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Med Surg > Neurologic Diagnostic Procedures > Flashcards

Neurologic Diagnostic Procedures Flashcards

1
Q

Cerebral Angiography

A

Cerebral angiography provides visualization of the cerebral blood vessels.

  • Digital subtraction angiography hides the bones and tissues from the images, providing x-rays with only the vessels parent.
  • the procedure detects defects, narrowing, or obstruction of arteries or blood vessels in the brain.
  • the procedure is preformed within the radiology department because iodine-based contract dye is injected into an artery during the procedure.
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2
Q

Indications for Cerebral Angiography

A

Cerebral angiography is used to assess the blood flow to and within the brain, identify aneurysms, and define the vascularity of tumors (useful for surgical planning). It is also used therapeutically to inject medications that treat blood clots or to administer chemotherapy.

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3
Q

Procedure for Cerebral Angiography

A

If the client is pregnant, a determination of the risk to the fetus versus the benefits of the information obtained by this procedure should be made.

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4
Q

Nursing Actions During Cerebral Angiography

A
  • instruct the client to refrain from consuming food or fluids for 4-6 hours prior to the procedure.
  • asses for allergies to shellfish or iodine, which would require the use of a different contrast medium,
  • any history of bleeding or taking anti-coagulant medication requires additional consideration and additional monitoring to ensure clotting after the procedure.
  • assess BUM and serum creatinine to determine kidneys ability to excrete the dye.
  • ensure that the client is not wearing any jewelry
  • a mild sedative for relaxation is occasionally administered prior to and during the procedure, and vital signs and continuously monitored during the procedure.
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5
Q

Client Education During Cerebral Angiography

A
  • instruct the client about the importance fo not moving during the procedure and about the need to keep head immobilized.
  • instruct the client to void immediately before the test.
  • warn the client about a metallic taste in the mouth, and the warm sensation over the face, jaw, tongue, lips, and behind the eyes from the dye injected during the procedure.
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6
Q

Intraprocedure for Cerebral Angiography

A
  • the client is placed on the radiography table, where the clients head is secured.
  • a catheter is placed into an artery (usually groin or the neck), dye is injected, and x ray pictures are taken.
  • once all pictures are take, the catheter is removed and an arterial closure device is used or pressure is held over the artery to control bleeding by thrombus formation sealing the artery.
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7
Q

Postprocedure for Cerebral Angiography

A
  • closely monitor the area to ensure that clotting occurs.
  • movements are restricted depending on the type of procedure used to seal the artery to precent rebreeding at the catheter sire.
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8
Q

Complications with Cerebral Angiography

A

There is risk for bleeding or hematoma formation at the entry site.

  • check the insertion site frequently.
  • check the affected extremity distal to the puncture site for adequate circulation (eg, color, temperature, pulses, and cap refill)
  • if bleeding occurs, apply pressure over the artery and notify the provider.
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9
Q

Cerebral Computed Tomorgraphy Scan (CT Scan)

A

a CT scan provides cross sectional images of the cranial cavity. A contrast media can be used to enhance the images.

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10
Q

Indications for CT Scan

A

an be used to identify tumors and infarctions, detect abnormalities, monitor responses to treatment, and guide needles used for biopsies.

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11
Q

CT Scan Procedure

A

if the client is pregnant, a determination of the risk to fetus versus the benefits of the information obtained by this procedure should be made.

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12
Q

CT Scan Procedure Nursing Actions

A

If contrast media and/or a sedation is expected… instruct the client to refrain from consuming food or fluids for at least 4-6 hours prior to the procedure.
Assess for allergies to shellfish or iodine, which would require the use of a different contrast media.
Assess renal function (BUN and Creatinine) because contrast media is excreted by kidney
- Because this procedure is preformed with the client in a supine position, placing pillows in the small of the clients back can assist in preventing back pain.
- Ensure that the clients jewelry is removed prior to this procedure. In general, clients wear a hospital gown to prevent and metal from interfering with the x-rays.

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13
Q

CT Scan Intraprocedure

A
  • the client must lay supine with the head stabilized during the procedure.
  • although CT scanning is painless, sedation can be provided.
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14
Q

CT Scan Postprocedure

A
  • There is no follow-up care associated with a CT scan.
  • if contrast media is injected, monitor for allergic reaction and changes in kidney function.
  • if sedation is administered, monitor the client until stable.
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15
Q

Electroencephalography (EEG)

A

This noninvasive procedure assessed the electrical activity of the brain and is used to determine if there are abnormalities in the brain wave patterns. an EEG provides information about the ability of the brain to function and highlights areas of abnormality.

