Nursing Care Plan (NCP) for Hydrocephalus

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Outline

Pathophysiology

Hydrocephalus is a condition where cerebrospinal fluid (CSF) is not absorbed by the brain (non-obstructive) or is unable to drain (obstructive) and builds up inside or around the brain, progressively increasing the pressure on the brain.  Without treatment to relieve this pressure, the patient can suffer from growth and developmental abnormalities. Infants and toddlers with this condition may develop an abnormally large head circumference.

Etiology

Genetic abnormalities and birth defects such as spina bifida and encephaloceles can cause congenital hydrocephalus. Acquired hydrocephalus can result as a complication of head injuries, tumors, or infections such as meningitis. Left untreated, severe brain damage can occur.

Desired Outcome

The patient will have optimal brain function without developmental delays; the patient will be free from injury; the patient will be free from infection

Hydrocephalus Nursing Care Plan

Subjective Data:

  • The rapid increase in head circumference
  • Poor appetite or feeding
  • Headaches
  • Personality changes
  • Difficulty concentrating

Objective Data:

  • Large or oddly shaped head
  • Bulging fontanelles
  • Fussy (infants)
  • Excessive drowsiness
  • Vomiting
  • Seizures
  • Eyes fixed downward (sunsetting) or strabismus

Nursing Interventions and Rationales

  • Assess vital signs hourly per facility protocol
  To monitor for signs of increased intracranial pressure such as tachycardia, shallow breathing, or rapid changes in blood pressure.
  • Assess neurological status, examine pupils
  To monitor for changes in mental status, reflexes, and motor function.  Changes in pupil reaction may indicate altered brain stem functioning.
  • Assess head circumference and fontanelles
  Increasing head circumference and bulging of fontanelles indicates accumulating fluid.
  • Initiate safety and seizure precautions
    • Place an infant or toddler in a crib
    • Keep oxygen and suction at the bedside
    • Keep head of bed elevated
    • Support enlarged head when holding an infant
    • Position the patient on the opposite side of the operation
  • Increased cranial pressure can lead to seizures which may require oxygen supplementation or suction of secretions to clear airway.
  • Elevating the head of the bed promotes CSF drainage and breathing.
  • The weight of an enlarged head increases the difficulty for an infant to hold head upright. Maintain support of the head when holding an infant to prevent head and neck injuries.
  • Following surgery, position the patient to prevent injury to the surgical site, and maintain patency of the shunt.
  • Administer medications appropriately
    • Diuretics
    • Corticosteroids
  • Diuretics can help control the production of CSF in the case of non-obstructive hydrocephalus.
  • Corticosteroids help to reduce inflammation.
  • Prepare patient for surgery/shunt placement
    • Maintain NPO status 2-4 hours before surgery per facility protocol
    • Administer IV fluids
  Patients may undergo surgery to place a Ventriculoperitoneal (VP) shunt that will drain fluid from the brain to the stomach.
  • Encourage frequent bowel movements by providing stool softeners as necessary
  To reduce the risk of increasing cranial pressure due to constipation and straining. More appropriate for toddlers and children than infants.
  • Monitor for signs of infection of the surgical site and prove appropriate wound care
  Prevent localized or systemic infection and prevents the development of sepsis.
  • Provide education for patients and parents/caregivers
  • Encourage parents to practice good hand hygiene to prevent the spread of infection.
  • Teach the importance of safety and to reduce the risk of brain injury.
  • Educate caregivers about warning signs of increased cranial pressure and when to seek medical help after discharge.

