A CASE ANALYSIS ON

HYDROCEPHALY

In partial fulfillment of the requirements for NCM 109:

Care of Mother, Child at Risk or with Problems (Acute & Chronic)

Submitted by:

Group Leader:
FERNANDEZ, Robert Kelly M.

Group Members:
ESTREMOS, Noelyn G.
FERMO, Arthur Glenn M.
FERMO, Chris Angeline M.
FRIAS, Chevrolet P.
FUKUHARA, Ma. Christy Sheen B.

BSN 2C - Group 3

Submitted to:
Prof. Luth M. Mondano, RN MAN
Prof. Marilou T. Choa, RN MAN
Prof. Jo Angeli Maria B. Malonzo, RN MAN
Prof. Feresita A. Evia, RN MAN
Prof. Marilyn M. Santos, RN MAN PhD

May 2021
Learning Objectives
At the end of this case analysis, they will be able to:
For students:
- Gain knowledge about hydrocephaly, including its causative factors and course of
treatment.
- Identify the main nursing prioritizations in the care for a patient with ongoing treatment
for hydrocephalus.
- Develop necessary nursing skills and competencies in management of hydrocephaly,
including planning and nursing interventions.
- Explain the appropriate nursing health teachings to the patient regarding hydrocephaly.

For faculty:
- Assess the presenters’ knowledge, understanding and mastery of the case.
- Evaluate the strengths and weaknesses of the prioritization, planning, and nursing
interventions in the case.
- Impart deeper knowledge of the condition and the necessary interventions that need to be
done to maximize the quality of care to the patient.

For parents/guardians of the patient:

- Gain insight about what hydrocephaly is, including the recognition of its signs and
symptoms.
- Learn the purpose of shunt placement procedure in the management of hydrocephaly.
- Understand the treatment plan and the nursing interventions needed in the management of
hydrocephaly.
- Comply with the nursing interventions and treatment of hydrocephaly.
Introduction
Hydrocephalus, also known as hydrocephaly, is a neurological disorder wherein there is
an excessive buildup of cerebrospinal fluid (CSF) within the ventricles of the brain. Normally,
the CSF flows through the ventricles to circulate nutrients and chemicals from the bloodstream to
the brain. Hydrocephalus may be classified as either non-communicating or communicating.
Non-communicating hydrocephalus refers to an obstruction of CSF flow within the ventricular
system, usually due to the following congenital malformations: aqueductal stenosis,
meningomyelocele, intraventricular hemorrhage, infection, tumors, and head injury.
Communicating hydrocephalus refers to a blockage outside the ventricles, wherein the CSF flow
is not obstructed, but there is an excess of CSF production or a decrease in absorption.

Hydrocephalus does not exclusively occur in newborns. Hydrocephalus may either be

congenital—present at birth; or acquired, as a result of injury or disease. The exact cause of
hydrocephalus is currently not well understood, with the exception of hydrocephalus secondary
to physical obstruction of CSF flow by blood or presence of tumor (Silbert-Flagg, Pillitteri, &
Wolters Kluwer Health, 2018).

Congenital hydrocephalus are typically caused by inherited genetic abnormalities that

affect the CSF flow; developmental disorders associated with birth defects in the brain, spine,
and/or spinal cord; complications related to premature birth such as ventricular bleeding; and
infection during pregnancy that may cause inflammation of the fetal brain tissues. For acquired
hydrocephalus, predisposing factors include existing brain or spinal cord tumors; infections in
the central nervous system; and injury or stroke that causes bleeding in the brain.

The symptoms for hydrocephalus differ according to the age group. For children older
than 2 years, macrocephaly is not often observed. Signs of increased intracranial pressure (ICP),
such as vomiting, ataxia, and headache are observed. Other signs and symptoms include nausea,
vomiting, headache upon waking up, irritability, lethargy, apathy, impaired judgment,
incoherence, papilledema, strabismus, frequent urination or urinary incontinence, and decreased
visual acuity.
 Hydrocephalus is treated via surgical interventions, either shunt procedure or endoscopic
third ventriculostomy (ETV). With a shunt procedure, there is a risk of drainage failure
secondary to mechanical failure or infection, wherein symptoms will recur. Shunts require
frequent medical check-ups for monitoring. Surgery must be performed to replace ineffective
shunts.

