The document discusses hydrocephalus in children, defining it as a condition characterized by excessive cerebrospinal fluid in the brain. It covers the etiology, pathophysiology, clinical features, imaging studies, and treatment of hydrocephalus, noting that the mainstay of treatment is surgical placement of a ventriculoperitoneal shunt to drain excess cerebrospinal fluid from the brain to the abdomen. Complications of hydrocephalus and hydrocephalus treatment are also reviewed.
2. DEFINITION
īDiverse group of conditions characterised by excessive CSF
in the brain. Thus:
ī1. Impaired flow
ī2. Decreased reabsorbtion
ī3. Increased production
6. PATHOPHYSIOLOGY
īAccumulation of fluid leads to increased pressure in
the proximal part of pathway and progessive
dilatation.
īPressure effect on the surrounding nervous pathways
and delicate portions of brain: pyramidal tracts,
cortex, tectum
16. Ketan Thummar-Hydrochephalus in children
Patient Report: Assessments
Neurological/behavioral
Pupils sluggish L>R
Irritable, crying
VS: WNL
History:
âĸ Sunsetting eyes
âĸ Projectile vomiting
âĸ Irritability
âĸ Full fontanel
âĸ Slightly separated
sutures
âĸ Floppy
âĸ Lethargic
Labs:
âĸ LP - elevated pressure
âĸ No RBCs or WBCâs
âĸ CT scan/serial
transilluminations
demonstrate fluid/
no
signs of trauma, swelling,
or bleeding
17. Ketan Thummar-Hydrochephalus in children
Patient Report: Assessments
Hydration
Skin turgor: Skin supple
Weight: WNL
I&O: diaper dry
VS: WNL
History:
Last void 8 hours ago
Vomiting: 30-60 cc q 1h
Labs:
Elevated specific gravity
Normal blood glucose
18. Ketan Thummar-Hydrochephalus in children
Patient Report: Assessments
Nutrition
Well developed, floppy
Lethargic
Weight: Weight WNL
I&O: Intake = Output
Vs: WNL
History:
Last void 8 hours ago
Vomiting
19. Ketan Thummar-Hydrochephalus in children
Patient Report: Assessments
Family
Parental anxiety
Lack of primary, well child care
Poor eye contact
Motherâs comments
History:
Labs:
Family signs of stress
No signs of trauma
20. Ketan Thummar-Hydrochephalus in children
Patient Report: Assessments
Developmental
Patient has met age-appropriate milestones
Patient is alert, crying, irritable
Patient able to roll and sit with support
Developmental Milestones
âĸ Overall development
Gross and fine motor
Language
Cognitive
Social skills
âĸ Social and Emotional Development
âĸ Speech and Language Development
21. Ketan Thummar-Hydrochephalus in children
Patient Priority: Safety/Developmental Care
Nursing Actions
īProvide developmentally-appropriate
safety measures
īSiderails
īName band
īAllergy bracelet
īProvide developmentally-appropriate
toys and stimulation
22. Ketan Thummar-Hydrochephalus in children
Patient Priority:
Hydration
Nursing Actions
īPrinciples of IV therapy
īIV therapy - replace for losses
(bolus)
īRestrict fluids as indicated
for IICP
īAssess and maintain IV site
23. Ketan Thummar-Hydrochephalus in children
Patient Priority:
Care of the patient related to surgery
Nursing Actions
īConsents, teaching, preparation, sedation
īAssessments: prep for the operating room
īPost-operative care:
īIncision assessment
īAdvancing diet and
activity as tolerated
īPumping of shunt
as ordered
īAssess for infections
īPulmonary care
24. Ketan Thummar-Hydrochephalus in children
Patient Priority: Family-centered care
Nursing Actions
īEnsure patient safety
īFamily-oriented teaching and explanations
īInclude family in care
īAdapt family orientation for specific family needs
īFamily support, counseling, and referral
25. Ketan Thummar-Hydrochephalus in children
Patient Priority: Pain assessment and
management/meeting comfort needs
Nursing Actions
īPain assessment across the lifespan -
Using behavioral signs/vital signs/parental report
īNon-pharmacological measures Positioning, music, contact, comfort measures
īPharmacological measures - Fentanyl (Duragesic) or
acetaminophen with codeine (Tylenol #3 )
īAssessing response to pain interventions
īDocumentation
26. Ketan Thummar-Hydrochephalus in children
Complications:
Signs of increased intracranial pressure (IICP)
The night before surgery the patient
demonstrates signs of IICP
Monitor for Symptoms:
âĸ Increased systolic
blood pressure
âĸ Decreased HR and RR
âĸ Irritability
âĸ Sluggish pupils
âĸ Vomiting
âĸ Decreased level of
consciousness
Nursing Actions:
âĸ Providae oxygen
âĸ Encourage ventilation
to blow off CO2
âĸ Diuretics to decrease ICP mannitol (Osmitrol)
âĸ Surgery
âĸ Monitor
27. Ketan Thummar-Hydrocephalus in children
Complications: Hypothermia
Following surgery, during frequent vital sign while in
the PACU, the nurse assesses the childâs temperature.
