Patient Medical Profile

Name:

Matthew Sparrow

Address:

Vancouver, Canada

Age:

3 months old

Nationality: Canadian
Weight:

3 kilograms

Medical Data
At 3 months of age, Baby Sparrow develops Hydrocephalus after repair of his Neural
Tube Disorder; He is scheduled for a Ventriculo-peritoneal Shunt Insertion this afternoon.
What is the procedure of Ventriculoperitoneal Shunt Insertion?

An area of hair on the head is shaved. This may be behind the ear or on the top or back of
the head.
The surgeon makes a U-shape cut behind the ear. Another small surgical cut is made in
the belly.
A small hole is drilled in the skull. A thin tube called catheter is passed into a ventricle of
the brain. This can be with or without a computer guide. It can also be done with an
endoscope that allows the surgeon to see inside the ventricle.
Another catheter is placed under the skin behind the ear. It is sent down the neck and
chest, and usually into the belly area. Sometimes, it stops at the chest area. The doctor
may make a small cut in the neck to help position it.
A valve (fluid pump) is placed underneath the skin behind the ear. The valve is connected
to both catheters. When extra pressure builds up around the brain, the valve opens and
excess fluid drains through the catheter into the belly or chest area. This helps lower
intracranial pressure.
The patient is taken to a recovery area and then moved to a hospital room.

Family Assessment
Baby Sparrow lives with 16-year-old mother with her parents and 4 siblings. The childs
father work as a car mechanic; visits infant frequently. The mother is no longer attending school
because of child care.

Client Assessment
Baby Sparrows head circumference has continued to increase since his
myelomeningocele surgery at birth. The head circumference at birth was at the 40th percentile,
60th percentile at 6 weeks of age and now is at the 80th percentile. The mother noted that the
infant had increasing irritability and lethargy over the few weeks.
Anterior fontanelle 4 cm x 4 cm, posterior fontanelle 3 cm x 3 cm. Sagittal suture line
separated by inch. Scalp veins prominent. Eyes appear sunset. Parents report two episodes of
forceful vomiting yesterday.
His cry is so high-pitched and shrill, and he doesnt want anything to drink.
Mother is breastfeeding. Cerebral perfusion pressure: 55 mm Hg; Blood pressure 100/40 mm Hg;
Pulse: 100 bpm; Respiration: 16 cpm. Afebrile.

Diagnosis
Risk for Ineffective Cerebral Tissue Perfusion related to increased intracranial pressure
from Hydrocephalus.

Outcome Criteria
Infants vital signs are within age-appropriate parameters; head circumference is
maintained at current level; infant responds to auditory stimuli; Cerebral perfusion pressure
remains above 50 mm Hg.

Activities of Daily Living

Assessment: Assess if infant is able to turn because of increased head size.
Intervention: Provide an environment for child that is stimulating yet not tiring
(mobile, soft toys in crib); urge parent to interact.
Rationale: Lack of mobility can lead to pressure ulcers on head as well as insufficient 3-month
development.
Expected Outcome: The childs parents play with infant. Infant appears interested in ageappropriate toys. No irritated areas on head.

Consultation
Assessment: Assess if neurosurgeon is available for consultation.

Intervention: Arrange for consultation for mother with neuro-surgeon to discuss childs
prognosis.
Rationale: Viewing a child as totally disabled can cause a parent to not appreciate the childs
capabilities.
Expected Outcome: The neurosurgeon meets with the mother to discuss that childs IQ appears
normal. Shunting will halt head growth.

Procedures/Medication
Assessment: Assess infants neurologic status post-operatively, including response to sound,
pupillary response, increasing irritability or lethargy.
Intervention: Position the infant with head of the bed elevated 15
Rationale: Elevating head of bed aids shunt functioning, helping reduce intracranial pressure.
Cerebral perfusion reveals extent of intracranial pressure.
Expected Outcome: Childs cerebral perfusion pressure remains greater than established
parameter. Responds to sound, no increasing irritability or lethargy.

