Neurodiagnostic Studies Flashcards
CSF analysis
Obtained for cell count, culture, glucose and protein testing
Lumbar Puncture/Spinal Tap
Also used to measure CSF fluid or pressure, or instill air, dye, or meds
A spinal needle is inserted into the subarachnoid space between the 3rd and 4th or 4th and 5th lumbar vertebrae
Lumbar Puncture/Spinal Tap
Nursing Management in Assisting Spinal Tap/Lumbar Procedure
Pre-Procedure
- Signed consent
- Explain the procedure and clarify misconceptions
Nursing Management in Assisting Spinal Tap/Lumbar Procedure
During Procedure
- Position: Back of patient towards MD, lateral recumbent has client draw knees to abdomen and chin to chest.
- Pillows on patient’s head and between legs.
- Maintain position to prevent trauma resulting to a bloody tap.
- Instruct patient to breathe normally and relax; hyperventilation may lower an elevated pressure altering accurate pressure reading.
- Assist in cleansing lumbar area with betadine solution and draping (observe strict aseptic technique).
- MD will inject a local anesthetic to numb puncture site.
- A specimen is collected usually in 3 tubes; MUST be labeled in order of collection. Pressure reading may also be obtained.
Nursing Management in Assisting Spinal Tap/Lumbar Procedure
Post-Procedure
- Patient must lie PRONE for 2-3hrs - to reduce leakage of CSF
- Monitor for complications of Lumbar tap
- Force fluid intake to prevent post-procedure headaches
- MIO
Post Lumbar Tap Complications
- Post lumbar puncture headache
- Temporary voiding problems
- Slight elevation of temperature
- Backache or spasms
- Stiff neck
Rare but serious
1. Herniation of spinal intracranial contents
- Spinal epidural abscess
- Meningitis
Radiographic
X-ray of the skull reveal the size and shape of the skull bones, suture separation in infants, fracture or bony defects, erosion, or calcification
Skull and Spinal Radiography
Radiographic
Images provide cross-sectional view of the brain, distinguish differences in tissue densities of the skull, cortex, subcortical structures, and ventricles
CT Scan
Radiographic
Images is displayed on an Oscilloscope or TV monitor and is photographed digitally
Performed FIRST without contrast before imaging with contrast
CT Scan
CT Scan Nursing Interventions
- Pt needs to lie still during the entire procedure; essential to be instructed to pt
- Teach relaxation techniques
- Sedation maybe necessary if pt is confused, agitated, or restless
- Will require monitoring all throughout
CT Scan: if a contrast agent/dye will be used
- Assess allergy to iodine/shellfish
- 4hr fasting is required prior to test
- Monitor post-op dye reaction (N/V, flushing)
- Assess dye injection site for bleeding or hematoma, and monitor presence of distal pulses
- Provide fluid replacement because diuresis from dye is expected
Radiographic
Uses magnetic field to create an image
Magnetic Resonance Imaging
Radiographic
Provides info about chemical changes within the cell to monitor an organ’s response to Tx
Maybe used with or without dye
Magnetic Resonance Imaging
MRI Nursing Interventions
- Assess pt for claustrophobia
- Patient instructions: relaxation techniques, microphone is provided inside the scanner so pt may speak to staff
- All metal objects, credit cards, med patches with metal/foil backing (causing burns) must be removed
- No metal objects
Radiographic
Injection of contrast through the femoral artery into carotid arteries to visualize arteries and assess for lesions
Cerebral Angiogram
Radiographic
Used to investigate vascular disease, aneurysms
Frequently performed before craniotomy to assess patency and adequacy of cerebral circulation
Cerebral Angiogram
Radiographic
May use brachial artery to inject dye or a direct puncture of carotid or vertebral artery alternatively
Cerebral Angiogram
Angiography Nursing Interventions
Pre-Procedure
- Signed consent
- NPO 4-6hrs
- Obtain baseline neuro assessment
- Pt must be well hydrated 2 days prior to the exam. Pt will be asked to void before going to the x-ray department
- Explain the procedure
- Pt has to be immobile during the entire procedure
- A brief feeling of warmth in the face, behind the eyes, jaw, teeth, tongue, lips will be felt
- A metallic taste after the injection of the contrast agent will be experienced
- Mark peripheral pulses
Angiography Nursing Interventions
During Procedure
- The groin will be shaved and prepared, injected with a local anesthetic to numb as catheter is inserted
- Catheter will be flushed with heparinized saline
Angiography Nursing Interventions
Post-Procedure
- Observe for signs of altered cerebral blood flow d/t minor or major arterial blockages caused by thrombosis, embolism, or hemorrhage producing neurologic defects:
a. Altered LOC and responsiveness
b. Hemiparesis
c. Speech disturbances
- Monitor Neurological status, V/S until stable
- Monitor for swelling in the neck and for dysphagia and NOTIFY MD if these occur
- Maintain bed rest for 12hrs as prescribed
- Elevate head of bed 15-30 degrees only if prescribed
- Keep bed flat if femoral artery is used, as prescribed
- Assess peripheral pulses
- Apply sandbag and pressure dressing to the injection site as prescribed
- Place ice on the puncture site as prescribed
Neurodiagnostic Studies
- Lumbar Puncture/Spinal Tap
- Skull and Spinal Radiography
- CT Scan
- MRI
- Cerebral Angiogram
