Page 1109 - Saunders Comprehensive Review For NCLEX-RN

by malformations, tumors, hemorrhage, infections, or
trauma
2. Results in head enlargement and increased ICP
B. Types
1. Communicating
a. Hydrocephalus occurs as a result of
impaired absorption within the
subarachnoid space.
b. Obstruction of the cerebrospinal fluid
flow in the ventricular system does not
occur.
2. Noncommunicating: Obstruction of cerebrospinal
fluid flow in the ventricular system does occur.

C. Assessment

1. Infant
a. Increased head circumference
b. Thin, widely separated bones of the
head that produce a cracked-pot sound
(Macewen’s sign) on percussion
c. Anterior fontanel tense, bulging, and
nonpulsating; sutures will separate
prior to fontanel bulging
d. Dilated scalp veins
e. Frontal bossing
f. “Setting sun” eyes
2. Child
a. Behavior changes, such as irritability
and lethargy
b. Headache on awakening
c. Nausea and vomiting
d. Ataxia
e. Nystagmus
3. Late signs: High, shrill cry and seizures
D. Surgical interventions

1. The goal of surgical treatment is to prevent

further CSF accumulation by bypassing the blockage
and draining the fluid from the ventricles to a location
where it may be reabsorbed.
2. In a ventriculoperitoneal shunt, the CSF drains into
the peritoneal cavity from the lateral ventricle (Fig.
38-4).
3. In a ventriculoatrial shunt, CSF drains into the right
atrium of the heart from the lateral ventricle,
bypassing the obstruction (used in older children and
in children with pathological conditions of the

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