Assessment: Measure and record head circumference every 4 hours. Assess anterior fontanelle
for tenseness and bulging.
Intervention: Document head circumference and appearance of anterior fontanelle.
Rationale: Head circumference, if increasing, or a tense, bulging fontanelle, indicates
accumulating CSF.
Expected Outcome: Childs head circumference does not increase in size, fontanelles no longer
feel tense.

Nutrition
Assessment: Observe mother breast-feeding infant; Monitor intake and output closely
Intervention: Encourage mother to breast-feed infant: assist mother with positioning the infant
properly; supporting the head without flexion or hyperextension during feeding.
Rationale: Breast milk is the optimal nutrition for an infant. Proper positioning is important to
avoid neck vein compression, which would increase intracranial pressure; Adequate hydration is
necessary to ensure renal function.

Expected Outcome: Childs output remains over set parameter.

Diet for a Week

Since Baby Sparrow is only 3 months old, thus cannot chew and digest solid food, liquid
diet is recommended.
Frequency of
Feeding

Amount

Length of Feeding

Breast milk

Every 2-4 hours

Approx. 10 minutes
for each breast

Formula milk
(Enfamil A+ for 0-6
mos. Old)

Every 3-4 hours

5 oz.
(1 oz:1 scoop)

Approx. 10-15 mins

Toileting and Hygiene

How to change diapers:
Before proceeding, ensure that you use the correct size of diaper
1.
2.
3.
4.
5.

Put the diaper under the babys body.

Pull the elastic side properly.
Apply both sides in symmetrical position on the landing zone.
Adjust the cuff around the legs on both sides.
Change diaper every 4-6 hours, depending on wetness. Always check if soiled to avoid
rashes.

Hygiene: Wash the childs head daily and change the position head approximately every 2 hours
so that no portion of headrests against the mattress for a long period.
Make sure the bandage does not become wet from backward draining oral secretions or
shunt leakage.

HYDROCEPHALUS
Hydrocephalus is a medical condition in which there is an abnormal accumulation of
cerebrospinal fluid (CSF) in the ventricles of the brain. This causes increased intracranial
pressure inside the skull and may cause progressive enlargement of the head if it occurs in
childhood, convulsion, tunnel vision, and mental disability.
Hydrocephalus can be caused by congenital or acquired factors. Congenital causes
include ArnoldChiari malformation, craniosynostosis, DandyWalker syndrome, and Vein of
Galen malformations. Acquired causes include hemorrhage, meningitis, head trauma, tumors,
and cysts.

CAUSES

here's a blockage in one of the ventricles so that excess fluid can't move out of the brain
there's a problem with the arachnoid villi so that fluid is unable to filter into the blood
vessels

the brain starts to produce too much cerebrospinal fluid (this is very rare)

Congenital Hydrocephalus
Congenital hydrocephalus, when a baby is born with the condition, may be the result of a
brain defect restricting the flow of cerebrospinal fluid

usually idiopathic
spina bifida

premature birth

X-linked hydrocephalus where the condition occurs as a result of a mutation (change in

the genetic material) of the X chromosome

rare genetic disorders, such as Dandy Walker malformation

arachnoid cysts fluid filled sacs located between the brain or spinal cord and the
arachnoid membrane, which is one of the three membranes surrounding the brain and
spinal cord

Acquired Hydrocephalus
Hydrocephalus that develops in adults or children (acquired hydrocephalus) is usually the
result of an injury or illness causing a blockage between the ventricles of the brain.
Possible causes of acquired hydrocephalus include:

bleeding inside the brain for example, if blood leaks out of blood vessels over the
surface of the brain (subarachnoid haemorrhage)
blood clots inside the blood vessels in the brain (venous thrombosis)

meningitis an infection of the protective membranes surrounding the brain and spinal
cord

brain tumours

head injury

stroke

SIGNS and SYMPTOMS

In infants with hydrocephalus, CSF builds up in the central nervous system, causing
the fontanelle (soft spot) to bulge and the head to be larger than expected. Early symptoms may
also include:

Eyes that appear to gaze downward;

Irritability;

Seizures;

Separated sutures;

Sleepiness;

Vomiting.

