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I. Introduction
Hydrocephalus or "water on the brain." is a build-up of fluid inside the skull, leading to brain swelling, and ventriculoperitoneal shunt is a basic part of its treatment. Hydrocephalus is due to a problem with the flow of cerebrospinal fluid (CSF), the liquid that surrounds the brain and spinal cord. The fluid brings nutrients to the brain, takes away waste from the brain, and acts as a cushion.
CSF normally moves through areas of the brain called ventricles, then around the outside of the brain and the spinal cord. It is then reabsorbed into the bloodstream. Buildup of CSF can occur in the brain if its flow or absorption is blocked or if too much CSF is produced. This build-up of fluid puts pressure on the brain, pushing the brain up against the skull and damaging or destroying brain tissues.
Hydrocephalus may start while the baby is growing in the womb. It is commonly present with myelomeningocele, a birth defect involving incomplete closure of the spinal column. Genetic defects and certain infections that occur during pregnancy may also cause hydrocephalus. In young children, hydrocephalus may also be associated with the following conditions: Infections that affect the central nervous system (such as meningitis or encephalitis), especially in infants, bleeding in the brain during or soon after delivery (especially in premature babies), injury before, during, or after childbirth, including subarachnoid hemorrhage, tumors of the central nervous system, including the brain or spinal cord, Injury or trauma.
The goal of ventriculoperitoneal shunting is to reduce or prevent brain damage by improving the flow of CSF.
The blockage may be surgically removed, if possible. If the blockage cannot be removed, a shunt (flexible tube) may be placed within the brain to allow CSF to flow around the blocked area. The shunt tubing travels to another part of the body, such as the abdomen, where the extra CSF can be absorbed. This procedure is done in the operating room under general anaesthesia. It takes about 1 1/2 hours. The child's hair behind the ear is shaved off. A surgical cut in the shape of a horseshoe
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(U-shape) is made behind the ear. Another small surgical cut is made in the child's belly. A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain. Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity. Sometimes, it goes to the chest area. The doctor may make a small cut in the neck to help position the catheter. A valve (fluid pump) is placed underneath the skin behind the ear. The valve is attached to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure. The valves in newer shunts can be programmed to drain more or less fluid from the brain.
As Nurses, one should always be updated with current procedures, treatment, and management applied in the clinical setting. One should be well informed in advances in the field since this can be used in fulfilling the role of a Nurse as a Health Educator. An In-depth study of this procedure should be advocated by the Nurses since they are also involved in the Procedure. As a member of the Health team and a member of the sterile team, it is important to be well educated and well informed not only in skills but also in theory during practice since one is dealing with life. . Research in this area can help shed light into the workings of the disease, the predisposing factors, impact on the morbidity and mortality rates and the measures taken by the health care team in the treatment and control of the condition.
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AnatomyCerebrospinal fluid or CSF surrounds the brain and spinal cord. This clear fluid
serves to cushion and protect the brain and spinal cord. CSF is produced in an area of the brain, flows around the brain through special channels, and then is absorbed in another location of the brain. Any blockage of the channels can result in fluid buildup, or hydrocephalus.
Brain AnatomyThe brain is well protected by:
The scalp The skull The dura
o A tough 3-layer sheath that surrounds the brain and spinal cord
o Layers include the dura mater (strongest layer), arachnoid mater (middle layer), and pia mater (closest to the brain)
The brain is a complicated structure containing many parts. These include:
The cerebrum:o Made up of two cerebral hemispheres that are connected in the middle o It is the largest part of the brain o Each area of the cerebrum performs an important function, such as
language or movement o Higher thought (cognition) comes from the frontal cortex (front portion of
the cerebrum)o Outside of the cerebrum are blood vessels o There are fluid-filled cavities and channels inside the brain o
The cerebellum:o Located in the lower, back part of the skull
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o Controls movement and coordination
The brainstem and pituitary gland:o Responsible for involuntary functions such as breathing, body temperature,
and blood pressure regulation o Pituitary gland is the "master gland" that controls other endocrine glands in
the body, such as the thyroid and adrenal glandsThe cranial nerves:
o Twelve large nerves exit the bottom of the brain to supply function to the senses such as hearing, vision, and taste
The cerebral blood vessels:o A complicated system that supplies oxygenated
blood and nutrients to the brain
The blood supply to the brain is divided into two main parts:
Anterior cerebral circulation:o The front of the brain is supplied by the paired carotid arteries in the neck.
