Laboratory and Diagnostic Tests

• Skull Films


  X-ray visualization of the skull is primarily used to detect fractures.
• Skull Films

  Nursing Responsibility: Remove metallic items from the hair.
• Spine Films


  X-ray visualization of the spine.
• Spine Films

  Nursing Responsibility

  • Remove metallic items from around the neck.
  • Avoid flexion/rotation of the spine when fracture is suspected. To prevent further injury.
• CAT Scan


  Computerized reconstruction of body parts by passage of multiple X-ray beams.
• CAT Scan

  Nursing Responsibility:

  • Assess for claustrophobia.
  • Remove metallic objects from hair.
  • NPO 4-6 hours if contrast medium is used.
  • Observe for allergic reaction to iodinated contrast material.
• Electroencephalography (EEG)


  Graphical recording of spontaneous electrical impulses of the brain from scalp electrodes.
• EEG

  Nursing Responsibilities: Before

  • Explain procedure to the client. Reassure the client, there is no sensation of electrocution.
  • Hair shampoo to remove oils and dirt which may interfère with transmission of electrical impulses from the brain.
  • Avoid caffeine, anticonvulsant and other stimulants for at least 24hours before the test.
• EEG

  Nursing Responsibilities: After

  • Wash hair to remove EEG paste.
• Electromyography


  Records electrical activity in muscles at rest, during involuntary contraction, and in response to electrical stimulation.
• Nerve Conduction Velocity


  Record speed of conduction in motor and sensory fibers of peripheral nerves.
• EMG & NCV

  • Detects neuromuscular disorders like MG, MS, PD, etc.
  • Explain to the client, electrode needles will be inserted into the muscles.
  • Inform the client that he will experience mild discomfort.
• Cerebral Angiography


  Intra-arterial injection of contrast medium with simultaneous radiographs of head and neck to visualize intracranial and extracranial vessels.
• Cerebral Angiography

  Nursing Interventions: Before

  • Explain the procedure to the client.
  • Contrast material is injected into femoral, brachial, or carotid artery.
  • Remove metallic clips from hair.
  • Check allergy to iodine and sea foods. Contrast medium is iodinated.
  • NPO 4-6 hours.
  • IV fluids to ensure adequate hydration.
• Cerebral Angiography

  Nursing Interventions: After

  • Observe arterial puncture site for bleeding or hematoma; apply pressure dressing or ice pack to the area.
  • Observe pulse distal to the puncture site. Diminished or absent pulse may indicate impaired circulation due to thrombosis or hematoma.
  • Observe affected limb for color and temperature. To further assess for circulation distal to the puncture site.
  • Bed rest for 12- 24 hours; if femoral puncture was done, keep affected leg extended and immobile for few hours to prevent dislodgement of blood clot.
• Lumbar Puncture


  Introduction of needle into spinal subarachnoid space usually at L3 to L5 intervertebral spaces, to assess cerebrospinal fluid (CSF).
• Lumbar Puncture

  Nursing interventions: Before and During

  • Encourage client to void. To ensure comfort during the procedure.
  • Position: Fetal or Side lying or Lateral recumbent (but (+) csf leakage so = upright) to widen intervertebral spaces. This facilitates insertion of spinal needle.
• Lumbar Puncture

  • Queckenstedt's test may be performed to test for subarachnoid obstruction. The jugular veins are compressed for 10 secs., first on one side, and then on the other side; note for any change in pressure of spinal fluid. Sudden rise of CSF in the water manometer is observed during compression of jugular vein.
  • Sudden decline = normal
  • Slow decline = obstruction.
• Lumbar Puncture

  Nursing Interventions: After

  • Position: Flat on the bed for 6 - 8 hours (may turn to sides).
  • Encourage fluids if not contraindicated.
  • Headache may develop due to CSF leakage; treated with bedrest, analgesics and ice application on head.
  • Assess neurostatus.
• Myelography


  Introduction of a radiopaque solution, oil - based or water - based, into the spinal subarachnoid space with fluoroscopic and radiographic observation.
• Myelography

  Nursing Interventions: Before

  • Written consent must be signed.
  • Requires lumbar puncture for introduction of contrast medium.
  • Premedicate client as ordered.
• Myelography

  Nursing Interventions: After

  • For pantopaque myelogram (oil - based), patient lies flat for 6 to 24 hrs. to prevent spinal headache.
  • For metrizamide myelogram (water - based), HOB is elevated at 30 degrees (semi- Fowler's) for at least 8 hrs. to prevent meningeal irritation
  • Encourage fluids to enhance excretion of the dye.
• MRI 


  Uses strong magnet combined with radio frequency waves and a computer to produce X-ray - like images of body chemistry.
• Magnetic Resonance Imaging

  Nursing Interventions: Before

  • Obtain history of metal implants, including artificial cardiac pacemaker. These make the client ineligible to undergo the procedure.
  • Reassure the client that the procedure is painless.
  • Assess for claustrophobia. The procedure is done in a tunnel - like device, similar to CAT Scan.
  • Inform client that the machine makes drum - like knocking sound, to prevent unnecessary anxiety.
  • Request client to remove credit cards, watches and other which things that may be demagnetized.