A study by Kahle, Kulkarni, Limbrick, & Warf (2016) explores the possible structural
causes of both congenital and acquired hydrocephalus. The most common causes of congenital
hydrocephalus are premature birth, congenital aqueductal stenosis, myelomeningoceles, and
hemorrhage. The most common causes of acquired hydrocephalus are aqueductal stenosis
secondary to brain tumors, as well as hemorrhage and infection (Gul, Arslantas, & Kasapoglu,
2018).

Hydrocephalus occurs in at least 1 per 1000 neonates and children in developed

countries. For developing countries, prevalence of hydrocephalus is significantly higher, with an
estimate of 316 per 100,000 births. The primary cause of hydrocephalus in developing countries
is infection, with bacterial meningitis being the most common (Kahle, Kulkarni, Limbrick, &
Warf, 2016).

The mortality rate of patients with hydrocephalus ranges from 0 to 3%, highly depending
on the course of therapy and the continuity of care through frequent follow-up management.
Survival in untreated hydrocephalus is poor, with 50 to 80% of pediatric patients with either
congenital or acquired hydrocephalus die before reaching adulthood (Kahle, Kulkarni, Limbrick,
& Warf, 2016).

This case study will serve as a framework and guide for nursing students who will
encounter cases of hydrocephaly in the future. It will provide the necessary information and
explanation as to the presentation and manifestation of hydrocephalus and its associated factors.
This case study will provide a holistic view of the care and treatment for hydrocephaly. The case
study will sharpen the nursing students’ perception and critical thinking skills in dealing with
cases related to hydrocephalus and increased intracranial pressure. Through exposure to the
complete details of this case, the nursing students will have an overview of the approach and the
nursing interventions necessary to provide quality nursing care. The interventions presented in
this case study will help the nursing students perform well when presented with a similar
situation in a clinical setting.

Patient Case Scenario

A 7-year-old male was brought to the emergency department by the mother due to vomiting,
irritability, and headache for the past 24 hours. The patient was observed to be exhibiting signs
and symptoms of increased intracranial pressure—vomiting, ataxia, and headache. The child’s
vaccine booklet shows complete immunization, and the patient had no significant medical or
surgical history. Physical assessment revealed the child to have lethargy, decreased level of
consciousness, strabismus and papilledema present on both eyes. The patient was observed to
have decreased heart rate with a regular heart rhythm and bradypnea. MRI revealed aqueductal
stenosis secondary to benign brain tumor.

Patient Profile
Name: A.B.
Age: 7 years old
Sex: Male
Weight: 22 kg
Religion: Roman Catholic
Citizenship: Filipino
Address: Quezon City
Admitting Diagnosis: increased intracranial pressure
Final Diagnosis: non-communicating hydrocephalus
Pathophysiology
 A patient may suffer from hydrocephalus due to different reasons, but there are several
factors that increase the risk of hydrocephalus. Predisposing factors include the genetics and age
of the patient which is 7 years old. Precipitating factors include prematurity; babies with
premature delivery are at higher risk of ventricular bleeding that may experience hydrocephalus,
hemorrhage; blocks the passage of cerebrospinal fluid and leads to obstructive hydrocephalus,
infection; swollen meningitis will result in scarring, tumor; causes an obstruction in the flow of
cerebrospinal fluid and idiopathic; absence of elevated cerebrospinal fluid pressure.
Choroid plexus is responsible for producing the CSF in the CNS. wherein it is located in
the lateral ventricle. Once triggered by any external or internal factors there is a probability that
it will increase the amount of CSF produced. The produced CSF will flow in the Foramen of
monro or the channel that connects the lateral ventricle and the 3rd ventricle. The CSF flows
from the 3rd ventricle to the 4th ventricle through the Aqueduct of Sylvius of the channel that
connects the 3rd & 4th ventricle. Once Aqueduct of Sylvius is obstructed due to incomplete
formation of lateral & medial foramina (lateral & median foramina/ aperture is the conduit for
the CSF to flow from the brain's ventricular system into subarachnoid space) Since aqueduct is
obstructed, CSF will not flow which means it will just stays there in the 3rd ventricle. Start and
accumulate CSF then dilate the 3rd and lateral ventricle which causes ataxia, headache and
vomiting.

