The nurse is giving discharge teaching to the mother of a ...

[ereecah]

The nurse is giving discharge teaching to the mother of a 3-year-old who has had a shunt revision. The nurse teaches the mother that which of the following are signs of shunt malformation? Select all that apply.
 
  1. Fever
   2. Vomiting
   3. Dizziness
   4. Bulging fontanel
   5. Personality change

Question 2

The nurse is caring for a 9-month-old who just returned from the PACU after a shunt placement for hydrocephalus. Which of the following physician's orders would the nurse question?
 
  1. Elevate head of bed.
   2. Daily head circumference
   3. Small, frequent formula feedings
   4. Vital signs and neuro checks hourly

[epscape]

Answer to Question 1

1, 2, 5
Rationale:
1. Fever can be a sign of shunt malfunction.
2. Vomiting can be a sign of shunt malfunction, and might indicate increased intracranial pressure.
3. Dizziness is not necessarily seen with a shunt malfunction, and can be difficult to assess in a 3-year-old.
4. Fontanels are closed in a 3-year-old.
5. Personality change can be indicative of a shunt malfunction.

Answer to Question 2

1
Rationale:
1. The 9-month-old should be placed in a flat position so that CSF drainage is not too rapid.
2. Daily head circumferences are needed to help evaluate shunt functioning.
3. Small, frequent feedings are appropriate to decrease the chance of vomiting.
4. Frequent vital signs and neuro checks are needed postoperatively.