Time Specific Content Teaching AV Evaluat

objective learning aids -ion

activity

HYDROCEPHALUS

Introduction 
“Hydrocephalus is a condition in which there is excessive fluid accumulation in the
Introduce the Explaining
topic brain.” The word Hydrocephalus derived from two words -hydro means water, cephalus
means head
Definition:-
Define the “is a condition in which portion of the entire ventricular system is abnormally
condition dilated & the CSF has been under increased pressure.” Explaining LCD
Incidence using LCD slides
Sex slides
Enlist the  Bickers adam syndrome
male
incidence  NPH
Age
 Infancy Explaining
 Adulthood (40%)
Mortality and morbidity
 Due to brain herniation and resp. arrest
Related anatomy
CSF circulation & pathway

Discuss the
related Anatomy Explaining
using LCD LCD
slides slides
 Classification and etiology:
A. Depending on the type of block
Identify the Explaining LCD
etiology  Non communicating (block is intraventricular) using LCD slices
¾ Mal development of the aqueduct slides
¾ Obstruction due to mass lesions
¾ Obstruction secondary to exudate , haemorrhage or paracsites
¾ Obstruction of the fourth ventricle outlet foramina- dandy Walker malformation
 Communicating type(block is extra ventricular)
Enumerate the ¾ Post infectious, post hemorrhagic, or developmental adhesions of basal cisterns
classification or surface arachnoid space
¾ Commonly after neonatal meningitis or intra ventricular haemorrhage
¾ Arachnoid villi obstruction by erythrocytes, exudates
¾ Skeletal defects- achondroplasia
B ) depending on the time of presentation
 Congenital hydrocephalus
¾ Intra utrerine infections- TORCH
¾ Congenital malformations of the aqueduct
¾ Congenital midline tumors of CNS
 Acquired hydrocephalus
¾ TB/ Bacterial meningitis
¾ Posterior fossa tumors
Pathophysiology : internal

