I. Introduction Hydrocephalus or "water on the brain.

" is a build-up of fluid inside the skull, leading to brain swelling, and ventriculoperitoneal shunt is a basic part of its treatment. Hydrocephalus is due to a problem with the flow of cerebrospinal fluid (CSF), the liquid that surrounds the brain and spinal cord. The fluid brings nutrients to the brain, takes away waste from the brain, and acts as a cushion. CSF normally moves through areas of the brain called ventricles, then around the outside of the brain and the spinal cord. It is then reabsorbed into the bloodstream. Buildup of CSF can occur in the brain if its flow or absorption is blocked or if too much CSF is produced. This build-up of fluid puts pressure on the brain, pushing the brain up against the skull and damaging or destroying brain tissues. Hydrocephalus may start while the baby is growing in the womb. It is commonly present with myelomeningocele, a birth defect involving incomplete closure of the spinal column. Genetic defects and certain infections that occur during pregnancy may also cause hydrocephalus. In young children, hydrocephalus may also be associated with the following conditions: Infections that affect the central nervous system (such as meningitis or encephalitis), especially in infants, bleeding in the brain during or soon after delivery (especially in premature babies), injury before, during, or after childbirth, including subarachnoid hemorrhage, tumors of the central nervous system, including the brain or spinal cord, Injury or trauma. The goal of ventriculoperitoneal shunting is to reduce or prevent brain damage by improving the flow of CSF. The blockage may be surgically removed, if possible. If the blockage cannot be removed, a shunt (flexible tube) may be placed within the brain to allow CSF to flow around the blocked area. The shunt tubing travels to another part of the body, such as the abdomen, where the extra CSF can be absorbed. This procedure is done in the operating room under general anaesthesia. It takes about 1 1/2 hours. The child's hair behind the ear is shaved off. A surgical cut in the shape of a horseshoe 1

(U-shape) is made behind the ear. Another small surgical cut is made in the child's belly. A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain. Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity. Sometimes, it goes to the chest area. The doctor may make a small cut in the neck to help position the catheter. A valve (fluid pump) is placed underneath the skin behind the ear. The valve is attached to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure. The valves in newer shunts can be programmed to drain more or less fluid from the brain. As Nurses, one should always be updated with current procedures, treatment, and management applied in the clinical setting. One should be well informed in advances in the field since this can be used in fulfilling the role of a Nurse as a Health Educator. An In-depth study of this procedure should be advocated by the Nurses since they are also involved in the Procedure. As a member of the Health team and a member of the sterile team, it is important to be well educated and well informed not only in skills but also in theory during practice since one is dealing with life. . Research in this area can help shed light into the workings of the disease, the predisposing factors, impact on the morbidity and mortality rates and the measures taken by the health care team in the treatment and control of the condition.

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Anatomy Cerebrospinal fluid or CSF surrounds the brain and spinal cord. This clear fluid serves to cushion and protect the brain and spinal cord. CSF is produced in an area of the brain, flows around the brain through special channels, and then is absorbed in another location of the brain. Any blockage of the channels can result in fluid buildup, or hydrocephalus. Brain Anatomy The brain is well protected by:
• • •

The scalp The skull The dura o o A tough 3-layer sheath that surrounds the brain and spinal cord Layers include the dura mater (strongest layer), arachnoid mater (middle layer), and pia mater (closest to the brain)

The brain is a complicated structure containing many parts. These include: The cerebrum: o o o o o o o The cerebellum: o o Located in the lower, back part of the skull Controls movement and coordination 3 Made up of two cerebral hemispheres that are connected in the middle It is the largest part of the brain Each area of the cerebrum performs an important function, such as language or movement Higher thought (cognition) comes from the frontal cortex (front portion of the cerebrum) Outside of the cerebrum are blood vessels There are fluid-filled cavities and channels inside the brain

vision. such as the thyroid and adrenal glands The cranial nerves: o Twelve large nerves exit the bottom of the brain to supply function to the senses such as hearing. 4 . Posterior cerebral circulation: The back portion of the brain is supplied by the paired vertebral arteries in the spine. body temperature. and blood pressure regulation Pituitary gland is the "master gland" that controls other endocrine glands in the body. and taste The cerebral blood vessels: o A complicated system that supplies oxygenated blood and nutrients to the brain The blood supply to the brain is divided into two main parts: • Anterior cerebral circulation: o • • The front of the brain is supplied by the paired carotid arteries in the neck.The brainstem and pituitary gland: o o Responsible for involuntary functions such as breathing.

