Grade 8 - Ang Katamaran ngm ga Pilipino ni Dr. JoseRizal
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Teaching learning activity
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HYDROCEPHALUS
Introduce the topic
Introduction “Hydrocephalus is a condition in which there is excessive fluid accumulation in the brain.” The word Hydrocephalus derived from two words -hydro means water, cephalus means head
Define the condition
Definition:“is a condition in which portion of the entire ventricular system is abnormally dilated & the CSF has been under increased pressure.”
Enlist the incidence
Incidence Sex • •
Bickers adam syndrome male
NPH
Explaining
Explaining using LCD slides
LCD slides
Explaining
Age •
Infancy
•
Adulthood (40%)
Mortality and morbidity •
Discuss the related Anatomy
Due to brain herniation and resp. arrest
Related anatomy CSF circulation & pathway pathway
Explaining using LCD slides
LCD slides
Evalua t-ion
Identify the etiology Explaining using LCD slides
Enumerate the classification
Classification and etiology: A. Depending on the type of block •
Non communicating (block is intraventricular)
Mal development of the aqueduct
Obstruction due to mass lesions
Obstruction secondary to exudate , haemorrhage or paracsites
Obstruction of the fourth ventricle outlet foramina- dandy Walker malformation
•
Communicating type(block is extra ventricular)
Post infectious, post hemorrhagic, or developmental adhesions of
basal cisterns or surface arachnoid space
Commonly after neonatal meningitis or intra ventricular haemorrhage
Arachnoid villi obstruction by erythrocytes, exudates
Skeletal defects- achondroplasia
LCD slices
pathophysiol ogy
•
Congenital hydrocephalus
Intra utrerine infections- TORCH
Congenital malformations of the aqueduct
Congenital midline tumors of CNS
•
Acquired hydrocephalus
TB/ Bacterial meningitis
Posterior fossa tumors
Explaining using LCD slides
slides
Pathophysiology : internal
LCD slides Explaining using LCD slides
Discuss the pathophysiol ogy
External hydrocephalus
Identify the clinical features
Explaining using LCD slides
LCD slides
Explaining Enlist the diagnostic measures
LCD slides
Clinical features
Enlargement of the head(speed of enlargement proportional to ICP ) & small face
Discuss the goals of medical management
Sunsetting eye sign
Separation of the sutures &
widening , fullness of ant. Frontanelle
Prominent scalp vein
Wasting is common with progression of hydro cephalus
CRACK POT RESONANCE(Macewen sign)
Epileptic attack
Explaining using LCD slides
LCD slides
Diagnosis
Head circumference Radiographs
Explaining using LCD
management
USG
MRI
Management : Goals
To reduce the CSF pressure
To reduce irritability
To prevent infection
To improve nutrition
To improve the skin integrity
Medical management
Enlist the complications of shunt
Osmotic diuretic: cerebral edema
Carbonic anhydrase inhibitors: Acetazolamide
Antibiotics
Slightly elevate the head end of the bed to 15º
Stationary or arrested type No surgical intervention is needed
Progressive type
Site of block should be localised
Repeated lumbar puncture
LCD slides Explaining using LCD slides
Expanding lesion
Discuss the nursing management
Excision of the tumor
Ventricular tapping
Endoscopic 3rd ventriculostomy
Cauterisation of the choroid plexes
Surgical intervention required
Ventriculoatrial shunt
Ventriculoperitoneal shunt
Ventriculogallbladder shunt
Ventriculoureteric shunt
Discussing
Complications of shunt •
Outgrows tube length
•
Subdural haematoma
•
Mechanical failure
•
Obstruction
•
Over/ under drainage
•
Failure of the valve
•
Perforation
•
Infections
•
Collapse of the ventricular valve
•
Other Complications like Physical injury, Delayed growth and development and Decreased intracranial adaptive capacity
Nursing Nursing Management
LCD slides
Discuss the nursing management
•
Increased HC , usually increases during infancy
•
Full ,tense , bulging frontanels
•
Widening suture lines
•
Distended scalp vein
•
Irritability , or lethargy , decreased attention span
•
High pitched cry
•
Sunset sign
•
Inability to support the head when upright
•
Cracked pot
Nursing diagnosis 1. Disturbance in comfort , irritability r/t disaese condition 2. High risk for respiratory arrest related to increased ICP 3. Risk for blockage of the shunt 4. Risk for infection related to the presence of shunt 5. Risk for impaired nutrition r/t poor feeding 6. Risk for complication(seizures) 7. Anxiety 8. Knowledge deficit 9. Altered parental coping Nursing intervention Disturbance in comfort , irritability r/t disaese condition -Provide a quiet environment with less stimuli. -Advice to use zero watt bulbs to minimize photosensitivity. -Avoid too much neck flexion or manipulation.
