Unit 2: Nursing care of clients with neurosensory disorders
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| 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.
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| Digital subtraction angiography (cerebral angiogram) | Subtracts tissues/bones from image allowing only visualization of blood vessels
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| Where is cerebral angiogram performed? | Radiology department d/t iodine based contrast dye injected into an artery during the procedure
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| 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
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| 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
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| 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
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| 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
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| Preprocedure to CT -If contrast used; | -No foods/fluids at least 4 hrs before
-Allergy to iodine/shellfish
-BUN/creat
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| 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
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| Postprocedure for CT | No follow-up care
-If contrast used, monitor BUN/creat or allergic reactions
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| 3. Electrocephalography (EEG) | Noninvasive procedure assesses the electrical activity of the brain
-Determines if there are abnormalities in brain wave patterns
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| EEG performed for? | -Mostly to identify/determine seizure activity
-Sleep disorders/behavioral changes too
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| Preprocedure for EEG -Hair, sleep | -Wash hair before to eliminate gels, oils, sprays
-Sleep deprived; cranial stress= ^ possibility of abnormal electrical activity
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| Ways to increase electrical activity during an EEG? | -Bright flashing lights
-Hyperventilate for 3-4 minutes
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| 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)
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| 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
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| GCS; Eye opening | Best eye response, (4-1)
pg. 30
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| GCS; Verbal response | Best (5-1)
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| GCS; Motor response | Best (6 to 1)
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| 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
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| 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
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| 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
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| 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.
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| Why use ICP? | Early identification/tx of high ICP
-Comatose, or <8 GCS
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| 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)
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| Normal ICP level; (Pg. 31) | 10-15 mm Hg
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| Preprocedure for ICP -Head, clean | -Shave head around insertion location
-Site cleansed w antibacterial solution
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| ICP Intraprocedure -Anesthetic? clean? | -Local anesthetics to numb area if somewhat conscious (GCS 8-11)
-Surgical aseptic technique possible
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| 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
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| 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
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| 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.
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| 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
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| 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
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| 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
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| 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
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| Postprocedure MRI | -No follow-up care
-If contrast dye, monitor allergic reaction
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| 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)
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| What is injected for a PET and SPECT scan? | PET; glucose-based tracer injected into blood stream before; regional metabolic activity
SPECT; radioisotope
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| Preprocedure PET/SPECT -DM | Radiation is used.
-DM? alterations in meds may be necessary to avoid hypo/hyperglycemia
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| Intraprocedure PET/SPECT | -Supine w head secure
-Not painful, sedation rarely used
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| Postprocedure PET/SPECT | -Radioisotopes used; assess allergic response
-No follow up care
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| 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
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| X-ray preprocedure | No prep for no contrast
-No jewelry
-Are you pregnant?
-Small amount of radiation is used
-Remain still
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