hemorrhage. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head. such as Chairi malformations. and mental disability. though such a rarity may occur if onset is gradual rather than sudden. Etiology: Congenital hydrocephalus usually results from defects. and “cephalus” meaning head. Hydrocephalus occurs with a number of anomalies. When production exceeds absorption. 5 . usually under pressure. or cavities. producing dilation of the ventricles. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head. CSF accumulates. convulsion. It is also associated with spina bifida. hydrocephalus does not cause any intellectual disability if recognized and properly treated. of the brain. People with hydrocephalus have abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles. convulsion. It is a term derived from the Greek words “hydro” meaning water. such as NTD’s. A massive degree of hydrocephalus rarely exists in typically functioning people. or cavities. Acquired hydrocephalus usually results from space-occupying lesions. of the brain. and this condition is sometimes known as “water on the brain”. intracranialinfections or dormant development defects. People with hydrocephalus have abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles. Usually.Hydrocephalus is a condition caused by an imbalance in the production and absorption of CSF in the ventricular system. and mental disability.

A massive degree of hydrocephalus rarely exists in typically functioning people.Usually. such as NTD’s. 6 . Hydrocephalus occurs with a number of anomalies. hydrocephalus does not cause any intellectual disability if recognized and properly treated. though such a rarity may occur if onset is gradual rather than sudden.

PATHOPHYSIOLOGY Choroid Plexuses of the Lateral Ventricles CSF Formation Impaired Absorption of CSF within the Arachnoid Space (communicating hydrocephalus) Obstruction to the flow of CSF through the ventricular system (non-communicating hydrocephalus) Abnormal increase in volume of CSF Dilation of the pathways proximal to the site of obstruction Increased ICP Enlargement of the head in infancy 7 .

Another small surgical cut is made in the child's belly.III. It takes about 1 1/2 hours. CLINICAL INTERVENTION 1. The doctor may make a small cut in the neck to help position the catheter. it goes to the chest area. 8 . A surgical cut in the shape of a horseshoe (U-shape) is made behind the ear. Another catheter is placed under the skin behind the ear and moved down the neck and chest. and usually into the abdominal (peritoneal) cavity. The child's hair behind the ear is shaved off. A small thin tube called a catheter is passed into a ventricle of the brain.1 Description of prescribed surgical treatment performed Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus). Description This procedure is done in the operating room under general anesthesia. A small hole is drilled in the skull. Sometimes.

THE PROCEDURE Position of the child is important to correctly implant the shunt. An adequate length of ventricular catheter needs to be selected to place the tip anterior to the foramen of Munroe. The burr hole is placed approximately 4 cm up from the inion and 3-4 cm off the mid-line. This is to lessen the risk of occlusion. the valve opens. the dura is opened with a pinpoint cautery to have just a big enough opening to allow the passage of the catheter (a large dural opening can allow CSF to flow around the shunt and cause a subcutaneous fluid collection). even enough to allow for full 9 . to insure that the valve system is opened. and then it should then be placed into the peritoneal cavity. which can happen with shunt placement sites that are more lateral and inferior. an 8 cm catheter in an older infant and young child. though definitive data showing that this is mandatory is lacking. and a 10 cm catheter is used in a children 18 months or older. The ventricle is tapped using a rigid brain cannula and. Perioperative antibiotics can be used. The shoulder blades should be raised to elevate the chest and neck. This is done without a stylette. Once the shunt is laid in position. and allow for a straight passage of the shunt passer with no secondary incisions between the head and the abdomen. This trajectory avoids the risk of going too low. the ventricular catheter is fed into the ventricle through this tract. The abdominal incision is a horizontal incision. This occipital placement allows a relatively straight shot into the body of the ventricle so that the shunt catheter is mostly within it. This helps decrease intracranial pressure. Generally. Fluid should then be aspirated from the lower end of the shunt.A valve (fluid pump) is placed underneath the skin behind the ear. where there is less choroid plexus. once a good flow of CSF has been obtained. The valve is attached to both catheters. and excess fluid drains out of it into the belly or chest area. through the internal capsule. When extra pressure builds up around the brain. either just below the rib cage or just lateral to the umbilicus. The head is turned sharply to the left to accommodate a right occipital placement. A large amount of tubing can be placed in the peritoneal cavity. The valves in newer shunts can be programmed to drain more or less fluid from the brain. a 6 cm catheter is used in a small newborn.

