DIAGNOSTIC TEST

• DIAGNOSTIC TESTS

  • skull and spinal radiography - skull radiographs, spinal radiographs
  • computed tomography scan (CT scan)
  • magnetic resonance imaging (MRI)
  • lumbar puncture
  • myelogram
  • cerebral angiography
  • electroencephalography
• skull radiographs - reveal size and shape of skull bones, suture separation in infants, fractures or body defects, erosion or calcification
• spinal radiographs - identify fractures, dislocation, compression, curvature, erosion, narrowed spinal cord, degenerative process
• skull and spinal radiography nursing interventions

  pre-operative process:

  • provide nursing support to the confused combative & ventilator dependent
  • maintain immobilization of neck if spinal is fractured
  • remove metal items
  • document thick and heavy hair because it may affect interpretation

  post procedure intervention:

  • maintain immobilization until results
• Computed tomography scan (CT scan) - a type of brain scanning whihc may ir may not require an injection of dye
• Computed tomography scan (CT scan)- used to detect intracranial bleeding, space occupying lesions, cerebral atrophy, shift of brain structures
• Computed tomography scan (CT scan)

  pre procedure interventions:

  • obtain consent (for dye)
  • assess allergies (contrast dye: shellfish)
  • instruct client too be still and flat
  • instruct client to hold breath when requested
  • initiate IV line if prescribed
  • remove object from head
  • assess for claustrophobia
  • inform patient for mechanical noise
  • inform patient for hot flushes in mouth
  • if allergic, dye with antihistamine and corticosteroid
• magnetic resonance imaging (MRI)

  • non invasive procedure
  • identiifes type of tissues, tumor, and vascular abnormalities
• MRI - similar to ct scan but more detailed
• MRI pre procedure intervention:

  • remove metals
  • determine if client has pace maker
  • remove IV during test
  • provide precaution for px with pulse ox (might burn)
  • provide assessment for claustrophobia
  • administer needs for claustrophobia
  • determine if contrast agent is with food, fluid, or meds
  • remain still

  post procedure interventions

  • resume normal activities
  • expect diuresis if contrast is used
• lumbar puncture - insertion of spinal needle through L3-L4 interspace into lumbar subarachnoid space to obtain cerebrospinal fluid (CSF)

  • measure ICP
  • contraindicated with px with increased ICP (procedure will cause rapid decrease of pressure) - could lead to brain herniation
• lumbar puncture pre procedure int.

  • consent
  • empty bladder

  during proceudre:

  • position patient in a lateral recumbent position, draw knees up to abdomen and chin to chest (fetal position)
  • assist pt with collection of specimen (label specimen)
  • maintain strict asepsis

  post proceudre:

  • monitor vs and neurological signs
  • position client flat
  • force fluids
  • monitor IPO
• myelogram - injection of dye or air in subarachnoid space to detect abnormalities in spinal cord and vertebrae
• myelogram pre proceudre

  • consent
  • provide hydration (at least 12 hours)
  • assess for allergies for iodine
  • if patient is taking phenothiazine, hold meds because it lower seizure threshold
  • premedicate for sedation

  post

  • assess vs and neurological signs
  • if water based dye is used (more often), elevate head 15-30 degrees for 6-8 hours
  • oil based dye, keep flat for 6-8 hours
  • if air, keep head lower than trunk for 48 hours
  • administer analgesic
  • encourage fluid
  • monitor IPO
  • assess bladder for distention and voiding
• cerebral angiography- injection of contrast through femoral artery into carotid arterie to visualize cerebra and assess for lesions
• cerebral angiography pre

  • consent
  • assess for allergies to iodine and shellfish
  • encourage hydration 2 days before test
  • obtain baseline neurological assessment
  • mark peripheral pulses
  • remove metal items from hair
  • administer premedication

  post:

  • monitor vs and neuro signs
  • monitor for swelling in neck and difficulty swallowing
  • bed rest for 12 hours
  • elevate head for 15-30 degrees
  • BUT flat if femoral artery is used
  • apply sandbags and pressures in injection site
  • place ice in puncture site
  • encourage fluid
• electroencephalography - graphic recording of electrical activity of superficial layers of cerebral cortex
• eeg pre

  • wash hair
  • inform client electrodes attached to head and electricity enters head
  • withhold stimulant, antidepressant, tranquilizer, anticonvulsant for 24-48 hours before
  • allow client for breakfast
  • premedicate sedation

  post

  • wash
  • maintain side rails
• skull and spinal radiography - size and shape of skull

  skull- fractures, bony defects, erosion

  spine- narrowed spinal cord
• ct scan- brain scanning

  • w or without injection dye
  • intracranial bleeding, lesions
• mri - noninvasive

  • identify type of tissue, tumor, and vascular abnormality
• lumbar puncture- needle injection on l3-l4 for icp

  • measure csf, pressure/instill air
• myelogram - for spinal cord

  • injection of dye or air in subarachnoid space to detect abnormalities in spinal cord and vertebrae
• cerebral angiography - for cerebra

  • injection of contrast
  • femoral artery - carotid artery
  • visualize cerebr
• electroencephalography - for cerebral cortex

  • graphic recording of electrical activity of superficial layers of cerebral cortex