nursing care of patients with neurological conditions

Question 1

CT scan patient position

Answer 1

patient must lie still (takes 5-10 min)

head motion can distort image

Question 2

CT w/o contrast

Answer 2

no special precaution

Question 3

CT w/ contrast

Answer 3

assess for allergy to fish/shellfish (if yes, use non-iodinated contrast); check creatinine; if not contraindicated then increase fluids to eliminate dye

Question 4

CT w/ contrast pros

Answer 4

more enhanced picture, can visualize blood vessels

Question 5

Function of CT scan

Answer 5

cross-section view of brain, distinguishes in tissue densities of skull, subcortical structures and ventricles

Question 6

CT education

Answer 6

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)

Question 7

MRI vs MRA

Answer 7

MRI can be w/ or w/o contrast, MRA uses contrast

MRI (we use non-iodine contrast)

Question 8

MRA function

Answer 8

visualize the blood vessels

Question 9

is MRI safe for pregnant women

Answer 9

yes, does not involve iodizing radiation

Question 10

when is MRI/MRA useful?

Answer 10

dx brain tumpr, stroke, MS

Question 11

MRI nursing

Answer 11

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

Question 12

How are CT angiogram and cerebral angiography injected differently

Answer 12

CT angiogram with contrast dye is injected into the vein (less issues)

cerebral angiography the contrast is injected into artery

Question 13

what is cerebral angiography

Answer 13

x-ray study of cerebral circulation with contrast injected in artery (more invasive)

used to determine vessel patency, provide details vascular abnormalities

Question 14

Cerebral angiography nursing responsibilities

Answer 14

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.

Question 15

cerebral angiography nursing pre-procedure

Answer 15

NPO 4-6 hrs prior, assess for allergy to iodine– if allergic use gadolinium or CO2– asses kidney function

Question 16

cerebral angiography post-procedure nursing

Answer 16

monitor insertion site, limit the movement of the site to prevent rebleeding, asses extremity affected for pulse/color/temp – use doppler for pulse

Question 17

non-invasive carotid flow studies

carotid doppler

Answer 17

uses ultrasound imagery and doppler measurement of arterial blood flow

Question 18

carotid doppler

Answer 18

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

Question 19

PET (Positron emission tomography)

Answer 19

computer-based imaging technique that produces images of actual organ functioning

Question 20

PET scan functions

Answer 20

allows measurements of blood flow, tissue composition and brain metabolism

Question 21

PET scan useful for

Answer 21

showing metabolic changes in brain ex: Alzheimers; location lesions ex: brain tumor, epileptogenic lesion

Question 22

PET scan nursing

Answer 22

patient either inhales or injected with radioactive substances

IMPORTANT: may feel dizziness, lightheadedness, or HA

Question 23

PET scan nursing

Answer 23

patient either inhales or injected with radioactive substances

IMPORTANT: may feel dizziness, lightheadedness, or HA

Question 24

Lumbar puncture procedure

Answer 24

done by inserting a needle into the lumbar subarachnoid space to get CSF; inserted b/w 3rd-4th or 4th-5th lumbar vertebrae

Question 25

Lumbar puncture uses

Answer 25

MS, syphilis, meningitis, some malignancies

Question 26

position for lumbar puncture

Answer 26

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)

Question 27

after lumbar puncture procedure

Answer 27

flat on bed for 4-8 hrs b/c post lumbar HA

• bed rest, increase fluids, analgesic (opioids probs)

Question 28

EEG - Electroencephalogram

Answer 28

records electrical activity of the brain; purely diagnostic NOT therapeutic

Question 29

EEG education

Answer 29

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

Question 30

if a person is in a coma we can do an EEG to determine what

Answer 30

if the person is brain dead or not

Question 31

standard EEG procedure

Answer 31

• 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

Question 32

sleep EEG procedure

Answer 32

-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)

Question 33

sleep-deprived EEG (combo of standard and sleep)

Answer 33

• 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