Posterior cerebral circulation:
The back portion of the brain is supplied by the paired vertebral arteries in the spine.
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Hydrocephalus is 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.
It is a term derived from the Greek words “hydro” meaning water, and “cephalus” meaning head, and this condition is sometimes known as “water on the brain”.
People with hydrocephalus have abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, and mental disability.
Usually, hydrocephalus does not cause any intellectual disability if recognized and properly treated. A massive degree of hydrocephalus rarely exists in typically functioning people, though such a rarity may occur if onset is gradual rather than sudden.Hydrocephalus occurs with a number of anomalies, such as NTD’s.
Etiology:Congenital hydrocephalus usually results from defects, such as Chairi
malformations. It is also associated with spina bifida.Acquired hydrocephalus usually results from space-occupying lesions,
hemorrhage, intracranialinfections or dormant development defects.
People with hydrocephalus have abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. This may cause increased
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intracranial pressure inside the skull and progressive enlargement of the head, convulsion, and mental disability.Usually, hydrocephalus does not cause any intellectual disability if recognized and properly treated. A massive degree of hydrocephalus rarely exists in typically functioning people, though such a rarity may occur if onset is gradual rather than sudden.Hydrocephalus occurs with a number of anomalies, such as NTD’s.
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PATHOPHYSIOLOGY
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Choroid Plexuses of the Lateral Ventricles
CSF Formation
Impaired Absorption of CSF within the Arachnoid Space
(communicating hydrocephalus)
Obstruction to the flow of CSF through the ventricular system
(non-communicating hydrocephalus)
Increased ICP
Dilation of the pathways proximal to the site of obstruction
Abnormal increase in volume of CSF
Enlargement of the head in infancy
III. CLINICAL INTERVENTION
1.1 Description of prescribed surgical treatment performed
Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus).
Description
This procedure is done in the operating room under general anesthesia. It takes about 1 1/2 hours.
The child's hair behind the ear is shaved off. A surgical cut in the shape of a horseshoe (U-shape) is made behind the ear. Another small surgical cut is made in the child's belly.
A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain.
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Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity. Sometimes, it goes to the chest area. The doctor may make a small cut in the neck to help position the catheter.
A valve (fluid pump) is placed underneath the skin behind the ear. The valve is attached to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure.
The valves in newer shunts can be programmed to drain more or less fluid from the brain.
THE PROCEDURE
Position of the child is important to correctly implant the shunt. The head is turned sharply to the left to accommodate a right occipital placement. The burr hole is placed approximately 4 cm up from the inion and 3-4 cm off the mid-line. This occipital placement allows a relatively straight shot into the body of the ventricle so that the shunt catheter is mostly within it. This trajectory avoids the risk of going too low, through the internal capsule, which can happen with shunt placement sites that are more lateral and inferior.
An adequate length of ventricular catheter needs to be selected to place the tip anterior to the foramen of Munroe, where there is less choroid plexus. This is to lessen the risk of occlusion. Generally, a 6 cm catheter is used in a small newborn; an 8 cm catheter in an older infant and young child; and a 10 cm catheter is used in a children 18 months or older. Perioperative antibiotics can be used, though definitive data showing that this is mandatory is lacking.
The shoulder blades should be raised to elevate the chest and neck, and allow for a straight passage of the shunt passer with no secondary incisions between the head and the abdomen. The abdominal incision is a horizontal incision, either just below the rib cage or just lateral to the umbilicus. Once the shunt is laid in position, the dura is opened with a pinpoint cautery to have just a big enough opening to allow the passage of the catheter (a large dural opening can allow CSF to flow around the shunt and cause a subcutaneous fluid collection). The ventricle is tapped using a rigid brain cannula and, once a good flow of CSF has been obtained, the ventricular catheter is fed into the ventricle through this tract. This is done without a stylette.