Too much pressure. In hydrocephalus. 1. or pressure that is present too long.2 Indication of prescribed surgical treatment The procedure is indicated for people with hydrocepahalus. 15-20" of peritoneal catheter is usually inserted at the same time as the initial shunt placements.3 Required instruments. Infection in the brain Damage to brain tissue Seizures 1. will damage the brain tissue. Risks Risks for any anesthesia are: • • • Reactions to medications Problems breathing Changes in blood pressure or breathing rate Risks for any surgery are: • • Bleeding Infection Possible risks of ventriculoperitoneal shunt placement are: • • • • • • • Blood clot or bleeding in the brain Brain swelling The shunt may stop working and fluid will begin to build up in the brain again. supplies. there is a buildup of fluid of the brain and spinal cord (cerebrospinal fluid or CSF). A shunt should be placed as soon as hydrocephalus is diagnosed. equipment and facilities 10 . This buildup of fluid causes higher than normal pressure on the brain. The shunt may become infected. devices.growth of the child. A shunt helps to drain the excess fluid and relieve the pressure in the brain.

11 .The Operating Room Surgical Drill Used to created a burr hole.

Blunt instruments. Clamps 12 .Dissecting Instruments In the first part of the surgery. the most well know example being the scalpel. which are either sharp or and are used to make precise incisions. such as the elevator or the curette are mostly used to scrape tissues. incisions are made with dissectors.

the surrounding skin is clamped with the use of forceps or clips. but also other instruments.After the incision is made. Suction 13 . These instruments are also used to hold not only tissues. e. Cauterization An electrocautery machine is used to remove lesions and tissues that are highly vascularized. The machine reduces the risk of bleeding. sealing off blood vessels by using high frequency electric currents to instantly stop bleeding.

Removal of the drains is the prerogative of the surgical team. f. Drains Before surgical closure. The suction machine is tied to a container where the loss of fluid can be measured and monitored during the procedure. The needles. Sutures can be absorbable or nonabsorbable. It also allows the medical personnel to monitor the amount of bleeding during the post-operative phase. 14 . Staples. are used frequently nowadays to speed up the surgery and reduce the chance of infection due to an open wound g. including a ventriculoperitoneal shunt procedure. along with the sutures are used to properly close the site.Oozing of blood and other fluids are inevitable in a surgical procedure. Needles Closure of the incision site occurs after the procedure. however. which usually leave it in place for five to six post-operative days. Its drainage also helps a physician determine if an infection is developing or healing. Sutures. Staples. a drain is attached to the site to remove the remaining fluid left over from the procedure.

g. wet hands thoroughly and apply soap (preferably an iodophre. gauze.1. fingertips first. using a circular motion: Wash between all fingers. Hold hands above the level of the elbow. Begin at the fingertips and lather and wash. instruments) are available and not beyond expiry date • • • • Surgical handscrub • • Remove all jewelry. including drugs and an oxygen cylinder emergency equipment is available and in working order there are adequate supply of theatre dress for the anticipated members of the surgical team clean linens are available sterile supplies (gloves. holding hands above the level of the elbows. e. Move from the fingertips to the elbows of one hand and then repeat for the second hand. Wash for three to five minutes Rinse each arm separately.4 Perioperative tasks and responsibilities of the Nurse PRE-OPERATIVE CARE Preparing the operating theatre Ensure that: • • the operating theatre is clean (it should be cleaned after every procedure) necessary supplies and equipment are available. 15 • • • • • . betadine).