The electronic thermometer reads 35.8 C (96.5 F).
Nursing Actions:
Monitor for Symptoms:
âĸ Warming blankets
âĸ Warmed blankets
âĸ Warmed intravenous
fluids
âĸ Frequent assessments
âĸ Body temperature
âĸ Signs of vasoconstriction
âĸ Decreased level of
consciousness
28. Ketan Thummar-Hydrocephalus in children
Complications: Seizures
Patient has a seizure upon transfer to the patient care unit.
The child becomes mildly cyanotic around the lips, has
rapid eye movements, demonstrates tonic/clonic
movements of upper and lower extremities.
Monitor for Symptoms:
Aura, seizure activity (tonic/clonic movement, random muscle
movement,eye movement, cyanosis)
Nursing Actions:
Maintain patent airway, seizure precautions, padded siderail,
loosen clothing, oxygen, suction at bedside, safety, monitor
timing and characteristics of seizure activity,
Anticonvulsants: phenytoin (Dilantin); status epilepticus
diazepam (Valium)
29. Ketan Thummar-Hydrochephalus in children
Complications: Infection
Two days after the insertion of the VP shunt,
the patient develops signs of a shunt infection.
Temperature at 1600 39.4 C (103 F).
Child demonstrating behaviors consistent with IICP.
Monitor for Symptoms:
âĸ Temperature
âĸ Pain and tenderness
âĸ Irritability
âĸ Incisional changes,
abdominal distension/ pain
assess for meningitis
(nuchal pain, etc.)
Nursing Actions:
âĸ Culture wound (+S. Aureus)
âĸ CSF (from LP)
âĸ Provide antipyretics
acetaminophen [Tylenol]or
ibuprofen [Advil]
âĸ Administer antibiotics
cefuroxine [Ceftin])
âĸ Comfort
30. Ketan Thummar-Hydrochephalus in children
Complications: Family Stress
During the post-operative period, the unit nurses note
the interactions are strained between the mother and
father. The father interacts little with the infant but visits
frequently. Both parents express concern about cost of
hospitalization and missed work.
Monitor for Symptoms:
Nursing Actions:
âĸ Body language
âĸ Family support,
counseling, and referral
âĸ Family aspects
âĸ Role as mandatory
(family communication,
boundaries, dynamics,
reporters
and decision-making)
âĸ Referral to resources/
âĸ History
social service consult
âĸ Stress levels
âĸ Assess for cardinal signs of abuse
31. PROGNOSIS
īIncreased risk for developmental disabilities
īMean IQ is reduced compared to general population
īAbnormalities in memory
īSome patients show aggressive or delinquent
behavior.
35. Definition
Meningitis is the inflammation of the membranes
surrounding the brain & spinal cord, including the
dura, arachinoid & pia matter.
36. Incidence
īMeningitis can occur at all ages but it is commonest
in infancy. While 95% of the cases take place between
1 month- 5 years of age.
īIt is more common in males than females.
37. īļTransmission
īThe bacteria are transmitted from person to
person through droplets of respiratory or throat
secretions.
īClose and prolonged contact (e.g. sneezing and
coughing on someone, living in close quarters or
dormitories (military recruits, students), sharing
eating or drinking utensils, etc.)
īThe incubation period ranges between 2 -10 days.
