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107 Cards in this Set
- Front
- Back
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Assessment of the Neurologic system
3 components: |
-Comprehensive history
-Physical examination -Diagnostic Studies |
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Neuro: comprehensive history
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Identify data - age, birthplace, fam. members, occupation
Reliability of source - varies with knowledge, memory and trust Source of history - client, family, friends or letter of referral Chief complaint - symptoms or concerns for which the pt. is seeking care - use pt.'s own words |
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Neuro: physical examination
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V/S - even though cortical changes occur first, assess vital signs first
-neurological disorders can cause life threatening changes in v/s ex; spinal cord injury cause hypotension, bradycardia, hypothermia |
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Neuro: spinal cord injury causes:
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hypotension, bradycardia, hypothermia
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Neuro: Late stage ICP
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increased BP, widened pulse pressure (systolic), bradycardia
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Mental status: LOC
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-sensitive indicator of changes in neurologic status:
*Orientation - person place time *Memory - remote or recent *Mood & affect *Intellectual performance *Language & communication |
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Aphasia
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-is a disorder caused by damage to the parts of the brain that control language. It can make it hard for you to read, write, and say what you mean to say. It is most common in adults who have had a stroke. Brain tumors, infections, injuries, and dementia can also cause it. The type of problem you have and how bad it is depends on which part of your brain is damaged and how much damage there is.
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Expressive aphasia
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-you know what you want to say, but you have trouble saying or writing what you mean
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Receptive aphasia
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-you hear the voice or see the print, but you can't make sense of the words
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arousal
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alertness controlled by brain stem activity including reticular activation system (RAS)
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awareness
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self & environment; requires intact cerebral cortex & associated fibers
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state of consciousness
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depends on interactions between intact brainstem & cerebral cortex
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Altered level of consciousness
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Alert - responds appropriately, min, stimuli
Confused - disoriented to surrounding Lethargic - drowsiness Obtunded - responds slowly Stuporous - minimal response, needs vigorous stimuli Comatose - no observable response to any stimuli |
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Raccoon eyes- Periorbital ecchymosis
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-anterior basilar skull fracture
drainage of CSF from nose |
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Battle signs
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-middle fossa basilar fracture
ecchymosis over the mastoid process behind the ears with drainage of blood, CSF or both from ears |
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Nuchal Rigidity
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is when a patient is unable to flex his or her head forward due to an un-natural rigidity of the neck muscles.
-Nuchal Rigidity is a primary sign of Acute Meningitis |
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Cranial nerve 1 Olfactory
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sensory
-have pt. occlude one nostril at a time and ask pt. to identify familiar odors. Use 2 scents (coffee, mint). |
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Cranial nerve 2 Optic
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sensory
inspect for foreign bodies, inflammation, cataract Visual acuity - Snellen chart or newspaper each eye Visual fields - (peripheral) test by confrontation -Examine eye fundus with opthalmoscope to identify if ICP or any abnormality |
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Cranial nerve 3 Oculomotor
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motor
controls pupillary constriction shine bright light into pt.'s eyes to evaluate functioning -include extraoculor movement (EOM) |
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Cranial nerve 4 trochlear
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motor
controls downward & inward movement of eyes |
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Cranial nerve 6 Abducens
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motor
controls lateral eye movement |
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Cranial nerve 5 Trigeminal
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sensory & motor
Motor- temporal & masseter muscles (jaw clenching), also lateral movement of jaw. - chewing As pt clenches teeth, palpate muscles over the jaw for tone, strength, equality Sensory - The nerve has three divisions (1) Opthalmic - forehead (2) Maxillary - cheek (3) Mandibular - jaw - use tongue blade sharp/dull -Test the forehead, cheeks, & jaw on each side for pain, soft, & dull sensation. Use a suitable sharp object, occasionally substituting the blunt end for the point as a stimulus. Ask patient to report whether it is “sharp” or “dull” or “soft” & compare sides. *If abnormality found, further test by temperature sensation. 2 test tubes filled with hot & cold water-Pt identifies “hot” & “cold” |
