Question | Answer |
Neurological Dx procedures:
1. Cerebral Angiogram (pg. 26) | Provides visualization of the cerebral blood vessels
-Detects defects, narrowing/obstructions of vessels in brain
-Assess blood flow to/within the brain
-Identifies aneurysms
-Vascularity of tumors, etc. |
Digital subtraction angiography (cerebral angiogram) | Subtracts tissues/bones from image allowing only visualization of blood vessels |
Where is cerebral angiogram performed? | Radiology department d/t iodine based contrast dye injected into an artery during the procedure |
Preprocedure of cerebral angiogram
-Fluids/food, allergies, kidneys, accessories, relax | -No fluids/food 4-6hrs before
-Allergy to shellfish/iodine? need a dif contrast media
-BUN/creat pre/post op (kidney's ability to excrete dye)
-No jewelry on
-Mild sedative for relaxation pre/during |
Client Education during cerebral angiogram
-Movement, voiding, feelings | -Don't move, keep head still
-Void immediately before the test
-Dye injecting can cause; metallic taste in the mouth, warm sensation over the face/jaw/tongue/lips/behind the eyes |
Intraprocedure of cerebral angiogram
-Placed on what, pressure
& Post op | -Radiography table, secure head
-Catheter into artery (groin/neck), inject dye, x-ray pictures taken
-Remove catheter, arterial closure device/pressure over site
Post;
-Movement restricted depending on where artery is
-Monitor for bleeding; CMS |
Dx 2. Cerebral Computed Tomography (CT) scan
-What is it?
-Why is it used? | Provides cross-sectional images of the cranial cavity
-Contract may be used to enhance images
-Can identify tumors, infarctions, abnormalities, guide needles for biopsies |
Preprocedure to CT
-If contrast used; | -No foods/fluids at least 4 hrs before
-Allergy to iodine/shellfish
-BUN/creat |
What position for a CT?
Back pain, head, accessories | Supine, secure head, pillows in the small of the back to prevent pain
-No jewelry (metals interfere)
-Possible sedation, painless though |
Postprocedure for CT | No follow-up care
-If contrast used, monitor BUN/creat or allergic reactions |
3. Electrocephalography (EEG) | Noninvasive procedure assesses the electrical activity of the brain
-Determines if there are abnormalities in brain wave patterns |
EEG performed for? | -Mostly to identify/determine seizure activity
-Sleep disorders/behavioral changes too |
Preprocedure for EEG
-Hair, sleep | -Wash hair before to eliminate gels, oils, sprays
-Sleep deprived; cranial stress= ^ possibility of abnormal electrical activity |
Ways to increase electrical activity during an EEG? | -Bright flashing lights
-Hyperventilate for 3-4 minutes |
Intraprocedure EEG?
-how long, risks, position, connections | -Takes 1 hr
-No risks
-Rest in a chair or lying in bed
-Small electrodes are placed on scalp & connected to a brain wave machine/computer
-Electrical signals by brain are recorded (wavy lines) |
Dx 4. GCS (Glasgow coma scale) | Neuro function
-Determines LOC and response to tx
-Stimuli given then assess
-Reported as a # (3-15) low is bad
<8 = severe head injury/coma
9-12- moderate head injury
>13- minor head trauma |
GCS; Eye opening | Best eye response, (4-1)
pg. 30 |
GCS; Verbal response | Best (5-1) |
GCS; Motor response | Best (6 to 1) |
Dx 5. Intracranial pressure (ICP) monitoring
-What is it?
-Who performs and where? | Device inserted into the cranial cavity that records pressure & is connected to a monitor that shows pressure in waveforms
-Neurosurgeon in OR, ER, CCI
-RARE; unless comatose |
3 types of ICP monitoring systems: (Pg. 31)
First type; IV catheter | 1. Intraventricular catheter; Fluid filled cath inserted into anterior horn of lateral ventricles through a burr hole.
-Drainage system |
Second type of ICP | 2. Epidural/subdural sensor; fiber-optic sensor inserted into epidural space through a burr hole.
