Case Scenerio Hydrocephalus

CHILD HEALTH NURSING
Case Scenario on Hydrocephalus
Master Abdus a 3 months old baby diagnosed with Hydrocephalus presented with c/o progressive
increase in head size, Feeding difficulty , Fast breathing , Irritability . No h/o fever , vomiting,
loose stool, seizure or cyanosis
*Antenatal History
• Ist trimester uneventful, 2 TT doses, iron & folate supplements taken
• 2nd trimester: USG showed dilated lateral ventricles
• 3rd trimester: no fever/ GDM/PIH
*Natal History : born at term, NVD, birth wt : 3.5 kg
*Postnatal History: NICU X 10 days with HIE, sepsis
*Diet : on formula feeds ( not sucking well)
*Immunization: upto date
*Development : social smile 1 month , not attained head control
On Examination
* Vital signs
 HR- 160/Min
 RR – 48/min
 Spo2 – 93%
*On Physical Examination
 Anterior and posterior fontanelle had widen.

 Impaired up gaze(setting sun signs) Dilation of scalp veins
 Hypertonic lower extremities and the face was broadened.
 No other abnormal features were seen.
*Anthropometric measurement
 Occipito frontal Circumference- 49.5cm (normal32-35 cm conclusion ,Hydrocephalus)

 Length 49cm,
 Weight 3.9kg.
*On systemic examination of the central nervous system
 The baby was alert with partial sucking reflex , positive glabellar, rooting, grasp both hand
and plantar, stepping, biceps, triceps, knee, ankle, tendon and moro reflexes.
 The muscle tone was hypertonic.
 On examination of other systems no abnormality was detected.
*Cranial ultrasound scan (US) revealing huge hydrocephalus with bilateral ventriculomegally
merging into one
Management and Treatment
*The baby is kept warm with daily monitor of the respiratory rate , heart rate, temperature,
Hypoxic Ischaemic and Encephalopathy.
*Pharmacologic Management
 Vitamin K 1mg stat

 Cloxacillin 195mg twice a day
 Gentamycin 20mg once a day
 Acetazolamide (Diamox) twice a day
*All for seven days
*The treatment of hydrocephalus is done to shunt the CSF fluid to peritoneum

(ventricoloperitoneal shunting)
REQUIREMENTS:
 Kardex
 Nurses Notes
 Medicine cards
 Investigation chart
 Feeding chart
 Nursing process according to NANDA diagnosis
 Immunization schedule
 Growth and Development:
 Reflexes
 Head to foot examination
 Play therapy and play materials
KARDEX
Sn Nursing care plan

no Medication Dose Route Freq Time
uenc
y Time
1. Vitamin K 1 mg IM Stat  Monitor vital signs hourly. 7 am
Acetazolamide  Assess neurological status and

7:15 am
2 15 mg IV BD 9-9 cranial nerves.
(Diamox)
 Assess the head circumference, 7: 25 am
3. Cloxacillin 195 mg IM BD 9-9 quality and tone of cry.
 Elevate the head of the bed gradually 7:30 am

4. Gentamycin 20 mg IM OD 2pm about 15-45 degrees.
8-
8  Maintain head in neutral position.
 Provide non stimulating environment 8 am

2 and adequate rest.
8:10 am
 Provide oxygen therapy if necessary.
 Assess anxiety for sources and 9 am

intensity.
9:15 am
 Allow expressions of concern and
opportunity to ask questions about
condition and recovery of ill infant.
 Encourage parents to stay with infant 9:30 am

and involve the parents in care of
child.
9:45 am
 Provide information regarding
hospital routines and modalities of
treatment.
 Explain the need for surgery and 10:30 am

clarify the doubts of the parents what
to except before, during and after
surgery.
 Explain the reason for and what to

expect for each procedure or type of
therapy; use drawings and pictures,
videotapes for the child.
 Teach about shunt placement and

reason; possible future revision of
shunt placement, signs and
symptoms of shunt complication or
malfunction.
Name: Master Abbas Age: 3 months
Diagnosis: IP No: 1234

Hydrocephalus
Religion: Muslim Doctor:
TPR & BP Diet: Formula feeding
Kardex
Post-operative:
Nursing care plan Time
S. Medication Dose Route Freq Time
no
 Perform neurologic and vital 2 pm

1 195 IM BD 9-9 assessment every hourly.
Cloxacillin
mg
IM OD 2pm
Gentamycin  Position carefully on non-operative 2:15
2. 20 8
mg - side postoperatively; maintain bed pm
8 position and activity level as ordered
depending on shunt dynamics.
2
 Elevate the head end of the bed
p
m gradually 15-45 degrees.
 Maintain head in neutral

position. 2: 30
pm
 Assess for early signs of increased
ICP
 Monitor skin integrity.
 Support an enlarged head by cradling

it in an arm when holding.
 Place the infant on a pillow when

moving, move head and body of the
infant at the same time.
 Monitor for Postoperative

complications. 4 pm
 Assess for swelling along shunt tract,

inflammatory process, temperature
elevation, increased WBC,
characteristics of drainage on
dressings. 5:30
pm
 Emphasize the parents regarding life

long treatment followup.
 Provide information about referral

agencies for guidance and support.
 Educate parents regarding signs of
infection at the site of surgery and
shunt & notify the physician.
 Teach the parents regarding

principles of asepsis during dressing
Name: Master Abbas Age: 3 months
Diagnosis: IP No: 1234