39. Signs & Symptoms
The symptoms of meningitis vary and depend on the age of the
child and cause of the infection. Common symptoms are:
īFlu-like symptoms
īfever
īlethargy
īAltered consciousness
īirritability
īheadache
īphotophobia
īstiff neck
īBrudzinski sign
īKernig sign
īskin rashes
īseizures
40. Symptoms
Other symptoms of meningitis in Neonates/infants
can include:
īApnea
ījaundice
īneck rigidity
īAbnormal temperature (hypo/hyperthermia)
īpoor feeding /weak sucking
īa high-pitched cry
ībulging fontanelles
īPoor reflexes
42. Pyogenic Meningitis
ETIOLOGY
ī âMeningococcalâ meningitis- N. meningitidis. A, B, C and W135) are
recognized to cause epidemics
ī The commonest organisms according to age groups are:
0-2 months
E.Coli, Group B streptococci, S.Aureus, Listeria
Monotocytogenes
2 months- 2yrs H.Influenzae type b, S.Pneumoniae,
N.Meningitides.
2 yrs â 15+yrs
N.Meningitides (serotypes A,B,C, Y & W135)
S.Pneumoniae (serotypes 1,3, 6,7)
H.Influenzae
43. Bacterial Meningitis
Pathogenesis:
īEntry of organism through blood brain barrier
īrelease of cell wall & membrane products
īOutpouring of polymorphs & fibrin
īcytokines & chemokines
īInflammatory mediators
īInflamed meninges covered with exudate (most
marked in pneumoccocal meningitis).
44. Pathogenesis
īMeningeal irritation signs: inflammation of the spinal nerves &
roots.
īHydrocephalus: Adhesive thickening of the arachinoid in basal
cistern or fibrosis of aqueduct or Foramina of Lushka or
Magendie
īCerebral atrophy: thrombosis of small cortical veins resulting in
necrosis of the cerebral cortex.
īSeizures: depolarisation of neuronal membranes as a result of
cellular electrolyte imbalance.
īHypoglycorhachia: decreased transport of glucose across
inflammed choroid plexus & increased usage by host.
45. Viral meningitis
īViral meningitis comprises most aseptic
meningitis syndromes. The viral agents for aseptic
meningitis include the following:
īEnterovirus (polio virus, Echovirus,
Coxsackievirus )
īHerpesvirus (Hsv-1,2, Varicella.Z,EBV )
īParamyxovirus (Mumps, Measles)
īTogavirus (Rubella)
īRhabdovirus (Rabies)
īRetrovirus (HIV)
46. Fungal Meningitis
īItâs rare in healthy people, but is a higher risk in those
who have AIDS, other forms of immunodeficiency or
immunosuppression.
īThe most common agents are Cryptococcus
neoformans, Candida, H capsulatum.
47. Parasitic Meningitis
īInfection with free-living amoebas is an infrequent
but often life-threatening human illness.
īItâs more common in underdeveloped countries
and usually is caused by parasites found in
contaminated water, food, and soil.
īThe most common causative agents are:
Free-living amoebas (ie, Acanthamoeba, Balamuthia,
Naegleria)
Helminthic eosinophilic meningitis
48. Non-infectious meningitis
Rarely, meningitis can be caused by exposure to certain
medications, such as the following:
īImmune globulin
īLevamisole
īMetronidazole
īMumps and rubella vaccines
īNonsteroidal anti-inflammatory drugs (e.g., ibuprofen,
diclofenac, naproxen)
49. Tuberculous meningitis
īItâs a complication of Childhood
tuberculosis & common cause of
prolonged morbidity, handicap &
death.
īChildren below 5 years are specially
prone.
50. CLINICAL FEATURES
Always sec. to primary tuberculosis.
First Phase: Vague symptoms.
īChild doesnât play, is irritable, restless or drowsy.
īAnorexia & vomiting may be present
īOlder child may complain of headache.
īPossibly preceding history of Measles or another illness
with incompletely recovery
51. SECOND PHASE:
īChild is drowsy with neck stiffness, &
rigidity.
īKernig & Brudzinski sign may become
positive, anterior fontanels bulges
īTwitching of muscles, convulsions, raised
temperature.
īstrabismus, nystagmus, and papilloedema
may be present.
īFundoscopy: Choroidal TB may be seen
52. TERMINAL PHASE
īChild is characteristically comatose
with opisthotonus, & multiple focal
paresis.
īCranial nerve palsies are present.
īHigh grade fever often occurs
terminally.
53. Diagnostic Tests
īLumbar Puncture: pressure usually raised,
10-500 PMNs early but later lymphocytes
predominate
īProtein- 100-500,raised
īGlucose less than 50mg/dl in most cases
īCulture for tubercle bacilli.
īPresence of tuberculous focus elsewhere in the
body is strong supportive diagnosis.