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16
Q

Indications for EEG

A

EEGs are most commonly preformed to identify and determine seizure activity, but they are also useful in detecting sleep disorders and behavioral changes.

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17
Q

Prodecure for EEG

A

review medications with the provider and determine If they should be continued prior to this procedure.

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18
Q

Client Education for EEG

A
  • instruct the client to wash his hair prior to the procedure and eliminate all oils, felt, and sprays.
  • if indicated, instruct the client to be sleep-deprived because this provides cranial stress, increasing the possibility of abnormal electrical activity, such as seizure potentials, occurring during the procedure.
  • increased electrical activity can be stimulated with exposure to bright flashing lights, or by requesting the client to hyperventilate for 3-4 minutes.
  • instruct the client to avoid taking any stimulant or sedative mediation 12-24 hours prior to the procedure.
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19
Q

Intraprocedure for EEG

A
  • the procedure generally lasts 1 hour.
  • there are no risks associated with this procedure.
  • with the client resting in a chair or lying in bed, small electrodes are placed on the scalp and connected to a brain wave machine.
  • electrical signals produced by the brain are recorded by the machine or computer in the form of wavy lines. This documents brain activity
  • notations are made when stimuli are presented or when sleep occurs ( Flashed of light or pictures can be used during the procedure to assess the clients response to stimuli.
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20
Q

Postprocedure for EEG

A

Instruct the client that normal activities may be resumed.

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21
Q

Glasgow Coma Scale

A

This assessment concentrates on neurologic function and is useful to determine the level of consciousness and monitor response to treatment. the GCS is reported as a number that allows providers to immediately determine if neurologic changes have occurred.

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22
Q

Indications for GCS

A

GCS scores are helpful in determining changes in level of consciousness for clients who have head injuries, space-occupying lesions or cerebral infarctions, and encephalitis. This is important because complications related to neurologic injuries can occur rapidly and require immediate action.

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23
Q

GCS considerations

A
  • in critical situations, where head injury is present and close monitoring is required, subscale results may also be documented. Thus, a GCS may be reported as either a single number, indicating the sum of 3 scales (3-15) or as 3 numbers , one from each subscale result, and the total. This allows providers to determine specific neurologic function.
  • intubation limits the ability to use GCS summed scored. If intubation is present, the GCS may be reported as 2 scores, with modification noted. This is generally interpreted as “GCS 5t” ( with the t representing the intubation tube.
24
Q

Interpretation of GCS findings

A
  • the best possible GCS score is 15. In general, total scores of the GCS correlate to the degree or level of coma.
  • A score less than 8 is associated with severe head injury and coma.
  • a score of 9-12 indicates moderate head injury
  • a score greater than 13 is associated with minor head trauma.
25
Q

Intracranial Pressure Monitoring

A

An intracranial pressure (ICP) monitor is a device inserted into cranial cavity that records pressure and is connected to a monitor that shows a picture of the pressure waveforms.

  • Monitoring ICP facilitates continual assessment and is more precise than vague manifestations.
  • The insertion procedure is preformed by a neurosurgeon in the operating room, ED, or critical care setting. This procedure is rarely used unless the client is comatose, so there is minimal need for pain mediation and preprocedural client teaching
26
Q

Three basic types of ICP monitoring systems

A
  1. Intraventricular catheter
  2. Subarachnoid screw or bolt
  3. Epidural or subdural sensor.
27
Q

Intraventricular Catheter

A

aka: ventriculostomy
a fluid filled catheter is inserted into the anterior horn of the lateral ventricles ( most often on the R side) through a burr hole. The catheter is connected to a sterile drainage system with a 3 way stopcock that allow simultaneous monitoring of pressures by a transducer connected to a bedside monitor and drainage of CSF.

28
Q

Subarachnoid screw or bolt

A

a hollow, threaded screw or bolt that is placed into the subarachnoid space through a twist-drill burr hole in the front of the skull, behind the hairline. The bolt is connected by fluid-filled tubing to a transducer leveled at the approximate location of the lateral ventricles

29
Q

Epidural or subdural sensor

A

A fiber-optic sensor is inserted into the epidural space through a burr hole. the fiber-optic device measures changes in the amount of light reflected from a pressure-sensitive diaphragm in the catheter tip. The cable is connected to a precalibrated monitor that displays numerical value of ICP. This method of monitoring is noninvasive because the device does not penetrate the dura.