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Fluid should then be aspirated from the lower end of the shunt, to insure that the valve system is opened, and then it should then be placed into the peritoneal cavity. A large amount of tubing can be placed in the peritoneal cavity, even enough to allow for full growth of the child. 15-20" of peritoneal catheter is usually inserted at the same time as the initial shunt placements.
Risks
Risks for any anesthesia are:
Reactions to medications Problems breathing
Changes in blood pressure or breathing rate
Risks for any surgery are:
Bleeding Infection
Possible risks of ventriculoperitoneal shunt placement are:
Blood clot or bleeding in the brain Brain swelling
The shunt may stop working and fluid will begin to build up in the brain again.
The shunt may become infected.
Infection in the brain
Damage to brain tissue
Seizures
1.2 Indication of prescribed surgical treatment
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The procedure is indicated for people with hydrocepahalus. In hydrocephalus, there is a buildup of fluid of the brain and spinal cord (cerebrospinal fluid or CSF). This buildup of fluid causes higher than normal pressure on the brain. Too much pressure, or pressure that is present too long, will damage the brain tissue.
A shunt helps to drain the excess fluid and relieve the pressure in the brain. A shunt should be placed as soon as hydrocephalus is diagnosed.
1.3 Required instruments, devices, supplies, equipment and facilities
The Operating Room
Surgical Drill
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Used to created a burr hole.
Dissecting Instruments
In the first part of the surgery, incisions are made with dissectors, which are either sharp
or and are used to make precise incisions, the most well know example being the
scalpel. Blunt instruments, such as the elevator or the curette are mostly used to scrape
tissues.
Clamps
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After the incision is made, the surrounding skin is clamped with the use of forceps or
clips. These instruments are also used to hold not only tissues, but also other
instruments.
Cauterization
An electrocautery machine is used to remove lesions and tissues that are highly
vascularized. The machine reduces the risk of bleeding, sealing off blood vessels by
using high frequency electric currents to instantly stop bleeding.
e. Suction
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Oozing of blood and other fluids are inevitable in a surgical procedure, including
a ventriculoperitoneal shunt procedure. The suction machine is tied to a container
where the loss of fluid can be measured and monitored during the procedure.
f. Sutures, Staples, Needles
Closure of the incision site occurs after the procedure. The needles, along with the
sutures are used to properly close the site. Sutures can be absorbable or non-
absorbable. Staples, however, are used frequently nowadays to speed up the surgery
and reduce the chance of infection due to an open wound
g. Drains
Before surgical closure, a drain is attached to the site to remove the remaining fluid left
over from the procedure. It also allows the medical personnel to monitor the amount of
bleeding during the post-operative phase. Its drainage also helps a physician determine 14
if an infection is developing or healing. Removal of the drains is the prerogative of the
surgical team, which usually leave it in place for five to six post-operative days.
1.4 Perioperative tasks and responsibilities of the Nurse
PRE-OPERATIVE CARE
Preparing the operating theatre
Ensure that:
the operating theatre is clean (it should be cleaned after every procedure)
necessary supplies and equipment are available, including drugs and an oxygen
cylinder
emergency equipment is available and in working order
there are adequate supply of theatre dress for the anticipated members of the
surgical team
clean linens are available
sterile supplies (gloves, gauze, instruments) are available and not beyond expiry
date
Surgical handscrub
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Remove all jewelry.
Hold hands above the level of the elbow, wet hands thoroughly and apply soap
(preferably an iodophre, e.g. betadine).
Begin at the fingertips and lather and wash, using a circular motion:
Wash between all fingers;
Move from the fingertips to the elbows of one hand and then repeat for the
second hand.
Wash for three to five minutes
Rinse each arm separately, fingertips first, holding hands above the level of the
elbows.
