INTRODUCTION

Overview:

HYDROCEPHALUS
Hydrocephalus is a term derived from the Greek words "hydro" meaning water, and
"cephalus" meaning head and this condition is sometimes known as "water on the brain".
People with hydrocephalus have abnormal accumulation of cerebrospinal fluid (CSF) in the
ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the
skull and progressive enlargement of the head, convulsion, and mental disability.
Hydrocephalus is usually due to blockage of CSF outflow in the ventricles or in the
subarachnoid space over the brain. In a normal healthy person, CSF continuously circulates
through the brain, its ventricles and the spinal cord and is continuously drained away into the
circulatory system. Alternatively, the condition may result from an overproduction of the CSF
fluid, from a congenital malformation blocking normal drainage of the fluid, or from
complications of head injuries or infections.

Classification
Hydrocephalus can be caused by impaired cerebrospinal fluid (CSF) flow,
reabsorption, or excessive CSF production.
 The most common cause of hydrocephalus is CSF flow obstruction, hindering the
free passage of cerebrospinal fluid through the ventricular system and
subarachnoid space (e.g., stenosis of the cerebral aqueduct or obstruction of the
interventricular foramina - foramina of Monro secondary to tumors, hemorrhages,
infections or congenital malformations).
 Hydrocephalus can also be caused by overproduction of cerebrospinal fluid
(relative obstruction) (e.g., papilloma of choroid plexus).

Based on its underlying mechanisms, hydrocephalus can be classified into communicating

and non-communicating (obstructive). Both forms can be either congenital, or acquired.

Communicating
Communicating hydrocephalus, also known as non-obstructive hydrocephalus, is
caused by impaired cerebrospinal fluid resorption in the absence of any CSF-flow obstruction.
It has been theorized that this is due to functional impairment of the arachnoid granulations,
which are located along the superior sagittal sinus and is the site of cerebrospinal fluid
resorption back into the venous system. Various neurologic conditions may result in
communicating hydrocephalus, including subarachnoid/intraventricular hemorrhage,
meningitis, Chiari malformation, and congenital absence of arachnoidal granulations
(Pacchioni's granulations).
  Normal pressure hydrocephalus (NPH) is a particular form of communicating
hydrocephalus, characterized by enlarged cerebral ventricles, with only
intermittently elevated cerebrospinal fluid pressure. The diagnosis of NPH can be
established only with the help of continuous intraventricular pressure recordings
(over 24 hours or even longer), since more often than not, instant measurements
yield normal pressure values. Dynamic compliance studies may be also helpful.
Altered compliance (elasticity) of the ventricular walls, as well as increased
viscosity of the cerebrospinal fluid, may play a role in the pathogenesis of normal
pressure hydrocephalus.

Main article: normal pressure hydrocephalus

 Hydrocephalus ex vacuo also refers to an enlargement of cerebral ventricles and
subarachnoid spaces, and is usually due to brain atrophy (as it occurs in
dementias), post-traumatic brain injuries and even in some psychiatric disorders,
such as schizophrenia. As opposed to hydrocephalus, this is a compensatory
enlargement of the CSF-spaces in response to brain parenchyma loss - it is not
the result of increased CSF pressure.

Non-communicating
Non-communicating hydrocephalus, or obstructive hydrocephalus, is caused by a CSF-
flow obstruction (either due to external compression or intraventricular mass lesions).
 Foramen of Monro obstruction may lead to dilation of one or, if large enough (e.g.,
in colloid cyst), both lateral ventricles.
 The aqueduct of Sylvius, normally narrow to begin with, may be obstructed by a
number of genetically or acquired lesions (e.g., atresia, ependymitis, hemorrhage,
tumor) and lead to dilatation of both lateral ventricles as well as the third ventricle.
 Fourth ventricle obstruction will lead to dilatation of the aqueduct as well as the
lateral and third ventricles.
 The foramina of Luschka and foramen of Magendie may be obstructed due to
congenital failure of opening (e.g., Dandy-Walker malformation).
 The subarachnoid space surrounding the brainstem may also be obstructed due to
inflammatory or hemorrhagic fibrosing meningitis, leading to widespread dilatation,
including the fourth ventricle.

Congenital
 The cranial bones fuse by the end of the third year of life. For head enlargement to occur,
hydrocephalus must occur before then. The causes are usually genetic but can also be
acquired and usually occur within the first few months of life, which include

1) Intraventricular matrix hemorrhages in premature infants

2) Infections
3) Type II Arnold-Chiari malformation
4) Aqueduct atresia and stenosis, and
5) Dandy-Walker malformation.

