Ventriculostomy N451 Clinical Presentation Megan Bess Michael Coughlin Melissa Johnston Lakesa Williams

Objectives · Identify an external ventricular drain Explain the operation of an external ventricular drain Describe the indications for a ventriculostomy · Identify three of six nursing interventions for the patient with increased intracranial pressure

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Indications Obstructive Hydrocephalus is the most common cause Inflammation (Trauma or infection) Neoplastic obstruction (Tumors) Aqueduct Stenosis Connects the 3rd ventricle and the 4th Stenosis does not allow for fluid to flow causing hydrocephalus. median aperture blockage Lateral aperture blockage

Indications Shunt Malfunction Myelomeningocele Spine does not fuse together to cover the spinal cord Cerebellum falls low causing block in circulation and CSF produced in the brain to over accumulate.

Nursing Interventions Nurses are the first to see changes in the Intensive care patient! WHY?

Nursing Interventions Retrieved from:http://farm4.staticflickr.com/3521/3308648138_5bc232a95e_z.jpg?zz=1 3308648138_5bc232a95e_z.jpg Retrieved from:http://g.psychcentral.com/news/u/2014/03/ICU-patient-nurse-SS.jpg

Nursing Interventions Maintain core body temperature within normal range using antipyretics or hypothermia blankets as ordered. Maintain head of bed( HOB) at 30 degrees unless contraindicated Maintain head and neck in neutral alignment. Avoid neck flaexion and rotation.

Nursing Interventions Avoid Valsalva maneuver with position changes Reorient the patient to the environment as needed Limit direct care activities

Research Single Versus Bilateral External Ventricular Drainage for Intraventricular Fibrinolysis using Urokinase in Severe Ventricular Hemorrhage Nursing Interventions for Critically Ill Traumatic Brain Injury Patients

Post-est Identify the following device: Internal Ventricular Drain External Ventricular Drain Bilateral Ventricular Drain None of the Above

Post-test When operating a external ventricular drain a nurse will...SELECT ALL THAT APPLY Maintain the drain level to the tragus Read drainage amount at the bottom of the meniscus and note color Maintain the drain level to the pinna Zero the drain prior to first use and every 4 hrs Flex the patient’s neck for better drainage

Post-test The client head of bed (HOB) should be kept at what level? A. 30 degrees B. 30 degrees unless contraindicated C. 25 degrees D. 25 degrees unless contraindicated

Post-test All of the following nursing care activities should be avoided in a patient with ICP except? A. Routine linen change B. Oral care C. Routine Bathing D. Hourly position changes

Post-test The most important goal for the nurse taking care of patient with increased ICP is to decrease ICP? A. True B. False

Post-test Which of the following signs in a patient are an early indication of possible hydrocephalus? Select all that apply. Headache Dilated nonreactive pupils Nausea/Vomiting Altered LOC Cushing's Triad Photophobia