Symptoms that may occur in older children can include:

Brief, shrill, high-pitched cry;

Changes in personality, memory, or the ability to reason or think;

Changes in facial appearance and eye spacing;

Crossed eyes or uncontrolled eye movements;

Difficulty feeding;

Excessive sleepiness;

Headache;

Irritability, poor temper control;

Loss of bladder control (urinary incontinence);

Loss of coordination and trouble walking;

Muscle spasticity (spasm);

Slow growth (child 05 years);

Slow or restricted movement;

Vomiting

DIAGNOSING HYDROCEPHALUS
ULTRASOUND SCAN
In some cases, an ultrasound scan can detect congenital hydrocephalus before your baby
is born. An ultrasound scan uses high-frequency sound waves to create an image of your womb
and the baby inside.
CT SCAN
-

a computerised tomography (CT) scan takes a series of X-rays at slightly different

angles and uses a computer to put the images together

a magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio
waves to produce detailed images of the brain

MRI

These scans can examine the brain in greater detail. As well as showing the build-up of fluid on
the brain and the increased pressure, the scans can also highlight any defects in the structure of
the brain that may be causing the hydrocephalus.
Healthcare professionals have devised a diagnostic checklist which examines:

how you walk (your gait)

your mental ability

symptoms that affect your bladder control such as urinary incontinence

the appearance of your brain during CT, MRI and ultrasound scans

LUMBAR PUNCTURE
A lumbar puncture, also known as a spinal tap, is a procedure used to take a sample of CSF from
your lower back.
A hollow needle is inserted between your back bones (vertebrae), and a small amount of the fluid
is removed. The pressure of the CSF sample can then be checked.
Removing some CSF during a lumbar puncture may help to improve your symptoms. If this is
the case, it's a good indication that you may benefit from treatment with surgery.
LUMBAR DRAIN
If having a lumbar puncture doesn't improve your symptoms, this doesn't mean that you do not
have NPH. If the lumbar puncture test is negative, you may have a lumbar drain.
A lumbar drain involves inserting a tube between your back bones to drain a large amount of
CSF. This is done over a few days to see if this improves your symptoms, such as your ability to
walk around. This is usually done under local anaesthetic to numb the area, or sedation to relax
you.
LUMBAR INFUSION TEST
A lumbar infusion test can also be used to help diagnose NPH and decide whether you need
surgery. The procedure should be carried out under local anaesthetic so it shouldn't be painful.
The test involves slowly injecting fluid into your lower back while measuring the pressure. The
additional fluid should be absorbed by your body so the pressure stays low. However, if your
body can't absorb the extra fluid, the pressure will rise. This could indicate that you have NPH
and that surgery will be beneficial.

TREATMENT
Shunt surgery
Shunt surgery involves implanting a thin tube, called a shunt, in the brain. The excess
cerebrospinal fluid (CSF) in the brain runs through the shunt to another part of the body, usually
the abdomen. From here the fluid is absorbed into your blood stream. The shunt has a valve
inside to control the flow of CSF and to ensure it does not drain too quickly. You can feel the
valve as a lump under the skin of your scalp.
Endoscopic third ventriculostomy (ETV)
An alternative procedure to shunt surgery is an endoscopic third ventriculostomy (ETV).
ETV involves making a hole in the floor of the brain, allowing the trapped CSF to escape to the
surface of the brain where it can be absorbed, instead of inserting a shunt.
An ETV is not suitable for everyone. However, it could be a possible treatment option if the
build-up of CSF in your brain is the result of a blockage (obstructive hydrocephalus). The CSF
will be able to drain through the hole, avoiding the blockage

Philippine Womens University

Sta. Cruz Campus

HYDROCEPHALUS

Submitted by:
Leah R. Payba
Batch 59
Submitted to:
Mr. Joven Cajipe
Culture and Traits