Anatomy and Physiology

THE BRAIN
It is well protected by:
● Scalp - composed of soft tissue layers that cover the cranium
● Skull - (cranium) is the skeletal structure of the head that supports the face and protects
the brain.
Normal Findings:
The head circumference 34-35 cm in infant and 47 cm by 1 yr of age
Abnormal Findings:
The head circumference is enlarged with size for infants is greater than 35 cm and greater than
47 cm for 1 yr old.
Normal Findings:
● Meninges - are protective coverings of the brain (cranial meninges) and spinal cord
(spinal meninges). They consist of three layers of membranous connective tissue:
1. Dura Mater - tough outer layer lying inside the skull and vertebrae, the spaces within the
fold of dura mater is called dural venous sinus, which collects blood from the small veins
of the brain. The dura mater is surrounded by an epidural space between the dura mater
and periosteum of vertebrae
2. Arachnoid Mater - very thin later on the middle of meninges, the spaces between dura
mater and arachnoid mater is the subdural mater, which is normally only a potential space
containing a very small amount of serous fluid
3. Pia Mater - very tightly bound to the surface of the brain and spinal cord, the spaces
between arachnoid mater and pia mater is subarachnoid space which is filled with
cerebrospinal fluid containing blood vessels

Abnormal Findings: Hydrocephalus may result from a thickening of the arachnoid around the
base of the brain, which blocks the flow of CSF from the spinal to the cortical subarachnoid
spaces.
THE VENTRICLES
Normal Findings:
The ventricles are filled with cerebrospinal fluid (CSF) that absorbs physical shocks to the brain,
distributes nutritive materials to and removes wastes from nervous tissue and provides a
chemically stable environment.
1. Lateral Ventricle - two lateral ventricles occupies a cerebral hemisphere that contains
relatively large cavities
2. Third Ventricle - a smaller midline cavity located in the center of diencephalon between
two halves of the thalamus and connected to the foramina to the lateral ventricles
3. Fourth Ventricle - connects to the third ventricle (via the cerebral aqueduct) and to the
central canal of the spinal cord (a narrow, central tube extending the length of the spinal
cord). Additional openings in the fourth ventricle allow CSF to flow into the
subarachnoid space.

Abnormal Findings: Hydrocephalus occurs when there is a build-up of CSF in the ventricles and
the excess fluid increases the size of ventricles and puts pressure on the brain. Communicating
hydrocephalus all the 4 ventricles are enlarged while the Obstructive hydrocephalus there is
dilation of lateral and third ventricles with small, compressed or normal size of 4th ventricle.
CSF PRODUCTION AND ABSORPTION
Normal Findings:
● CSF is a clear colorless liquid which fills the space between the arachnoid membrane and
the pia mater.
● CSF is to cushion the brain within the skull and serve as a shock absorber for the central
nervous system.
● CSF is produced primarily by the choroid plexus, which is responsible for 60 to 80
percent of CSF production.
● The choroid plexus tissue is located in each cerebral ventricle and consists of villous
folds lined by epithelium with a central core of highly vascularized connective tissue.
● CSF supplies brain tissue with nutrients and flows through the ventricles before being
absorbed back into circulation from the venous sinus.
● CSF production rates are constant in physiological conditions unless extremely high
levels of intracranial pressure are reached.
● Thus, absorption of CSF generally matches the rate of production to accommodate the
volume of CSF being formed each day.
 ● CSF is absorbed into the systemic circulation primarily across the arachnoid villi into the
venous channels of the sagittal sinus. Some CSF absorption also occurs across the
ependymal lining of the ventricles and from the spinal subarachnoid space
● CSF returns to circulation via the venous sinus.

