Use this nursing care plan and management guide to help care for patients with hydrocephalus. Learn about the nursing assessment, nursing interventions, goals and nursing diagnosis for hydrocephalus in this guide.
What is Hydrocephalus?
Hydrocephalus is an excess accumulation of cerebrospinal fluid in the ventricular system resulting in the enlargement of the intracranial cavity. This occurs from an irregularity in the production and absorption of the fluid which causes an increase in intracranial pressure as the fluid builds up.
Hydrocephalus can be classified as communicating or noncommunicating. Communicating hydrocephalus occurs when there is impaired resorption of cerebrospinal fluid, usually at the level of the arachnoid villi. Noncommunicating hydrocephalus is caused by an obstruction within the ventricular system.
As the head enlarges to an abnormal size, the infant experiences changes in the level of consciousness, irritability, shrill cry, lower extremity spasticity, and opisthotonus and, if the hydrocephalus is allowed to progress, the infant experiences difficulty in sucking and feeding, emesis, seizures, sunset eyes, and cardiopulmonary complications as the lower brainstem and cortical function are disrupted or destroyed. In the child, increased intracranial pressure (ICP) focal manifestations are experienced related to space-occupying focal lesions and include headache, emesis, ataxia, irritability, lethargy, and confusion.
Table of contents
Nursing Care Plans and Management
The nursing care planning goals for a client with hydrocephalus include monitoring and maintaining adequate cerebral perfusion pressure, promoting optimal neurological function, preventing complications related to increased intracranial pressure, and educating the client and the family about the condition and its management.
Nursing Problem Priorities
The following are the nursing priorities for patients with hydrocephalus:
- Maintaining or improving neurological status and cognitive function
- Preventing perioperative injury
Assess for the following subjective and objective data:
- See nursing assessment cues under Nursing Interventions and Actions.
Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with hydrocephalus based on the nurse’s clinical judgment and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.
Goals and expected outcomes may include:
- The child/Infant will demonstrate improved brain function as evidenced by normal vital signs, improvement of alertness and crying, and no further deterioration in the level of consciousness.
- The child will experience decreased anxiety.
- The client will not experience injury by (date and time to evaluate).
- The child/Infant will remain free of infection as evidenced by an absence of signs & symptoms of infection such as fever and laboratory studies related to infection within the normal limits.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients with hydrocephalus may include:
1. Improving Neurological Status
In hydrocephalus, the excessive accumulation of cerebrospinal fluid (CSF) within the brain ventricles causes pressure on the surrounding cerebral tissue, resulting in inadequate blood flow and oxygen delivery to the brain. Improving the neurological status of patients with hydrocephalus is a critical aspect of their overall care. Addressing and managing hydrocephalus aim to alleviate the pressure and improve the patient’s neurological function. Each patient with hydrocephalus is unique, and their treatment plan should be tailored to their specific needs and circumstances.
Assess vital signs hourly, noting for any irregularity in breathing and heart rate, and rhythm, and measure the pulse pressure.
Monitoring vital signs closely to recognize early signs of increased intracranial pressure (such as fluctuating blood pressure, tachycardia, and shallow breathing) or Cushing’s triad (bradycardia, apnea, and widening pulse pressure).
Assess neurological status (such as mental status, motor, and balance, reflexes (for newborns and infants), and cranial nerves.
These assessments will determine changes in the child’s neurological conditions associated with ICP.
Examine the pupils by noting the size, shape, equality, and position of the pupils, and their response to light.
Pupil reaction which is controlled by the cranial nerve III (Oculomotor nerve) is beneficial for assessing brain stem function.
Note the quality and tone when children cry
A high-pitched cry may indicate increased intracranial pressure.
Measure the client’s head circumference and appearance of the anterior fontanelle.
Head circumference, if increasing, or a tense bulging fontanelle reveals CSF accumulation.
Provide a non-stimulating environment and adequate rest periods.
Continual activity and stimulation may increase intracranial pressure.
Elevate the head of the bed gradually about 15-45 degrees as indicated. Maintain the client’s head in a neutral position.
