The Final Chapter

This last post is a summary of Nursing Diagnoses directed at those with Hydrocephalus

This post is my last and will cover nursing diagnoses related to the care of individuals who suffer from hydrocephalus. If you have any questions about any part of the blog feel free to message me. I will do my best to answer any questions or direct you to someone who can. 

----

[1] Risk for impaired skin integrity R/T weakness of head tissue via swelling of the head. 

The first risk here is the risk for skin breakdown, nurses would watch for breakdown and attempt to position the patient as needed to alleviate the risk. This is a pretty common diagnosis in hospital bound patients. Similar interventions would be needed but the focus would be on the tissue in the head.

----

[2] Risk for impaired cognitive function/delayed physical maturation R/T damaged brain tissue caused by increased ICP.

It is very likely that infants who suffer from an increased ICP will suffer some sort of mental or physical developmental defect. Support will have to made available to the patient and parents to help the infant to grow cognitively and physically as much as is possible to increase the infants quality of life (which can be quite high by the way). 

----

[3] Risk for infection R/T surgical procedure

Because 99% of those with hydrocephalus will receive surgery of some sort they will have suture sites that require care and cleaning to prevent infection. This is a very common diagnosis as well, so nurses will have had experience dealing with it. With infants though they will have to focus their efforts on preventing the tiny little ones from getting infections as an infection in an already compromised little guy could be disastrous to his or her little brain. 

----

[4] Risk for caregiver role strain R/T workload in caring for impaired child

Often children who survive hydrocephalus will have a mental and or physical deficit when maturing. This can be extremely taxing on caregivers. our goal as nurses is to provide patient support but also to help support the family and caregivers that will be caring for our patients. We can offer access to resources and support groups that may help the caregivers. 

----

This is the end of my blog. This is Nursing student survivor signing off. Thanks for the good times. 

There Is Always Hope

This post will cover support groups for parents of children with Hydrocephalus

There are several support groups out there for parents or caregivers of individuals with Hydrocephalus. I will cover and give a brief summary of a few of them here. Part 3 of 3 of website recommendations!

Firstly

Hydrocephalus Association

The aforementioned Hydrocephalus Association is a huge resource for those caring for someone with HC. It has information about conferences, support groups, assistance, and stories of hope and perseverance. If you or someone you know needs support, please contact them and get the support you need and deserve. This is a wonderful organization and I highly recommend their support. 

----

Secondly

Children's Hydrocephalus Support Group

Based out of Seattle Children's Hospital, this online support group offers support from anonymous users. It is a place where care-giving individuals can share their stories, frustrations, concerns, and joys. The support of others can go along way and sharing your successes can mean more to someone else than you can possibly imagine. 

----

Thirdly

Ontario- Spina Bifida and Hydrocephalus

Spina Bifida and Hydrocephalus Association of Ontario is a parent support group for individuals whose children have suffered from Spina Bifida or Hydrocephalus. They offer access to personal support, online meetings, groups support, and resources. All of these can be immensely valuable and they offer membership into their organization as well. 

----

Lastly

National Hydrocephalus Foundation

The National Hydrocephalus Foundation reaches across the entire nation offering support to individuals who may be overwhelmed with a seemingly immense diagnosis. This organization offers support and resources, they also offer assistance in searching for medical care if you are finding difficulties in selecting a physician or provider. 

----

That raps up my recommendations! I hope that any one of these resources can be of the least bit help. If you need assistance please reach out. It is okay to feel overwhelmed and troubled, but it is best to do something about it! Especially when there are options. Join us next week as we dive into a relatively boring post if you are not a Nurse or Nursing Student! I will be discussing Nursing Diagnoses for patients that have Hydrocephalus. This will be my last post, so if this where you jump ship I understand. Safe swimming and thanks for joining me on this adventure. 

~Good luck out there, may the wind be at your back. 

There Is An App For That

This post will cover Apps that may help patients and family members with Hydrocephalus

Welcome back, this will be part 2 of 3 of website recommendations. This posts recommendations will instead though be apps that you may find helpful or useful to either the patient or family members. 

Without further ado.

First recommendation

Constant Therapy

Constant Therapy is an app that provides mental strengthening exercises for those who suffer from mental disability. It creates a map of your personal mental strengths and deficits and allows you to track them over time as well as work on them and build them up. It has a constantly growing library that promises to offer a continued and expanded learning environment that can be accessed at home, on the go, or anywhere. 

