2.3 Diagnostic Procedures

SKULL X-RAYS

Skull X-rays are the oldest, non-invasive neurological test used to evaluate the bones, which make up the skull. Because of complex anatomy of the skull, a series of films is usually required for a complete evaluation.

These X-rays are used for detecting fractures in patient's with head trauma, aiding in the detection and assessment of increased intracranial pressure, tumors, bleeding, and infection. aid in the diagnosis of pituitary tumors and congenital anomalies.

Nursing implications begin with a review the patient's clinical record to determine the reason (purpose) for the specific scheduled skull x-rays. Approach and identify the patient, and interview the patient to determine his/her knowledge of the purpose of the skull x-rays. As indicated, explain to the patient the specific purpose of the skull x-rays in his/her particular situation. Explain purpose in a manner consistent with that offered by the physician to avoid confusing the patient.

(5) Explain to the patient the events which will occur prior to the skull x-rays.

(a) Patient is not required to restrict food and fluids before x-rays.

(b) All jewelry and other metal objects must be removed from patient's head and neck and placed in safekeeping.

(c) Tell the patient where and when the x-rays will be performed.

(6) Explain to the patient events which will occur during the skull x-ray procedure.

(a) Patient will be placed in a supine position on a radiographic table, or seated in a chair, and instructed to remain still.

(b) A headband, foam pads, or sandbags may be used to immobilize the patient's head and increase patient comfort.

(c) Tell the patient that several (usually five) x-ray films of the skull will be taken from various angles.

Reassure patient that the procedure will cause no discomfort, and explain that films will be developed and checked before leaving the x-ray department.

Explain to the patient he will be returned to their room and that the physician will report the results of the x-rays to the patient when they are available.

2-18.  LUMBAR PUNCTURE

Lumbar puncture is the insertion of a sterile needle into the subarachnoid space of the spinal canal, usually between the third and fourth vertebra, to reach the cerebral spinal fluid. This test requires sterile technique and careful patient positioning. It is performed therapeutically to administer drugs or anesthetics and to relieve intracranial pressure.

Diagnostic uses for lumbar puncture include determining the pressure of the cerebral spinal fluid, detecting any increased intracranial pressure, detecting the presence of blood in the cerebral spinal fluid which indicates cerebral hemorrhage, and obtain cerebral spinal fluid specimens for laboratory analysis.

Nursing implications begin with a review the patient's clinical record to determine the reason for the patient's scheduled lumbar puncture procedure and what the patient has been told about the procedure.

Assemble the necessary equipment.

  • Local anesthetic
  • Labels
  • Laboratory request slips

Approach and identify the patient, then interview the patient to determine his/her knowledge of the purpose of the lumbar puncture procedure. As indicated, explain to the patient the specific purpose of the lumbar puncture procedure. Explain purpose in a manner consistent with that offered by the physician to avoid confusing the patient. Finally, explain the procedure, itself.

Ask the patient to empty his/her bladder. Position the patient--lateral recumbent, at the edge of the bed, knees drawn up to abdomen, and chin tucked to chest. To help the patient maintain this position, the nursing paraprofessional places one hand behind the patient's neck and the other behind patient's knees to help support the patient's position throughout the procedure.

The physician will clean the puncture site area with sterile applicators from the lumbar puncture tray, then drape the area with a fenestrated drape to provide a sterile field. The physician will inject local anesthetic into the planned needle puncture site, followed by inserting the spinal needle. The patient will feel some pressure at this time.

If the procedure is being performed to administer contrast media for radiologic studies or spinal anesthetic, the physician will inject the dye or anesthetic.

When the needle is in place, the physician will attach a manometer with stopcock to the needle hub to read CSF pressure. (The patient may need to extend his legs to provide a more accurate pressure reading.) The physician will detach the manometer and allow the fluid to drain from the needle hub into four collection tubes. When there is approximately 2 or 3 ml of fluid in each tube, the physician will hand them to the assistant, who will mark the tubes in sequence, stopper them securely, and label them properly

The physician will finally remove the spinal needle, apply pressure to the area briefly, and apply a band-aid or small dressing. The entire procedure will last approximately 15 minutes.