In newborns and toddlers with hydrocephalus, the head circumference is enlarged rapidly
and soon surpasses the 97th%. Since the skull bones have not yet firmly joined together,
bulging, firm anterior and posterior fontanel’s may be present even when the patient is in
an upright position.

The infant exhibits fretfulness, poor feeding, and frequent vomiting. As the hydrocephalus
progresses, torpor sets in, and the infant shows lack of interest in his surroundings. Later on,
the upper eyelids become retracted and the eyes are turned downwards (due to
hydrocephalic pressure on the mesencephalic tegmentum and paralysis of upward gaze).
Movements become weak and the arms may become tremulous. Papilledema is absent but
there may be reduction of vision. The head becomes so enlarged that the child may
eventually be bedridden.

About 80-90% of fetuses or newborn infants with spina bifida—often associated with
meningocele or myelomeningocele—develop hydrocephalus.

Acquired
This condition is acquired as a consequence of CNS infections, meningitis, brain tumors,
head trauma, intracranial hemorrhage (subarachnoid or intraparenchymal) and is usually
extremely painful.

Symptoms
Symptoms of increased intracranial pressure may include headaches, vomiting, nausea,
papilledema, sleepiness, or coma. Elevated intracranial pressure may result in uncal and/or
cerebellar tonsill herniation, with resulting life threatening brain stem compression. For details
on other manifestations of increased intracranial pressure:

Intracranial pressure
The triad (Hakim triad) of gait instability, urinary incontinence and dementia is a relatively
typical manifestation of the distinct entity normal pressure hydrocephalus (NPH). Focal
neurological deficits may also occur, such as abducens nerve palsy and vertical gaze palsy
(Parinaud syndrome due to compression of the quadrigeminal plate, where the neural centers
coordinating the conjugated vertical eye movement are located).

Normal pressure hydrocephalus

Effects
Because hydrocephalus injures the brain, thought and behavior may be adversely affected.
Learning disabilities are common among those with hydrocephalus, who tend to score better
on verbal IQ than on performance IQ, which is thought to reflect the distribution of nerve
damage to the brain. However, the severity of hydrocephalus differs considerably between
individuals and some are of average or above average intelligence. Someone with
hydrocephalus may have motivation and visual problems, problems with coordination, and
may be clumsy. They may hit puberty earlier than the average child (see precocious puberty).
About one in four develops epilepsy.

Because the problem resides inside the head, doctors rely heavily upon computer
tomography scanning (CT scans), which may be used frequently to evaluate the condition of
the disorder throughout the patient's life. Each CT scan exposes the patient to many times
the level of x-ray radiation of a chest x-ray. See CT radiation exposure.

Treatment
Hydrocephalus treatment is surgical. It involves the placement of a ventricular catheter (a
tube made of silastic), into the cerebral ventricles to bypass the flow
obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body
cavities, from where it can be resorbed. Most shunts drain the fluid into the peritoneal cavity
(ventriculo-peritoneal shunt), but alternative sites include the right atrium (ventriculo-atrial
shunt), pleural cavity (ventriculo-pleural shunt), and gallbladder. A shunt system can also be
placed in the lumbar space of the spine and have the CSF redirected to the peritoneal cavity
(LP Shunt). An alternative treatment for obstructive hydrocephalus in selected patients is the
endoscopic third ventriculostomy (ETV), whereby a surgically created opening in the floor of
the third ventricle allows the CSF to flow directly to the basal cisterns, thereby shortcutting
any obstruction, as in aqueductal stenosis. This may or may not be appropriate based on
individual anatomy.

NURSING HISTORY
I. PERSONAL DATA:
NAME: "AR"
AGE: 1year and 6 months
DATE OF BIRTH: August 25, 2007
GENDER: Female
NATIONALITY: Filipino
RELIGION: Roman Catholic
ADDRESS: Quezon City

II. CHIEF COMPLAINT: On and off fever for 2 weeks

III. HISTORY OF PRESENT ILLNESS:
The patient's history of present illness revealed that 15 days prior to admission the
patient experienced a sudden onset of loose watery stool (non-bloody, yellowish in color, 10
times of frequent stool of about 1/4 cup). The patient was also noted for fever (low to high
grade intermittent), cough and colds and vomited with worms. The patient was brought up to
a local hospital where the patient was managed to have Pneumonia, Hydrocephalus, T/C
CNS infection where Cefuroxine 35mg was given. On the 8th day prior to admission the
patient is still with fever and LBM but no laboratory examinations were done. With the
continuous LBM of (6-8) and still with fever of 39 C, The patient was advised THOC to be
hospitalized in Manila and travelled from Samar.

