HYDROCEPHALUS  Obstruction occurs because infections

such as meningitis or encephalitis may

leave adhesions behind that block fluid
flow.
 Obstruction of the passage:
 in narrow aqueduct of Sylvius (the
most common cause)
 foramina of Magendie
 Luschka, the openings that allow fluid
to leave the fourth ventricle
 Hemorrhage from trauma or a
CSF  formed in the first and second ventricles
growing tumor
of the brain  passes through the aqueduct of
 An Arnold-Chiari disorder
Sylvius and the fourth ventricle  empty into the
 elongation of the lower
subarachnoid space of the spinal cord
brain stem and
absorbed
displacement of the fourth
 is an excess of CSF in the ventricles or the ventricle into the upper
subarachnoid space cervical canal
 excess fluid causes enlargement of the  An interference with the absorption of CSF
skull in the infant whose cranial sutures from the subarachnoid space
are not firmly knitted
surgery for meningocele  portion of the
 classified regarding whether it occurs at
subarachnoid membrane is removed
birth (congenital) or from an incident later
in life (acquired) extensive subarachnoid hemorrhage  portions
 3 to 4 per 1000 live births of the membrane absorption surface become
obscured
fluid reaches the spinal cord  the disorder is
called communicating hydrocephalus or
extraventricular hydrocephalus
ASSESSMENT
a block to such passage of fluid  the disorder is
 prenatal sonogram
an obstructive hydrocephalus or
 can be shunted in utero
intraventricular hydrocephalus
 infant’s fontanelles widen and appear
tense
 the suture lines on the skull separate
CAUSE
 the head diameter enlarges
 unknown  scalp becomes shiny

FACTORS  scalp veins become prominent

 brow bulges forward (bossing)
 maternal infection
 eyes become “sunset eyes” (the sclera
o toxoplasmosis
shows above the iris because of upper lid
o infant meningitis
retraction)
 symptoms of increased intracranial
pressure
excess of CSF in the newborn occurs because:
 decreased pulse and respirations
 Overproduction of fluid by a choroid  increased temperature and blood
plexus in first or second ventricle, as could pressure
occur from a growing tumor (rare).  hyperactive reflexes
  strabismus  If a noncommunicating type,
 optic atrophy  Dye inserted into a ventricle
 irritable through the anterior fontanelle will
 lethargic not appear in CSF obtained from a
 fail to thrive lumbar puncture.
 typical shrill
 high-pitched cry
 Measure the head circumference of all THERAPEUTIC MANAGEMENT

infants within an hour of birth and again

If caused by overproduction of fluid,
before discharge from the health care
acetazolamide (Diamox), a diuretic, may be
facility to establish a baseline.
prescribed to promote the excretion of this
 Older children who have suffered head
excess fluid.
trauma should have their head
circumference noted at the time of the  ventricular endoscopy

accident.  Destruction of a portion of the

 Note any asymmetry that is occurring, choroid plexus may be attempted

because this may suggest the point of by

obstruction  removal of the tumor

 skull that is enlarging anteriorly with a  if a tumor in that area is

shallow posterior fossa, for example, responsible for the overproduction

suggests the obstruction is in the of fluid

aqueduct or third ventricle.  laser surgery

 infant’s motor function becomes impaired  to reopen the route of flow or

as the head enlarges, because of both bypassing the point of obstruction

neurologic impairment and atrophy caused by shunting the fluid to another

by the inability to move such a heavy point of absorption

head.  shunting procedure

 a child with more than 1 cm of cerebral  involves threading a thin

tissue present has no impaired motor polyethylene catheter under the

function skin from the ventricles to the

 Even with an extremely enlarged head, peritoneum

children’s intelligence may remain normal,  Fluid drains via this route into the

although fine motor development may be peritoneum and is absorbed across

affected the peritoneal membrane into the

 demonstrated by: body circulation.

 ultrasound  Usually has to be replaced as the

 computed tomography (CT) child grows or it will become too

 magnetic resonance imaging (MRI) short

 A skull x-ray film  could become enclosed in a fold of

 reveal the separating sutures and peritoneum and become obstructed

thinning of the skull  could become infected

 Transillumination (holding a bright light  The ultimate prognosis depends on

such as a flashlight/ specialized light [a whether brain damage occurred before

Chun gun] against the skull with the child shunting and, if a shunt is in place,

in a darkened room) whether the parents can recognize when it

 reveal the skull is filled with fluid needs to be replaced to prevent increased

rather than solid brain intracranial pressure.

  most children NGT placed during surgery
 NPO  bowel sounds return  tube
NURSING DIAGNOSIS
can be removed  introduce fluid
1. Risk for ineffective cerebral tissue gradually in small quantities  to avoid
perfusion related to increased intracranial vomiting leading to increased intracranial
pressure pressure
 After a shunt is inserted, the infant’s bed  held when being fed if possible
is usually left flat or raised only about 30  Note how the child sucks
degrees so the child’s head remains level  Observe for constipation
with the body.
 if the child’s head is raised excessively
CSF may flow too rapidly 
decompression  possible tearing of
cerebral arteries
 one-way valve is inserted in the shunt 3. Risk for impaired skin integrity related to

that opens when CSF has accumulated to extra weight and immobility of head

the extent that pressure has increased  Wash the child’s head daily

 Assess for signs of increased intracranial  change the position of the head

pressure after surgery such as: approximately every 2 hours

 tense fontanelles  A synthetic sheepskin or silicon pad or an

 increasing head circumference air, water, or alternating air mattress may

 irritability or lethargy help to relieve pressure points

 decreased level of consciousness

 poor sucking ability
 vomiting 4. Deficient knowledge related to home care

 an increase in blood pressure needs of child with hydrocephalus

(difficult to measure accurately in 5. Risk for delayed growth and development

infants unless arterial or umbilical related to potential neurologic challenge

lines are used with Doppler

instrumentation)
Baby Sparrow may be developing increased
 increasing temperature
intracranial pressure.
 decrease in pulse and respiratory
rates What vital sign changes occur with this?
 assess for symptoms of infection such as:
a. Decreased temperature; increased blood
 increased temperature
pressure.
 increased pulse rate
 general malaise b. Increased respirations; decreased pulse rate.
 signs of meningitis such as:
c. Increased temperature; decreased pulse rate.
 a stiff neck
 marked irritability d. Decreased blood pressure; increased

 Be certain a child receives adequate pain temperature.

management, because crying elevates

CSF pressure.

2. Risk for imbalanced nutrition, less than

body requirements, related to increased
intracranial pressure