not absorbed by the brain. That's when it's a nonobstructive hydrocephalus or it's unable to drain at all. That's obstructive hydrocephalus that builds up inside or around the brain. Remember some other subjective data that they're going to present with is they aren't going to present as poor feeders. They're going to have rapid rise in the head circumference. Some of the things that we are going to monitor, and we're going to assess and observe is the objective data that they're going to be fussy.
When they're infants, they're going to be vomiting. We may observe some seizures. We're going to see those sunset eyes, those low eyes when they're focusing downward, and we may see some falls in functionality, what are we going to do for these patients? Well, first we're going to do frequent neuro checks. So we're going to do frequent neuro exams, and we're going to pay close attention to their pupils. Remember any changes with the pupils can indicate that the brainstem has been compromised with this. We're also going to prepare for surgery. We're going to keep the patient NPO. We're going to monitor their EVD or their external ventricular drain. And we're going to monitor for post op infection and to ensure that the drain is draining properly. We love you guys; go out and be your best self today. And, as always, happy nursing.
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