Writing a Nursing Care Plan (NCP) for Hydrocephalus

A Nursing Care Plan (NCP) for Hydrocephalus starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

This is the nursing care plan for hydrocephalus. So hydrocephalus is a condition where the CSF is not absorbed by the brain, or it’s unable to drain and builds up inside or around the brain. This progressively increases the pressure on the brain without treatment to relieve this pressure. The patient can suffer growth in developmental abnormalities, infants and toddlers with this condition may develop abnormally large head circumference. So some nursing considerations that we want to be mindful of is we want to do frequent neuro checks. These patients are at risk for seizures. So we also want to make sure that we initiate seizure precautions. We want to administer any medications that are ordered as assess and monitor the intracranial regulation. We want to maintain safety and prevent injury, and we want to maintain fluid balance. The desired outcome for this patient is that this patient will have optimal brain function without developmental delays. And the patient will be free from injury. This patient will also be free from infection. So this patient comes in and this parent tells us, Hey, my child has hydrocephalus. What is some subjective data that you think this parent will tell us? Well, I do think that this parent will say that there was a rapid increase in their child’s head circumference. Maybe they’ll say that the child has a poor appetite, Headaches, personality changes, And they may have some difficulty concentrating. So when we see this, this child, what are we going to notice? Well, we’re going to notice a large or oddly shaped head.

And we’re going to notice the bulging fontanelles. Remember the fontanelles are those soft spots on the head where the skull is closing and fusing. So those should not be bulging. So we’re going to have bulging fontanelles. We’re going to also see infants are fussy and that’s for infants. They’re going to be very fussy. Remember infants tend to communicate by fussing if they have something that’s going wrong with them, there’ll be some excessive drowsiness. And some vomiting. Remember this patient is at risk for seizures. So you may see some seizures and eyes fixed downward, or sunsetting, and we call that sunsetting. So let’s take a look at some of the nursing interventions that we can do. Well, the first thing we want to do when the patient arrives at the hospital is we want to assess their neurological status and examine their pupils. Remember we see these patients and we want to monitor for changes in their mental status and their motor function changes with their pupil reaction may indicate the altered brainstem functioning

All right. The next thing we want to do is we want to assess their head circumference and their fontanelles. Remember, we should not see fontanelle bulgy. We shouldn’t see a rapid increase in head circumference. If, and if the head size is increasing, this is indicating excessive fluid buildup. 

We want to initiate safety as seizure precautions. So these patients are at high risk for a seizure, and we want them to be protected and safe. So we want to monitor the intracranial pressure. We want to protect them from seizures. They may need some oxygen supplementation because of those seizures, but also may need suctioning. So we want to make sure that that is set up at the bedside as well, so we can clear the airway. Okay. The next thing that we want to do is to administer medication. Some medications that we may give the patient are diuretics or water pills. They want to remove the water and we want to administer steroids. Okay? The steroids control the production of CSF. In the case of nonobstructive hydrocephalus, if they are blocked because of any type of inflammation, those corticosteroids are going to help reduce that inflammation. We want to prepare this patient for surgery. This patient, if it is not going to be managed with the medications for the diabetes and the corticosteroids, they are going to prepare for surgery. 

This patient needs to be NPO. So nothing by mouth, nothing by mouth two to four hours prior to the surgery; we want to make sure that we administer IV fluids once they’re NPO. And we want to realize that they may undergo surgery to put a VP drain or ventriculoperitoneal shunt. That’s going to drain fluid from the brain into the stomach. Okay. Let’s look at the key points. So cerebral spinal fluid is not absorbed by the brain. That’s when it’s a nonobstructive hydrocephalus or it’s unable to drain at all. That’s obstructive hydrocephalus that builds up inside or around the brain. Remember some other subjective data that they’re going to present with is they aren’t going to present as poor feeders. They’re going to have rapid rise in the head circumference. Some of the things that we are going to monitor, and we’re going to assess and observe is the objective data that they’re going to be fussy. 

When they’re infants, they’re going to be vomiting. We may observe some seizures. We’re going to see those sunset eyes, those low eyes when they’re focusing downward, and we may see some falls in functionality, what are we going to do for these patients? Well, first we’re going to do frequent neuro checks. So we’re going to do frequent neuro exams, and we’re going to pay close attention to their pupils. Remember any changes with the pupils can indicate that the brainstem has been compromised with this. We’re also going to prepare for surgery. We’re going to keep the patient NPO. We’re going to monitor their EVD or their external ventricular drain. And we’re going to monitor for post op infection and to ensure that the drain is draining properly. We love you guys; go out and be your best self today. And, as always, happy nursing.

 

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