hydro

• Hydrocephalus


  • A condition caused by an imbalance in the production and absorption of CSF in the ventricular system
  • When production exceeds absorption, CSF accumulates, usually under pressure, producing dilation of the ventricles

  NORMAL= CHILD= 60-100mL
• Types of hydrocephalus


  • Communicating
  • Noncommunicating
• Communicating hydrocephalus


  • Impaired absorption within the subarachnoid space
  • Interference of CSF within ventricular system does not occur
• Noncommunicating hydrocephalus


  Obstruction of CSF flow within ventricular system
• Hydrocephalus clinical manifestations


  • Abnormal rate of head growth
  • Bulging fontanelle
  • Tense anterior fontanelle (often bulging and non-pulsatile)
  • Dilated scalp veins
  • Macewen's sign ("cracked pot")
  • Frontal bossing
  • Irritability and lethargy with varying LOC
  • Abnormal infantile reflexes
  • Possible cranial nerve damage
  • Setting sun sign
  • Sluggish and unequal pupils
  • Signs of increased ICP: Headache on awakening with improvement following emesis, Papilledema, Strabismus, Ataxia, Large head, Irritability, Lethargy, Apathy, confusion
• Hydrocephalus diagnosis


  1. Level II ultrasonography of the fetus will allow a prenatal diagnosis (Transuterine placement of Ventriculoamniotic shunts during late pregnancy is still being developed as a treatment modality)

  2. Physical examination (HC)

  3. CT scan (diagnose most cases postnatally)

  4. MRI (if complex lesion is suspected)
• Hydrocephalus treatment


  1. Surgical Intervention: VP shunt(from ventricles to peritoneal cavity), VA shunt(right atrium), Ventriculopleural shunt(pleural cavity), Ventriculostomy (non-shunting procedure), Surgical removal of obstruction (if cause is removable such as tumor/ hematoma)

  2. Medication: Acetazolamide
• Hydrocephalus nursing management - preoperative


  • Assess head circumference, fontanelles, cranial sutures, and LOC; check also for irritability, altered feeding habits and a high-pitched cry
  • Firmly support the head and neck when holding the child
  • Provide skin care for the head to prevent breakdown
  • Give small, frequent feedings to decrease the risk of vomiting
  • Encourage parental-newborn bonding
• Hydrocephalus nursing management - postoperative


  • Assess for signs of increased ICP and check for: head circumference (daily), Anterior fontanelle for size and fullness, and behavior
  • Administer prescribed medications which may include antibiotics to prevent infection and analgesics for pain
  • Provide shunt care: Monitor for shunt infection and malfunction, Prevent infection (usually from staphylococcus epidermis or aureus)
  • Monitor for shunt overdrainage (headache, dizziness and nausea)- may lead to slit ventricle syndrome
• Hydrocephalus complications


  • Infections and malfunction (shunt)
  • Subdural hematoma (too rapid reduction of CSF)
  • Peritonitis
  • Abdominal abscess
  • Perforation of organs
  • Fistulas
  • Hernias
  • Ileus