The patient was admitted last Sept. 21, 2008 in NCH with an admitting diagnosis of
Persistent diarrhea with no dehydration, Hydrocephalus, T/C Global developmental delay and
Severe Malnutrition.

IV. PAST HEALTH HISTORY:

Past health history revealed the AR was the 5th child of a 38years old female, with full
term and normal in delivery with a duration of labor that lasted for 10 hours and has a face
presentation with a good cry and activity, no cyanosis and jaundice seen but there was a note
of multiple hematoma on the face 2nd degree to delivery and stayed in the hospital for 5 days.
The mother had a prenatal check-up on the 5th month with no complications but on the 6th
months of AOG the mother had UTI.

The nutritional history of the patient revealed that AR was breastfed since birth and
started taking solid foods on the 7th month. AR was fully immunized; she received one (1)
dose of BCG, three (3) doses of Hepatitis B, three (3) doses of DPT, three (3) doses of OPV
and a dose of AMV. AR's mother has first seen her child to smile when she is two month of
age, roll over when she is seven months old, can say the words mama and papa, can only
turn to side and able to walk with support. The patient was diagnosed at the local hospital for
having asthma at the age of four months .

V. FAMILY HISTORY:
 Family history revealed that the patient was in a good state of health when she was
good born. No known allergies. The father of AR has an asthma and her mother is healthy
and only had an infection (UTI) when she’s on the six month of pregnancy.

VI. PERSONAL AND SOCIAL HISTORY:

The patient was one (1) year and six (6) months old, female born on August 25, 2007.
Her father is a pedicab driver and her mother is a housewife. They are presently residing
somewhere in Quezon City. The patient is a shy, irritable, child who usually cry when other
people come to see her and she seldom interact with other people.

At the age of 1year and 6months she still cannot stand or walk without the help from
her mother that is why her learning through communication by means of playing is not that
active.
 VI. Usual Patterns of Daily Living
Before During Hospitalization
Activities
hospitalization Day 1 Day 2 Significance
-complete rest and
sleep pattern is very
important to one
-hours of sleep 8 -Interrupted sleep individual. The
-Interrupted sleep
pm to 3 am pattern due to patient sleep
pattern due to
every hour pattern is
every hour
Rest and sleep Continuous sleep monitoring of v/s continuous but
monitoring of v/s
pattern pattern when she
-with 1-2 times of hospitalized patient
-with 1-2 times of
-with 1-2 times of nap a day sleep pattern was
nap a day
nap a day deprived due to
monitoring of v/s but
her nap is still the
same.
Nutrition 4 meals in a day OF (breastfeeding) Nutrients are
with snack OF (breastfeeding) essential for our
-1 skyflakes body development
Sky flakes -1 skyflakes -1 cup of sopas and maintenance of
Noodles (lucky-1 cup of sopas -1/2 of water health. Our patient
me) -1/2 of water intake of food is
½ of water inadequate and less
breastfeeding than body
requirements.
Elimination
The color of urine
has to do with what
2-3 times a day
2-3 times a day 2-3 times a day is consumed into
Urine light yellow in
light yellow in color light yellow in color the body as well as
color
the hydration status
of the person.
Elimination is the
process of excretion
10 times a day of metabolic waste
2-3 times a day 2-3 times a day
Stool watery stool products. Change in
yellowish in color yellowish in color
greenish in color bowel habits that
persist can be a
serious matter.
Our patient is 1 ½
Total body
Total body hygiene Total body hygiene years of age, so the
hygiene
Hygiene performed by the performed by the body hygiene is
performed by the
mother mother performed by the
mother
mother.
 Theoretical Framework

“Dorothea Orem’’

”Self Care Deficit Theory’’