īChest X-Ray.
īTuberculin skin test.
54. Treatment
īAntituberculous Therapy:
īIncludes simultaneous administration of 4 drugs
(Isoniazid, rifampicin,streptomycin , pyrazinamide) for
first 3 months, followed by 2 drugs for another 15 months
usually Rifampicin & INH.
īTotal period: 18 months.
55. Treatment
īSTEROIDS: to reduce cerebral edema and to prevent
subsequent fibrosis & subsequent obstruction to CSF
2mg/kg/24 hours of prednisolone for 6-8 weeks at the start
of treatment starting 3 days after initiation of anti
tuberculous therapy.
56. Examination
īą General physical- Check for Consciousness level according to GCS
scoring, jaundice or irritability.
īą Resuscitation: incase of septic shock, or DIC.
īą Vitals: temperature , HR, B.P., R/R.
īą Signs of Increased ICP- Bulging fontanelle, headache, nausea,
vomiting, ocular palsies, altered level of consciousness, and
papilledema
īą Fundus: papilloedema
īą CN palsies: (esp. occulomotor, facial, and auditory)
57. Examination
īą
Meningismus - check for nuchal rigidity with passive
neck flexion (gives 'involuntary resistance).
īą
Brudzinski sign (hip & knee flexion with neck
movement)
īą
Kernig sign (extend knee with hip flexed)
īą
Hemiparesis.
īą
Rash: petechial or purpuric rash (not only in
meningococcal but also pneumococcal bacteremia).
62. Diagnostic Tests
īLatex particle agglutination: detects presence of
bacterial antigen in the spinal fluid. useful for detection
of H.influenzae type b, S.Pnemoniae, N.Meningitidis,
E.Coli
īConcurrent immuno-electrophoresis (CIE)-used for
rapid detection of H.influenza, S.pneumoniae &
N.meningitides.
īSmears: taken from purpuric spots may show
meningococci in Meningococcaemia
īDNA sequences : are helpful in identifying bacteria
64. Treatment
īSteroids:
Dexamethasone useful for H.influenzae type b, First
dose should be given 1 hr prior to starting
antibiotics.
īAntibiotics IV.
Duration:1-3 weeks depending on age & type of
organisms.
65. Treatment
īInitial till results of
īAmpicillin
īProbable/Proved
īPenicillins
C/S are known
Meningococci
300mg/kg/day+
īChloramphenicol
75-100mg.kg/day
2-5 lac units /kg/day
69. Prevention
īThe vaccines against Hib, measles, mumps, polio,
meningococcus, and pneumococcus can protect against
meningitis
īHib vaccine: all infants should receive at 2,4,6 months of
age & booster 1 year later.
īAfter 1 year 1 dose is given till the age of 5 years.
īPneumococcal vaccine: 0.5 ml is given IM (<2 yrs)
70. Prevention
īHigh-risk children should also be immunized routinely.
īVaccination before travelling to an endemic area
īChemoprophylaxis for susceptible individuals or close
contacts:
H influenzae type b : Rifampin(20 mg/kg/d) for 4 days
N meningitidis: Rifampin (600 mg PO q12h) for 2 days upto
10weeks
Ceftriaxone (250 mg IM) single dose or
Ciprofloxacin(500-750 mg) single dose.
71. Complications
Bacterial meningitis may result in
īCranial nerve palsies
īSubdural empyema
īBrain abscess
īHearing loss
īObstructive hydrocephalus
īBrain parenchymal damage: Learning disability, seizures,
Mental retardation.
īSeptic shock
īAtaxia
īStroke
īSIADH (Na+ <130 mE/l), puffiness of face, dec UO.
72. Treatment of Complications:
īConvulsions: Diazepam I.V, Can be
repeated q4 hours as required.
īCerebral edema: *I.V Mannitol 1g/kg in 20-
30 mins 6-8 hourly given for first few days.
īIV Dexamethasone can then be used 6 hourly.
73. īSubdural effusion:
Aspirate subdural effusion if large.
īShock: Treat with IV Fluids, maintanence of BP.
īSIADH: Increase body weight, decreased serum
osmolality, hyponatremia.
Prevented by fluid restriction to 800-1000ml/m2/24
hours.
īHyperpyrexia: Tepid sponging, correction of
dehydration.
74. Nursing care
īObtain a history of recent infections such as
upper respiratory infection, and exposure to
causative agents
īAssess neurologic status and vital signs,signs of
meningeal irritation
īAssess sensorineural hearing loss (vision and
cranial nerve damage.