This position will reduce arterial pressure by promoting venous drainage and enhancing cerebral perfusion.
Provide oxygen therapy as needed.
Supplemental oxygen decreases hypoxemia levels which may improve cerebral vasodilation and blood volume.
Administer diuretics, carbonic hydrase, corticosteroids as ordered.
Acetazolamide (Diamox) and furosemide (Lasix) may control communicating hydrocephalus by reducing the production of cerebrospinal fluid; Corticosteroids reduce inflammation.
2. Reducing Anxiety
Anxiety can be a common experience for clients with hydrocephalus due to the uncertainty of the condition and potential complications, as well as the impact it can have on daily activities and quality of life. Anxiety may also be exacerbated by the need for frequent medical interventions and potential changes in social roles and relationships. Reducing anxiety in patients with hydrocephalus is an important aspect of their care, as anxiety can significantly impact their well-being and quality of life.
Assess the source and level of anxiety and the need for information and support about the condition and impending surgery.
Provides information about the severity of anxiety and need for interventions and support; allows for identification of fear and uncertainty about the condition and/or surgery and treatments and recovery; guilt about the condition, possible loss of infant/child or of parenteral responsibility.
Communicate therapeutically with parents and answer questions calmly and honestly.
Promotes a calm and supportive environment.
Allow expressions of concern and opportunity to ask questions about the condition and recovery of the ill infant/child.
Provides an opportunity to vent feelings, and secure information needed to reduce anxiety.
Encourage parents to remain involved in care and decision-making regarding the infant/child.
Promotes constant monitoring of infant/child for improvement or worsening of symptoms.
Encourage parents to stay with infant/child or visit when able if hospitalized, assist in care (hold, feed, diaper) and make suggestions for routines and methods of treatment.
Allows parents to care for and support the child instead of becoming increasingly anxious because of the absence of the child and wondering about the infant/child’s condition.
Prepare the child/parents for diagnostic tests and potential surgical procedures.
Promotes reduction in anxiety if they have knowledge of expectations.
When surgery is planned, answer all questions from parents and child with honesty; refer to physician for answers and explanations if needed.
Promotes a supportive environment and reduces anxiety caused by fear of the unknown.
Teach parents and child (age dependent) about the reason for and type of surgery to be done, site, and dressings, time of surgery, length of time of the procedure, preoperative care, and treatments.
Provides information about the surgery and desired effects as well as possible residual effects.
Explain the reason for and what to expect for each procedure or type of therapy; use drawings, pictures, and videotapes for the child.
Reduces fear which causes anxiety.
Clarify any misinformation and answer all questions honestly and in simple understandable language.
Prevents unnecessary anxiety resulting from inaccurate information or beliefs.
Teach about shunt placement and reason; possible future revision of shunt placement, signs, and symptoms of shunt complication or malfunction.
Shunt is placed to bypass an obstruction or removes excess cerebrospinal fluid that predisposes to increased ICP; a shunt revision may be done to treat shunt complication such as infection or obstruction or as a result of child growth.
3. Preventing Perioperative Injury
Patients with hydrocephalus may experience sensory, integrative, and effector dysfunction preoperatively, which can increase the risk of injury. These dysfunctions can impair the patient’s ability to process sensory information, coordinate movement, and respond to environmental stimuli, which may make it difficult for the patient to be protected from injury or navigate their surroundings safely. Also, patients with hydrocephalus are at risk for injury postoperatively due to the potential for increased intracranial pressure, bleeding, or infection. Additionally, the presence of neurological deficits or impairments related to the condition may also increase the risk of injury during recovery and rehabilitation.
Perform neurologic and vital assessments every 4 hours or as needed.
Provides data indicating an increasing ICP causing decreased respirations, increased blood pressure, and pulse.
Assess for a rapidly increased circumference of the head, tense, bulging fontanels, widening suture lines, irritability, lethargy, “cracked pot” sound percussion, sunset sign, opisthotonus, spasticity of lower extremities, seizures, high-pitched cry, distended scalp veins, changes in normal feeding patterns.
Indicates increasing ICP in infants/small child.
