nursing care of patients with neurological conditions Flashcards
CT scan patient position
patient must lie still (takes 5-10 min)
head motion can distort image
CT w/o contrast
no special precaution
CT w/ contrast
assess for allergy to fish/shellfish (if yes, use non-iodinated contrast); check creatinine; if not contraindicated then increase fluids to eliminate dye
CT w/ contrast pros
more enhanced picture, can visualize blood vessels
Function of CT scan
cross-section view of brain, distinguishes in tissue densities of skull, subcortical structures and ventricles
CT education
quick, painless, small amt of radiation, can NOT do CT of abd on pregnant woman (mostly all CT are contraindicated for preg unless necessary– use alternative)
MRI vs MRA
MRI can be w/ or w/o contrast, MRA uses contrast
MRI (we use non-iodine contrast)
MRA function
visualize the blood vessels
is MRI safe for pregnant women
yes, does not involve iodizing radiation
when is MRI/MRA useful?
dx brain tumpr, stroke, MS
MRI nursing
takes 1 hr, get adequate hx (implants, pacemakers, IUD, all metal objects, get pts weight), give lorazepam IV if claustrophobic, checklist done by RN, cover nicotine patch with 4x4, remove leads
How are CT angiogram and cerebral angiography injected differently
CT angiogram with contrast dye is injected into the vein (less issues)
cerebral angiography the contrast is injected into artery
what is cerebral angiography
x-ray study of cerebral circulation with contrast injected in artery (more invasive)
used to determine vessel patency, provide details vascular abnormalities
Cerebral angiography nursing responsibilities
kidney, injection site (femoral), extremities involved, neurovascular check
keep the head immobilized
void before the test
tell the patient that they might have a metallic taste, warm sensation over the face, the jaw, the tongue, the lips→ when the dye is being injected.
cerebral angiography nursing pre-procedure
NPO 4-6 hrs prior, assess for allergy to iodine– if allergic use gadolinium or CO2– asses kidney function
cerebral angiography post-procedure nursing
monitor insertion site, limit the movement of the site to prevent rebleeding, asses extremity affected for pulse/color/temp – use doppler for pulse
non-invasive carotid flow studies
carotid doppler
uses ultrasound imagery and doppler measurement of arterial blood flow
carotid doppler
The graph produced indicates blood velocity-
- -Increased velocity→ indicates stenosis or partial obstruction→ movement of blood velocity increased
- -total blockage= stroke
- -carotid endarterectomy→ carotid obstruction
PET (Positron emission tomography)
computer-based imaging technique that produces images of actual organ functioning
PET scan functions
allows measurements of blood flow, tissue composition and brain metabolism
PET scan useful for
showing metabolic changes in brain ex: Alzheimers; location lesions ex: brain tumor, epileptogenic lesion
PET scan nursing
patient either inhales or injected with radioactive substances
IMPORTANT: may feel dizziness, lightheadedness, or HA
PET scan nursing
patient either inhales or injected with radioactive substances
IMPORTANT: may feel dizziness, lightheadedness, or HA
Lumbar puncture procedure
done by inserting a needle into the lumbar subarachnoid space to get CSF; inserted b/w 3rd-4th or 4th-5th lumbar vertebrae
Lumbar puncture uses
MS, syphilis, meningitis, some malignancies
position for lumbar puncture
side lying with legs and thighs flexed as much as possible (fetal position)
Or
straddling chair and leaning forward (sitting leaning over back over chair)
after lumbar puncture procedure
flat on bed for 4-8 hrs b/c post lumbar HA
- bed rest, increase fluids, analgesic (opioids probs)
EEG - Electroencephalogram
records electrical activity of the brain; purely diagnostic NOT therapeutic
EEG education
withhold anticonvulsants, tranquilizers, stimulants, depressants for 24-48 before test, no coffee/tea/soda
night before the test: no hair conditioner, hair cream, sprays, styling gel
if a person is in a coma we can do an EEG to determine what
if the person is brain dead or not
standard EEG procedure
- lasts 40-60 mins
- the person will just come→ sit or lie down→ they may be asked to breathe deeply→ electrodes are connected→ then they would record the brain activity or…
- the person is asked to look at flashing lights or bright to stimulate brain activity
- CAREFUL: MAY CAUSE SEIZURES
sleep EEG procedure
-takes 2 hours
-the patient should be in the hospital setting
-they will connect and person will sleep
-coordinate with nurse and tech
do vitals and med then let patient sleep (2 hours)
sleep-deprived EEG (combo of standard and sleep)
- may last a few hours
- the patient is asked to not sleep the night before or wake up at much earlier than usual
-then they will do standard
patient may fall asleep
that is ok