Abnormal Findings: When hydrocephalus occurs, excess CFS builds up in the brain’s cavities,
it causes them to widen, which puts harmful pressure on the brain. In communicating
hydrocephalus the CSF can still flow between the ventricles while in non-communicating
hydrocephalus the flow of CSF from ventricles to subarachnoid space is obstructed. Also, if CSF
is able to get out but it’s not being efficiently absorbed in the linings around the brain, the fluid
backs up in the spaces in the brain because it’s continuing to be produced, it results in the spaces
getting larger and builds up fluid that results in Hydrocephalus.
FLOW OF CSF
Normal Findings:
● CSF is secreted by choroid plexus in each lateral ventricles
● CSF flows through interventricular foramen into third ventricle
● Choroid plexus in the third ventricles adds more CSF
● CSF flows down cerebral aqueduct to fourth ventricles
● Choroid plexus in fourth ventricles adds more CSF
● CSF flows out two lateral apertures and one median aperture
● CSF fills subarachnoid space and bathes external surfaces of brain and spinal cord
● At arachnoid villi, CSF is reabsorbed into venous blood of dural venous sinuses

Abnormal Findings: Communicating hydrocephalus occurs when the flow of cerebrospinal fluid
(CSF) is blocked after it exits the ventricles while Non-communicating hydrocephalus occurs
when the flow of CSF is blocked along one of or more of the narrow passages connecting the
ventricles
Medical Management
Cerebrospinal fluid shunting is the standard treatment for hydrocephalus, but there are
certain medical treatment approaches alternatively applied alone or in combination with
shunting. Treatment of hydrocephalus depends on its cause and it’s used to delay surgical
procedures.

Medical treatment in long term treatment of chronic hydrocephalus can be resumed to

balance CSF dynamics (production or absorption) during this interim period. Medications
include decreasing CSF secretion by the choroid plexus(Acetazolamide), increasing CSF
absorption (Isosorbide, Furosemide), or osmotic diuretics (Mannitol) which increase water
excretion and used to reduce intracranial pressure.

Laboratory test
● CBC - a complete blood count is a test used to evaluate the overall health and detect a
wide range of disorders, including anemia, infection and leukemia. It also measures
several components and features of the blood, including;
Red blood cells - which carry oxygen, (Males: 2–12 years 4.0–4.9 x 106 /L. (L = mm3)
White blood cells - which fight infection (Males: 6–12 years 4.5–10.5 x 103/mL. (L = mm3)
 Hemoglobin - the oxygen- carrying protein in red blood cells (Males: 6–12 years 11.0–
13.3 (g/dL)
Hematocrit - the proportion of red blood cells to fluid components or plasma, in the
blood, (Males: 6–12 years 32.7–39.3 %)
Platelets- which may help with blood clotting. ( Males: 6–12 years 194–364 x 103/mL. (L =
mm3)

● Urinalysis - it is a laboratory test for urine. It used to detect and manage a wide range of
disorders, such as urinary tract infections, kidney disease and diabetes. It also involves
the checking of the appearance , concentration and content of the urine. Abnormal results
of urinalysis may indicate a disease or illness. Normal urine output of a child - > 1
mL/kg/hr.