-measures by light changes in the tip
-numeric value of ICP
-noninvasive bc it doesn't penetrate the dura |
Third type of ICP | 3. Subarachnoid screw/bolt; hollow threaded screw/bolt placed into subarachnoid space through a twist-drill burr hold in the front of the skull, behind the hairline. |
Why use ICP? | Early identification/tx of high ICP
-Comatose, or <8 GCS |
Symptoms of high ICP | Severe headache, low LOC, restlessness, irritability, dilated/pinpoint pupils, slow to react, cheynes-stokes, hyperventilation/apnea, poor motor function, abnormal posturing (decerebrate, decorticate, flaccidity) |
Normal ICP level; (Pg. 31) | 10-15 mm Hg |
Preprocedure for ICP
-Head, clean | -Shave head around insertion location
-Site cleansed w antibacterial solution |
ICP Intraprocedure
-Anesthetic? clean? | -Local anesthetics to numb area if somewhat conscious (GCS 8-11)
-Surgical aseptic technique possible |
ICP Postprocedure
-Inspect site, neuro checks, irrigate, monitoring | -Inspect site q24hr REEDA, TACO
-Sterile dressing changed per protocol
-Observe waves
-Neuro checks and VS q1hr & PRN
-Irrigate PRN to maintain patency
-Limit monitoring to 3-5 days |
Dx 6. Lumbar Puncture (Spinal Tap) (Pg. 32)
-Why used? | Small amount of CSF is withdrawn from spinal canal and analyzed
-Diseases; MS, Meningitis, syphilis, etc, infection, malignancies
-Can reduce CSF pressure
-Chemo directly into spinal canal |
Lumbar Puncture preprocedure
-Jewelry, void, position | -No jewelry
-Void before procedure
-Stretch spinal canal.. "cannonball" position while lying on one side or by having the client stretch over an overbed table if sitting is preferred. |
Intraprocedure Spinal Tap
-Site, anesthetic, pain?, manometer | -Area of needle inserted cleansed and local anesthetic injected
-Not painful
-Insert needle/withdraw CSF
-Manometer; monitors pressure, can be used |
Post procedure Spinal Tap
-Position, headache | CSF sent to pathology department
-Monitor puncture site
-Remain lying for several hours; prevent post-lumbar puncture headache cause by CSF leakage
-Pain meds/fluids
-If headache, epidural blood patch to seal off hole if persisting |
Dx. 7 Magnetic Resonance Imaging (MRI)
-Pregnancy, artificial devices
-Why? | Cross sectional images of the cranial cavity. Contract media may be used to enhance images
-Safer for pregnancy women.. no radiation like x-ray. Magnets used
-D/t magnets, can scan people w/ artificial things
-Used detect abnormalities, guide |
Preprocedure MRI
-Allergy, jewelry, if sedated, hx of, implants, position | -Shellfish/iodine allergy
-No jewelry
-If sedated; no food/fluid 4-8hrs before
-Hx of claustrophobia; tight space/noise
-Any metal implants, ie. pacemaker
-People in there remove all metal things; phones, etc.
-Supine position, pillows, secure head |
Postprocedure MRI | -No follow-up care
-If contrast dye, monitor allergic reaction |
Dx. 8 PET and SPECT scans | Nuclear medicine procedures that produce 3 dimensional images of the head
-Can be static; (depicting vessels)
-Functional; (depicting brain activity)
-Captures regional metabolic, tumor activity, dementia (brain can't respond to tracer) |
What is injected for a PET and SPECT scan? | PET; glucose-based tracer injected into blood stream before; regional metabolic activity
SPECT; radioisotope |
Preprocedure PET/SPECT
-DM | Radiation is used.
-DM? alterations in meds may be necessary to avoid hypo/hyperglycemia |
Intraprocedure PET/SPECT | -Supine w head secure
-Not painful, sedation rarely used |
Postprocedure PET/SPECT | -Radioisotopes used; assess allergic response
-No follow up care |
Dx. 9 Radiography (X-Ray) | Electromagnetic radiation to capture images of internal structures
-light or dark relative to amount of radiation the tissue absorbs
-interpreted by radiologist |
X-ray preprocedure | No prep for no contrast
-No jewelry
-Are you pregnant?
-Small amount of radiation is used
-Remain still |