30
Q

Indications for ICP monitoring

A
  • ICP monitoring is useful for early identification and treatment of increased ICP. Clients whoa re comatose or have GCS scores of 8 are candidates for ICP monitoring.
  • Manifestations of increased ICP include severe headache, deteriorating LOC, restlessness, irritability, dilated or pinpoint pupils, slowness to react, alteration in breathing pattern (Cheyne-Stokes respirations, central neurologic hyperventilation, apnea), deterioration in motor function, and abnormal posturing (decerebrate, decorticate, flaccidity)
31
Q

Preprocedure of ICP monitoring

A

The head is shaved around the insertion location. The sire is then cleansed with an antibacterial solution.

32
Q

Intraprocedure of ICP monitoring

A
  • local anesthetic can be used to numb the area if the clients GCS indicates some level of consciousness (8-11).
  • Insertion and care of any ICP monitoring device requires aseptic technique to reduce the risk for CNS infection.
33
Q

Postprocedure of ICP monitoring

A
  • Maintain system integrity at all times. There is a risk of serious, life-threatening infection.
  • Inspect the insertion site at least every 24 hours for redness, swelling, and drainage. Change the sterile dressing covering the access sire per facility protocol.
  • ICP monitoring equipment must be balances and recalibrated per facility protocols.
  • After the insertion procedure, observe ICP waveforms, noting the pattern of waveforms and monitoring for increased ICP (a sustained elevation of pressure greater than 15mmHg)
  • assess the clients clinical status and monitor routine and neurologic vital signs every hour as noted.
34
Q

Interpretation of Findings for ICP monitoring

A

Normal ICP is 10-15mmHg.

Persistant elevation of ICP extinguished cerebral circulation, which will result in brain death if not treated urgently.

35
Q

Complications of ICP monitoring

A

The insertion and maintenance of an ICP monitoring system can cause infection and bleeding.

  • follow strict surgical aseptic technique.
  • perform sterile dressing changes per facility protocol
  • keep drainage system closed
  • limit monitoring to 3-5 days
  • irrigate the system only as needed to maintain latency.
36
Q

Lumbar Puncture (LP)

A

A lumbar puncture is a procedure during which a small amount of CSF is withdrawn from the spinal canal and then analyzed to determine its constituents.

37
Q

Indications for a LP

A

This procedure is used to detect the presence of some diseases (MS, syphilis, meningitis), infection, and malignancies. A LP may also be used to reduce the CSF pressure, instill a contrast medium or air for diagnostic tests, or administer medication or chemotherapy directly to spinal fluid.

38
Q

Pre-procedure for LP

A

The risks versus benefits of a LP should be discussed with the client prior to this procedure.

  • A LP can be associated with rare but serious complications, such as brain herniation, especially when preformed in the presence of increased ICP.
  • LP for clients who have bleeding disorders or who are taking anticoagulants can result in bleeding that compresses the spinal cord.
39
Q

RN Actions Pre-procedure of LP

A
  • ensure that all of the clients jewelry is removed and that the client is wearing only a hospital gown.
  • instruct the client to void prior to the procedure.
  • clients should be positioned to stretch the spinal canal. This can be done by having the client assume a “cannonball” position while on one side of by having the client stretch over an overbed table if sitting is preferred.
40
Q

Intraprocedure for LP

A
  • the area of the needle insertion is cleaned, and local anesthesia is injected
  • the needle is inserted and the CSF is withdrawn, after which the needle is removed.
  • a manometer ca be used to determine the opening pressure of the spinal cord, which is useful if increased pressure is a consideration.
41
Q

Postprocedure for LP

A

CSF is sent to pathology department for analysis.

  • Monitor the puncture site. The client should remain lying for several hours to ensure that the site clots and to decrease the risk of post lumbar puncture headache, caused by CSF leakage.
  • once the client is stable, advise the client that normal activities may be resumed.
42
Q

Complications of LP

A

If clotting does not occur to seal the dura puncture site, CSF can leak, resulting in a headache and increasing potential for infection.

  • Encourage the client to lie flat in bed. Provide fluids for hydration, and administer pain medication.
  • Prepare the client for an epidural blood patch to seal the hole in the dura if the headache persists.
43
Q

MRI

A

Magnetic Resonance imaging scan

An MRI scan provides cross sectional images of the cranial cavity. A contrast media may be used to enhance images.