Dry hands with a clean or disposable towel, wiping from the fingertips to the
elbows, or allow hands to air dry.
Ensure that scrubbed hands do not come into contact with objects (e.g.
equipment, protective gown) that are not high-level disinfected or sterile. If the
hands touch a contaminated surface, repeat surgical handscrub.
INTRA OPERATIVE CARE
Assist in the sterile gowning and gloving of the surgeon and his or her assistant.
Prevent injury to the patient by removing heavy or sharp instruments from the
operative site as soon as the surgeon has finished using them.
Constantly be alert to any intraoperative dangers to the patient.
Take part in sponge, needle, and instrument counts, as needed. All of these
items must be accounted for during the procedure. The technologist takes part in
counting the items before, during, and after surgery to ensure that they are not
left in the wound. The count is done in an orderly way and is performed using
accepted technique.
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Properly identify and preserve specimens received during surgery. The
technologist is responsible for maintaining the specimens in a prescribed manner
so that the material can be subsequently examined by the pathologist.
Anticipate the needs of the surgeon by watching the progress of the surgery and
knowing the various steps of the procedure. He or she passes instruments and
other supplies in an acceptable manner so that the surgeon does not have to turn
away from the wound site to receive them.
Assist the surgeon by tissue retraction, suture cutting, fluid evacuation, or
sponging the wound when asked to do so.
At the end of the procedure, assemble all instruments and supplies and prepare
them for decontamination and resterilization and assist in the safe clean-up of the
operating suite following Universal Precautions.
POST OPERATIVE CARE
At the recovery room, the nurse will monitor the blood pressure, pulse and
breathing of the patient
Place a dressing (bandage) over the surgery site
Provide instructions on how to care for the patient at home, including taking care
of the incision and drains, recognizing signs of infection and understanding
activity restrictions
Talk to the patient about when to resume wearing a bra or wearing a breast
prosthesis
Give prescriptions for pain medication and possibly an antibiotic
Remind the patient to meet with her doctor a week or two after surgery. The
drainage tubes will likely be removed at that time.
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1.5 Expected outcomes of surgical treatment performed
Shunt placement is usually successful in reducing pressure in the brain. But if hydrocephalus is related to other conditions, such as spina bifida, brain tumor, meningitis, encephalitis, or hemorrhage, these conditions could affect the prognosis. The severity of hydrocephalus present before surgery will also affect the outcome.
Support groups for families of children with hydrocephalus or spina bifida are available in most areas.
The major complications to watch for are an infected shunt and a blocked shunt.
The patient will need to lie flat for 24 hours the first time a shunt placed. After that your child will be helped to sit up.
The usual stay in the hospital is 3 to 4 days.The doctor will check vital signs and neurological status often. Your child may get medication for pain. Intravenous fluids and antibiotics are given. The shunt will be checked to make sure it is working properly.
1.6 Medical management of physiologic outcomes
Pain Management
People experience different types and amount of pain or discomfort after surgery.
The goal of pain management is to assess the level of discomfort and to take
medication as needed. The patient will be given a prescription for analgesics for the
management of moderate pain. It is recommended to take medication for pain when
pain is experienced on a regular schedule. Ibuprofen (Advil) can be added to or replace
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the analgesic. Everyone is different and if one plan to decrease pain is not working, it
will be changed. Healing and recovery improve with good pain control.
An icepack may also be helpful to decrease discomfort and swelling.
Incision and Dressing Care
Incision, or scar, has both stitches and steri-strips, which are small white strips of
tape, and is covered by a gauze dressing and tape or a plastic dressing. Advise the
patient not to remove the dressing, steri-strips or stitches. The nurse will remove the
dressing in seven to 10 days. The nurse will also remove the sutures in one to two
weeks unless they absorb on their own. If the dressing or steri-strips fall off, tell the
patient not to attempt to replace them.
Educate patient that bruising and some swelling are common after surgery. Also,
a low-grade fever that is below 100 degrees Fahrenheit is normal the day after surgery.