----

Secondly:

Any ICE (In Case of Emergency) App

Many different phones offer ICE apps of varying degrees. (Searching ICE in your app store should allow you to find one that fits you best). ICE apps are extremely helpful in many situations. The first and foremost is anytime you need access to your personal medical information you will have it with you. This is great for Emergency room visits, Doctor's appointments and other situations where you may need to access your info. Another situation is if you find yourself disabled emergency medical personnel can access your records in your mental absence. This works just as equally for parents. The parent can store their child's info on the app as well and always have access to it if needed. As well as storing information about other health conditions that doctors may need to be aware of. 

----

Thirdly

Hydro Assist

Hydro assist is similar to an ICE App, but it is specifically designed for those with hydrocephalus. This allows providers easy access to information regarding the patients hydrocephalus. It can contain valve settings, shunt types, and other important information regarding check ups adjustments and future plans for the shunts and the patient's treatments. 

----

Fourthly

Hydrocephalus Procedure App

Stanford Medical Center has developed this app for patients or parents of patients who may be undergoing a shunt procedure to help treat their hydrocephalus. This app delves into the surgical procedures and allows individuals to explore them at their own pace and leisure. It is also very informative, allowing individuals to understand the pathophysiology behind HC and information regarding what damage it may be causing. Overall and excellent and highly helpful app. 

That raps up my app recommendations. There are put in no particular order, but they are all worth checking out. Next post we will jump into support groups for parents of children with HC and finish up the part 3 of 3 of website recommendations.

A Keen Eye

This post will cover nurses observance and part 1 of 3 of parent website recommendations

Nurses will have to keep a sharp eye on high risk neonates when working in any neonatal or pediatric unit. Sometimes the signs of hydrocephalus occurrence will not present until weeks or months later, and of course any child or infant who suffers head trauma will be at risk for developing increased ICP. As such nurses should remain vigilant and be aware of what the signs and symptoms may be pointing towards. 

We have already discussed the signs and symptoms in an earlier post, so refer to that if you want specifics, but the major one for neonates is any increase in cerebral circumference, distension of the cerebral veins, or bulging or distended fontanels. 

Now for website recommendations. Here are a couple with information regarding Hydrocephalus itself. 

The first will be the Fact sheet from the National Institute of Neurological Disorders and Stroke.  

National Institute of Neurological Disorders and Stroke. (2016) Hydrocephalus Fact Sheet. retrieved from: http://www.ninds.nih.gov/disorders/hydrocephalus/detail_hydrocephalus.htm

This will give you a comprehensive overview of the information regarding hydrocephalus as a whole. Read this if you want factual information from a medical source. You can contact their board for more information or with any questions. 

----

The second recommendation is the Hydrocephalus Association.

Hydrocephalus Association

This website offers information as well as support groups for those suffering from or caring for someone with hydrocephalus. This website will be explored further in a future post as well when I cover website recommendations for support groups. 

----

Thirdly we can look at this wonderful article from the American Association of Neurological Surgeons. 

AANS-Hydrocephalus

The AANS website discuss the basic information about HC but also goes into some detail regarding surgery options, treatment, recovery, and prognosis. It is a patient focused site that should help answer some questions that parents may be having.

----

Last recommendation for this post. Medicinenet is a website that offers a look at hydrocephalus that is a a bit less medical and still gives you a lot of information over several pages that may be easier to digest. It can be viewed here.

Medicinenet

Take a look there if you want a bit simpler look at the whole picture of HC. 

That raps up this post! Thanks so much for reading this far if you have made it, and I have not bored you to death yet. Next post will touch a bit on some helpful tools for parents (hopefully) and then we will look towards rapping this whole thing up in the next couple of posts!

A Tube For A Tube

This post will cover treatment modalities of Hydrocephalus

Now that we have covered all the bad stuff lets take a gander at the awesome and amazing ways we can help infants and people with hydrocephalus recover and live normal lives!

Since the most common causes of hydrocephalus are tube defects we will be focusing on the treatment method for that specific type. Also this treatment method is what is used for excess creation of CSF as well so that will be covered as well. Hooray for two birds. 

The primary and most effective treatment method is called a cerebral shunt. A shunt is basically an alternate tube and in this case it is one that allows the CSF to drain into another part of the body where it can be absorbed easily. The most common drainage location is the peritoneum (in the abdomen near the intestines), but it is occasionally drained into one of the heart vessels as well. 

[1] Types of cerebral shunts

As you can see the shunt is placed into the ventricle between brain tissue and is then directed to its drop off point. A valve is put in place to determine the rate of CSF drainage. As the infant ages the shunts length will have to be increased and the valve may have to be adjusted to match increasing or decreasing CSF production. This will have to happen multiple times until they reach full size, and they must be monitored throughout this process to make sure the CSF is draining properly.  As they grow older though it is easier to determine early warning sign of CSF accumulation. 