● Chest X-ray - The chest X-ray is the most common radiologic procedure. The X-ray is
projected toward the chest to show the heart and lungs, bones and soft tissues. The actual
time of the average X-ray exposure is extremely short - often less than one-half second.
Some of the radiation penetrates the part of the body being examined and thus creates the
X-ray image. The X-ray exposes the film to form an image just as the light exposes the
film inside a camera. The film in a camera is developed and used to make a photographic
print or it is used directly as a slide. The X-ray film is also developed and viewed with
transmitted light on a light box or computer screen. The chest X-ray technique in young
children involves two views. The initial view is from the front, and the second is a side
view.
● Magnetic Resonance Imaging (MRI) - uses radio waves and magnetic fields to produce
detailed 3D or cross-sectional images of the brain. This test is painless, but it is noisy and
requires lying still. MRI scan can show enlarged ventricles caused by excess
cerebrospinal fluid. They may also be used to identify underlying causes of
hydrocephalus or other conditions contributing to the symptoms.
● Perioperative Anesthesia Management
Perioperative anesthesia management depends on the underlying cause of hydrocephalus,
associated congenital anomalies, and their effect on the neurophysiology of the child,
whether the signs and symptoms of raised intracranial pressure are present. One must
know if these are acute or chronic in nature. A history of meningitis, seizures, altered
level of consciousness, posturing, intracranial hypertension, headache, nausea, vomiting,
or any signs of dehydration, nystagmus, diplopia, abnormal respiratory pattern, arterial
hypertension in the pediatric patient is always a concern, and must be investigated and
managed promptly.
Premedication - sedation usually is not required because patients’ altered level of
consciousness is being monitored. Any resultant respiratory depression may cause
hypercapnia with further increase in end-tidal CO2(Carbon dioxide) and grave
consequences. As soon as possible, intravenous access should be established in
preparation for any possible emergency and also can serve induction of anesthesia.

Anesthesia - latex precautions are recommended for patients with myelomeningoceles

undergoing shunt replacement. Inhalation induction of anesthesia is avoided because all
inhalation agents dilate cerebral vessels in a dose-dependent manner and may cause
increased intracranial pressure. The patient is preoxygenated, and a modified rapid-
sequence induction is preferred to minimize the risk for aspiration caused by recent
consumption of food or decreased gastric emptying from increased intracranial pressure.
Induction of anesthesia usually is done with intravenous thiopental, 3 to 4 mg/kg,
followed by a nondepolarizing neuromuscular blocking agent, such as rocuronium, 0.5 to
0.8 mg/kg, that has a rapid onset and intermediate duration after intravenous
administration. This drug has been given in the deltoid intramuscularly (1.8 mg/kg in
children) to intubate the tracheas of pediatric patients, and provided satisfactory
conditions. An inhalational agent is introduced in low concentrations once adequate
hyperventilation is established. Muscle relaxation is maintained throughout the
procedure, and an intravenous antibiotic, such as vancomycin or ceftriaxone, is given
slowly over 60 minutes after checking sensitivity to the drug. If required, a short-acting
analgesic is used in small doses. Surgeons usually infiltrate the surgical site to reduce the
 requirement for intravenous analgesics so that a neurologic assessment may be carried
out in the immediate postoperative period. At the end of the procedure, the stomach is
well suctioned, and the trachea is extubated when the patient is fully awake.

Postoperative care
The patient is transported to the recovery room with an oxygen mask, and the vital signs
are monitored for 1 hour. Neurologic stability is confirmed before transfer to the floor for
continued care.

● Shunt placement procedure standard treatment for hydrocephalus. It involves threading

a thin polyethylene catheter under the skin from the ventricles to the peritoneum (a
ventriculoperitoneal shunt). Fluid drains by this route into the peritoneum, where it is
absorbed across the peritoneal membrane into the body circulation.

● Furosemide, a potent loop diuretic used to treat high blood pressure, congestive heart
failure, hyperkalemia and acute renal failure, also reduces cerebrospinal fluid production
by inhibiting the transport of Cl- to the cerebrospinal fluid.

● Mannitol raises the osmolality of the blood and creates an osmotic gradient between the
blood and intracranial compartment. As a result, the removal of brain water lowers ICP.
 In most cases, intracranial pressure rapidly after a bolus dose of mannitol is administered,
but in some patients, it can worsen intracranial hypertension.

● Gentamicin is the antibiotic of choice to prevent or to treat a wide variety of bacterial

infections.

