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    Nursing Care Plan Hydrocephalus

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    Farnii Marquez
    The document discusses a nursing care plan for a patient with hydrocephalus. The plan includes assessing the patient for signs of increased intracranial pressure like irritability, changes in vital signs, and monitoring intake/output. Nursing interventions are aimed at reducing stimuli and maintaining proper positioning to decrease pressure and promote drainage. Medications like diuretics and oxygen may also be used to reduce swelling and hypoxemia. The goal is to improve the patient's vital signs and avoid signs of increased pressure within 8 hours.

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    Nursing Care Plan Hydrocephalus

    Uploaded by

    Farnii Marquez
    931 views7 pages
    The document discusses a nursing care plan for a patient with hydrocephalus. The plan includes assessing the patient for signs of increased intracranial pressure like irritability, changes in vital signs, and monitoring intake/output. Nursing interventions are aimed at reducing stimuli and maintaining proper positioning to decrease pressure and promote drainage. Medications like diuretics and oxygen may also be used to reduce swelling and hypoxemia. The goal is to improve the patient's vital signs and avoid signs of increased pressure within 8 hours.

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    NursingCrib.com - Nursing Care Plan Hydrocephalus

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    The document discusses a nursing care plan for a patient with hydrocephalus. The plan includes assessing the patient for signs of increased intracranial pressure like irritability, changes in vital signs, and monitoring intake/output. Nursing interventions are aimed at reducing stimuli and maintaining proper positioning to decrease pressure and promote drainage. Medications like diuretics and oxygen may also be used to reduce swelling and hypoxemia. The goal is to improve the patient's vital signs and avoid signs of increased pressure within 8 hours.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as TXT, PDF, TXT or read online from Scribd
    Download as txt, pdf, or txt
    931 views7 pages

    Nursing Care Plan Hydrocephalus

    Uploaded by

    Farnii Marquez
    The document discusses a nursing care plan for a patient with hydrocephalus. The plan includes assessing the patient for signs of increased intracranial pressure like irritability, changes in vital signs, and monitoring intake/output. Nursing interventions are aimed at reducing stimuli and maintaining proper positioning to decrease pressure and promote drainage. Medications like diuretics and oxygen may also be used to reduce swelling and hypoxemia. The goal is to improve the patient's vital signs and avoid signs of increased pressure within 8 hours.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as TXT, PDF, TXT or read online from Scribd
    Download as txt, pdf, or txt
    of 7

    Nursingcrib.

    com NURSING CARE PLAN

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    ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION SUBJECTIVE: Napansin ko na hindi normal ang laki ng ulo ng anak ko (My son s head is abnormally large) as verbalized by the mother. Ineffective cerebral tissue perfusion related to decreased arterial or venous blood flow. Hydrocephalus is characterized by an abnormal increase in cerebrospinal fluid (CSF) volume within the intracranial cavity and by enlargement of the head in infancy. Pressure from increased fluid After 8 hours of nursing interventions, the patient will demonstrate improved vital signs and absence of signs of increased ICP. INDEPENDENT: Monitor temperature. Administer tepid sponge bath in presence of fever. Fever may reflect damage to hypothalamus. Increased metabolic needs and oxygen consumption occur After 8 hours of nursing

    interventions, the patient was able to demonstrate improved vital signs and absence of signs of OBJECTIVE: Restlessness Irritability Changes in vital signs V/S taken as follows: volume can damage the brain tissue. Hydrocephalus results from two major causes: obstruction of CSF flow (noncommunicating hydrocephalus) or faulty CSF Monitor Intake and output. (especially with fever and shivering), which can further increased ICP. Useful indicators of increased ICP. T: 37.5 P: 90 R: 22 absorption or overproduction of CSF (communicating hydrocephalus). In Weigh as indicated. Note skin turgor, status, and body water, which is an integral part of tissue the noncommunicating type, obstruction may result from congenital defects, infections, trauma, spontaneous intracranial bleeding, and neoplasms. In

    the communicating type, faulty CSF absorption may result from mucous membrane. Maintain head or neck in midline or in neutral position, support with small towel rolls and pillows. Avoid placing head on large pillows. perfusion. Turning bed to one side compresses the jugular veins and inhibits cerebral venous drainage that may cause

    Nursingcrib.com

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    meningeal adhesions or excessive production of CSF fluid caused by a tumor or from unknown causes. Complications of hydrocephalus includes seizures, spontaneous arrest due to natural compensatory mechanisms, persistent increased intracranial pressure (ICP), brain herniation, developmental delays. Provides rest periods between care of activities and limit duration of procedures. Decrease extraneous stimuli and provide comfort measures such as back massage, quiet environment, gentle touch. increased ICP. Continual activity can increase ICP by producing a cumulative stimulant effect. Provides calming effect, reduces adverse physiological response, and promotes rest. Help patient avoid or limit coughing, crying, vomiting, and straining at stool. Reposition the patient slowly. These

    activities increase intrathoracic and intraabdominal pressure. Elevate the head of bed gradually to 15-30 degrees as tolerated or indicated. Promotes venous drainage from head, reducing cerebral congestion and edema and increased ICP.

    Nursingcrib.com COLLABORATIVE: Administer diuretics as indicated. Administer supplemental oxygen as indicated. Diuretics may be used in acute phase to draw water from brain cells, reducing cerebral edema and ICP. Reduces hypoxemia, which may increase cerebral vasodilation and blood volume.

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