A home care nurse may be assigned to check your progress at home.
Activity
Inform patient to avoid strenuous activity, heavy lifting and vigorous exercise until
the stitches are removed. Walking is a normal activity that can be restarted right away.
Recommend exercises to regain movement and flexibility. Most people return to work
within three to six weeks.
Diet
The patient may resume regular diet as soon as you can take fluids after
recovering from anesthesia. Encourage to drink eight to 10 glasses of water and non-
caffeinated beverages per day, plenty of fruits and vegetables as well as lower fat
foods.
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NURSING CARE PLAN
Deficient knowledge related to client and family understanding of the preoperative, operative, and postoperative phases of ventriculoperitoneal shunt
Assessment Nursing Diagnosi
s
Scientific Explanation
Planning NursingInterventions
Rationale Evaluation
S> “Napansin ko nahindi normal anglaki ng ulo nganak ko” asverbalized by themother.
O> the patient may manifest:
Deficient knowledge related to client and family understanding of the preoperative, operative, and postoper
Due to its complicated procedure, the parents of such patients who undergo this surgery may have many misconception and lack of information which leads to deficient knowledge of
After 4 hours of nursing interventions, the family will be able to participate in learning process and exhibit increased interest/ assume responsibilit
>Establish rapport
>Assess patient’s general condition
>Monitor and record vital signs
>Obtain baseline neurologic assessment:
a. Motor and sensory
>To gain the trust and cooperation of the patient
>To obtain base line data
>To obtain baseline data
>Establishes baseline motor and sensory function for later comparisons, determines level of
Short-term:
The family shall have participated in learning process and exhibited increased interest/ assumed responsibil
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- RestlessnessIrritability
-Changes in VS
-verbalization of misconceptions about the surgery of So
ative phases of ventriculoperitoneal shunt
the family. y for own learning by beginning to look for information and ask questions
Long-term:
After 3-5 days of nursing interventions, the client and family will be able to have sufficient knowledge regarding the surgical procedure, preoperativ
function
b. Psychological readiness
>Discuss activity limitation
>Review pain management
>Discuss proper wound care
ability and knowledge
>Prevents damage to surgical site
>To gain knowledge on treating / managing postoperative pain
> to provide non pharmacologic interventions to alleviate pain
>To prevent
ity for own learning by beginning to look for information and ask questions
Long-term:
The family shall have sufficient knowledge regarding the surgical procedure, preoperative preparations, and
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e preparations, and the postoperative precautions and needs to be able to prevent the development of complications
>Discuss changes in home environment:
occurrence of infection
>Anticipate home care needs
the postoperative precautions and needs to be able to prevent the development of complications
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Risk for infection secondary to surgical incision
Assessment Nursing Diagnosis
Scientific Explanation
Planning NursingInterventions
Rationale Evaluation
S> Ø
O>the patient may manifest:
-increased body temperature
-increased WBC
-inflammation in the surgical
Risk for infection secondary to surgical incision
The skin considered as the first line of defense against any foreign organism when surgical procedure impaired the skin, possible entry of microorganism therefore may cause infection
Short term:After 4 hours of nursing interventions, the patient will identify and demonstrate intervention to prevent infection
Long term:
After 3-5 days of nursing intervention the patient will
>Establish rapport>Monitor V.S.
>Note signs and symptoms of sepsis
>Provide wound healing such as cleaning of wound
>Provide care, change dressing as needed
>To gain trust>To obtain baseline data
>To reduce complication and monitor for infection
>To reduce risk for infection
>To promote healing to the incision
>to prevent occurrence of
Short term:The patient identified and demonstrated interventions to prevent risk of infection
Long-term:
the patient shall have achieved timely wound healing without developing infections
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incision
-bleeding in the surgical incision
achieve timely wound healing without developing infections
Prevent stress on incision line, cleanse site daily as ordered, and apply dry, sterile dressing
> emphasize importance of proper hygiene and wound care
>Encourage ongoing nutritional needs
> Emphasize necessity of taking antibiotics to s.o as directed
infection
>To prevent infection to increase immune resistance
>To increase healing of wound
> Premature discontinuation of treatment when client begins to feel well may result in return of infection
>To prevent occurrence of
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> Administer prophylactic antibiotics as ordered
infection
Decreased Intracranial Adaptive Capacity r/t Space- Occupying Lesion secondary to reoccurrence of fluid accumulation due to shunt defect.