(eg, facial nerve d diminished cognitive function.
75. Cont;
īReducing Fever
īAdminister antimicrobial agents on time to
maintain optimal blood levels.
īMonitor temperature frequently or continuously,
and administer antipyretics as ordered.
īInstitute other cooling measures, such as a
hypothermia blanket, as indicated.
77. Cont;
īEnhancing Cerebral Perfusion
īAssess LOC, vital signs, and neurologic parameters
frequently. Observe for signs and symptoms of ICP (eg,
decreased LOC, dilated pupils, widening pulse
pressure).
īMaintain a quiet, calm environment to prevent
agitation, which may cause an increased ICP.
īPrepare patient for a lumbar puncture for CSF
evaluation, and repeat spinal tap, if indicated. Lumbar
puncture typically precedes neuroimaging
īNotify the health care provider of signs of deterioration:
increasing temperature. decreasing LOC. seizure
78. Cont;
īRedusing Pain
īAdminister analgesics as ordered; monitor for
response and adverse reactions. Avoid opioids which
may mask a decreasing LOC.
īDarken the room if photophobia is present.
īAssist with position of comfort for neck stiffness, and
turn patient slowly and carefully with head and neck
in alignment.
īElevate the head of the bed to decrease ICP and
reduce pain.
79. Cont;
īPromoting Return to Optimal Level of Functioning
īImplement rehabilitation interventions after admission
(eg, turning, positioning).
īProgress from passive to active exercises based on the
patient's neurologic status.
īPatient Education and Health Maintenance
īAdvice close contacts of the patient with meningitis
that prophylactic treatment may be indicated: they
should check with their health care providers or the
local public health department.
80. Cont;
īTo help prevent the development of meningitis,
teach patients with chronic sinusitis or other
chronic infections the importance of proper
medical treatment.
īEncourage the patient to follow medication
regimen as directed to fully eradicate the
infectious agent.
īEncourage follow-up and prompt attention to
infections in future.
81. Cont;
īInform patient who have children about
the importance of vaccination with measles,
mumps, rubella vaccine, H. influenzae type
B vaccine, pneumocococcal vaccine as a
preventive measure. Vaccination is
recommended for children younger than
school age.
82. Prognosis
īIt depends on the age of the patient, the duration of the
illness, complications, micro-organism & immune status.
īPatients with viral meningitis usually have a good
prognosis for recovery.
īThe prognosis is worse for patients at the extremes of age
(ie, <2 y, >60 y) and those with significant comorbidities
and underlying immunodeficiency.
īPatients presenting with an impaired level of
consciousness are at increased risk for developing
neurologic sequelae or dying.
83. Prognosis
īA seizure during an episode of meningitis also is a
risk factor for mortality or neurologic sequelae.
īAcute bacterial meningitis is a medical emergency
and delays in instituting effective antimicrobial
therapy result in increased morbidity and
mortality.
īThe prognosis of meningitis caused by
opportunistic pathogens depends on the
underlying immune function of the host as may
require lifelong suppressive therapy.
84.
85.
86. DEFINITION
īConvulsion is involuntary contraction or
series of contraction of voluntary muscle.
īIt occur due to disturbance of brain
function resulting from abnormal
excessive electrical discharge from brain.
īIt may be associated with alteration of
level of consciousness.
īConvulsion is also termed as SEIZURE.
87. CAUSES OF CONVULSION
īNEONATAL PERIOD :
âĸ
âĸ
âĸ
âĸ
asphyxia & injury
Hypoglycemia & hypocalcemia
Narcotic & anesthetic drug
Septicemia, meningitis Birth, tetanus ,
kernicterus
âĸ Congenital malformation
âĸ Intra uterine infection
88. SIGNS & SYMPTOMS
īTwiching of limb
īTongue bite
īDischarge from the mouth
īPale face
īsucking movement
īTremors
89. Infant & young children
īFebrile convulsion
īCNS infection
īAccidental & non accidental
injury
īMetabolic disturbance
īDrug & poison
90. Febrile convulsion
īIt refers to the seizures
associated with fever but
excluding those related to CNS
infection.
īIt is related to increase in body
temperature rather than degree of
91. Types
īąTypical febrile
convulsion :-
âĸ it is usually found in children between 6 month
& 5 years of age.
âĸ The fits occur within 24 hours of the onset of
fever.