 Nursing is needed when the self-care demands are
greater than the self-care abilities
 Care is needed when people are affected by
limitations that do not allow meeting their self-care
needs.
 Our Patient can’t perform his own personal
hygiene without assistance so by applying Self-
Care deficit theory we help our patient by assisting
him through his daily morning care.
"Orem's model focuses on each individual's ability to perform self-care, defined as 'the
practice of activities that individuals initiate and perform on their own behalf in maintaining
life, health, and well-being. The basic premise of the model is that individuals can take
responsibility for their health and the health of others. In a general sense, individuals have the
capacity to care for themselves or their dependents.
We choose Dorothea Orem’s theory, she includes three related concepts: self care,
self care deficit and nursing system. Self care theory is based on four concepts: self care, self
care agency, self requisites and therapeutic self care demand. Self care refers to those
activities an individual performs independently throughout life to promote and maintain
personal well being. Self-care agency is the individual’s ability to perform self care activities. It
consists of two agents; a self care agent and a dependent care agent. Most adults care for
themselves whereas infants and people weakened by illness or disability require assistance
with self care activities. Therapeutic self care demand refers to all self care activities required
to meet existing self care requisites or in other words action to maintain health and well being.
Self care requisites also called self care needs are measures or actions taken to provide self
care.

Orem's self-care deficit theory provided a theoretical framework to guide assistance of

a client with myosis to meet self-management requirements. Ideally, the interpersonal
relationship between a nurse and a client contributes to the alleviation of the client's stress
and that of the family, enabling the client and the family to act responsibly in matters of health.
An activated nursing agency yields nursing diagnoses and a plan for self-care of people with
self-care deficits. Nursing agency is the expression of the purpose of nursing, which is to
compensate for or to overcome known or emerging health-associated limitations of clients for
self-care.
Self care deficit results when self care agency is not adequate to meet the known self
care demand. Orem’s self care deficit theory explains not only when nursing is needed but
also how people can be assisted through five methods of helping acting or doing for, guiding,
teaching, supporting and providing an environment that promotes the individual’s abilities to
 meet current and future demand.
CLINICAL APPRAISAL
September 24, 2008
General Physical
Normal Present Condition
Appearance
Skin Smooth and Soft Poor skin turgor
Rounded
(normocephalic)
Head Smooth skull contour Presence of Nodes in the occipital head
Absence of nodule or
masses
Hair evenly distributed,
skin intact
2 mm papillary size
Eyes Eyes brows
Sluggish in reaction to light
systematically aligned,
equal movement
Symmetric and straight
Located symmetrically no flaring of
Nose No discharge and flaring
nostrils.
Not tender and no lesions
Outer lips pink in color
Soft, moist, smooth Pale and dry lips, presence of plaque on
Mouth
texture the teeth
Ability to purse lips
Coordinated, smooth Symmetrically located, movement with full
Neck movements with no range of motion without complaint, lymph
discomfort nodes barely palpated
Chest wall intact, no Wheezing sound
Heart/Lungs
tenderness, no masses
Unblemished skin
Flat rounded (convex) or
scaphoid (concave)
Abdomen Firm and protruded abdomen
No evidence of
enlargement of liver or
spleen
Symmetrical in
Flexes and extends without difficulty.
appearance and
Upper Extremities With IV on right meta carpal
movements are done
With scars on both arms
with ease
Symmetrical in Flexes and extends without difficulty.
Left Extremities appearance and With scars on both legs
movements are done Walk with support
with ease
 COMPETENCIES

CRITERIA ACTUAL OBSERVATION

 The patient can move and walk with
the need of assistance
PHYSICAL  The patient needs assistance in
feeding

EMOTIONAL  The patient cannot understand what

had happened to her

 The patient show interest with the

SOCIAL health care provider by means of
smiling and being cradled.

 The patient wholly depends to divine

being finding peace within oneself by
SPIRITUAL having his rosary and a small booklet
of novena with him
 ANATOMY AND PHYSIOLOGY

Regardless of cause, the fluid accumulates in the ventricles. Compression of the brain by the
accumulating fluid eventually may cause convulsions and mental retardation. These signs occur sooner
in adults, whose skulls no longer are able to expand to accommodate the increasing fluid volume
within. Fetuses, infants, and young children with hydrocephalus typically have an abnormally large
head, excluding the face, because the pressure of the fluid causes the individual skull bones — which
have yet to fuse — to bulge outward at their juncture points. Another medical sign, in infants, is a
characteristic fixed downward gaze with whites of the eyes showing above the iris, as though the infant
were trying to examine its own lower eyelids. Hydrocephalus occurs in about one out of every 500 live
births and was routinely fatal until surgical techniques for shunting the excess fluid out of the central
nervous system and into the blood or abdomen were developed. Hydrocephalus is detectable during
prenatal ultrasound examinations.