The valves come in two major types according to the FDA, Fixed and Adjustable. (FDA, 2014)

A fixed valve allows CSF to flow through it after the pressure reaches a "fixed" threshold. The adjustable valve lets CSF flow through at a certain rates. Valves can be adjusted either externally or internally depending on the type. The externally adjustable ones are adjusted through use of a magnetic tool that can adjust the setting on the valve through the patient's skin and tissue. 

Shunts are amazing in the fact that once the patient has recovered from the procedure they can live a relatively normal life with the CSF movement causing no further issues as long as the shunt remains effective. 

In regards to other types of treatments for different types of issues: the most common other cause of hydrocephalus is either an intracranial bleed or a brain tumor, and for these situations it is corrected by surgical repair via tumor removal or stopping of the hemorrhage. In most cases long term CSF control is not needed, although with infant brain tumors prognosis can be poor, and hemorrhage can cause lasting effects on the mental and physical growth of infants. 

That raps up this post! Tune in next post as we dive in to the things nurses have to keep an eye out for as well as some helpful websites for parents of those with hydrocephalus. 

1 https://www.quora.com/Where-do-cerebral-shunts-drain-cerebrospinal-fluid-CSF-to-and-what-happens-to-CSF-once-drained

FDA. (2014). Cerebral Spinal Fluid (CSF) Shunt Systems. Medical Devices. Retrieved from: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/CerebralSpinalFluidCSFShuntSystems/default.htm

Do You See What I See?

This post will cover Signs and Symptoms of Hydrocephalus

So now we are going to look at the signs and symptoms, but first I want to help those who may not know learn the difference between a sign and a symptom. A sign is something you look for, it is objective and based on a fact. A symptom is something the patient experiences, it is subjective and more of a feeling. 

So signs of HC are things like increased ICP. So with increased ICP the telltales are bulging of the fontanels, cerebral vein distension, and eventually swelling of the head and expansion of the skull bones. This can on occasion cause the symptoms of irritability and restlessness in the newborn. as well as vomiting, but these are not consistent amongst newborns, and reliance on these to determine the presence of increased ICP is highly undesirable. Other signs can be determined with imaging as we discussed last post. With imaging it is very easy to determine the extent of the increased CSF. 

Overall the easiest and most obvious sign to interpret is rapidly expanding head circumference in a neonate. 

Here is a fact sheet published by the National Institute of Neurological Disorders and Stroke. 

Hydrocephalus Fact Sheet (2016)

This publication has excellent information regarding hydrocephalus while also offering breakdown of each category. Also noted are other signs and symptoms such as sleepiness, downward deviation of the eyes, and seizures. (It should be noted that this sheet compacts both signs and symptoms into one section called "Symptoms", but remember there is a difference!). 

I don't want to oversaturate my blog with similar pictures so I won't be adding and pretty colors to this post. But the fact sheet is an excellent resource so check it out if you are interested in learning more. 

That raps up this post. Tune in next post for some really awesome treatment options for HC and how docs go about implementing and following up on them. 

National Institute of Neurological Disorders and Stroke. (2016) Hydrocephalus Fact Sheet. retrieved from: http://www.ninds.nih.gov/disorders/hydrocephalus/detail_hydrocephalus.htm

The Diagnosis

Diagnosing Hydrocephalus and determining the cause

This post is going to talk about how hydrocephalus is diagnosed. I have already posted a couple pictures and one included a CT scan which is a very common diagnostic tool. Others that can be done are an MRI or ultrasoundography. 

[1] MRI from the American Academy of Neurology

Neuroligsts are pretty smart and when they get images of the infant's brain they can tell what structures may be causing the issue. Things like it's origin and possible methods of treatment can be determined now too. (But we will discuss treatment in another post) 

In adults and children early signs are changes in neurological function but neonates do not have these signs due to their developmental stage. Signs that can be looked for in neonates though is bulging or taut fontaneles (the space between the skull bones) and distended cranial veins. (Christiansen, C. 2002) This article I will be linking at the bottom of this post is a bit old from an academic standpoint but it is quite up to date on aspects of HC and actually has a a good composition of a lot of the information I have written about earlier. It is somewhat disappointing that I did not find it sooner in my research, but I give it to you now as a gift. 

In adults a spinal tap can be performed as well to measure the severity of the increased ICP, but this is far harder and very risky to assess in neonates. 

