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hydrocephalus.pptx

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hydrocephalus.pptx

  1. 1. HYDROCEPHALUS
  2. 2. Definition Hydrocephalus is a condition with abnormal accumulation of cerebrospinal fluid in the ventricles of the brain due to an imbalance in the production and absorption of CSF causing ventriculomegaly and increased intracranial pressure. (Susamma&Anupama )  Hydrocephalus is a condition of imbalance between the production and absorption of CSF (Rimple sharma)
  3. 3. ETIOLOGY and TYPES 1. Communicating HC No blockage in the CSF pathway, but the absorption may be affected 2. Non communicating HC the block is at any level of ventricular system
  4. 4. A. Congenital hydrocephalus - Intrauterine infection Rubella, CMV, Toxoplasmosis - Congenital malformation eg.tumors,spinabifida B. Acquired hydrocephalus Tuberculosis, chronic and pyogenic meningitis Post intraventricular haemorrhage, tumours, intracranial haemorrhage
  5. 5. Normal pathway of CSF Lateral ventricle (foramen of monro) 3rd ventricle 4th ventricle Cisterna of subarachnoid space Finally reabsorbed in to venous sinuses by arachnoid villi
  6. 6. Pathophysiology Production Obstruction Reabsorption ICP Non- communicating HC Volume of CSF Ventricular dilation S/S
  7. 7. CLINICAL FEATURES EARLY INFANCY  Abnormally rapid head growth  Bulging fontanelles  Dilated scalp veins  Separated sutures  Macewen sign (cracked –pot sound) on percussion  Thinning of skull bones
  8. 8. LATER INFANCY 1. Frontal enlargement 2. Depressed eyes 3. Setting sun sign/sunset sign (sclera visible above the iris) 4. Pupils sluggish, with unequal response to light
  9. 9. CHILDHOOD ◦ Headache on awakening ◦ Papilledema ◦ Strabismus ◦ Ataxia ◦ Irritability ◦ Lethargy ◦ Apathy (lack of interest/enthusiasm) ◦ Confusion ◦ Impaired judgement and reasoning skills
  10. 10. DIAGNOSTIC EVALUATION  History and physical examination  Increase in head circumference in first 3 months, more than 1cm every 15days(suspicion of hydrocephalus)  CT, MRI (to reveal ventricular enlargement)  X-ray skull  Ultrasonography  CSF dynamic scan  angiography
  11. 11. Management  Objectives: - Relief of hydrocephalus or reducing ICP - Prevention ad management of complication - Managing problems caused by pathology
  12. 12. Medical management  For mild hydrocephalus  Osmotic diuretics (to reduce CSF secretion) Acetazolamide or frusemide, 50mg/kg/day Glycerol is also used for same purpose.  Inj. Mannitol (to reduce production& ICP)
  13. 13. Surgical management  OBJECTIVES : 1. Removal of the obstruction 2. Reduction in CSF production 3. Shunting of CSF from the ventricle to another site
  14. 14. 1. Shunting - Ventriculoperitoneal shunt(most commonly used) - Ventriculoatrial shunt - Ventriculopleural shunt - Ventriculoureteric shunt
  15. 15. COMPLICATIONS  Shunt block at ventricular or peritoneal end due to cell debris  Malposition of ventricular end  Displacement of shunt tube  Psuedocyst in the abdomen  Shunt infection: Septicemia, wound infection,  meningitis, ventriculitis, peritonitis.  Seizures  Acute subdural hygroma
  16. 16. Nursing management 1. Preoperative nursing care - Daily measure HC - Palpate fontanels for increased ICP - Assess the pupillary response - Monitor vital signs
  17. 17. NURSING DIAGNOSIS |  Risk for injury related to increased Intracranial pressure  Imbalanced nutrition less than body requirement related to poor feeding/vomiting  Deficit knowledge of parents regarding the care of shunt.  Risk for injury related to shunt complications.
  18. 18. Maintenance of nutrition  Observe nutritional status of the child.  Frequent feed with small amount.  Serve food which the child likes.  Hold the head in proper position  Avoid strain on neck  Burping  Administer antiemetics half an hour before feeds.
  19. 19. Prevention of infection ad irritation  Change position frequently  Place soft cotton pads or water pillow under the head  Keep the baby clean and dry

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