● Metoclopramide - used to treat or prevent reflux, and to relieve symptoms such as

nausea, vomiting, and continued feelings of fullness after meals and loss of appetite, and
may also improve feeding problems and spitting up. It can also be used to prevent nausea
and vomiting caused by other medicines.
Prioritized Problems

Nursing Problems Cues Justification

Ineffective cerebral tissue Subjective: Ineffective cerebral tissue

perfusion related to increased “Nahihilo ang anak ko maya’t perfusion is considered the
intracranial pressure maya at mabagal siyang top priority according to ABC
gumalaw” as verbalized by prioritization, as the patient’s
the patient's mother. blood circulation to the brain
is decreased.
Objective data:
- Vomiting
- Irritability
- Lethargy
- Decreased LOC
- Instability of balance
- Blurring of vision
- Head circumference of
47.5 cm

Vital signs
Temp: 38.0 C
HR: 55 bpm
RR: 14 bpm
BP: 115/75 mmHg

Fluid and electrolyte Subjective: The problem is considered as

imbalance related to vomiting “Laging sumusuka po ang second top priority according
aking anak at hindi to MAAUAR prioritization,
makakain ng maayos” as as it pertains to an abnormal
diagnostic result.
verbalized by the patient’s
mother.
Objective:
● Vomiting 4-5 times a
day
● Dehydrated
● Dry skin
● Poor skin turgor
● Loss of appetite
● Patient seems
lethargic

Vital signs
Temp: 38.0 C
HR: 55 bpm
RR: 14 bpm
BP: 115/75 mmHg

Diagnostic result
Na: 120 mmol/L
K: 3.30 mmol/L

Hyperthermia related to Objective: The problem is considered as

postoperative infection Postoperative client after the third top priority
shunt placement surgery. according to Maslow’s
-Dry skin hierarchy of needs as it
-Warm to touch pertains to meeting the
physiological needs of the
Vital signs patient, particularly their
Temp: 38.0 C homeostatic imbalance with
HR: 55 bpm regards to temperature.
RR: 14 bpm
BP: 115/75 mmHg
 Nursing Care Plans
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective Pre-operative Independent: Pre-operative

“Nahihilo ang tissue care Assess the general To obtain a baseline care
anak ko maya’t perfusion Short term: condition of the patient data that will serve as Short term:
related to
maya at mabagal Within 2 to 3 the basis for Within 2 to 3
increased
siyang intracranial hours of nursing comparison in hours of nursing
gumalaw.” as pressure as intervention, the assessing for the intervention, the
verbalized by evidenced by patient’s ICP effectiveness of patient’s ICP
the patient's decreased will gradually nursing interventions. gradually
mother. LOC, lethargy, decrease. decreased
instability of Assess vital signs hourly To recognize early
balance and
Objective data: Long term: signs of increased Long term:
blurring of
- Vomiting vision After 7 days of intracranial pressure After a series of
- Irritability nursing nursing
- Lethargy intervention, the Assess the client’s level To monitor patient’s intervention and
- Decreased patient’s LOC of consciousness using LOC by the time
LOC will improve glasgow coma scale shunting is done
- Instability of from lethargic to as suggested by
balance alert as Elevate the head of the This position will the pediatrician,
- Blurring of evidenced by bed gradually about 15- reduce arterial patient’s
vision stable vital signs 45 degrees as indicated. pressure and enhance intracranial
Head Maintain the client’s cerebral perfusion. pressure
circumference of head in a neutral eventually
47.5 cm position. stabilized, as
evidenced by
Vital signs Adjust the room To prevent shivering, stable vital signs
Temp: 38.0 C temperature. which increases ICP.
HR: 55 bpm
RR: 14 bpm
BP: 115/75 Dependent:
mmHg Administer mannitol and To reduce production
furosemide as ordered. of cerebrospinal fluid.
 To reduce body
Prepare the patient for temperature and
shunt placement relieve hyperthermia.
procedure

Collaborative:
Request for laboratory To check for the
extraction as ordered. intracranial pressure
of the patient.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Fluid and Pre-operative Independent: Short term:

“Laging electrolyte Short term: Monitor and record vital To obtain a baseline After 3 to 5
sumusuka po imbalance After 3 to 5 hours signs every 3 hours data hours of nursing
related to
ang aking anak of nursing intervention, the
vomiting as
at hindi evidenced by intervention, the Encourage the patent to To prevent patient lessened
makakain ng 4-5 times patient will increase fluid intake and dehydration and the occurence of
maayos” as vomiting and lessen the recommend drinking replenish lost vomiting from
verbalized by low sodium occurence of fluids containing electrolytes. 4-5 times to 2-3
the patient’s and potassium vomiting from 4- electrolytes. times a day
mother. level 5 times to 2-3
times a day Monitor and record Long term:
Objective: patient intake and output To assess if the patient After 2-3 days of
Vomiting 4-5 Long term: every 2 hours. is undergoing fluid nursing
times a day After 2-3 days of loss, which contributes intervention the
Dry skin nursing to electrolyte patient
Poor skin turgor intervention the imbalance. completely
Lethargy patient will Dependent: eliminated the
Loss of appetite completely Administer electrolyte occurrence of
eliminate the replacements as To normalize the vomiting and the
occurrence of prescribed. serum electrolyte patient’s fluid
Vital signs vomiting and the levels of the patient. and electrolyte
Temp: 38.0 C patient’s fluid Administer famotidine were restored
HR: 55 bpm and electrolyte as ordered. To reduce the acidity
RR: 14 bpm will be restored of the patient’s
BP: 115/75 stomach, which will
mmHg reduce the incidence of
vomiting

Diagnostic Collaborative:
result Refer laboratory results
Na: 120 mmol/L to the physician for To regularly check and
K: 3.30 mmol/L review of patient care monitor the serum
electrolyte levels in the
 body.

Drug Study
Drug Name Mechanism of Action Indications Contraindications Side Effects Nursing Responsibilities
Osmitrol Mannitol acts as an Increased Hypovolemia Dry mouth Observe the 14 rights of
(Mannitol) osmotic agent, which ICP Nausea drug administration.
limits tubular Impaired renal Dehydration
Dosage reabsorption of water, function Pain on injection Check for patency of IV
5.5g/22 mL therefore reducing the site fluid prior to administering
(0.25 g/kg/dose) fluids present in the eyes Nephrotoxicity the drug.
and brain.
Frequency Adverse Effects Monitor renal function
Every 6 to 12 Classification Renal failure closely through input and
hours Diuretic medication CNS toxicity output. Watch out for
Rebound increase urinary output reduction.
Route in ICP
Intravenous (IV)

Drug Name Mechanism of Action Indications Contraindications Side Effects Nursing Responsibilities
Lasix Furosemide acts by Cerebral Anuria Nausea Observe the 14 rights of
(Furosemide) reducing the production edema Hypotension Thirst drug administration.
of CSF via the inhibition Dizziness
Dosage of chloride electrolytes. Weakness Monitor the patient’s blood
40 mg/4 mL Increased pressure before
(2 mg/kg/dose) Classification urination administering the drug.
Diuretic medication Decreased blood
Frequency pressure Check for patency of IV
Every 6 to 12 fluid prior to administering
hours Adverse Effects the drug.
Jaundice
Route Pancreatitis Monitor the client’s intake
Intravenous (IV) Tinnitus and output. Watch out for
reduced urination.

Monitor the patient’s skin

color and turgor.
Discontinue the infusion if
jaundice is observed.
Drug Name Mechanism of Action Indications Contraindications Side Effects Nursing Responsibilities
Pepcid Reduces the acid and Hyperacidity Hypersensitivity to Headache Observe the 14 rights of
(Famotidine) pepsin content, as well drug Constipation drug administration.
as the volume, of basal, Diarrhea
Dosage nocturnal, and Assess the patient’s heart
20 mg stimulated gastric Adverse Effects rate and rhythm prior to
secretion. Tachycardia administration of the drug.
Frequency Palpitation
Twice a day Classification Dizziness Assess for gastrointestinal
Histamine-2 Blocker Seizure complaints, such as nausea,
Route vomiting and constipation.
Oral (Suspension)
Rinse mouth frequently to
combat dryness.

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