Send the CSF specimens to the laboratory immediately. Instruct the patient to lie flat for several hours to reduce chance of headache. Monitor the patient carefully following the procedure.  Adverse reactions including headache, vertigo, syncope, nausea, tinnitus, respiratory distress, change in vital signs, meningitis, and fever should be reported to the professional nurse. Give the patient increased fluids for at least 24 hours after the procedure.

Inform the patient that the physician will report the results of the lumbar puncture as soon as they are available. Ensure the comfort and safety of the patient, remove equipment from bedside and dispose of properly, and record the procedure in the patient's chart.

2-19.  ELECTROENCEPHALOGRAM

An electroencephalogram (EEG) is a recording of brain wave activity. Electrodes are attached to specific areas of a patient's scalp. Electrical impulses are received and transmitted to a machine called an electroencephalograph, which magnifies the impulses and records them on moving strips of paper. (Much the same as an electrocardiogram.)

Diagnostic uses for EEG include determining the presence and type of epilepsy, aiding in diagnosis of intracranial lesions, evaluating the brain's electrical activity in metabolic disease, head injury, meningitis, and encephalitis, and confirming brain death.

Nursing implications are first to review the patient's clinical record to determine the reason for the patient's scheduled electroencephalography and what the patient has been told about the procedure. Check the patient's medication history for drugs that may interfere with test results, and report positive findings to charge nurse. These drugs would include anticonvulsants, tranquilizers, barbiturates, and any other sedative.

Approach and identify the patient. Conduct a brief interview of the patient to determine his/her knowledge of the purpose of the electroencephalogram procedure.  As indicated, explain to the patient the specific purpose of the electroencephalogram.

Explain to the patient events which will occur prior to the electroencephalogram.

Explain to the patient events that will occur during the procedure.

Explain to the patient events which will occur after the electroencephalogram procedure.

2-20.  BRAIN SCAN

Brain scanning is the use of a specialized camera to provide images of the brain after an I.V. injection of a radionucleotide. Normally, the radionucleotide cannot permeate the blood-brain barriers, but if pathologic changes have destroyed the barrier, the radionucleotide may concentrate in the abnormal area.

Diagnostic uses include detecting an intracranial mass or vascular lesion, locating areas of ischemia, cerebral infarction, or hemorrhage, and evaluating the course of certain lesions postoperatively and during chemotherapy.

Nursing implications begin with a review the patient's clinical record to determine the reason (purpose) for the specific patient's scheduled brain scanning procedure and what the patient has  been told about the procedure.

Approach and identify the patient, the conduct a brief interview to determine his/her knowledge of the purpose of the brain scanning procedure. As indicated, explain to the patient the specific purpose of the brain scan. Explain the purpose in a manner consistent with that offered by the physician to avoid confusing the patient.

Explain to the patient events that will occur prior to the brain scanning procedure:

Explain to the patient events that will occur during the brain scanning procedure:

Explain to the patient events that will occur after the brain scan:

2-21.  CEREBRAL ANGIOGRAPHY

A cerebral angiogram is a radiographic examination of the cerebral vasculature after injection of a contrast medium. Common injection sites are the carotid, brachial, and femoral arteries.

Diagnostic uses for cerebral angiography are the detection of cerebrovascular abnormalities, and to study vascular displacement caused by tumor, hematoma, edema, arterial spasm, or increased intracranial pressure. the procedure also helps locate surgical clips applied to blood vessels during surgery and to evaluate the postoperative status of the vessels.

Nursing implications include reviewing the patient's clinical record to determine the reason (purpose) for the specific patient's scheduled cerebral angiography and what the patient has been  told about the procedure.

Check the patient's medication history for hypersensitivity to iodine, seafoods, or the dyes used for other local tests, and report significant findings to the Professional Nurse.

Approach and identify the patient, and interview the patient to determine his/her knowledge of the purpose of the cerebral antiography procedure. As indicated, explain to the patient the specific purpose of the cerebral angiography in his/her situation. Explain purpose in a manner consistent with that offered by the physician to avoid confusing the patient.

Explain to the patient events that will occur prior to the cerebral angiography procedure:

Explain to the patient events that will occur during the cerebral angiography procedure:

Explain to the patient events, which will occur after the cerebral angiography.