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Cranial nerve 7 facial nerve
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motor & sensory
Motor: Inspect face both at rest & during conversation. Note any asymmetry, weakness, tics or other abnormal movements. raise the eyebrows squeeze the eyes shut wrinkle the forehead frown then smile show the teeth purse lips puff out cheeks evaluate speech look for facial droop Sensory: Taste for salty, sweet, sour, and bitter substance on anterior 2/3 of tongue. Taste on posterior portion of tongue is tested with CN IX Test for taste: Use sugar, salt, Keep tongue protruding and place appropriate solution on lateral side of tongue Have client point to card with solution name Give a sip of water before next solution Repeat on opposite side of tongue |
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Cranial Nerve 8 Acoustic
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sensory
Hearing (cochlear division ) and balance (vestibular division) Hearing evaluated by audiometric exam. Test one ear at a time. Pt occludes one ear, Nurse whispers 2 syllable word such as “99” or “baseball” If hearing loss is present, test use a tuning fork for Lateralization (Weber test) Compare air and bone conduction. (Rinne test) Normal AC>BC |
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pupil evaluation
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size
equality reaction accomodation (which means the ability of the eyes to focus on objects that are close up and faraway) |
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PERRLA:
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pupil response:
pupils Equal Round Reactive to Light and Accommodation |
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Eye exam
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An eye exam is done to check how someone's nervous system is functioning, especially after a head injury or during serious illness. An eye exam would be abnormal if the pupils are:
not of equal size not round (misshapen) don't change when a light is shined on them (should get smaller) don't change when looking at something close or faraway. |
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consensual response
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-relating to or being the constrictive pupillary response of an eye that is covered when the other eye is exposed to light
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Geriatric client
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overall decrease in size of pupil & ability to dilate in dark & constrict in light
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Geriatric client: Arcus senilis
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- an opaque ring, gray to white in color, that surround the periphery of the cornea. Caused by deposits of fat granules in cornea or hyaline degeneration & occurs primarily in older pt.
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cataract
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abnormal progressive condition of lens of eye, characterized by loss of transparency. Most cataracts caused by degenerative changes, often occurring after 50 yr of age. If cataracts are untreated, sight is eventually lost. At onset vision is blurred, then bright lights glare diffusely, & distortion & double vision may develop.
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Ectropion
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-eversion, most commonly of eyelid, exposing conjunctival membrane lining the eyelid & part of eyeball.
May involve only lower eyelid or both eyelid. The cause may be paralysis of facial nerve, or in older pt, atrophy of eyelid tissues |
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Entropion
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-turning inward or tuning toward, the eyelid turns inward toward the eye
An inflammion of eyelid may be result of infectious disease or irritation from inverted eyelash |
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Normal AC>BC (CN:8)
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In a normal ear, air conduction (AC) is better than bone conduction (BC) = this is called a positive Rinne
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negative Rinne AC<BC (CN:8)
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In conductive hearing loss, bone conduction is better than air
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positive Rinne AC>BC (CN:8)
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In sensorineural hearing loss, bone conduction and air conduction are both equally depreciated, maintaining the relative difference of bone and air conductions
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bone conduction (CN:8)
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bone conduction bypasses some or all of these and allows the sound to be transmitted directly to the inner ear albeit at a reduced volume, or via the bones of the skull to the opposite ear.
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Air conduction (CN:8)
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Air conduction uses the apparatus of the ear (pinna, eardrum and ossicles) to amplify and direct the sound
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Conduction hearing loss (CN:8)
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caused by external ear & middle ear problems. Ex-excessive cerumen (earwax), pus, ossicle fusion, damaged eardrum.
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Sensorineural hearing loss (CN:8)
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due to cochlear or nerve damage
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(CN:8) Vestibular function by Romberg Test
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balance (vestibular division)
test of position sense With feet together, arms at side, and eyes open, evaluate balance. Repeat test with eyes closed. Positive Romberg - pt stands fairly well with eyes open but loses balance when they are closed. |
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(CN:8) cerebellar ataxia
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-pt has difficulty standing with feet together whether eyes are open or closed. In ataxia due to loss of position sense, vision compensates for sensory loss.
