Oklahoma City Community College脑积水俄克拉荷马城社区学院ppt课件.ppt

VA shunt Reserved for older children who have attained most of somatic growth, or children with abdominal pathology. Contraindicated in children with cardiopulmonary disease or with elevated CSF protein. Major Complications Shunt infection is most serious complication! Period of greatest risk is 1 to 2 months following placement. Staph and strep most common organisms Complications Mechanical difficulties kinking, plugging, migration of tubing. Malfunction is most often by mechanical obstruction! Look for signs of increased ICP; fever, inflammation and abdominal pain. Post-op care In addition to routine post-op care: 1. Place on unoperated side to prevent pressure on shunt valve 2. Keep HOB flat; rapid decrease in IC fluid may cause subdural hematoma due to small vein rupture in cerebral cortex. 3. Do not pump shunt without specific direction from doctor (too many different pump devices) Post-op care 4. Observe for signs of Increased ICP! May indicate obstruction of shunt! Assess pupil size; as pressure on oculomotor nerve may cause dilation on same side as pressure. Blood pressure may be variable due to hypoxia to brainstem Abdominal distention- due to CSF peritonitis or post-op ileus due to catheter placement. Post-op 5. Monitor I and O- may be on fluid restriction or NPO for 24 hours to prevent fluid overload. 6. Monitor VS- increased temp may indicate infection. 7. Give good skin care to prevent tissue damage, etc. Family support Fear Communication of procedures Prepare for discharge. SPINA BIFIDA Neural Tube defects are largest group of congenital anomalies. Failure of neural tube to close produces defects of either entire neural tube or small areas. Etiology Anacephaly and spina bifida occur together very often. Higher in females than males 50% occur due to nutritional deficiency (folic acid) Spina Bifida Defined as midline defects involving failure of the bony spine to close. Spina bifida occulta- defect not visible externally. Occurs most often in lumbosa