Discuss the Explaining

pathophysiology using LCD LCD
slides slides
 External hydrocephalus

Explaining LCD
using LCD slides
slides
Discuss the
pathophysiology

Clinical features
¾ Enlargement of the head(speed of enlargement proportional to  ICP ) & small
face
Explaining
Identify the ¾ Sunsetting eye sign using LCD LCD
clinical features ¾ Separation of the sutures & slides slides
¾ widening , fullness of ant. Frontanelle
¾ Prominent scalp vein
¾ Wasting is common with progression of hydro cephalus
¾ CRACK POT RESONANCE(Macewen sign)
¾ Epileptic attack
Diagnosis
¾ Head circumference
¾ Radiographs
Explaining
¾ CT
Enlist the ¾ USG
diagnostic
¾ MRI
measures
 Management :
Goals
¾ To reduce the CSF pressure
¾ To reduce irritability Explaining LCD
¾ To prevent infection using LCD slides
Discuss the slides
goals of medical ¾ To improve nutrition
management ¾ To improve the skin integrity
Medical management
¾ Osmotic diuretic: cerebral edema
¾ Carbonic anhydrase inhibitors: Acetazolamide
¾ Antibiotics
¾ Slightly elevate the head end of the bed to 15º
Stationary or arrested type
¾ No surgical intervention is needed
Progressive type
Discss the Explaining
¾ Site of block should be localised LCD
medical using LCD
management ¾ Repeated lumbar puncture slides slides
¾ Use of Acetazolamine 50-75 mg/kg/day
Expanding lesion
¾ Excision of the tumor
¾ Ventricular tapping
¾ Endoscopic 3rd ventriculostomy
¾ Cauterisation of the choroid plexes
¾ Surgical intervention required
¾ Ventriculoatrial shunt
¾ Ventriculoperitoneal shunt
¾ Ventriculogallbladder shunt
¾ Ventriculoureteric shunt
Complications of shunt
 Outgrows tube length
 Subdural haematoma
 Mechanical failure
  Obstruction
 Over/ under drainage
 Failure of the valve
Enlist the  Perforation Explaining LCD
complications of using LCD slides
 Infections
shunt slides
 Collapse of the ventricular valve
 Other Complications like Physical injury, Delayed growth and development and
Decreased intracranial adaptive capacity
Nursing Nursing Management
Assessment
 Increased HC , usually increases during infancy
 Full ,tense , bulging frontanels
 Widening suture lines
 Distended scalp vein
 Irritability , or lethargy , decreased attention span
 High pitched cry
 Sunset sign
 Inability to support the head when upright
 Cracked pot
Nursing diagnosis Discussing
Discuss the 1. Disturbance in comfort , irritability r/t disaese condition
nursing 2. High risk for respiratory arrest related to increased ICP
management 3. Risk for blockage of the shunt
4. Risk for infection related to the presence of shunt
5. Risk for impaired nutrition r/t poor feeding
6. Risk for complication(seizures)
7. Anxiety
8. Knowledge deficit
9. Altered parental coping
Nursing intervention
Disturbance in comfort , irritability r/t disaese condition
-Provide a quiet environment with less stimuli.
-Advice to use zero watt bulbs to minimize photosensitivity.
 -Avoid too much neck flexion or manipulation.
-Sit near the child and speak in a low ,modulated voice
-Minimal handling of the baby is advised
-Elevate head end to 300 to reduce cerebral oedema
-Monitor TPR every two hourly
High risk for respiratory arrest related to increased ICP
 Check signs of increased ICP
 Assess the respiratory status
 Monitor vital signs every 2 hrly
 Support the child’s head when the child is upright
Risk for blockage of the shunt
Discussing LCD
 Measure HC to aid in diagnosis of hydrocephalus slides
 Monitor vital signs and intake and out put
 Assess neurologic status
Discuss the
 Don’t allow the child to lie on the same side of shunt
nursing
management  Instruct to lay flat to avoid rapid decompression
 Signs of ICP
 Teach parents signs of increasing ICP
Risk for infection related to the presence of shunt
 Observe signs of infection
 Provide proper skin care to the head , turn it frequently
 Monitor signs of infection like elevated W.B.C, E.S.R
 Follow strict aseptic techniques to minimize infection
 Maintain fluid volume through IV therapy
Risk for impaired nutrition r/t poor feeding
-Maintain fluid volume through IV therapy
-Give expressed breast milk
-Provide ryles tube feeding
-Provide soft diet to avoid too much difficulty by mastication
Risk for complication(seizures)
 Educate seizure precautions
 Administer anticonvulsants as prescribed.
 Raise the padded side rails of bed to prevent any falls
 Ensure that injurious toys and instruments are kept at a safer place.
  Monitor the pattern of seizures
 Teach the parents how to use padded spoons to clench between teeth during
seizures
 Provide side-lying position after seizures to prevent aspiration.
 Avoid overcrowding during seizure episode.
 Administer O2 and do suction in case of status epileptics
Anxiety
-provide psychological support to parents
-Be with the child and speak in a low and calm voice
-Ensure the safety of the child in the absence of his parents
-Support family members while explaining about the child’s prognosis
-Provide play articles or transitional objects to the child to avoid boredom and to
make him feel comfortable
Knowledge deficit
- Teach parents signs of increasing ICP
-Educate the family about need calm environment
-Provide them a copy of immunization protocol
-Educate the need for HiB vaccine for unimmunized siblings at home
-Encourage them to clarify their doubts LCD
-Teach them about the disease ,its prognosis and management slides
Discuss the Discussing
Altered parental coping
nursing
management  provide psychological support
 encourage them to verbalise feelings
 advise about supporting agencies
BIBLIOGRAPHY:
1. Wong D.L etal . Essentials Of Paediatric Nursing. 6th edition. Missouri:
Mosby;2001
2. Marlow D.R. Redding B. Textbook of Paediatric nursing. 1st edition.Singapore:
Harwourt Brace & company; 1998
3. Dr.Chaudari KC. Indian Journa of Paediatrics. Nov22 2007
4. Parthasarathy IAP textbook of Paediatrics. 2nd edition. jaypee: NewDelhi; 2002
 LESSON PLAN
TOPIC : HYDROCEPHALUS
SUBJECT : PAEDIATRIC NURSING
GROUP : II YEAR MSc NSG STUDENTS
METHODS : LECTURE CUM DISCUSSION
VENUE : MSc NSG CLASS ROOM
DATE : 23. 06. 2010
STUDENTR TEACHER: Ms. SHESLY P. JOSE
AVAIDS : LCD SLIDES
PREVIOUS KNOWLEDGE:
Students have had classes on convulsion in children in their BSc nsg course
General Objective
On completion of the class the students will be able to understand the disease condition hydrocephalus so as to apply this knowledge in their
future practice with a positive attitude.
Specific objective:
On completion of the class the students will be able to;
1. Define the condition
2. Enlist the incidence
3. Discuss the related Anatomy
4. Identify the etiology
5. Enumerate the classification
6. Discuss the pathophysiology
7. Identify the clinical features
8. Enlist the diagnostic measures
9. Discuss the goals of medical management
10. Discss the medical management
11. Enlist the complications of shunt
12. Discuss the nursing management
 Lesson plan
on
Hydrocephalus
Submitted to: Submitted by:
Ms. G. Laviga Ms. Shesly P . Jose
Lecturer II MSc (N)
NUINS NUINS