Hydrocephalus
Religion: Muslim Doctor:
TPR & BP Diet: NPO

NURSES NOTES:
Name: Master Abbas Diagnosis: Hydrocephalus
Age/Sex: 3 months/Male
IP No: 1234
Ward : Pre-operative
Nursing Interventions
Date Diet Time
16/04 Formul  The baby looks alert, partial sucking reflex, hypertonic lower 7 am
/19 a extremities, impaired up gaze, dilation of scalp veins with head high
feeding position of 90 degrees.
 Raised the head end of bed at 30 degrees 7:10 am
 Vitals stable 7: 15 am
 Noted high pitched cry. 7: 30 am
 Head circumference - 49.5 cm, anterior and posterior fontanelle 7:40 am

widened
 Maintained the child’s head in neutral position.
 Adminstered oxygen @ 2LPM through oxygen hood. 8 am
 Maintained non stimulating environment and adequate rest.
 Severe anxiety in parents due to child’s disease condition and impending 9 am

surgery.
 Provided information to parents:

 Treatment for hydrocephalus is the surgical insertion of a drainage
system, called a shunt.
 It consists of a long, flexible tube with a valve that keeps fluid from
the brain flowing in the right direction and at the proper rate.
 One end of the tubing is usually placed in one of the brain's ventricles
and the other end will be placed in the peritoneum of abdomen.
Explained the procedure of shunting for hydrocephalus by using
videotapes for the parents.
 Parents accompanied infant and assisted in care (hold, feed, diaper 11 am

change).
 Taught signs and symptoms of shunt complications or malfunction. 11 am
 Swelling along shunt tract
 Temperature elevation
 Characteristics of drainage on dressings.
 Parents were taken for a visit to post operative ward 11: 30 am
Post-operative Nurses Notes

Name: Master Abbas Diagnosis: Hydrocephalus
Age/Sex: 3 months/Male
IP No: 1234
Ward : Post-operative
Nursing Interventions
Date Diet Time
16/04 NPO  The child is semi conscious, VP shunt patent, IV cath in right foot with 2:10 pm
/19 RL @ 62 drops/ min , 2 LPM through oxygen hood.
 Vitals stable. 2:20 pm
 Noted early signs : irritability, decreased motor performance, sleep loss, 2:30 pm

weight loss.
 Positioned head to neutral position on non operative side . 2: 35 pm
 Maintained bed position at 30 degrees and restricted activity level.
 Position changed 2 hourly.
 Supported an enlarged head by cradling it in an arm when holding and

placed the infant on a pillow when moving.
 Drainage is patent and clear. 3: 30 pm
 Informed parents that follow-up care is after 1 week. 4 pm
 Taught about signs and symptoms of infection of site and shunt tract and
to notify position if noted.
 Swelling along shunt tract

 Redness along the site
 Temperature elevation
 Characteristics of drainage on dressings.
 Informed parents of agencies for guidance and support such as National

Hydrocephalus Foundation.

Case Scenerio Hydrocephalus

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CHILD HEALTH NURSING

Case Scenario on Hydrocephalus

• Ist trimester uneventful, 2 TT doses, iron & folate supplements taken

• 2nd trimester: USG showed dilated lateral ventricles

• 3rd trimester: no fever/ GDM/PIH

*Natal History : born at term, NVD, birth wt : 3.5 kg

*Postnatal History: NICU X 10 days with HIE, sepsis

*Diet : on formula feeds ( not sucking well)

*Immunization: upto date

*Development : social smile 1 month , not attained head control

*On Physical Examination

 Anterior and posterior fontanelle had widen.

 Occipito frontal Circumference- 49.5cm (normal32-35 cm conclusion ,Hydrocephalus)

*On systemic examination of the central nervous system

Management and Treatment

 Vitamin K 1mg stat

*All for seven days

*The treatment of hydrocephalus is done to shunt the CSF fluid to peritoneum

 Nursing process according to NANDA diagnosis

Sn Nursing care plan

1. Vitamin K 1 mg IM Stat  Monitor vital signs hourly. 7 am

Acetazolamide  Assess neurological status and

 Elevate the head of the bed gradually 7:30 am

 Provide non stimulating environment 8 am

 Assess anxiety for sources and 9 am

 Encourage parents to stay with infant 9:30 am

 Explain the need for surgery and 10:30 am

 Explain the reason for and what to

 Teach about shunt placement and

Name: Master Abbas Age: 3 months

Diagnosis: IP No: 1234

TPR & BP Diet: Formula feeding

 Perform neurologic and vital 2 pm

 Maintain head in neutral

 Support an enlarged head by cradling

 Place the infant on a pillow when

 Monitor for Postoperative

 Assess for swelling along shunt tract,

 Emphasize the parents regarding life

 Provide information about referral

 Teach the parents regarding

Name: Master Abbas Age: 3 months

Diagnosis: IP No: 1234

TPR & BP Diet: NPO

Name: Master Abbas Diagnosis: Hydrocephalus

 Raised the head end of bed at 30 degrees 7:10 am

 Noted high pitched cry. 7: 30 am

 Head circumference - 49.5 cm, anterior and posterior fontanelle 7:40 am

 Maintained the child’s head in neutral position.

 Adminstered oxygen @ 2LPM through oxygen hood. 8 am

 Maintained non stimulating environment and adequate rest.

 Severe anxiety in parents due to child’s disease condition and impending 9 am

 Provided information to parents:

 Parents accompanied infant and assisted in care (hold, feed, diaper 11 am

 Parents were taken for a visit to post operative ward 11: 30 am

Post-operative Nurses Notes

 Vitals stable. 2:20 pm

 Noted early signs : irritability, decreased motor performance, sleep loss, 2:30 pm

 Positioned head to neutral position on non operative side . 2: 35 pm

 Maintained bed position at 30 degrees and restricted activity level.

 Position changed 2 hourly.

 Supported an enlarged head by cradling it in an arm when holding and