That raps up this post. Next post we ill dive a bit deeper into what the patient will experience as symptoms and the signs we can be alert for as parents and medical professionals to be alert to changes that might be indicative of impending complications. 

1 http://www.neurology.org/content/74/21/1746/F1.expansion.html

Christiansen, C. (2002). Understanding Hydrocephalus. Physician assistant journal. 26 (12) pp 30-36. retrieved from: http://web.a.ebscohost.com.georgefox.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=7ea8b6e3-a083-4453-81e4-6214618232cb%40sessionmgr4002&vid=0&hid=4114

The Damage Wrought

Here we will discuss the damage caused by hydrocephalus.

As we have touched on earlier, the main causes of HC are either birth defects (such as a bloakcage of the tube, or too much CSF production) or adverse events that cause damage to the brain. Basically anything that might damage the tubes that store and drain CSF from the brain. 

Let's first take a look at the ventricles. I showed a picture in my last post of a child with HC and the extra CSF that was present, but let's take a look at what the ventricles are supposed to look like. 

Ventricles in the brain (Wikipedia)

Here we can see the lot of internal structures that are present in the brain. The blue is where the CSF flows inside the brain. Remember that CSF's job is to bring nutrients to the brain. 

ventricle comparison (Wikipedia, CDC)

Now what happens when too much fluid builds up in the brain? Well with the increase in fluid comes and increase in pressure. In an infant the head can swell because the skull bones are not all fused, but this does not free them from the damaging effects of increased pressure. Slight to severe learning difficulties can be present in infants who have treated HC, but research on adults who had had shunts placed within their first year of life have been promising, showing that they may present with learning difficulties without having an overall impact on intelligence or functioning. (Lindquist, B. et. al. 2011)

This increase in pressure causes damage to the small blood vessels, the nerves, and the other structures in the brain. As the pressure increases more and more damage is caused. Time is of the essence with Increased ICP. The sooner the pressure is relieved the less damage and risk for complications there will be. 

That raps up this post. Next we will be diving in to the diagnostic measures, and how docs go about determining what is causing the HC. 

https://en.wikipedia.org/wiki/Ventricular_system#/media/File:Blausen_0896_Ventricles_Brain.png

https://en.wikipedia.org/wiki/Hydrocephalus#/media/File:Hydrocephalus_CDC.png

Lindquist, B. et. al. (2011). Very Long term follow up of cognitive function in adults treated in infancy for hydrocephalus. Child's Nervous System. 27 (4) pp. 597-601 retrieved from: http://link.springer.com/article/10.1007/s00381-010-1311-y

Some People Are Born With a Big Head

This post is about answering the questions "Where?", "Who?", and "How Often?" in regards to the population it affects.

Because Hydrocephalus (which I will now be abbreviating HC) is not a standalone disorder it does not have precise statistics. According to a Medscape article covering the surgical methods used to deal with HC (which we will go into later) when you take into account spina bifida in regards to it have a high chance of HC the incidence is about 2-5 per 1000 live births. Congenital HC also only includes a small portion of potential HC cases. The leading factors of non-congenital HC include head trauma, neuro tumors, intracranial hemorrhage, and infections in the brain. (Medscape, 2015)

Shows what HC might look like in an older child with sutures fully closed

It hard to explain the picture (Medscape, 2015) without being able to point at your screen for you but I will try. See the dark wobbly line between the brain and the skull? That is filled with extra fluids. Also in the very center the black spot there is part of the brain's ventricles, and usually it does have CSF there and is black, but it is not normally that large and swollen looking, as well as just below it near the cerebellum. 

According to the CDC in the United States about 1,500 babies are born with Spina bifida a year, which can often include HC. Health care costs can be quite high for these individual ranging from a couple thousand to well over a million dollars in the child's first year of life. (CDC, 2015). Spina bifida also appears to affect Hispanics more often than it does those of Caucasian or African decent. Lastly, according to research by John Hopkins Medical Center unterated hydrocephalus has a 50-60% mortality rate, but if the children survive after their first year of treatment most will go on to live a full life span. (John Hopkins, r.2016)

That raps up this post. Tune in next time as we tackle the pathophysiology of the disease, where we will see how and what damage it may cause and what that might affect in an individual. 

CDC, 2015. Data and statistics, spina bifida. retrieved from: http://www.cdc.gov/ncbddd/spinabifida/data.html

John Hopkins, Retrieved 2016. Hydrocephalus. retrieved from: http://www.hopkinschildrens.org/hydrocephalus.aspx

Medscape, 2015. Neurosurgery for hydrocephalus. retrieved from: http://emedicine.medscape.com/article/247387-overview#a7