Usually, hydrocephalus need not cause any intellectual impairment if recognized and properly treated.
A massive degree of hydrocephalus rarely exists in normally functioning people, though such a rarity
may occur if onset is gradual rather than sudden.
PATHOPHYSIOLOGY
Predisposing Factors Precipitating Factors
Mother has an BABY GIRL AR. 1 year and 6 months
infection during Female
pregnancy (UTI) Fifth Child

Face presentation, BRAIN

Normal delivery

HEMATOMA Accumulated during

delivery

Compression of the Delayed Global

Brain Growth

Compression of
the fourth Ventricle
or the Cerebral
Aqueduct Dilatation of the
Compression of the ventricles
Nervous system

Obstruction of the
Cerebro Spinal
fluid flow

Accumulation of the
fluids in the Brain

HYDROCEPHALUS

NURSING CARE PLAN

Nursing Care plan is an essential part of nursing practice that provides written means of
planning patient care and discharge planning based upon nursing diagnosis. Nursing care
plans functions as a means of communicating patient care needs between members of the
nursing team to ensure those needs are met.

High Priority:

People require the essential nutrients in food for growth and maintenance of all body tissue
and the normal functioning of all body processes. Although people are bombarded with
information about what to eat and what not to eat, each person is responsible for selecting
foods that provide essential nutrients

Moderate Priority:

Altered Growth and development is state in which an individual has or is at risk for impaired
ability to perform task of his or her group impaired growth.

The skills, talent and social involvement develop as individual grows. It should improve during
growing years.

Low priority:

The skin is the largest organ in the body and serves a variety of important functions in
maintaining health and protecting individual from injury. Impaired skin integrity is not a
frequent problem for most healthy people but is a threat to older people.

LABORATORY EXAMINATION
 Clinical Chemistry

Clinical Chemistry Section

Sample type: Serum
TEST VALUE REFERENCE REMARKS SIGNIFICANCE
RANGE
Protein total 53.57 65-80 g/L Low Higher level of protein loss may
mean there is kidney disease.
Glucose 3.57 3.8-6.1 Low This test is most commonly used
mmol/L to screen for possible diabetes.
Albumin 26.73 35-50 g/L Low This test is most often
performed when kidney disease
is suspected.
Globulin 26.84 20-35 g/L Normal Protein is not normally found in
large quantities in the urine.
However, the presence of
albumin can indicate a multitude
of disorders.
A/G ratio 0.99 1.2-2.5 g/L Low A reversed A/G Ratio may be a
helpful indicator with severe liver
cell damage.

Sample type: CSF

TEST VALUE REFERENCE REMARKS SIGNIFICANCE
RANGE
Protein 18.4 8-43 mg/dl Normal Diagnosis of central nervous
tumors and multiple sclerosis.
Glucose 1.98 2.2- Low This test may be done to
3.85mmol/L diagnose tumors, infections,
inflammation of the central
nervous system, delirium, and
other neurological and medical
conditions

Sample type: Urine

CHARACTER NORMAL RESULT SIGNIFICANCE
Color Varying Yellow The color of urine has to do with what is
degrees of consumed into the body like food,
yellow vitamins, toxins.
Transparency Clear Hazy Semen, mucus, and lipid may cause
turbidity in normal urine. Increased
numbers of cells, crystals, casts, or
organisms can increase the turbidity of
urine in disease conditions.
Reaction Usually acidic Alkaline Alkaline urine is caused by increased
alkali excretion or production (decreased
protein catabolism [e.g., low protein diet],
cystitis due to urea-splitting bacteria, and
prolonged storage at room temperature,
metabolic or respiratory alkalosis).
Specific 1.000-1.038 1.005 Specific gravity of urine is a
Gravity measurement of the concentration of
urine. The higher the specific gravity, the
more concentrated urine is.