Assess for early signs including (headache, nausea, vomiting, diplopia, blurred vision, seizures, irritability, restlessness, decrease in school performance, decreased motor performance, sleep loss, weight loss, memory loss progressing to lethargy, and drowsiness). Assess for late signs: (decreased level of consciousness, decreased motor response to commands, decreased response to pain, change in pupils, posturing, papilledema).
Indicates increasing ICP in children with symptoms related to the cause of hydrocephalus.
Assess for signs and symptoms of increased ICP, swelling along shunt tract; note presence/severity of headache and neck pain; behavior changes (lethargy, irritability), physical changes (full fontanel, nausea, vomiting, edematous eyes, tender, swollen abdomen).
Provides data that indicates shunt malfunction.
Note vomiting, drowsiness, irritability, swelling at the pump site, redness, exudate, and temperature of the child.
Indicates shunt blockage.
Educate parents on signs and symptoms of increased ICP and changes to reporting to the physician.
Promotes knowledge of the risk of developing increased ICP and encourages preventive measures.
Carry out seizure precautions including padding of crib/bed, removing toys and objects from the bed, maintaining suction and oxygen at the bedside, and noting and reporting characteristics of seizure.
Prevents injury to self during seizure activity caused by increased ICP and treats apnea during seizure activity.
Position with the head elevated 30 degrees and support the head when handling or changing position; monitor skin integrity with position changes.
Promotes drainage of CSF and reduces the accumulation of CSF; the infant may not be able to lift and move the head.
Support an enlarged head by cradling it in an arm when holding, place the infant on a pillow when moving, and move the head and body of the infant at the same time.
Protect’s infant’s head from trauma and neck from the strain.
Inform parents that the condition is lifelong and monitoring and follow-up care on a regular basis is required.
Provides realistic and honest information that promotes optimal health and function for the infant/child.
Instruct parent on hydrocephalus and shunt placement; teaching should include: Definition of hydrocephalus (brain anatomy), causes, diagnostic test, treatment, signs of shunt malfunction and infection, interventions and proper notifications of health professionals, and documentation; supplemental written materials are important; emphasize the importance of early identification of infection/malfunction and prompt notification.
Promotes understanding of illness/treatments which may decrease anxiety; knowledge of the prompt treatment of complications is often lifesaving.
Teach parents about the need for bowel elimination at least every 2 days and the steps to take to ensure bowel movement.
Prevents complications associated with a ventriculoperitoneal shunt.
Position carefully on the nonoperative side postoperatively; maintain bed position and activity level as ordered depending on shunt dynamics.
Prevents trauma to the surgical site; maintains shunt patency.
Discuss and encourage parents to treat the child as a member of the family and instruct in activities to be avoided such as rough contact sports.
Promotes growth and development and a feeling of belonging.
Inform parents of agencies for guidance and support such as National Hydrocephalus Foundation.
Provides assistance with the management of a child with hydrocephalus.
4. Preventing Infections
Patients with hydrocephalus are at risk for infection following an invasive procedure such as shunt insertion, due to the potential for bacteria to enter the cerebrospinal fluid and cause meningitis or other infections. The presence of a foreign body such as the shunt itself can also increase the risk of infection, making careful monitoring and management of the patient’s condition essential to prevent this potential complication.
Assess the site for inflammatory process, temperature elevation, increased WBC, and characteristics of drainage on dressings.
Provides data indicating the presence or potential for infection which affects shunt function.
Monitor temperature every four (4) hours.
An elevation of temperature indicates infection.
Teach about signs and symptoms of infection of the site and shunt tract and notify position if noted.
Promotes early detection of infection that may occur for up to 1 to 2 months after shunt insertion.
Follow principles of asepsis when performing procedures such as dressing changes.
Prevents transmission of microorganisms to shunt site.
Teach parents about wound care and dressing change, emphasizing the importance of good handwashing techniques.
Provides clean, sterile dressings when soiled or wet.
Administer prophylactic antibiotics as ordered.
The use of antibiotics before and after surgery has been shown to significantly reduce the risk of shunt infections, which can be a serious complication that can lead to meningitis or other potentially life-threatening conditions.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
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