Hydrocephalus is a condition marked by an excessive accumulation of cerebrospinal fluid resulting in dilation of the cerebral ventricles and raised intracranial pressure; may also result in enlargement of the cranium and atrophy of the brain.
There are two types of hydrocephalus: communicating and non-communicating.
Communicating Hydrocephalus:
- It occurs as a result of impaired absorption within the subarachnoid space
- Interference of the cerebrospinal fluid within the ventricular system does not occur
Non-communicating Hydrocephalus:
- It is an obstruction of cerebrospinal flow within the ventricular system.
Signs and Symptoms Hydrocephalus in Infant:
- Increased head circumference
- Macewen’s sign: thin, widely separated bones of the head that produce a cracked-pot sound on percussion
- Dilated scalp vein
- Frontal bossing
- Sunsetting eyes
- Anterior fontanel tense, bulging, and non pulsating
Signs and Symptoms Hydrocephalus in Child:
- Changes of behavior: irritability and lethargy
- Nausea and vomiting
- Headache on awakening
- Ataxia
- Nystagmus
Surgical Intervention:
Surgical intervention of Hydrocephalus is to prevent further CSF accumulation by bypassing the blockage and draining the fluid from the ventricles to a location where it can be reabsorbed. There are two types of surgical intervention: Ventriculoperitoneal Shunt and Atrioventricular Shunt.
- Ventriculoperitoneal Shunt: the CSF drains from the lateral ventricles into the peritoneal cavity.
- Atrioventricular Shunt: the CSF drains into the right atrium of the heart from the lateral ventricle, bypassing the obstruction. It is mostly used in older children and in children with pathological conditions of the abdomen.
Nursing Intervention (post-op)
- Monitor and assess vital signs and neurological signs
- Position client on the un-operated side to prevent pressure on the shunt valve
- Keep the child flat: to avoid rapid reduction of intracranial fluid
- Observe for increased ICP, if ICP is increased, elevate the head of the bed to 15-30 degrees
- Monitor for signs of infections
- Assess dressings for drainage
- Monitor intake and output
- Measure head circumference
- Administer medications as prescribed
- Teach parents how to recognize shunt infection and shunt malfunction
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