Nursing Care Plan | NCP Hydrocephalus

Definition: Increased accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain.

Pathophysiology: Hydrocephalus results from obstructed flow of CSF (noncommunicating hydrocephalus) or an imbalance between production and reabsorption of CSF (communicating hydrocephalus). There is increased intracranial pressure, and head size increases abnormally if sutures and fontanels have not closed.

Etiology: Noncommunicating hydrocephalus (most common type) may result from development anomalies, tumors, abscesses, or trauma and occurs in about 80% of infants with myelomeningocele. Communicating hydrocephalus may result from tumors or infections such as meningitis.

Manifestations: Infant: abnormal increase in head circumference, bulging fontanel, enlargement of forehead, “setting sun sign” (sclera is visible above iris of the eye), pupils sluggish and/or unequal, highpitched cry, irritability, and opisthotonos (head and body arch backward). Older child: Headache and nausea on awakening (lessened pain after vomiting), papilledema, strabismus, ataxia, and confusion.

Med Tx: Surgical removal of obstruction if possible or surgical placement of a shunt that drains CSF from the ventricles to the peritoneum or right atrium.

Nsg Dx: Potential for injury related to increased intracranial pressure, potential for infection related to mechanical drainage, knowledge deficit (parents).

Nsg Care: Measure head circumference, daily, of infants with myelomeningocele or meningitis. Monitor diagnosed infant for signs of increasing intracranial pressure (anorexia, vomiting, irritability, lethargy, seizures, or increased blood pressure). Postop shunt placement: Monitor for signs of infection (similar to signs of increased intracranial pressure). Teach parents to monitor for infection and signs of increased intracranial pressure, as shunt infection or malfunction may occur after discharge.

Prognosis: If untreated, outcome is fatal in about half the cases. Seventy percent of surgically treated cases have at least a 5-year survival rate. About one-third of survivors are intellectually and neurologically normal.