Sample Type: Feces

CHARACTER NORMAL RESULT SIGNIFICANCE

Color Brown Yellow- Vary significantly in appearance,
orange depending on the state of the whole
digestive system, diet and health.
Consistency Firmed Soft Diet and certain disease can affect
consistency of stools.
Mucus Negative Negative May indicate infection and inflammation
in the GI tract.
Pus Negative Negative May indicate infection and inflammation
in the GI tract.
Test: Complete blood count
TEST REFERENCE RESULT SIGNIFICANCE
VALUES
Hemoglobin M: 140-180 g/L 100 g/L Decreased with anemia; increased when
F: 120-160 g/L too many made and with fluid loss due to
diarrhea, dehydration, burns.
Hematocrit M: .40-.54 0.30
F: .37-.47
WBC count Adult: 5-10 8.0 x109/L May be increased with infections,
@birth: 10-25 inflammation, cancer,leukemia; decreased
1-yr: 0-10 with some medications (such as
methotrexate), some autoimmune
conditions, some severe infections, bone
marrow failure, and congenital marrow
aplasia (marrow doesn't develop normally)
Platelet 150-450 299 x109/L May indicate blood clotting. Decreased or
count increased with conditions that affect
platelet production; decreased when
greater numbers used, as with bleeding;
decreased with some inherited disorders),
with Systemic lupus erythematosus,
pernicious anemia, hypersplenism (spleen
takes too many out of circulation),
leukemia, and chemotherapy.

Differential count
TEST REFERENCE RESULT SIGNIFICANCE
VALUES
Neutrophils 0.40-0.75 0.34 May indicate blood agglutination and
infection. Neutrophils are phagocytes and
will cluster at a site of infection so that they
can eat, or "phagocytose", the foreign
invader.
Lymphocytes 0.20-0.45 0.65 Lymphocytes increase in many viral
infections and certain diseases.
Eusinophils 0.01-0.04 0.01 Increase in the eosinophil count are
allergic reactions such as hay fever,
asthma, or drug hypersensitivity.
 DRUG STUDY
Drug Znso4
 Zinc is an essential mineral that is a component of more
than 300 enzymes needed to repair wounds, maintain
fertility in adults and growth in children, synthesize
Action
protein, help cells reproduce, preserve vision, boost
immunity, and protect against free radicals, among other
functions.
 Caffeine and alcohol may decrease zinc concentrations.
Special Concerns Birth control pills loop and thiaide diurectics may
decrease zinc absorption.
 impair immune function
 stomach ache
 nausea
 mouth irritation
 bad taste
Side effects
 gastrointestinal upset
 metallic taste in the mouth
 blood in the urine
 lethargy

 Caffeine and alcohol may decrease zinc concentrations.

Birth control pills, loop and thiaide diurectics may
decrease zinc absorption.
Drug interaction  Zinc may decrease the plasma concentrations of certain
quinolone and tetracycline antibiotics.

Dosage 20/15 5ml OD (IV)

Nursing Considerations Family teaching:
 Do not take more zinc gluconate than is directed. Taking
zinc gluconate with food may decrease stomach upset.
 Before taking zinc gluconate, tell your doctor if you have
any other medical conditions, allergies, or if you take
other medicines or herbal/health supplements. Zinc
gluconate may not be recommended in some situations.
 Overdose of this drug can cause toxicity.
 Side effects are rare, but if you experience difficulty
breathing, closing of the throat or swelling of the lips
tongue or face or experience hives consult the physician
immediately. 
 Deficiency in Zinc can delay human development during
childhood or adolescence.
 It is an important component of bodily antioxidant
 systems.

Drug Chloramphenicol

 Bacteriostatic effect against susceptible bacteria;

Action prevents cell replication

CNS:
 Headache
 Mild depression
 Delirium
GI:
 Nausea
Side effects  Vomiting
 Glossitis
 Diarrhea
OPTHALMIC:
 Bone marrow
 hypoplasia

Dosage 170mg q6
Assessment:
 history; allergy to drug
 renal hepatic failure
 physical; culture infection
 orientation
 reflexes
Nursing Considerations
Family teaching:
 report sore throat
 tiredness
 unusual bleeding
 numbness
Drug PARACETAMOL
 Treatment of mild to moderate pain & as an antipyretic;
for symptomatic relief of headache, migraine, neuralgia,
Action toothache & teething pains, sore throat, rheumatic
aches & pains, flu, feverishness & feverish cold..

