Anatomy
What are the cavities within the brain containing CSF called?
Ventricles
What does hydrocephalus mean?
Hydro = water
Cephalus = head
A fine tube inserted from inside a ventricle into the peritoneum to drain CSF
A ventriculoperitoneal (VP) shunt
What vital signs need to be taken when completing a set of neurological obs?
Temperature, Pulse, Blood pressure, Respirations, Pulse oximetry
A child is unable to be woken for neuros
Turn lights on, sit patient up, if avaliable parent involvement, gentle touch
Fontanelle
Name 3 signs and symptoms of hydrocephalus in children and adults
Vomiting, headaches, poor concentration, visual disturbances, papilloedema, reduced function/coordination, irritability, drowsiness, seizures
A small catheter used for the aspiration of CSF or the instillation of medication
A rickhams reservoir
When should a neurological assessment be completed?
Between nurses on patient transfer between wards
Between nurses at change of shift handover
If any concerns of possible neurological deterioration
Prior to any neurological surgery/intervention to assess baseline
A patient has deteriorated in total GCS by 2 points or in motor response of 1 point
MET Call
What is the area of the brain located behind the brain stem that controlls muscle activity called?
The cerebellum
What are the three types of Ventricular Shunts?
Ventriculoperitoneal (VP)
Ventriculoatrial (VA)
Ventriculopleural (VPl)
Surgically removing part of the skull temporaily to operate on the brain
Crainotomy
Think CVR/FOA - How do you assess the patient's eyes when swollen?
You can't. When swollen, please do not force the eyes open. Document C for swollen
A patient has had a shunt inserted and has been cleared to discharge over the weekend. How best is education provided to the family?
Print consumer health information sheets
Provide family with NC phone number, symptoms magnets and shunt information card with details filled in
Name 3 functions of the hypothalamus
Emotional response, sleep-wake cycles, body temperature, hunger, thirst, hormone control, regulates involuntary actions such as heart rate, digestion, and breathing.
Name 2 short term treatments of hydrocephalus
Ventricular tap
Lumbar puncture
EVD
Ventricular (Rickham) Reservoir
Surgically correcting a spinal cord that is anchored too low in the spine
Spinal Cord Untethering
What frequency of neurological obs should be completed post VP shunt insertion?
If GCS is 14-15: ½ hourly for 2 hours, hourly for 4 hours, then 2 hourly until review by neurosurgery M.O. and management plan documented
If GCS is less than 14 (unless patients baseline): ½ hourly until score of 14 is reached
Its 0400 and the EVD hasn't had any drainage for 1 hour. What should you do?
Ensure not kinked
Lower drip chamber
Set of neuros and monitor closely
Which area of the brain processes sensory information, including position of body parts, as well as processes language and visual information?
The Parietal Lobe
What are three signs and symptoms of hydrocephalus that present in only infants?
Increased head size
Bulging fontanelle
Sunsetting eyes
Surgically removing a small piece of skull, and sometimes the top vertebrae (C1), to restore normal cerebrospinal fluid flow
Chiari Decompression
What is Cushing's Triad?
Set of vital signs that are indicative of increase ICP
Bradycardia, irregular respirations, hypertension
A patient on the ward is having a tonic clonic seizure who does not have a pmhx of seizures
call for help
monitor airway
time seizure
midazolam after 5 minutes