-Elevate head end to 30 0 to reduce cerebral oedema -Monitor TPR every two hourly High risk for respiratory arrest related to increased ICP
Check signs of increased ICP
Assess the respiratory status
Monitor vital signs every 2 hrly
Support the child’s head when the child is upright
Risk for blockage of the shunt Discuss the nursing management
Measure HC to aid in diagnosis of hydrocephalus
Monitor vital signs and intake and out put
Assess neurologic status
Don’t allow the child to lie on the same side of shunt
Instruct to lay flat to avoid rapid decompression
Signs of ICP
Teach parents signs of increasing ICP
Risk for infection related to the presence of shunt
Observe signs of infection
Provide proper skin care to the head , turn it frequently
Monitor signs of infection like elevated W.B.C, E.S.R
Follow strict aseptic techniques to minimize infection
Maintain fluid volume through IV therapy
Risk for impaired nutrition r/t poor feeding
LCD slides
Discussing
-Give expressed breast milk -Provide ryles tube feeding -Provide soft diet to avoid too much difficulty by mastication Risk for complication(seizures)
Educate seizure precautions
Administer anticonvulsants as prescribed.
Raise the padded side rails of bed to prevent any falls
Ensure that injurious toys and instruments are kept at a safer place.
Monitor the pattern of seizures
Teach the parents how to use padded spoons to clench between teeth during seizures
Provide side-lying position after seizures to prevent aspiration.
Avoid overcrowding during seizure episode.
Administer O2 and do suction in case of status epileptics
Anxiety -provide psychological support to parents -Be with the child and speak in a low and calm voice -Ensure the safety of the child in the absence of his parents -Support family members while explaining about the child’s prognosis -Provide play articles or transitional objects to the child to avoid boredom and to make him feel comfortable Knowledge deficit
-Provide them a copy of immunization protocol -Educate the need for HiB vaccine for unimmunized siblings at home -Encourage them to clarify their doubts -Teach them about the disease ,its prognosis and management Altered parental coping
provide psychological support
encourage them to verbalise feelings
advise about supporting agencies
BIBLIOGRAPHY: 1. Wong D.L etal . Essentials Of Paediatric Nursing. 6 th edition. Missouri: Mosby;2001 2. Marlow D.R. Redding B. Textbook of Paediatric nursing. 1st edition.Singapore: Harwourt Brace & company; 1998 3. Dr.Chaudari KC. Indian Journa of Paediatrics. Nov22 2007 4. Parthasarathy IAP textbook of Paediatrics. 2 nd edition. jaypee: NewDelhi; 2002
LESSON PLAN
TOPIC
:
HYDROCEPHALUS
SUBJECT
:
PAEDIATRIC NURSING
GROUP
:
II YEAR MSc NSG STUDENTS
METHODS
:
LECTURE CUM DISCUSSION
VENUE
:
MSc NSG CLASS ROOM
DATE
:
01. 05. 2013
STUDENTR TEACHER:
Mrs. Nimisha Rajan
AVAIDS
LCD SLIDES
:
PREVIOUS KNOWLEDGE:
Students have had classes on convulsion in children in their BSc nsg course General Objective
On completion of the class the students will be able to understand the disease condition hydrocephalus so as to apply this knowledge in their future practice with a positive attitude. Specific objective: On completion of the class the students will be able to;
1
Define the condition
4. 5. 6. 7. 8. 9. 10. 11. 12.
Identify the etiology Enumerate the classification Discuss the pathophysiology Identify the clinical features Enlist the diagnostic measures Discuss the goals of medical management Discss the medical management Enlist the complications of shunt Discuss the nursing management
