CASE SCANERIO 2 HYDROCEPHALUS

Torred, Charmaine Grace BSN II- F

Questions:
1. What is hydrocephalus ( Discuss briefly)

Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF)

builds up within the fluid-containing cavities or ventricles of the brain. The
term hydrocephalus is derived from the Greek words "hydro" meaning
water and "cephalus" meaning the head. 
Cerebrospinal fluid normally flows through the ventricles and bathes the
brain and spinal column. But the pressure of too much cerebrospinal fluid
associated with hydrocephalus can damage brain tissues and cause a
range of impairments in brain function.
Hydrocephalus can happen at any age, but it occurs more frequently
among infants and adults 60 and over. Surgical treatment for
hydrocephalus can restore and maintain normal cerebrospinal fluid levels in
the brain. Many different therapies are often required to manage symptoms
or functional impairments resulting from hydrocephalus.

2. what are the common causes of hydrocephalus?

Some cases of hydrocephalus are present at birth, while others develop in

childhood or adulthood. Hydrocephalus can be inherited genetically, may
be associated with developmental disorders,like spina bifida  or
encephalocele, or occur as a result of brain tumors, head injuries,
hemorrhage or diseases such as meningitis. Based on onset, presence of
structural defects or high vs. normal CSF pressures, hydrocephalus can
be divided into categories:

 Acquired Hydrocephalus: This is the type of hydrocephalus that

develops at birth or in adulthood and is typically caused by injury or
disease.
 Congenital Hydrocephalus: It is present at birth and may be caused
by events that occur during fetal development or as a result of genetic
abnormalities.
 Communicating Hydrocephalus: This type of hydrocephalus occurs
when there is no obstruction to the flow of CSF within the ventricular
system. The condition arises either due to inadequate absorption or
due to an abnormal increase in the quantity of CSF produced.
 Non-communication (Obstructive) Hydrocephalus: It occurs when
the flow of CSF is blocked along one of more of the passages
connecting the ventricles, causing enlargement of the pathways
upstream of the block and leading to an increase in pressure within
the skull.
 Normal Pressure Hydrocephalus: It is a form of communicating
hydrocephalus that can occur at any age, but is most common in the
elderly. It is characterized by dilated ventricles with normal pressure
within the spinal column.
 Hydrocephalus Ex-vacuo: It primarily affects adults and occurs
when a degenerative disease, like Alzheimer’s disease, stroke or
trauma, causes damage to the brain that may cause the brain tissue
to shrink.
 CASE SCANERIO 2 HYDROCEPHALUS
Torred, Charmaine Grace BSN II- F

3. Trace the pathophysiology of the disease process using the

schematic diagram.

Predisposing Factors Precipitating Factors

CSF forms in the Choroid plexus

of the lateral ventricles

CSF flows from the foramen of

Monro to the third ventricle

Obstruction in the aqueduct of

Sylvius due to incomplete
formation of the lateral and
medial foramina

Dilatation of the third and

lateral ventricles

Obstruction of CSF flow Increased intraventricular pressure

through the ventricular and dilatation of pathways proximal
system site of obstruction

Ventricles enlarge at the

expend of brain parenchyma

Continued enlargement
disrupts the ventricular lining
and then the underlying white
matter

Increase in water content due to

transpendymal flow of CSF from Bulging and protrution of the eyes;
elevated intraventricular and sunset eyes
intracranial pressure.

Edematous parenchyma
becomes spongy

Interhemispheric fissure
become elongated and thinned
out.

Axonal and myelin destruction.