during. or sponging the wound when asked to do so. Ensure that scrubbed hands do not come into contact with objects (e.g. assemble all instruments and supplies and prepare them for decontamination and resterilization and assist in the safe clean-up of the operating suite following Universal Precautions. repeat surgical handscrub. Constantly be alert to any intraoperative dangers to the patient. protective gown) that are not high-level disinfected or sterile. The count is done in an orderly way and is performed using accepted technique. as needed. • • • Properly identify and preserve specimens received during surgery. equipment. and after surgery to ensure that they are not left in the wound. wiping from the fingertips to the elbows. • Anticipate the needs of the surgeon by watching the progress of the surgery and knowing the various steps of the procedure. needle. At the end of the procedure. 16 • . • Assist the surgeon by tissue retraction. The technologist takes part in counting the items before. If the hands touch a contaminated surface. All of these items must be accounted for during the procedure.• Dry hands with a clean or disposable towel. Take part in sponge. suture cutting. and instrument counts. • INTRA OPERATIVE CARE • • Assist in the sterile gowning and gloving of the surgeon and his or her assistant. or allow hands to air dry. Prevent injury to the patient by removing heavy or sharp instruments from the operative site as soon as the surgeon has finished using them. fluid evacuation. The technologist is responsible for maintaining the specimens in a prescribed manner so that the material can be subsequently examined by the pathologist. He or she passes instruments and other supplies in an acceptable manner so that the surgeon does not have to turn away from the wound site to receive them.

encephalitis. The major complications to watch for are an infected shunt and a blocked shunt. or hemorrhage. these conditions could affect the prognosis. 1.5 Expected outcomes of surgical treatment performed Shunt placement is usually successful in reducing pressure in the brain. such as spina bifida. brain tumor. pulse and breathing of the patient  Place a dressing (bandage) over the surgery site  Provide instructions on how to care for the patient at home. meningitis. But if hydrocephalus is related to other conditions. the nurse will monitor the blood pressure. The drainage tubes will likely be removed at that time.POST OPERATIVE CARE  At the recovery room. The severity of hydrocephalus present before surgery will also affect the outcome. Support groups for families of children with hydrocephalus or spina bifida are available in most areas. 17 . recognizing signs of infection and understanding activity restrictions  Talk to the patient about when to resume wearing a bra or wearing a breast prosthesis  Give prescriptions for pain medication and possibly an antibiotic  Remind the patient to meet with her doctor a week or two after surgery. including taking care of the incision and drains.

It is recommended to take medication for pain when pain is experienced on a regular schedule. After that your child will be helped to sit up. Educate patient that bruising and some swelling are common after surgery. Intravenous fluids and antibiotics are given. 1. Advise the patient not to remove the dressing. The goal of pain management is to assess the level of discomfort and to take medication as needed. steri-strips or stitches. 18 . it will be changed. An icepack may also be helpful to decrease discomfort and swelling. Incision and Dressing Care Incision. The nurse will also remove the sutures in one to two weeks unless they absorb on their own. The usual stay in the hospital is 3 to 4 days. If the dressing or steri-strips fall off. and is covered by a gauze dressing and tape or a plastic dressing. Ibuprofen (Advil) can be added to or replace the analgesic. Healing and recovery improve with good pain control. a low-grade fever that is below 100 degrees Fahrenheit is normal the day after surgery. Your child may get medication for pain.The doctor will check vital signs and neurological status often. which are small white strips of tape. The shunt will be checked to make sure it is working properly. Everyone is different and if one plan to decrease pain is not working.The patient will need to lie flat for 24 hours the first time a shunt placed. has both stitches and steri-strips. A home care nurse may be assigned to check your progress at home. The patient will be given a prescription for analgesics for the management of moderate pain.6 Medical management of physiologic outcomes Pain Management People experience different types and amount of pain or discomfort after surgery. tell the patient not to attempt to replace them. or scar. Also. The nurse will remove the dressing in seven to 10 days.

