1) Hydrocephalus is a condition where there is excess cerebrospinal fluid in the brain, causing increased pressure and head enlargement. It can be caused by issues with CSF production, flow, or absorption. 2) Symptoms in infants include rapid head growth, bulging fontanelles, vomiting, and irritability. Older children experience headaches, nausea, and personality changes. 3) Treatment involves surgical insertion of a shunt to drain CSF out of the brain and into other areas of the body like the abdomen. Nurses focus on monitoring the child closely after surgery for complications and teaching parents how to care for the child and the shunt long term.

1. CARING THE CHILD WITH
NEUROLOGIC DISORDERS

2. HYDROCEPHALUS

Hydrocephalus is a condition of altered
production, flow, or absorption of
CSF; it is characterized by an abnormal
increase in CSF volume within the intracranial
cavity and by enlargement of the head in
infancy

3. 1 Non communicating hydrocephalus:
Obstruction in the system between the Source
of CSFproduction (ventricles) and the area of its
reabsorption (the subarachnoid space).
May be partial, intermittent, or complete.

Occurs in the majority of cases.
Caused by
1) congenital defects such As aqueductal
stenosis (neurofibromatosis).
2) acquired conditions such as infections, trauma,
spontaneous intracranial bleeding, and neoplasms.
Types and Etiology

4. Types and Etiology
2 Communicating hydrocephalus:
Failure in the absorption system
Cause unknown
Excessive production
of CSf
Cause unknown

5. Clinical Manifestations
Clinical signs depend on the age of the child
Infants
 Excessive head growth (may be seen up to age
3).
 Delayed closure of the anterior fontanelle
 Fontanelle tense and elevated above the surface
of the skull.
 Signs of increased intracranial pressure (ICP).
 Alteration of muscle tone of the extremities,
spasticity.

6. Clinical Manifestations
 Later physical signs:
O Forehead becomes prominent
O Scalp appears shiny with prominent scalp veins.
O Sunset eyes.
O Infant has difficulty holding head up.
O Child may experience physical or mental
developmental lag.

7. Clinical Manifestations
 Older Children
Older children have closed sutures and present with
signs of increased ICP
Signs and Symptoms of ICP in Infants and Children
Vomiting
Restlessness and irritability
High-pitched, shrill cry (infants)
Rapid increase in head circumference (infants)
Tense, bulging fontanelle (infants)
Changes in vital signs:
O Increased systolic blood pressure
o Decreased pulse

8. Clinical Manifestations
o Decreased and irregular respirations
o Increased temperature
Papilledema
Possible seizures
Lethargy, stupor, coma
Older children may also experience:
O Headache, especially on awakening
O Lethargy, fatigue, apathy
O Personality changes
O Separation of cranial sutures (may be seen in children up
to age 10)
O Visual changes such as double vision

9. MANAGEMENT
 Surgical intervention
 Extra cranial Shunt Procedures :
O Ventriculoperitoneal (VP) shunt
O Ventriculoatrial (VA) shunt.
O Ventriculopleural shunt
O Ventricle-gall bladder shunt

10. components of shunts
Most shunts have the following components:
O Ventricular tubing.
O A one- way or unidirectional pressure -
sensitive flow valve.
O A pumping chamber.
O Distal tubing.

11. Shunt Complications
O Occlusion, infection, or malfunction,
especially in the first year of life.
O Shunt revision may be necessary because
of growth of the child.
O Bacterial endocarditis, bacteremia, and
ventriculitis or thromboembolism

12. Hydrocephalus Complications
1 Seizures.
2 Herniation of the brain.
3 Spontaneous arrest due to natural
compensatory mechanisms, persistent increased
ICP, and brain herniation.
4 Developmental delays.
5 Depression in adolescents is common

13. Nursing Interventions
 Maintaining Cerebral Perfusion
 Observe for evidence of increased ICP,
and report immediately.
Assist with diagnostic procedures to
determine cause of hydrocephalus and
indication for surgical intervention.

14. Nursing Interventions
Providing Adequate Nutrition
Be aware that feeding is frequently difficult because
the child may be listless, anorectic, and prone to
vomiting.
 Complete nursing care and treatments before
feeding so the child will not be disturbed after
feeding.
 Hold the infant in a semi-sitting position with head
well supported during feeding
Offer small, frequent feedings
 Place the child on side with head elevated after
feeding to prevent aspiration.

15. Nursing Interventions
 Maintaining Skin Integrity
 Prevent pressure sores.
 Keep the scalp clean and dry.
 Change position at least every 2 hours.
 Provide meticulous skin care to all parts of the
body, and observe skin for the effects of pressure.
 Keep the eyes moistened with artificial tears if the
child is unable to close the eyelids normally. This
prevents corneal ulcerations and infections.

16. Nursing Interventions
 Reducing Anxiety
Prepare the parents for their child's surgery by
answering questions.
 Encourage the parents to discuss all the risks and
benefits with the surgeon.
 Prepare the child for surgery by using dolls or
other forms of play to describe what interventions
will occur.

17. Nursing Interventions
Improving Cerebral Tissue Perfusion Postoperatively
 Monitor the child's vital signs and pupillary size and
reaction every 15 minutes until stable; then monitor every
1 to 2 hours.
 Avoid hypothermia or hyperthermia.
 Suctioning to prevent respiratory difficulty.
 Change position frequently.
 Promote optimal drainage of CSF through the shunt by
positioning the child (30–40 degrees)
 Assess for excessive drainage of CSF.
O Sunken fontanelle, agitation, restlessness (infant).
O Decreased LOC (older child).
 Assess closely for increased ICP, indicating shunt
malfunction.

18. Nursing Interventions
 Maintaining Fluid Balance
 Accurately measure and record total fluid intake and output.
 Administer I.V. fluids as prescribed; carefully monitor infusion
rate to prevent fluid overload.
 Use a nasogastric tube if necessary for abdominal
distention.
 Do frequent mouth care while the child is NPO.
 Begin oral feedings as order
O Begin with small amounts of dextrose 5% in water.
O Gradually introduce formula.
O Introduce solid foods suitable to the child's age and
tolerance.

O Encourage a high-protein

19. Nursing Interventions
 Preventing Infection
 Assess for fever (temperature normally fluctuates
during the first 24 hours after surgery), purulent
drainage from the incision, or swelling, redness, and
tenderness along the shunt tract.
 Administer prescribed prophylactic antibiotics

20. Nursing Interventions
 Strengthening Family Coping
Begin discharge planning early, including specific techniques
for care of the shunt and suggested methods for providing daily
care.
O Turning, holding, and positioning.
O Skin care over shunt.
O Exercises to strengthen muscles -ncorporated with play.
O Feeding techniques and schedule.
 Encourage the parents to treat the child as normally as
possible, providing him or her with appropriate toys and love.
 Community and Home Care Considerations
Family Education and Health Maintenance