Expansion of the skull and
thinning and atrophy

Enlarged head, bulging fontanelle, shiny

scalp, dilated scalp veins.
 CASE SCANERIO 2 HYDROCEPHALUS
Torred, Charmaine Grace BSN II- F

Contraction of the
cerebral blood volume

Alteration of the cerebral

circulation.
Irritability, lethargy,
sleepiness, reduced, CSF circulation is altered
activity, drowsiness

Diagnostic Exam

Level II CT Scan
Ultrasonography MRI
 CASE SCANERIO 2 HYDROCEPHALUS
Torred, Charmaine Grace BSN II- F

Non Communicating Congenital

Hydrocephalus

Surgical
Management Complications may arise after
shunting:
Obstruction
a.) Ventricular shunting Overdrainage
b.) Endoscopic Third Infection.
Ventriculostomy
If not treated by the
physician…..
IF TREATED:

- Learning PROGNOSIS
disabilities IF UNTREATED:
- Memory Deficits -Decompensatory
- Psychological mechanism may
Deficits continue to occur
- Motor Skills
Disabilities a. Decreased
- Vision problems Cerebral
- Hearing Perfusion
Difficulties b. Decreased PO2
- Seizures and leading to
- Hormonal hypoxia
imbalances c. Brain Damage

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

The “setting sun” sign is an ophthalmologic phenomenon 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 Bby Susie is scheduled for ventriculoperitoneal shunt?

Because infants with congenital or post hemorrhagic hydrocephalus may

require a ventriculoperitoneal (VP) shunt to divert the flow of cerebrospinal
fluid, thus preventing increase in intracranial pressure.

6. What are the major complications of VP shunt?

 CASE SCANERIO 2 HYDROCEPHALUS
Torred, Charmaine Grace BSN II- F

 Shunt Malfunction
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.
A shunt obstruction from blood cells, tissue or bacteria can occur in any
part of the shunt. Both the ventricular catheter – the portion of the tubing
placed in the brain – and the distal part of the catheter – the tubing that
drains fluid to another part of the body – can become blocked by tissue
from the choroid plexus or ventricles. The distal part of the catheter is more
often blocked in adults.
Shunts are very durable, but their components can become disengaged or
fractured as a result of wear or as a child grows, and occasionally they
dislodge from where they were originally placed. More rarely, a valve will
fail because of a mechanical malfunction.
 Shunt Infection
Shunt infection is usually caused by a person’s own bacterial organisms
and isn’t acquired from other children or adults who are ill. The most
common infection is Staphylococcus Epidermidis, which is normally found
on the surface of a person’s skin and in the sweat glands and hair follicles
deep within the skin. This type of infection is most likely seen one to three
months after surgery, but can occur up to six months after the placement of
a shunt. People with ventriculoperitoneal (VP) shunts are at risk of
developing a shunt infection secondary to abdominal infection. Patients
treated with ventriculoatrial (VA) shunts may develop generalized infection,
which can quickly become serious.
 Subdural Hematoma
Subdural hematoma is a blood clot and is one of the more serious
complications that can occur following insertion of a shunt. The risk of a
subdural hematoma in people with normal pressure hydrocephalus and a
shunt is approximately five to ten percent. Because most shunts drain CSF
from the center of the brain or the ventricles, this may cause the surface of
the brain to pull away from the skull, stretching and tearing blood vessels
from the scalp to the surface of the brain. This is sometimes seen on a CT
scan as a fluid space between the brain and the skull called a hygroma.
Although a hygroma may not have clinical symptoms, it may increase the
risk of hematoma.

7. Formulate 3 nursing diagnosis and nursing interventions with

your rationale after VP shunt

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?
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?
 CASE SCANERIO 2 HYDROCEPHALUS
Torred, Charmaine Grace BSN II- F

10. Baby Susie is receiving Cloxacillin 195 mgs. BID. The stock of
Cloxacillin is 500 mgs dissolved in 4cc of diluent. how many cc will
you inject to the infant?
11. Baby Susie was discharged with VP shunt. What are the important
instructions that should be included in the discharge summary.
 Performed neurologic assessments at least q2h, including the Glasgow Coma Scale,
pupillary response, and strength.
 Allows for continuous monitoring of the patient’s condition and allows for early detection
of complications and capacity for acity for the adaptive response