Hydrocephalus

  1. General information
    1. Increased amount of CSF within the ventricles of the brain
    2. May be caused by obstruction of CSF flow or by overproduction or inadequate reabsorption of CSF
    3. May result from congenital malformation or be secondary to injury, infection, or tumor
    4. Classification
      1. Noncommunicating: flow of CSF from ventricles to subarachnoid space is obstructed.
      2. Communicating: flow is not obstructed, but CSF is inadequately reabsorbed in subarachnoid space.
  2. Assessment findings: depend on age at onset, amount of CSF in brain
    1. Infant to 2 years: enlarging head size; bulging, nonpulsating fontanels; downward rotation of eyes; separation of cranial sutures; poor feeding, vomiting, lethargy, irritability; high-pitched cry and abnormal muscle tone
    2. Older children: changes in head size less common; signs of increased ICP (vomiting, ataxia, headache) common; alteration in consciousness and papilledema late signs
    3. Diagnostic tests
      1. Serial transilluminations detect increases in light areas
      2. CT scan shows dilated ventricles as well as presence of mass; with dye injection shows course of CSF flow
  3. Nursing interventions: provide care for the child with increased ICP and for the child undergoing shunt procedures.

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