Diagnostics Flashcards
What is a lumbar puncture and what are its indications?
Also called a spinal tap, it is a procedure in which a small amount of CSF is withdrawn from the spinal canal and then analyzed. NEEDLE DOES NOT ENTER SPINAL CHORD
It is indicated for:
1) To detect/rule out some diseases (meningitis, MS, Syphilis)
2) reduce CSF Pressure
3) Administer medication or chemo directly into spinal fluid.
What 3 longterm COMPLICATIONS are CONSIDERATIONS associated with a Lumbar Puncture?
1) BRAIN HERNIATION (rare) r/t increased ICP caused by an increase in blood, CSF, or tissue size in brain.
2) BLEEDING THAT COMPRESSES THE SPINAL CHORD r/t –> Pt w. bleeding disorders or who are taking anticoagulant
3) infection = like meningitis (rare)
**A manometer is used if ICP is a consideration to determine the opening pressure of the spinal chord.
What are 3 pre-procedure Nursing Actions for Lumbar puncture?
1) Have pt remove all jewelry and only wear a hospital gown.
2) Have pt void BEFORE procedure.
3) Have pt assume sitting as CANNONBALL position or sidelying as LATERAL RECUMBANT
What are 2 normal findings with lumbar puncture that the patient may report?
1) Feeling sensation of COLD as the site is cleansed in solution.
2) A NEEDLE PRICK when local anesthetic is injected.
What can the nurse place in between the legs to prevent top leg from rolling forward? (Lumbar Puncture)
A PILLOW
How can the nurse help the pt maintain position for a lumbar puncture?
1) Instruct Pt to breathe normally= don’t want pt to hyperventilate.
2) Nurse describes procedure step-by-step AS IT PROCEEDS
Where is a Lumbar Puncture inserted?
In the subarachnoid space b/t 3rd and 4th or 4th and 5th LUMBAR INTERSPACE.
How many samples are collected? (Lumbar Puncture)
3 test tubes.
What is the PRIORITY nursing action POSTPROCEDURE for a lumbar puncture/spinal tap?
1) Prevent post-lumbar puncture headache, which is an indication of CSF leakage.
What is a post-lumbar puncture headache indicate and how do you prevent it as the nurse?
Indicates CSF Leakage
How to MANAGE post-Lumbar Puncture Headache? This headache can occur a few hours or several days post procedure.
1) Encourage increased fluid intake
2) Instruct patient to lie PRONE
3) Administer pain meds
Pt Teaching: Normal activities can resume AFTER PRESCRIBED bed rest.
When is the post lumbar puncture MOST and LEAST severe?
Upon standing or sitting = SEVERE/WORSE
Laying down = LESS/DISSAPEARS
What 2 Complications is the pt at risk for post procedure? - (Lumbar Puncture)
1) Risk of infection –if clotting doesnt form to seal site
2) Headache = CSF Leakage at site
Post Procedure Complication management? (Lumbar Puncture) HINT: A patch
Prep pt for epidural blood patch to seal the hole in the dura if headache continues
What hemodynamic COMPLICATION is a pt at risk for intraprocedure? HINT: think airway risk
Airway is more compromised = monitor for DECOMPENSATION
Nursing Care Post Procedure - Name the 2 positions the nurse ensures the pt is in post Lumbar Puncture?
Prone following procedure.
Supine for 4-8 hours afterwards (Supine = lying on back) 1/2 my shift or all my shift the pt will be supine. Supine like a pine tree fallen on its back.
Name 4 short-term complications of lumbar puncture?
1) temporary voiding problems
2) slight elevation in temperature
3) backache/spasms
4) STIFF NECK
Name 3 out of 7 signs of CSF leakage?
Signs of CSF leakage includes 1- positional headaches, 2- nausea and vomiting, 3- neck stiffness, 4- photophobia (sensitivity to light), 5- sense of imbalance, 6- tinnitus (ringing in the ear), 7- phonophobia (sensitivity to sound).
