In order to be able to function on a daily basis, we need a brain to help us communicate with all the systems in our body. Our brain is surrounded by fluid known as cerebrospinal fluid. Under normal circumstances we have just the right amount of fluid, but in some cases fluid accumulates in a ventricle adding pressure to the brain causing serious problems such as physical or mental impairment, this is known as hydrocephalus. Hydrocephalus occurs in 1 to 2 out of every 1000 babies that are being born and is the cause of most brain surgery in children. (Harris, 2018). Knowing the causes, treatment options, and what to expect with hydrocephalus, will better prepare the nurse on being a teacher and support system to these families.
According to Mayo Clinic, hydrocephalus is caused by an imbalance of cerebrospinal fluid production and how much cerebrospinal fluid is absorbed by the bloodstream (Hydrocephalus, 2018). Fluid is being produced faster than it can be absorbed causing it to accumulate in the ventricular system. The ventricles will then enlarge becoming so big that they begin to add pressure on the brain (Ricci, Kyle, & Carman, 2017). Hydrocephalus is a condition, not a disease. It can sometimes develop as part of another condition. There are two different types of hydrocephalus, congenital hydrocephalus and acquired hydrocephalus. Congenital hydrocephalus is caused by genetic and environmental factors as well as abnormalities in intrauterine development during fetal development. One ways to diagnosed it before birth through an ultrasound. Many may think that hydrocephalus only occurs in children, but acquired hydrocephalus can be develop after birth or at any age. Factors that contribute to acquired hydrocephalus include a serious injury or disease. This could be intentional or unintentional trauma, intraventricular hemorrhage in premature infants, neoplasms, infection, or malformations (Ricci, et al., 2017).
The most evident characteristic that you may note in a child with hydrocephalus is increase in head circumference. That is not the only characteristic that is found, altered level of consciousness, brisk reflexes, developmental delays, and a positive Macewen sign upon percussion are also expected findings. A child diagnosed with hydrocephalus is at risk for developmental disabilities, visual problems, abnormalities in memory, reduced intelligence, unsteady gait, and urinary incontinence or urgency (Ricci, et al., 2017). In order to get the appropriate treatment for hydrocephalus, it should be diagnosed as soon as possible to minimize brain damage that can be a results from the ICP that is created by hydrocephalus. Due to the pressure that is being added to the brain, you may expect to have headache, vision disturbances, altered level of conscious, and increased head circumference (Ricci, et al., 2017).
Treatment for this condition will vary from patient to patient. First we need to determine on weather it is congenital or acquired hydrocephalus. One of the most common treatment plans is surgically placing an extracranial shunt, also know as a ventriculoperitoneal shunt. CSF drains from a small perforation in the third ventricle to the subarachnoid space. The job of the shunt will be to drain the excess fluid that is causing pressure on the brain. This should be done as soon as possible in order to avoid complications that can appear with this condition (Ricci, et al., 2017). The surgery requires entering the brain which will alarm the caregiver of the patient. The nurse should make sure that all questions and concerns are understood. The nurse will also need to provide proper education on what will be done during the procedure as well as the expected outcomes of the surgery. Alternative treatment option to shunt placement is Endoscopic third ventriculostomy. With this treatment there will be no permanent hardware will be implanted (Ricci, et al., 2017).
The purpose on treating hydrocephalus with a ventriculoperitoneal (VP) shunt is to get rid of the excess fluid, decreasing the ICP and allowing for proper development of the child. Expected finding after the shunt is place include head circumference to be within normal parameters, improved sensory and motor function, gait, urine control, and improved memory. As with any other procedure, the shunt may cause complications that will require additional surgeries, if no complications arise, corrective surgery may only be needed during rapid periods of growth. Not all ventriculoperitoneal shunt outcomes are good. It is important for parents to be able to recognize when a shunt needs replacing, or when complications are occurring to decrease the possibility of death or disability that may occur due to increased ICP (Ricci, et al., 2017).
Due to potential devastating effects, parents and health professionals need to be aware of signs and symptoms of possible shunt malfunction and infection to provide prompt treatment. The family should be on the lookout for signs and symptoms that could indicate shunt infection such as an increase in vital signs, loss of appetite, vomiting, change in level of consciousness, even possible seizure activity. You also want to access the incision site for possible signs of infection such as inflammation, redness, warmth, or discharge. Shunt malfunction is another possible complication. Teach the caregiver to be aware of symptoms such as headache, drowsiness, or vomiting which may indicate a shunt malfunction (Ricci, et al., 2017). Shunt infections are likely to occur within 1 to 2 months after placement, although it is possible that they may occur later on and parents need to keep watching for potential signs. Intravenous antibiotics are the treatment of choice and if infection persist, the shunt may be removed and an external ventricular drainage (EVD) system will be put in place until the CSF is sterile (Ricci, et al., 2017).
A diagnosis of hydrocephalus will require a lifetime of compassionate care and right treatment. “Nursing management of the child with hydrocephalus will focus on maintaining cerebral perfusion, minimizing neurologic complications, and maintaining adequate nutrition” (Ricci, et al., 2017, p. 1404). It is important to continue to provide support and education these families in order to provide the best care for the child.
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