Pediatric Nursing Demystified

Hydrocephalus

What Went Wrong?

Hydrocephalus occurs when there is disruption of circulation and absorp-

tion of CSF resulting in an accumulation of CSF in ventricles of the brain

causing ventricles to dilate and increase intracranial pressure. There are two

types of hydrocephalus:

Noncommunicating hydrocephalus:Caused by an obstruction of CSF flow.

Communicating hydrocephalus:Caused by disruption of CSF absorption.

Signs and Symptoms

Rapidly increasing head circumference in infants

Bulging and widening of fontanels in infants

Underdeveloped neck muscles

Shiny thin scalp

Distended scalp veins

Setting-sun sign where the sclera is above the iris

Irritability

Projectile vomiting

Shrill cry

Anorexia

Weak sucking

Nuchal rigidity

Arnold-Chiari malformation

Test Results

Measure head circumference to detect enlargement.

CT scan: Visualizes the ventricles to determine if the ventricles are dilated.

MRI scan: Visualizes the ventricles to determine if the ventricles are dilated.

Radiograph: Determines if the skull is thinning or widening

Treatment

Surgical removal of or bypass the obstruction using a ventriculoperi-

toneal (VP) shunt that connects the ventricles to the peritoneal cavity or

to the right atrium of the heart.

Administer Tylenol as needed for postoperative pain.

VP shunt infection or malfunction:

• Administer vancomycin IV.


• Administer Tylenol if the temperature is >101.3°F (38.5°C).

Nursing Intervention

Before surgery:

• Measure the head circumference daily and report increases of 0.5 cm
  to the health-care provider.


• Monitor for increase intracranial pressure.

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