Nursing Care Plan for Hydrocephalus

Pathophysiology

Hydrocephalus  is a condition where cerebrospinal fluid (CSF) is not absorbed by the brain (non-obstructive) or is unable to drain (obstructive) and builds up inside or around the brain, progressively increasing the pressure on the brain.  Without treatment to relieve this pressure, the patient can suffer from growth and developmental abnormalities. Infants and toddlers with this condition may develop an abnormally large head circumference.

Etiology

Genetic abnormalities and birth defects such as spina bifida and encephaloceles can cause congenital hydrocephalus. Acquired hydrocephalus can result as a complication of head injuries, tumors or infections such as meningitis. Left untreated, severe brain damage can occur.

Desired Outcome

Patient will have optimal brain function without developmental delays; patient will be free from injury; patient will be free from infection

Hydrocephalus Nursing Care Plan

Subjective Data:

  • Rapid increase in head circumference
  • Poor appetite or feeding
  • Headaches
  • Personality changes
  • Difficulty concentrating

Objective Data:

  • Large or oddly shaped head
  • Bulging fontanelles
  • Fussy (infants)
  • Excessive drowsiness
  • Vomiting
  • Seizures
  • Eyes fixed downward (sunsetting) or strabismus

Nursing Interventions and Rationales

  1. Assess vital signs hourly per facility protocol

  2. To monitor for signs of increased intracranial pressure such as tachycardia, shallow breathing or rapid changes in blood pressure.

  3. Assess neurological status, examine pupils

  4. To monitor for changes in mental status, reflexes and motor function.  Changes in pupil reaction may indicate altered brain stem functioning.

  5. Assess head circumference and fontanelles

  6. Increasing head circumference and bulging of fontanelles indicates accumulating fluid.

  7. Initiate safety and seizure precautions

    • Place infant or toddler in crib
    • Keep oxygen and suction at bedside
    • Keep head of bed elevated
    • Support enlarged head when holding infant
    • Position patient on opposite side of operation
    • Increased cranial pressure can lead to seizures which may require oxygen supplementation or suction of secretions to clear airway.
    • Elevating the head of the bed promotes CSF drainage and breathing.
    • The weight of an enlarged head increases difficulty for an infant to hold head upright. Maintain support of the head when holding an infant to prevent head and neck injuries.
    • Following surgery, position patient to prevent injury to the surgical site and maintain patency of the shunt.

  8. Administer medications appropriately

    • Diuretics
    • Corticosteroids
    • Diuretics can be helpful in controlling the production of CSF in the case of non-obstructive hydrocephalus.
    • Corticosteroids help to reduce inflammation.

  9. Prepare patient for surgery / shunt placement

    • Maintain NPO status 2-4 hours prior to surgery per facility protocol
    • Administer IV fluids
  10. Patients may undergo surgery to place a VentriculoPeritoneal (VP) shunt that will drain fluid from the brain to the stomach.

  11. Encourage frequent bowel movements by providing stool softeners as necessary

  12. To reduce the risk of increasing cranial pressure due to constipation and straining. More appropriate for toddlers and children than infants.

  13. Monitor for signs of infection of surgical site and prove appropriate wound care

  14. Prevent localized or systemic infection and prevents development of sepsis.

  15. Provide education for patients and parents / caregivers

    • Encourage parents to practice good hand hygiene to prevent spread of infection.
    • Teach importance of safety and to reduce risk of brain injury.
    • Educate caregivers about warning signs of increased cranial pressure and when to seek medical help after discharge.


References

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