1.

What is hydrocephalus ( Discuss briefly)

Hydrocephalus is a condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF)
within the ventricles of the brain. CSF surrounds the brain and spinal cord. When the circulatory path of
the CSF is blocked, fluid begins to accumulate, causing the ventricles to enlarge and the pressure inside
the head to increase, resulting in hydrocephalus.
2. What are the common causes of hydrocephalus?
Causes of hydrocephalus include:
• spina bifida: when a baby's spinal cord does not fully develop
• aqueductal stenosis: when CSF flow between the ventricles inside the brain is blocked
• infection during pregnancy
• complications of prematurity (being born early)
• bleeding in the brain (from a stroke or brain injury)
• a brain tumor
• infection in the brain

3. Trace the pathophysiology of the disease process using the schematic diagram.

4. One of the manifestation of hydrocephalus is "setting-sun' sign. Explain this sign.

The “setting sun” sign is an ophthalmologic phe- nomenon where the eyes appear driven downward
bilaterally. The inferior border of the pupil is often covered by the lower eyelid, creating the “sunset”
appearance. This finding is classically associated with hydrocephalus in infants and children.

5. Why is  Baby Susie is scheduled for ventriculoperitoneal shunt?

Baby Susie is scheduled VP Shunt to drain extra cerebrospinal fluid (CSF) from her brain. CSF is the
fluid that surrounds your brain and spinal cord. It's made in the ventricles (hollow spaces) inside your
brain.
6. What are the major complications of VP shunt?
The most common shunt complications are malfunction and infection as well as subdural hematoma
malfunction and infection as well as subdural hematoma.
• Shunt malfunction is a partial or complete blockage of the shunt that causes it to function
intermittently or not at all. When a blockage occurs, cerebrospinal fluid (CSF) accumulates and
can result in symptoms of untreated normal pressure hydrocephalus.
 • Shunt infection is usually caused by a person’s own bacterial organisms and isn’t acquired from
other children or adults who are ill.
• Subdural hematoma is a blood clot and is one of the more serious complications that can occur
following insertion of a shunt.

7. Formulate 3 nursing diagnosis and nursing interventions with your rationale after VP shunt
Diagnosis
• Risk for Injury related to increased ICP.
• Risk for Impaired Skin Integrity related to pressure from physical immobility.
• Risk for Infection related to the presence of a shunt.

Nursing Intervention
• Preventing injury. At least every 2 to 4 hours, monitor the newborn’s level of
consciousness; check the pupils for equality and reaction; monitor the neurologic status,
and observe for a shrill cry, lethargy, or irritability; measure and record the head
circumference daily, and keep suction and oxygen equipment convenient at the bedside.

• Promoting skin integrity. After a shunting procedure, keep the newborn’s head turned
away from the operative site until the physician allows a change in position; reposition
the newborn at least every 2 hours, as permitted; inspect the dressings over the shunt site
immediately after the surgery, every hour for the first 3 to 4 hours, and then at least every
4 hours.

• Preventing infection. Closely observe for and promptly report any signs of infection;
perform wound care thoroughly as ordered, and administer antibiotics as prescribed.

8. One of the major responsibility of the nurse is to observed for  sign and symptoms of increased
intracranial pressure.  What are the sign/symptoms of increased ICP?
These are the most common symptoms of an ICP:
• Headache
• Blurred vision
• Feeling less alert than usual
• Vomiting
• Changes in your behavior
• Weakness or problems with moving or talking
• Lack of energy or sleepiness

9. Baby Susie has an IVF of D5IMB 500 cc x 40cc/hour started at 8am. What time the IVF will be
due  and how many hours to run?
7:00 am and 12.5 hrs to run
10. Baby Susie was discharged with VP shunt. What are the important instructions that should be
included in the discharge summary.
Continued care is required for the proper healing of a newly placed VP shunt. Caregivers should know
that all visible staples or stitches will be removed within 1 to 2 weeks, and that the head should not be
showered or shampooed until those staples or stitches are removed. The surgical wound should not be
submerged or soaked before it is completely healed. Once the swelling from surgery goes down, a raised
area will remain visible. Parents should be taught to protect these areas and that when the hair grows over,
it is usually unnoticeable. Apart from the initial recovery required after the placement of the VP shunt, the
infant will not have positioning or activity restrictions unless specified by the healthcare provider.