Diet The patient may resume regular diet as soon as you can take fluids after recovering from anesthesia. Encourage to drink eight to 10 glasses of water and noncaffeinated beverages per day. 19 . Most people return to work within three to six weeks. Walking is a normal activity that can be restarted right away. heavy lifting and vigorous exercise until the stitches are removed. plenty of fruits and vegetables as well as lower fat foods. Recommend exercises to regain movement and flexibility.Activity Inform patient to avoid strenuous activity.

Planning Nursing Interventions Rationale Evaluation S> “Napansin ko na hindi normal ang laki ng ulo ng anak ko” as verbalized by the mother. and postoperative phases of ventriculoperitoneal shunt Assessment Nursing Diagnosi s Deficient knowled ge related to client and family understa nding of the preopera tive. the family will be able to participate in learning process and exhibit increased interest/ assume responsibilit y for own >Establish rapport >To gain the trust and cooperation of the patient Shortterm: The family >Assess patient’s general condition >Monitor and record vital signs >Obtain baseline neurologic assessment: a. operative.NURSING CARE PLAN Deficient knowledge related to client and family understanding of the preoperative. O> the patient may manifest: After 4 hours of nursing intervention s. and postoper ative Scientific Explanation Due to its complicated procedure. operativ e. Motor and sensory function >To obtain base line data >To obtain baseline data >Establishes baseline motor and sensory function for later comparisons. the parents of such patients who undergo this surgery may have many misconceptio n and lack of information which leads to deficient knowledge of the family. determines level of ability and knowledge shall have participate d in learning process and exhibited increased interest/ assumed responsibil ity for own 20 .

Restlessnes s Irritability -Changes in VS phases of ventricul operiton eal shunt learning by beginning to look for information and ask questions Long-term: >Discuss activity limitation >Prevents damage to surgical site b. preoperati ve preparatio ns. preoperativ e preparations . the client and family will be able to have sufficient knowledge regarding the surgical procedure. Psychological readiness learning by beginning to look for informatio n and ask questions Long-term: >To gain knowledge >Review pain management on treating / managing postoperative pain > to provide non pharmacologic interventions to alleviate pain >Discuss proper wound care >To prevent occurrence of infection >Discuss changes in >Anticipate home care The family shall have sufficient knowledge regarding the surgical procedure. and the postoperat 21 verbalizatio n of misconcepti ons about the surgery of So After 3-5 days of nursing intervention s.

and the postoperativ e precautions and needs to be able to prevent the developmen t of complicatio ns home environment: needs ive precaution s and needs to be able to prevent the developme nt of complicati ons 22 ..

Rationale >To gain trust >To obtain baseline data Evaluation Short term: The patient identified and demonstrated interventions to prevent risk of infection .S. and >To prevent infection to 23 >to prevent occurrence of infection >To promote healing to the incision for infection the patient shall have achieved timely wound healing without developing infections >To reduce complication and monitor for infection Long-term: Nursing Interventions >Establish rapport >Monitor V.Risk for infection secondary to surgical incision Assessment S> Ø O>the patient may manifest: -increased body temperature -increased WBC inflammatio n in the surgical incision -bleeding in the surgical incision Nursing Diagnosis Risk for infection secondar y to surgical incision Scientific Explanation The skin considered as the first line of defense against any foreign organism when surgical procedure impaired the skin. cleanse site daily as ordered. the patient will identify and demonstrate intervention to prevent infection >Note signs and symptoms of sepsis >To reduce risk >Provide wound healing such as cleaning of wound >Provide care. change dressing as needed Prevent stress on incision line. possible entry of microorganis m therefore may cause infection Long term: After 3-5 days of nursing intervention the patient will achieve timely wound healing without developing Planning Short term: After 4 hours of nursing interventions.

infections apply dry. sterile dressing > emphasize importance of proper hygiene and wound care increase immune resistance >To increase healing of wound > Premature discontinuation >Encourage ongoing nutritional needs > Emphasize necessity of taking antibiotics to s.o as directed >To prevent occurrence of infection > Administer prophylactic antibiotics as ordered 24 of treatment when client begins to feel well may result in return of infection .