  • MRI images are obtained using magnets, thus the consequences associated with radiation are avoided. This makes the procedure safer for women who are pregnant.
  • The use of magnets precluded the ability to scan a client who has an artificial device (pacemaker, surgical clips, IV port). If these are present, shielding may be done to prevent injury.
  • Use MRI-approved equipment to monitor vital signs and provide ventilator/oxygen assistance to clients undergoing MRI scans.
44
Q

Indications for MRI

A
  • MRI scans are used to detect abnormalities, monitor response to treatment, and guide needles used for biopsies.
  • MRIs are capable of discriminating soft tissue from tumor or bone. This makes the MRI scan effective in determining tumor size and blood vessel location.
45
Q

Pre-Procedure for MRI

A
  • assess for allergy to shellfish or iodine, which would require use of a different contrast media.
  • ensure that the clients jewelry is removed prior to this procedure. The client should wear a hospital gown to prevent any metal from interfering with the magnet.
  • if sedation is expected, the client should refrain from eating or drinking for 4-8 hours prior to the procedure.
  • determine fi the client has a history of claustrophobia, and explain the tight space and noise.
  • ask the client about any implants containing metal. (pacemaker, orthopedic joints, artificial heart valves, intrauterine devices, aneurysm clips)
  • all people in the scanning area while the magnet is on use remove all jewelry, electronics, and phones to prevent damage to themselves or the magnet.
  • because this procedure is preformed with the client in a supine position, placing pillows int he small of the clients back can assist in preventing back pain. The head must be secured to prevent unnecessary movement during the procedure.
46
Q

Intraprocedure of MRI

A
  • the client must lie supine with the head stabilized.

- MRI scanning is noisy, and earplugs or sedation may be provided.

47
Q

Post Procedure of MRI

A
  • if contrast media is injected, monitor the site to ensure that clotting has occurred and monitor for any indications of an allergic reaction.
  • if sedation is administered, monitor the client until stable.
48
Q

PET/SPECT Scan

A

Positron emission tomography (PET)
Single-photon emission tomography (SPECT)
are nuclear medicine procedures that produce 3D images fo the head. These images can be static ( depicting vessels) or functional (depicting brain activity).
- a glucose based tracer is injected into the blood stream prior to the PET scan. This initiates regional metabolic activity, which is then documented in the PET scanner. A radioisotope is used for SPECT scanning.
- A CT scan may be preferred after a PET/SPECT can, as this provides information regarding brain activity and pathological location ( eg, brain injury, death, neoplasm)

49
Q

Indications for PET/SPECT

A

a PET/SPECT acan capture of regional metallic process is most useful in determining tumor activity and/or response to treatment. PET/SPECT scans are also able to determine the presence of dementia, indicated by the inability of the brain to respond to the tracer.

50
Q

Pre Procedure for PET/SPECT

A

PET/SPECT scans use radiation, thus the risk and benefits to a client who might be pregnant must be discussed.
- Assess for history of diabetes. while this condition does not preclude a PET/SPECT scan, alteration in the clients medications can be necessary to avoid hyperglycemia or hypoglycemia before and after this procedure.

51
Q

Intraprocedure for PET/ SPECT

A
  • while the pictures are being obtained, the client must lie flat with head restrained.
  • this procedure is not painful and sedation is rarely necessary
52
Q

Postprocedure for PET/SPECT

A
  • if radioisotopes are used, assess for allergic reaction.
  • there is no follow up care after a PET/SPECT scans.
  • because the tracer is glucose-baed and short acting (less than 2 hours), it is broken dow within the body as sugar, not excreted.
53
Q

X-Ray

A

Radiography
An x-ray uses electromagnetic radiation to capture images of the internal structures of an individual.
- a structures image is light or dark relative to the amount of radiation the tissue absorbs. the image is recoded on a radiograph, which is a black and white image that is held up to light for visualization. Some are recorded digitally and available immediately
- x-rays are interpreted by a radiologist, who documents the findings.

54
Q

Indications for X-ray

A

x-ray examinations of the skill and spine can reveal fractures, curvatures, bone erosion and dislocation, and possible soft tissue calcification, all of which can damage the nervous system.

55
Q

Preprocedure for X-ray

A
  • there is no specific preprodecure protocol for x-rays that do not use contract. x-rays are often the first diagnostic tool used after an injury (rule out cervical fx in head trauma), and they can be done without any preparation.
  • determine if female clients are pregnant.
  • ensure that the clients jewelry is removed and that no clothes cover the area.
  • explain that the amount of radiation use in contemporary X-ray machines is very small
56
Q

Intraprocedure for X-ray

A

instruct the client to remain still during the procedure

57
Q

Postprocedure for X-ray

A

No postprocedure care is required.

Inform the client when results will be available.

Med Surg (14 decks)

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