Assessment Diagnosis Scientific Explanation
Planning Nursing Interventions
Rationale Expected Outcome
S>Ø Decreased Complications Short term: >Establish >To gain the client The SO shall
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O> the pt. manifested the ff.
-Altered mental status-Speech abnormalities-Restlessness-Changes in mental state AEB (-) pupil reaction to light, flexion on pain, no verbal
Intracranial Adaptive Capacity r/t Space- Occupying Lesion secondary to reoccurrence of fluid accumulation due to shunt defect.
of ventriculoperitoneal shunting can occur. Some patients may experience blood clot or bleeding in the brain, swelling and infection in the brain, brain tissue damage, reoccurrence of fluid build up in the brain because the shunt may also stop working, the shunt may
After 1-2° of NI the SO will be able to understand the client’s condition and be able perform actively in promoting the clients condition having now a higher level of understanding of the client’s condition and complications that may occur.
rapport
>Monitor VS.
>Monitor/document changes in ICP waveform and responses to stimuli.
>Assess eye opening and position/movement, Pupils (size, equality, light reactivity), purposeful and non-purposeful motor response comparing left and right sides, presence of
and SO’s trust.
>To obtain data for comparison.
>To alter care appropriately.
> To note degree of impairment
>To increase SO’s understanding of
have understand the client’s condition and be able perform actively in promoting the clients condition having now a higher level of understanding of the client’s condition and complications that may occur.
The client shall have demonstrated stable ICP AEB
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response. also become infected and seizures may occur.
Intracranial pressure, (ICP), is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brain's circulating blood volume. ICP is a dynamic phenomenon constantly fluctuating in
Long term:
After 6-7 days of NI the client will be able to demonstrate stable ICP AEB normalization of pressure waveforms/response to stimuli.
reflexes, nuchal rigidity, consciousness and mental state.
>Provide information about the client’s condition including the complications which may arise once untreated
>Elevate HOB and maintain head/neck in midline/neutral position
>Decrease
the client’s condition and will be able to decide properly for the client’s care.
>To promote circulation/venous drainage
>To reduce CNS stimulation and promote relaxation.
>To decrease factors which may contribute in further increasing ICP.
>To pharmacologically manage client’s
normalization of pressure waveforms/response to stimuli.
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response to activities such as exercise, coughing, straining, arterial pulsation, and respiratory cycle. An increase in pressure, most commonly due to head injury leading to intracranial hematoma or cerebral edema can crush brain tissue, shift brain structures,
extraneous stimuli/provide comfort measures
>Limit activities that increases intrathoracic/abdominal pressure
>Administer medications as ordered (e.g. antihypertensives, diuretics, analgesics, antipyretics, vasopressors, antiseizure, neuromuscular blocking agents, and
condition and maintain homeostasis
>To reduce ICP and enhance circulation
>To have a continuous client’s care
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contribute to hydrocephalus, cause the brain to herniate, and restrict blood supply to the brain, leading to an ischemic cascade. If left untreated the patient may result to coma or worst death.
corticostreiods)
>Prepare pt. for surgery as indicated (Space Occupying Lesion)
>Refer accordingly
Impaired skin integrity related to surgical incision 2˚ ventriculoperitoneal shunting
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ASSESSMENTNURSING
DIAGNOSISSCIENTIFIC
EXPLANATIONOBJECTIVES
INTERVENTIONS
RATIONALEEXPECTED OUTCOME
S: Ø
O: The patient manifests:
>Surgical incision on head
The patient may manifest:
>redness>heat on incision
>inflammatory process
Impaired skin integrity related to surgical incision 2˚ ventriculoperitoneal shunting
Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus). The procedure is done by shaving the hair behind the ear, then a surgical cut in the shape of a horseshoe (U-shape) is made behind the ear and another small surgical cut is made in the child's belly. A small hole
SHORT TERM:
After 4 hours of nursing interventions, patient’s SO will be able to understand and participate in prevention measures and treatment program for the pt
>Establish rapport
>Assess vital signs
>Monitor Intakeand output.Weigh asindicated. Noteskin turgor,status, andmucousmembrane.
