Hydrocephalus Care Plan for a 14-Year-Old Child

Risk for Infection 

Etiology: 

Nosocomial infections and the patient’s skin microflora are the primary causes of shunt and catheter-associated infections. Staphylococcal infections, predominantly Staphylococcus epididymis , are the most common causes of concerns among caregivers. The bacteria get into the shunt tubing and colonize the internal walls of the catheters. Following this colonization, adherent colonies form in the shunt, resulting in external wound infection and ventriculitis (Haridas, Tomita, Patterson, & Armsby, 2019). 

Rationale: 

Foreign body insertions provide an easy pathway for the entry and colonization of infection-causing bacteria. Due to the high prevalence of hospital and community-acquired infections among patient populations, it is becomes relatively easy for the patient to contact the infections (Norkett, McLone, & Bowman, 2016). Colonization results in the presentation of clinical symptoms, predominantly elevated temperature and lethargy. 

CarePlan 

Compromised Family Coping 

Etiology: 

Excess accumulation of cerebrospinal fluid in the brain impedes normal brain functioning, thereby resulting in impaired neurologic and psychologic activities. Intracranial pressure due to accumulation of fluid also results in irritability, making it difficult for the patient to cope and perform normal social activities (Haridas, Tomita, Patterson, & Armsby, 2019). 

Rationale: 

The abnormal expansion of the head causes the patient to experience changes in their level of consciousness. Psychological functions such as social behavior is affected, as the patient becomes aware of his condition. 

Goals: 

Short term Goal: 

The patient will demonstrate better health outcomes with the elimination of infections within one month of initiation of the intervention. The attainment of this goal is assessed through routine evaluation of the wound to determine the wound healing progress. Also, routine monitoring of bacterial culture and patient symptoms indicate a decline in the rate of infection. 

Long term goal: 

The patient will demonstrate improved brain function as evidenced by improved cognitive development, better social and family coping mechanisms, and improved psychological functions after six months of initiation of the nursing interventions. The goal is evaluated monthly by observing how the patient is relating with his family and peers. Due to the intricacy of hydrocephalus, it is difficult to attain the goal within the provided timeframe. Thus, it would be appropriate to extend the timeline and intervention procedure by six more months. 

Nursing Interventions 

Hourly assessment of the vital signs within the first two weeks of catheter and shunt insertion. The pulse rate, temperature, and breathing patterns are analyzed to closely recognize and monitor the patterns of possible intracranial pressure (Norkett, McLone, & Bowman, 2016). Fluid accumulation often results in the buildup of intracranial pressure, consequently affecting the vital signs. 

Assessment of inflammatory processes, characteristics of the wound and wound healing patterns, regular white blood cell counts, and drainage on wound dressing. WBC and inflammation provide one of the key indicators of infection (Norkett, McLone, & Bowman, 2016). It is thus important to monitor this blood parameter to ascertain whether there is an increase or decrease of infection. Fever and sharp temperature changes are also integral in monitoring the patterns of infections. 

Encouraging the parents to be actively involved in the patient’s care process. This includes increased hospital stay during visitations, asking and responding to pertinent questions involving the patient’s condition and progress, and expressing concern in the patient’s social coping mechanisms. This provides an avenue for the patient to vent their feelings and acquire the information necessary for his wellbeing and amelioration of their symptoms. It also allows the patient to develop and improve his family coping mechanisms by promoting positive interactions. 

Evaluation of Interventions 

The regular basement of vital signs every hour helped to monitor the development of intracranial pressure. Thus, the intervention worked. 

Assessment of the inflammatory process and WBC was useful in monitoring the pattern of infection. 

The social coping intervention was effective in strengthening the patient’s social development functions. The intervention, however, required a longer than expected time to attain the stipulated goals. 

References 

Norkett, W., McLone, D. G., & Bowman, R. (2016). Current Management Strategies of Hydrocephalus in the Child With Open Spina Bifida.  Topics in spinal cord injury rehabilitation ,  22 (4), 241–246. https://doi.org/10.1310/sci2204-241 

Haridas, A., Tomita, T., Patterson, M., & Armsby , C. (2019). Hydrocephalus n children: 

management and prognosis . U: UpToDate [Internet]. Post TW r, UpToDate [Internet]. Watham, MA: UpToDate.