Nerves System Disease
Hydrocephaly:
Hydrocephaly is accumulation of move C.S.F in cerebral ventricles because of disorder in stream or absorption of cerebrospinal fluid conjoins with relative addition of its pressure and seldom because of more production of C.S.F.
Sometimes hydrocephaly is inherited as one feature dependant on sex.
Hydrocephaly is divided into two types:
Relative (non-closure) & non relative (closure) . In type of relative or eventual, the relation between place of production and absorption of C.S.F exists. Also the C.S.F stream is in natural path but absorption of C.S.F in the place of sub arachnoid velocities has been decreased and C.S.F is accumulating in ventricles.
Clinical symptoms:
Clinical symptoms of hydrocephaly are dependant on age of beginning it and severity of non-balance between production and absorption of cerebrospinal fluid.
The symptoms of this disease are as follows:
Immensity of cranium and creaks → particularly in frontal, the sign of vein Mack (the noise of creaked pitch during rapping cranium)
Craniotabes and delicacy of prominent and large fontanels, inability in nodding by infant, non-development of neck muscles, visual disorder and nystagmus and cross-eye, the sign of sunset (pupils divert down and out), diaphanous skin of head and extended veins, unusual spasm and down parts spasm, emotionality, variable cry, regurgitation, hard suck, anorexia and leanness, the weight of body and feet are fewer than head one, increase of I.C.P and convulsion.
The symptoms of healing cracks in elder children include headache (after getting up and changing position), mutant regurgitation without nausea, and disorder in work of cranial nerves, disorder in mental forces, sleepiness and coma.
Diagnostic Procedures:
CT scan is a selective way Encephalography or ventriculography can be used for determining the place of cerebrospinal fluid do sure.
Treatment:
It is necessary to start quickly treatment for prevention of cerebral injury. Its objective is to balance production and absorption of cerebral fluid. Medical treatment includes using acetazolamide (Diamox) for reducing the production of cerebral fluid. Also it includes resolving do sure related to a passage of cerebrospinal fluid, reducing cerebral fluid production by demolition of choroid , changing direction of cerebral fluid from ventricle to another place (putting shunt).
Nursing:
- Changing repeatedly the position of a child (one time per to minutes) to reduce a risk of infection of hypostatic pneumonia.
- Cleaning and drying a child (particularly around plicae of neck & back of ears) to reduce a risk of infection made by regurgitation and sweat.
- Protecting a child's head when changing position and movement to prevent injury and pressure on neck.
It should be noticed that hydrocephalic child's nutrition must be less and done in many times. Also she/he should be put beside after nutrition because of regurgitation.
These children should be limited in activities such as football that the possibility of injury is high.
Putting Shunt:
The purpose of putting shunt in hydrocephaly is path and stream of C.S.F from ventricle to outside of cerebral bursa (like peritoneum, right atrium, and lift bursa). Shunt used in hydrocephaly includes one ventricle catheter, one unilateral valve and one distal catheter. Ventricle catheter to putout C.S.F from vent ride distal catheter enters it to regarded place outside of cerebellum, and unilateral valve causes one-sided stream of shunt by prevention of C.S.F. reflex to ventricles.
Infection is the worst and most serious complication of putting shunt that causes septicemia and bacterium. If there is infection, shunt is brought out and wide range of antibiotic is used.
High fever, existing local signs of infection in path of shunt or nutritional problems, regurgitation, changeable behavior or convulsion show the possibility of infection.
Because of a child's growth, shunt should be changed regularly and this increases the possibility of infection.
Nursing:
Position after putting shunt should be in this way that doesn’t prevent of suitable evacuation of shunt. She/ he should be put supine from 1-24 houses after a child's surgical operation and her/his regurgitation should be controlled. Then she/he should be put on health for prevention of pressure on valve of shunt. Head should be located along body to prevent of quick evacuation.
The most important point is controlling the inflammation sings and protecting against shunt inflammation.
Nutrition should be full of fibers (plum, apple, rhubarb) after putting shunt to prevent of pressure on shunt because of intestines expansion and constipation and its closure.
Controlling the complications of putting shunt and learning it to parents:
Inflammation and swelling, redness and sensitivity to the head of shunt, disorder in stream, difficulty in nutrition, regurgitation, and changeable behavior are the complications of shunt that should be informed to parents by nurses. It should be recalled to parents the complications of shunt and the signs of increasing C.S.F The features of increasing C.S.F are as follows: dizziness, regurgitation, cross-eye, disorder in vital signs and the signs of cerebral hernia.
Other signs are the sign of Mackvien and Sunset.
Dr. Sheikh hospital
