Week 6: Neuro Pt. 2- Hydrocephalus and traumatic brain injury

What is hydrocephalus?

Too much fluid in the brain

What are the s/s of hydrocephalus?

Same as increased ICP

What disease process increases the risk of hydrocephalus?

Spina bifida

What are causes of hydrocephalus?

Congenital (spina bifida, intrauterine infection), acquired (hemorrhage, tumor, CSF infection, head injury)

What does treatment look like for hydrocephalus?

Relief of pressure (moving fluid to another area of the body), treatment of the cause, treatment of the complications, and promoting psychomotor development

What is Ventricular Peritoneal (VP) Shunting?

Shunt that moves/drains excess fluid in the brain into the peritoneal cavity

What is Ventriculoarterial (VA) Shunting?

Shunt that moves/drains excess fluid in the brain into the aortic area

What is the problem with the shunts used for hydrocephalus?

They malfunction frequently typically due to either an obstruction or an infection

What are s/s when a shunt used to manage hydrocephalus malfunctions?

Increased ICP, headache, lethargy, blurred vision

If someone has a shunt to manage hydrocephalus and it is malfunctioning due to an infection, what does the treatment look like?

Take out the shunt, give antibiotics until free of disease, then place a new shunt

Do parents and/or nurses help manage VP or VA shunts or EVDs (used to monitor ICP)?

No! Contact the neurosurgeon for any questions, problems, wound dressing changes, etc.

What are nursing interventions for pre-op patients about to get a VP or VA shunt to help treat their hydrocephalus?

Prevent breakdown of the scalp, prevention infection, monitor for increasing ICP, promote nutrition, keep eyes moist, child and family support

What are nursing interventions for post-op patients after a VP or VA shunt has been placed to help treat their hydrocephalus?

Bed rest, lay the patient flat with no pressure on shunted side, can elevate HOB once neurosurgeon says its okay, monitor VS, montior neuro status and signs, abdominal distension, s/s of infection, keep drainage bag at ear level, comfort measures, discharge teaching, record developmental milestones

What are important teaching topics for parents with a child who has a VP or VA shunt?

No contact sports, no military, signs of infection, signs of the device malfunctioning, do not touch the shunt

What is the most commonly used type of EVDs for ICP monitoring?

Intraventricular catheter

How can we tell if drainage is CSF or bloody drainage?

CSF has glucose in it/mucus does not, when on a dressing it will have a halo ring around it

What are nursing considerations and interventions for ICP monitoring devices?

Keep the patient’s head at midline (no turning side to side), keep HOB 15-30 degrees, assess CSF output every hour, make sure all stopcocks are turned the correct direction and cords are plugged in appropriately to ensure correct functioning of the device.

What is a traumatic brain injury?

Injury process involving the scalp, skull, meninges, or brain as a result of mechanical force

What age is at the highest risk for traumatic brain injury and why?

Toddlers because they are top heavy (head is larger than what would be proportional to the body)

What typically causes traumatic brain injury in adolescents and some school age children?

Higher incidence of risk-taking behaviors such as bikes, motor vehicles, alcohol, drugs, etc.

What is a scalp laceration?

Superficial cut that will bleed alot

What is a linear skull fracture?

A single crack in the skull that typically heals well on its own

What is a depressed skull fracture?

Broken into several fragments and pushed inward; may need more intervention

What is a basilar skull fracture?

Break in base of skull

What does a basilar skull fracture increase the risk of?

Secondary infections like meningitis

What are telltale signs of a basilar skull fracture?

Raccoon eyes, battle sign (bruising behind the ears), leakage of CSF from nose and/or ears

What is a concussion?

An alteration in mental status with or without loss of consciousness which occurs immediately after a traumatic blow to the head

How do we diagnose a concussion?

Diagnosis made after other structural injuries are ruled out with imaging, history assessment, and s/s

What are hallmark signs of concussion?

Confusion and amnesia

What are other s/s of concussion?

Headache, dizziness, difficulty concentrating, vision changes, sensitivity to light and noise, nausea, drowsiness, irritability, loss of consciousness

When should parents seek treatment for a concussion?

If it is an infant, if they have lost consciousness, won’t stop crying, head and neck pain, vomit repeatedly, are difficult to awaken, aren’t walking normally, are bleeding from the nose or mouth, or have watery discharge from ears or nose

What is treatment for concussion?

Rest in a dark, quiet room; no technology/screens

What are minor s/s of all traumatic brain injuries?

Confusion, lethargy, listlessness, pallor, irritability, vomiting

What are severe s/s of all traumatic brain injuries?

Signs of increased ICP, retinal hemorrhages, hemiparesis, elevated temperature, unsteady gait

What are nursing interventions for all traumatic brain injuries?

Establish ABCs, stabilize neck and spine, frequent neuro assessment, hypertonic solutions, steroids (decrease inflammation and edema), O2 (helps with constriction and dilation of vessels)

What are signs that someone with a traumatic brain injury is getting worse?

Mental status changes, increasing agitation, development of focal neurological signs, marked changes in VS, Cushing’s triad, signs of brainstem involvement