âĸ Higher incidence occur in twins & genetic
predisposition or immature neuronal membrane.
92. ATYPICAL FEBRILE
CONVULSION
īThere may have abnormal EEG
for 2 weeks after attack.
īThe children may have focal
convulsion of more than 20
minutes duration even without
significant fever.
97. EPILEPSY
īEpilepsy is recurrent episodic
paroxysmal transient disturbance of
brain function due to abnormal
electrical activity of neurons.
īIt is manifested as abnormal motor
sensory or psychomotor phenomena &
loss of consciousness.
106. MYOCLONIC SEIZURE
1. Mental retardation
2. Cerebral abnormality
3. Contraction of muscles of trunk,
neck, extremities
4. Duration: less than 1min
107. PARTIAL SEIZURES
īąSIMPLE PARTIAL SEIZURES
with motor sing
ī with somato-sensory or special
sensory
ī with autonomic manifestation
ī
īąCOMPLEX PARTIAL SEIZURES
īImpaired consciousness
108. MEDICAL MANAGEMENT
īPhenoberbital
: 3 to 5mg/kg/day
īDiphenylhydantoin : 10 to
20mg/kg/day
īCarbamazepin
: 10 to
20mg/kg/day
īSodium valproate : 15 to
20mg/kg/day
īEthosuximide
: 10 to
109. NURSING MANAGEMENT
īEnsuring safety during seizures
īļ protect child from injury
īļ side rail of bed
īļ oxygen therapy should be given
īļ close observation & monitoring child
condition for vital sign & airway
110. īļPreventive respiratory arrest &
aspiration
īļ loosen the clothing around neck &
placing the child flat
īļ Do not give anything between teeth
or in mouth when teeth are
clenched
during convulsion
īļ Clear airway, remove secretion &
111. īąProviding health teaching
īContinuation of medication, care during convulsion &
diet therapy, restricted activities.
īąDIET THERAPY
īŧ Ketogenic diet should be given.
īŧ Protien & fat amount should be calculated.
īŧ Child should not be given IV fluid with dextrose.
īŧ Strict fluid restriction
113. īHead injury includes any
injury including scalp,
skull, meninges or any
portion of the brain caused
by external forces.
īIt is one of the important
cause of childhood
mortality & morbidity.
īOne third of all head
injury cases are children.
114. CAUSES
īNEONATES - birth injury
instrumental delivery
īTODDLER - fall from height
hits on head by hard object
īOLDER
CHILDREN
- automobile accident
road traffic accident
sports injury
116. Diagnostic test
īPhysical & neurological examination
īExamination of blood, urin , CSF
īEEG
īX-RAY of skull
īCT SCAN
īMRI
117. Fracture of the skull
īA typical âping-pongâ fracture may
occur due to elasticity of bone.
īThe fracture may be fissured or
depressed type.
īOlder children may have comminuted
fracture with dural tear & laceration
with brain damage.
118. INTRACRANIAL
HEMORRHAGE
īExcessive moulding of skull bone
īRupture of delicate surface veins
leads to acute subdural
hemorrhage
īAbout 20 to 25 % neonatal death
due to intracranial hemorrhage
119. CONCUSSION OF BRAIN
īConcussion is reversible neurological
dysfunction
īTransient loss of consciousness &
loss of memory
īInjury at occipital area & shearing
srain at brain stem
120. CEREBRAL CONTUSION
īIt is bruising or petechial
hemorrhage in brain tissue
īIt consist of hemorrhagic brain
necrosis & infraction
īContusion at frontal & temporal
lobe are common
122. ACUTE SUBDURAL HEMATOMA
īIt results from any severe injury.
īIt is an accumulation of fluid, blood within potential
subdural space between dura & arachnoid.
īWhen sutures are not fused, the hematoma can grow
slowly.
123. BRAIN SWELLING
īIt may be occur due to
vascular congestion, may be
due to neurogenic vasoparalysis
& increase blood flow.
124. SIGNS & SYMPTOMS
īLoss of consciousness
īRespiratory obstruction
īIncrease icp
īHeadache
īVommiting
īConvulsion
īLoss of memory
īBladder bowel dysfunction
126. NURSING MANAGEMENT
īMaintain the airway
īEstablishment of breathing
īAssessment of neurological status
īMaintain nutritional status
īPrevent infection & related
complication
Editor's Notes
Image of a child with hydrocephalus and suspected child abuse