 Limit dose to <4 g/day. May cause severe hepatic

toxicity on acute overdose; in addition, chronic daily
Special Concerns dosing in adults has resulted in liver damage in some
patients. Use with caution in patients with alcoholic liver
disease.
Frequency not defined.
 Dermatologic: Rash
 Endocrine & metabolic: May increase chloride,
uric acid, glucose; may decrease sodium, bicarbonate,
calcium
Side effects
 Hematologic: Anemia; blood dyscrasias (neutropenia,
pancytopenia, leukopenia)
 Hepatic: May increase bilirubin, alkaline phosphatase
 Renal: May increase ammonia, nephrotoxicity with
chronic overdose, analgesic nephropathy
 Decreased effect: Barbiturates, carbamazepine,
hydantoins, rifampin, sulfinpyrazone may decrease
the analgesic effect of acetaminophen; cholestyramine
may decrease acetaminophen absorption
(separate dosing by at least 1 hour)
Drug interaction  Increased toxicity: Barbiturates, carbamazepine,
hydantoins, isoniazid, rifampin, sulfinpyrazone may
increase the hepatotoxic potential of acetaminophen;
chronic ethanol abuse increases risk for acetaminophen
toxicity; effect of warfarin may be enhanced

Dosage 100 ml 0.7 ml q4 P.O.

Nursing Considerations
Administration:
Suppositories: Do not freeze
Suspension, oral: Shake well before pouring a dose

Assessment:
Chewable tablets may contain phenylalanine (amount varies,
ranges between 3-12 mg/tablet); consult individual product
labeling. Assess patient if dizziness, nausea or vomiting
occurs.
 DISCHARGE PLANNING

 Take the prescribe medication on time

Medication  Report adverse reaction immediately to physician
 Avoid skipping medication

 Encourage range of motion and massage of the

Exercise lower extremities. Encourage deep breathing
exercises
 Assist in ambulating. Follow up V/P shunting
Treatment
surgery.

 mobilize support system

 Never leave the patient alone, always assist the
Health Teaching patient in he wants to do.
 Instruct to avoid bedtime foods and beverages
that interfere with sleep

Diet  Give patient nutritious foods

 the patient should come back for consultation, for

Referral follow up check up check up regarding to her
conditions
 OBJECTIVES

 To apply the theoretical knowledge we learned about the pathophysiology and

pharmacotherapeutics to actual clinical practice.

 To fully assess the patients in identifying the actual and potential problems.

 To evaluate the effectiveness of care rendered to the patient.

 To review the anatomy and physiology of the structure involved which is the brain?

 To know the significance of the laboratory findings regarding the situation.

 To understand the pathophysiology of the doctors diagnosis and its possible

complications and to relate with the sign and symptoms manifested by the patient.

 To formulate appropriate nursing intervention and to evaluate the effectiveness of the

nursing care plan.

 To improve critical thinking and communication skills through writing and responding to
case studies and associated questions.
 Case Study
On

Hydrocephalus
In partial fulfillment of the course in
RELATED LEARNING EXPERIENCE – NCM 501201

Submitted to:

Marilyn E. Ofamil, RN, MAN

(Clinical Instructor)

Submitted by:

Maria Janine Baliao

Richard Pierre Salva
Mel Rose Santiago
Alyssa Marie Saycon
Karen Era Serrano
Michael Angelo Serrano
Nelson Simangan Jr.
Jonilyn Tangonan
Jenny Chin Tucino
Wilfredo Uy
Grazielle Althea Yarcia
Jacqueline B. Sanchez - Leader

BSN III – 2

Group 8

First Semester 2008 – 2009

 PROGRAMME

Introduction & Overview---------------------------- Jacqueline Sanchez

Nursing History------------------------------------------ Karen Era Serrano

Theoretical Framework------------------------------ Grazielle Althea Yarcia

Clinical Appraisal -------------------------------------- Maria Janine Baliao

And Competencies Nelson Simangan

Anatomy and Physiology--------------------------- Jacqueline Sanchez

Pathophysiology---------------------------------------- Michael Angelo Serrano

NCP ------------------------------------------------------------ Karen Era Serrano

Jenny Chin Tucino
Alyssa Marie Saycon

Laboratory Examinations------------------------- Wilfredo Uy

Drug Study------------------------------------------------- Mel Rose Santiago

Discharge Planning----------------------------------- Richard Pierre Salva

 College of Nursing
Case Presentation

Name of Panelist: ____________________________________________________________________

Designation/Position: _______________________ Date: ____________________________________

Criteria of Evaluation Percentage Grade

Organization

20%
Accuracy and conciseness /
Grammar
30%
Mastery of the case/ congruency
and appropriateness of each topic
25%
Overall impression / delivery of the
report
25%

Total 100% _______________________

REMARKS: __________________________________

______________________________________________

______________________________________________

___________________________________ __________________________________
Signature over printed CLINICAL INSTRUCTOR
Panelist