> Maintain head or
>To gain trust
>To obtain baseline data
>Usefulindicators ofbody water,which is anintegral part oftissueperfusion.
> Turning bed toone sidecompresses
SHORT TERM:
The patient’s SO shall have understand and participated in prevention measures and treatment program for the pt.
LONG TERM:
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is drilled in the skull and a catheter is passed into a ventricle of the brain. Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity.
LONG TERM:
After 6 days of nursing interventions, the patient will be able to achieve timely healing of surgical incision.
neck in midline orin neutralposition, supportwith small towelrolls and pillows.Avoid placinghead on largepillows.
>Identify underlying condition involved
>Periodically assess skin and observe
the jugularveins andinhibitscerebralvenousdrainage thatmay cause ONCREASED icp
>To determine cause of impairment
>To monitor progress of wound healing
The patient shall have achieved timely healing of surgical incision.
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for possible complications
>Keep the area clean/dry, perform proper wound care, support incision
>Use appropriate barrier dressings and wound coverings, skin-protective agents for open/draining
>To assist body’s natural process of repair
>To protect the wound and/or surrounding tissues
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wounds and stomas
>Encourage to increase oral fluid intake
>Promote importance of proper nutrition of pt
>To boost immune system and enhance skin turgor
>To boost immune system and address ongoing nutritional needs of pt .For tissue repair to achieve timely healing
>Promotes
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> Elevate the headof bed graduallyto 15-30 degreesas tolerated orindicated.
venousdrainage fromhead, reducingcerebralcongestion andedema andincreased ICP.
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CONCLUSION:
Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus).
Hydrocephalus may start while the baby is growing in the womb. It is commonly present with myelomeningocele, a birth defect involving incomplete closure of the spinal column. Genetic defects and certain infections that occur during pregnancy may also cause hydrocephalus. In hydrocephalus, there is a build-up of fluid of the brain and spinal cord (cerebrospinal fluid or CSF). This build-up of fluid causes higher than normal pressure on the brain. Too much pressure, or pressure that is present too long, will damage the brain tissue
A shunt helps to drain the excess fluid and relieve the pressure in the brain. A shunt should be placed as soon as hydrocephalus is diagnosed. The procedure is done by shaving the hair behind the ear, then a surgical cut in the shape of a horseshoe (U-shape) is made behind the ear and another small surgical cut is made in the child's belly. A small hole is drilled in the skull and a catheter is passed into a ventricle of the brain. Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity. Sometimes, it goes to the chest area. The doctor may make a small cut in the neck to help position the catheter. A valve (fluid pump) is placed underneath the skin behind the ear. This will be attached to both catheters. When extra pressure builds up around the brain, these valve opens, and excess fluid drains out of it into the belly or chest area which then helps in decreasing intracranial pressure.
Complications can occur. Some patients may experience blood clot or bleeding in the brain, swelling and infection in the brain, brain tissue damage, reoccurrence of fluid build up in the brain because the shunt may also stop working, the shunt may also become infected and seizures may occur.
After the procedure the patient will need to lie flat for 24 hours the first time a shunt placed then the patient will be helped to sit up. The usual stay in the hospital is 3 to 4 days. Recording vital signs and neurological status often is
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needed. The patient may be given medications for pain. Intravenous fluids and antibiotics are given to maintain hydration and prevent the occurrence of infection. The shunt will be checked regularly to make sure it is working properly.
Math homework help
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