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Chapter 3
Unit 2: Nursing care of clients with neurosensory disorders
| 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 |
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