4 Hydrocephalus Nursing Care Plans

Hydrocephalus is rising intracranial pressure from cerebrospinal fluid that has nowhere to go. Your job is to catch the pressure climbing before it damages the brain, get the child safely through shunt surgery, prevent the infection that turns a shunt into meningitis, and teach the parents to spot a failing shunt for the rest of the child's life. This guide covers the assessment, goals, and interventions.

What is Hydrocephalus?

Hydrocephalus is an excess of cerebrospinal fluid in the ventricular system that enlarges the intracranial cavity. It comes from a mismatch between CSF production and absorption, and the buildup raises intracranial pressure.

It is either communicating or noncommunicating. Communicating hydrocephalus is impaired resorption of CSF, usually at the arachnoid villi. Noncommunicating hydrocephalus is an obstruction within the ventricular system.

As the head enlarges, the infant shows a changing level of consciousness, irritability, a shrill cry, lower extremity spasticity, and opisthotonus. If it progresses, you see difficulty sucking and feeding, emesis, seizures, sunset eyes, and cardiopulmonary complications as the lower brainstem fails. In the older child, increased intracranial pressure (ICP) brings headache, emesis, ataxia, irritability, lethargy, and confusion.

Nursing Care Plans and Management

Care centers on maintaining adequate cerebral perfusion, promoting neurological function, preventing complications of increased ICP, and teaching the family how to manage the condition.

Nursing Problem Priorities

• Maintain or improve neurological status and cognitive function.
• Prevent perioperative injury.

Nursing Assessment

Assess for subjective and objective data. See the cues under Nursing Interventions and Actions.

Nursing Diagnosis

Formulate the diagnosis from your assessment and clinical judgment, matched to the child's presentation. The interventions you build matter more than the label.

Nursing Goals

• The infant or child shows improved brain function: normal vital signs, better alertness and crying, and no further decline in level of consciousness.
• The child experiences less anxiety.
• The patient stays free of injury.
• The infant or child stays free of infection, with no fever and normal infection-related labs.

Nursing Interventions and Actions

1. Improving Neurological Status

Excess CSF presses on cerebral tissue and cuts blood flow and oxygen to the brain. Relieving that pressure is the point of treatment, and the plan is tailored to each child.

Assess vital signs hourly, noting any irregularity in breathing, heart rate, and rhythm, and measure the pulse pressure. Catches early signs of rising ICP such as fluctuating blood pressure, tachycardia, and shallow breathing, or Cushing's triad: bradycardia, apnea, and widening pulse pressure.

Assess neurological status: mental status, motor function, balance, reflexes in newborns and infants, and cranial nerves. Tracks the neurological changes that come with rising ICP.

Examine the pupils for size, shape, equality, position, and response to light. Pupil reaction, controlled by cranial nerve III (oculomotor), reflects brainstem function.

Note the quality and tone of a child's cry. A high-pitched cry may signal rising ICP.

Measure head circumference and check the anterior fontanelle. An increasing circumference or a tense, bulging fontanelle reveals CSF accumulation.

Provide a non-stimulating environment and adequate rest. Continual activity and stimulation can raise ICP.

Elevate the head of the bed 15 to 45 degrees as indicated and keep the head in a neutral position. Reduces arterial pressure by promoting venous drainage and improving cerebral perfusion.

Provide oxygen as needed. Reduces hypoxemia, which can otherwise drive cerebral vasodilation and raise blood volume.

Administer diuretics, carbonic anhydrase inhibitors, and corticosteroids as ordered. Acetazolamide (Diamox) and furosemide (Lasix) can control communicating hydrocephalus by reducing CSF production, and corticosteroids reduce inflammation.

2. Reducing Anxiety

The uncertainty of the condition, the threat of complications, and impending surgery all raise anxiety for the child and the parents. Address it directly.

Assess the source and level of anxiety and the need for information about the condition and surgery. Surfaces fear about the condition, surgery, treatment, and recovery, plus guilt and the fear of losing the child.

Communicate calmly and honestly with the parents and answer their questions. Builds a supportive environment.

Let the parents voice concerns and ask questions about the condition and recovery. Releases feelings and supplies the information that reduces anxiety.

Keep the parents involved in care and decisions. Keeps them watching the child for improvement or worsening.

Encourage the parents to stay with the child, help with care, and suggest routines. Caring for the child reduces the anxiety that comes from absence.

Prepare the child and parents for diagnostic tests and possible surgery. Knowing what to expect lowers anxiety.