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Diagnosis Decreased Intracrani al Adaptive Capacity r/t Space-Altered mental status -Speech abnormaliti es Restlessnes s -Changes in mental state AEB (-) pupil Occupying Lesion secondary to reoccurre nce of fluid accumulat ion due to shunt defect. equality. >To obtain data for comparison. Assessment S>Ø O> the pt. Scientific Explanation Complications of ventriculoperi toneal shunting can occur. Some patients may experience blood clot or bleeding in the brain. swelling and infection in the brain.Occupying Lesion secondary to reoccurrence of fluid accumulation due to shunt defect. purposeful and non-purposeful motor response 26 > To note degree of impairment Planning Short term: Nursing Interventions >Establish rapport Rationale >To gain the client and SO’s trust. >To alter care appropriately. brain tissue damage. . light reactivity).Decreased Intracranial Adaptive Capacity r/t Space. >Assess eye opening and position/movem ent. manifested the ff. Expected Outcome The SO shall have understand the client’s condition and be able perform actively in promoting the clients condition having now a higher level of understanding of the client’s condition and complications that may occur. reoccurrence of fluid build up in the brain because After 1-2° of NI the SO will be able to understand the client’s condition and be able perform actively in promoting the clients condition having now a higher level of understanding of the client’s condition and >Monitor VS. >Monitor/docum ent changes in ICP waveform and responses to stimuli. Pupils (size.

>Provide information about the client’s condition including the complications which may arise once untreated >To reduce CNS stimulation and promote relaxation. Intracranial pressure. nuchal rigidity. ICP is a complications that may occur. cerebrospinal fluid (CSF). .reaction to light. the shunt may also stop working. (ICP). comparing left and right sides. no verbal response. Long term: After 6-7 days of NI the client will be able to demonstrate stable ICP AEB normalization of pressure waveforms/res ponse to stimuli. the shunt may also become infected and seizures may occur. >To promote circulation/venous drainage The client shall have demonstrated stable ICP AEB normalization of pressure waveforms/res ponse to stimuli. presence of reflexes. is the pressure exerted by the cranium on the brain tissue. and the brain's circulating blood volume. consciousness and mental state. flexion on pain. >Elevate HOB and maintain head/neck in midline/neutral position >To decrease factors which may contribute in further increasing 27 >To increase SO’s understanding of the client’s condition and will be able to decide properly for the client’s care.

straining. arterial pulsation. antipyretics. and >To reduce ICP and enhance circulation >To have a continuous client’s care 28 .g. diuretics. and respiratory cycle. antihypertensiv es. coughing. An increase in pressure. >To pharmacologically manage client’s condition and maintain homeostasis >Administer medications as ordered (e. analgesics. antiseizure. most commonly due to head injury leading to intracranial hematoma or cerebral edema can crush brain >Decrease extraneous stimuli/provide comfort measures >Limit activities that increases intrathoracic/ab dominal pressure ICP. neuromuscular blocking agents. vasopressors.dynamic phenomenon constantly fluctuating in response to activities such as exercise.

corticostreiods) >Prepare pt. cause the brain to herniate.tissue. shift brain structures. If left untreated the patient may result to coma or worst death. leading to an ischemic cascade. for surgery as indicated (Space Occupying Lesion) >Refer accordingly 29 . and restrict blood supply to the brain. contribute to hydrocephalu s.

