A nurse is collecting data from an infant who has hydrocephalus.
Which of the following findings should the nurse expect?

 

Choice A rationale

Applying suction continuously while inserting the suction catheter is not recommended. This could potentially cause trauma to the trachea and lead to complications.

Choice B rationale

Using a large diameter suction catheter for better suctioning is not recommended. The size of the suction catheter should be appropriate for the size of the tracheostomy tube. Using a catheter that is too large could cause trauma to the trachea.

Choice C rationale

Suctioning for no more than 10 seconds at a time is recommended to prevent hypoxia (lack of oxygen). Prolonged suctioning can lead to complications such as hypoxia, trauma to the trachea, and cardiac arrhythmias.

Choice D rationale

Applying suction while the child is exhaling is not recommended. Suction should be applied while withdrawing the suction catheter, not during exhalation.

Choice A rationale: Soft and flat fontanels are normal in healthy infants. In hydrocephalus, increased intracranial pressure causes bulging fontanels due to excess cerebrospinal fluid accumulation.

Choice B rationale: Proteinuria is a renal finding and not associated with hydrocephalus. Hydrocephalus affects the central nervous system, not kidney filtration or protein excretion.

Choice C rationale: Dilated scalp veins occur due to elevated intracranial pressure from cerebrospinal fluid buildup. Venous distension is a visible sign in infants with hydrocephalus.

Choice D rationale: Hypertension is not a typical sign of hydrocephalus in infants. The condition primarily presents with neurological and cranial changes, not systemic blood pressure elevation.