CHILD HEALTH NURSING

Case Scenerio on Hydrocephalus

Master Abdus a 3 months old baby

diagnosed with Hydrocephalus presented
with c/o progressive increase in head
size,Feeding difficulty , Fast breathing ,
RR – 36/min • Irritability . No h/o fever ,
vomiting, loose stool, seizure or cyanosis
*Antenatal History
• Ist trimester uneventful, 2 TT doses, iron
& folate suppliments taken
• 2nd trimester: USG showed dilated
lateral ventricles
• 3rd trimester: no fever/ GDM/PIH
*Natal History : born at term, NVD, birth
wt : 3.5 kg
*Postnatal History: NICU X 10 days with
HIE, sepsis
*Diet : on formula feeds ( not sucking
well)
*Immunization: upto date
*Development : social smile 1 month , not
attained head control
On Examination
* Vital signs
 HR- 168/Min
 RR – 168/min
 Spo2 – 93%
*On Physical Examination
 Anterior and posterior fontanelle had
widen.
 Impaired up gaze(setting sun signs)
Dilation of scalp veins
  Hypertonic lower extremities and the
face was broadened.
 No other abnormal features were seen.
*Anthropometric measurement
 Occipito frontal Circumference-
49.5cm (normal32-35 cm
conclusion ,Hydrocephalus)
 Length 49cm,
 Weight 3.9kg.
*On systemic examination of the central
nervous system
 The baby was alert with partial sucking
reflex ,positive glabellar, rooting, grasp
both hand and plantar, stepping, biceps,
triceps, knee,ankle, tendon and Moro
reflexes.
 The muscle tone was hypertonic.
 On examination of other systems no
abnormality was detected.
*Cranial ultrasound scan (US) revealing
huge hydrocephalus with bilateral
ventriculomegally merging into one

Management and Treatment

*The baby is kept warm with daily
monitor of the respiratory rate , heartrate,
temperature,HypoxicIschaemic,
Encephalopathy and OFC.
*Pharmacologic Management
 IM vitamin K 1mg start
 IM cloxacillin 195mg twice a day
 IM gentamycin 20mg once a day
*All for seven days
* The treatment of hydrocephalus is done
to shunt the CSF fluid to peritoneum
(ventricoloperitoneal shunting)
REQUIREMENTS:
 Kardex
 Nurses Notes
 Medicine cards if administered
 Investigation chart
 Feeding chart
 Nursing process according to NANDA
diagnosis
 Immunization schedule
 Growth and Development:
 Reflexes
 Head to foot examination
 Play therapy and play materials