When surgery is planned, answer questions honestly and refer to the physician for explanations as needed. Reduces fear of the unknown.

Teach the parents and child, as age allows, about the reason for and type of surgery, the site, dressings, timing, and preoperative care. Explains the surgery, its desired effect, and possible residual effects.

Explain what to expect from each procedure or therapy, using drawings, pictures, and videos for the child. Reduces the fear that drives anxiety.

Clarify misinformation and answer in simple language. Prevents anxiety from inaccurate beliefs.

Teach about shunt placement: the reason for it, the chance of future revision, and the signs of shunt complication or malfunction. A shunt bypasses the obstruction or drains excess CSF that raises ICP, and revision treats infection, obstruction, or the effect of the child's growth.

3. Preventing Perioperative Injury

Before surgery, sensory and motor dysfunction make it hard for the child to navigate safely. After surgery, rising ICP, bleeding, or infection raise the risk of injury. Watch closely on both sides of the operation.

Perform neurologic and vital sign assessments every 4 hours or as needed. Catches rising ICP, shown by slowing respirations, rising blood pressure, and a changing pulse.

Assess for a rapidly increasing head circumference, a tense bulging fontanelle, widening sutures, irritability, lethargy, a "cracked pot" percussion sound, sunset sign, opisthotonus, lower extremity spasticity, seizures, a high-pitched cry, distended scalp veins, and changes in feeding. These signal rising ICP in the infant or small child.

Assess for early signs of rising ICP: headache, nausea, vomiting, diplopia, blurred vision, seizures, irritability, restlessness, falling school and motor performance, sleep loss, weight loss, and memory loss progressing to lethargy and drowsiness. Watch for late signs: decreased level of consciousness, decreased motor response and response to pain, pupil changes, posturing, and papilledema. Tracks rising ICP in the older child.

Assess for signs of rising ICP and shunt malfunction: swelling along the shunt tract, headache and neck pain, behavior changes such as lethargy and irritability, and physical changes such as a full fontanelle, nausea, vomiting, edematous eyes, and a tender, swollen abdomen. These point to shunt malfunction.

Note vomiting, drowsiness, irritability, swelling at the pump site, redness, exudate, and the child's temperature. These point to shunt blockage.

Teach the parents the signs of rising ICP and what to report. Builds awareness and encourages prevention.

Carry out seizure precautions: pad the crib or bed, clear toys and objects, keep suction and oxygen at the bedside, and document and report any seizure. Prevents injury during a seizure and treats apnea that may follow.

Position with the head elevated 30 degrees, support the head when moving the child, and check skin integrity with position changes. Promotes CSF drainage. The infant may not be able to lift or move the head.

Support an enlarged head by cradling it when holding the child, rest the infant on a pillow when moving, and move the head and body together. Protects the head from trauma and the neck from strain.

Tell the parents the condition is lifelong and needs regular monitoring and followup. Sets honest expectations.

Teach the parents about hydrocephalus and the shunt: brain anatomy, causes, diagnostic tests, treatment, signs of shunt malfunction and infection, when to notify the team, and documentation, with written materials to back it up. Understanding lowers anxiety, and prompt treatment of complications is often lifesaving.

Teach the parents about the need for a bowel movement at least every 2 days and the steps to ensure it. Prevents complications of a ventriculoperitoneal shunt.

Position the child on the nonoperative side after surgery and maintain bed position and activity as ordered for the shunt dynamics. Protects the surgical site and maintains shunt patency.

Encourage the parents to treat the child as a full member of the family and to avoid rough contact sports. Supports growth, development, and belonging.

Refer the parents to support agencies such as the National Hydrocephalus Foundation. Helps with managing a child with hydrocephalus.

4. Preventing Infection

A shunt is a foreign body, and shunt insertion opens a path for bacteria into the CSF, where infection becomes meningitis. Monitoring and asepsis are essential.

Assess the site for inflammation, temperature elevation, rising WBC, and the character of any drainage. Catches infection that threatens shunt function.

Monitor temperature every 4 hours. A rising temperature signals infection.

Teach the signs of infection at the site and along the shunt tract, and to notify the team. Catches infection early. It can occur up to 1 to 2 months after shunt insertion.

Follow aseptic technique for procedures such as dressing changes. Prevents transmission of microorganisms to the shunt site.

Teach the parents wound care and dressing changes, stressing good handwashing. Keeps the dressing clean and the site protected.

Administer prophylactic antibiotics as ordered. Antibiotics before and after surgery significantly reduce shunt infections, which can progress to meningitis and other life-threatening conditions.