and mucous membrane. integral part and . status. patient’s SO will be able to understand and participate in prevention measures and treatment program for the pt >Monitor Intake and output. Note skin turgor. The procedure is The patient may manifest: >redness >heat on incision >inflammator y process done by shaving the hair behind the ear. > Turning bed to one side compresses LONG TERM: The patient 30 INTERVENTIO NS >Establish rapport RATIONALE >To gain trust EXPECTED OUTCOME SHORT TERM: The patient’s SO shall have understand and participated in prevention measures treatment program for the pt. > Maintain >Assess vital signs >To obtain baseline data >Useful indicators of body water.Impaired skin integrity related to surgical incision 2˚ ventriculoperitoneal shunting ASSESSMENT S: Ø O: The patient manifests: >Surgical incision on head NURSING DIAGNOSIS Impaired skin integrity related to surgical incision 2˚ ventriculoperitone al shunting SCIENTIFIC EXPLANATION Ventriculoperitone al shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus). which is an of tissue perfusion. Weigh as indicated. then a surgical cut in the shape of a horseshoe (Ushape) is made behind the ear and another small surgical cut is made in the child's OBJECTIVES SHORT TERM: After 4 hours of nursing intervention s.

the jugular veins and inhibits cerebral venous drainage that may cause ONCREASE D icp >To determine cause of impairment shall have achieved timely healing of surgical incision. LONG TERM: After 6 days of nursing intervention s. Avoid placing head on large pillows. Another catheter is placed under the skin behind the ear and moved down the neck and chest.belly. support with small towel rolls and pillows. >Identify underlying condition involved >To monitor progress of wound healing >Periodically assess skin and observe 31 . A small hole is drilled in the skull and a catheter is passed into a ventricle of the brain. and usually into the abdominal (peritoneal) cavity. head or neck in midline or in neutral position. the patient will be able to achieve timely healing of surgical incision.

perform proper wound care. support incision >To protect the wound and/or >Use appropriate barrier dressings and wound coverings.for possible complications >To assist body’s >Keep the area clean/dry. skinprotective agents for open/draining wounds and >To boost 32 surrounding tissues natural process of repair .

For tissue repair to achieve timely healing >Promotes > Elevate the venous drainage 33 .stomas immune system and enhance >Encourage to increase oral fluid intake skin turgor >To boost immune system and >Promote importance of proper nutrition of pt address ongoing nutritional needs of pt .

as tolerated or and 34 . from head.head of bed gradually to 15-30 degrees indicated. reducing cerebral congestion edema and increased ICP.

reoccurrence of fluid build up in the brain because the shunt may also stop working. Genetic defects and certain infections that occur during pregnancy may also cause hydrocephalus. After the procedure the patient will need to lie flat for 24 hours the first time a shunt placed then the patient will be helped to sit up. The patient may be given medications for pain. Intravenous fluids and 35 . A small hole is drilled in the skull and a catheter is passed into a ventricle of the brain. In hydrocephalus. a birth defect involving incomplete closure of the spinal column. When extra pressure builds up around the brain.CONCLUSION: Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus). will damage the brain tissue A shunt helps to drain the excess fluid and relieve the pressure in the brain. The doctor may make a small cut in the neck to help position the catheter. there is a buildup of fluid of the brain and spinal cord (cerebrospinal fluid or CSF). This will be attached to both catheters. Some patients may experience blood clot or bleeding in the brain. and excess fluid drains out of it into the belly or chest area which then helps in decreasing intracranial pressure. and usually into the abdominal (peritoneal) cavity. the shunt may also become infected and seizures may occur. Another catheter is placed under the skin behind the ear and moved down the neck and chest. then a surgical cut in the shape of a horseshoe (U-shape) is made behind the ear and another small surgical cut is made in the child's belly. Complications can occur. A shunt should be placed as soon as hydrocephalus is diagnosed. or pressure that is present too long. The procedure is done by shaving the hair behind the ear. Sometimes. It is commonly present with myelomeningocele. swelling and infection in the brain. Recording vital signs and neurological status often is needed. these valve opens. brain tissue damage. This build-up of fluid causes higher than normal pressure on the brain. Too much pressure. A valve (fluid pump) is placed underneath the skin behind the ear. Hydrocephalus may start while the baby is growing in the womb. The usual stay in the hospital is 3 to 4 days. it goes to the chest area.

The shunt will be checked regularly to make sure it is working properly. 36 .antibiotics are given to maintain hydration and prevent the occurrence of infection.

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