Ataxia is a lack of muscle coordination which may affect speech, eye movements, the ability to swallow, walking, picking up objects and other voluntary movements. A person with persistent ataxia may have damage in the part of the brain that controls muscle coordination - the cerebellum. Ataxia may have several causes, including multiple sclerosis, a head injury, alcohol abuse, stroke, cerebral palsy, a faulty gene, or a tumor. Ataxia may also be a symptom of incoordination linked to infections. |
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Cranial Nerve 9: Glossopharyngeal
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Sensory & Motor
Sensory: Posterior portions of eardrum and ear canal, pharynx, posterior tongue, including taste (salty, sweet, sour, bitter) Anterior tongue taste tested with CN 7 Tested with tasting exam usually only if pt reports loss of taste. Motor: Pharynx Motor portion is tested along with CN 10. Vagus Gag reflex (vagal nerve exam) Ability to swallow |
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cranial nerve 10: Vagus Nerve
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Motor & Sensory
Motor: Palate, pharynx and larynx Sensory: Pharynx and larynx Test gag reflex by touching back of pharynx with tongue blade Have client say “ah” and observe soft palate and uvula for symmetry Should be able to swallow easily Pt’s speech should have no hoarseness, nasal quality or guttural sounds |
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Cranial nerve 11: Spinal Accessory
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motor
Motor-sternomastoid and upper portion of trapezius Compare one side of shoulders with other. Weakness with atrophy(wasting, decrease in size) and fasciculations (small bundle of nerves or muscle fibers)indicates a peripheral nerve disorder. When trapezius is paralyzed, shoulder droops and scapula is displaced downward and laterally. Musculoskeletal exam - Ask pt to shrug both shoulders upward against your hands. Note strength and contraction of trapezii. Ask pt to turn his head to each side against your hand as if shaking his head “no”. Observe contraction of opposite sternomastoid & note force of movement against your hand. |
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Cranial nerve 12: Hypoglossal Motor
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motor
Motor - tongue Listen to articulation of pt words. This depends on cranial nerves V, VII, X, as well as XII. Inspect pt tongue as it lies on floor of mouth. Look for atrophy or fasciculations. Some coarser restless movements are often seen in normal tongue. With pt tongue protruded, look for asymmetry, atrophy, or deviation from midline. Ask pt to move tongue from side to side, note symmetry of movement |
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Assessment of Motor Function
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Check ability to perform complete ROM
Check hand strength-ability to squeeze examiner’s hand (compare right to left) Check arm strength-ask pt to push away as you apply resistance (compare right to left) Check palmar (pronator) drift if you detect weakness in one extremity Check leg strength-ask pt to push against examiner’s hand (placed on bottom of pt feet) |
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palmar (pronator) drift
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Testing upper extremities
Pt stands for 20-30 seconds with both arms straight forward, palms up, eyes closed. Instruct pt to keep arms up & eyes shut, while the examiner taps the arms briskly downward. Arms normally return smoothly to the horizontal position. This response requires muscular strength, coordination, and a good sense of position. -The presence of pronator drift is a sign of upper motor neurone disease. The patient is asked to hold both arms fully extended at shoulder level in front of him, with the palms upwards. It is a way of eliciting relatively mild spasticity. The upper motor neurone weakness may be revealed by a tendency to pronate the forearm on the affected side when the eyes are closed. This is caused by a difference in the muscular tone between pronation and supination. |
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Muscle Strength – assess muscles against resistance – 5 pt scale:
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5/5- normal - full strength ; full ROM against gravity & resistance
4/5- Full strength against effect of gravity with weakness applied to resistance 3/5– moves against effect of gravity alone 2/5- moves across a surface but cannot overcome gravity 1/5- muscle contraction is palpable & visible; trace or flicker movement 0/5- muscle contraction or movement - undetectable |
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Pronator Drift- pronation of one forearm
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suggests a contralateral lesion in the corticospinal tract; downward drift of the arm with flexion of fingers & elbow may occur.
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Pronator Drift- A sideward or upward drift
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sometimes with searching, writhing movements of hands, suggests lost position sense.
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Pronator Drift- In cerebellar incoordination
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In cerebellar incoordination, arm returns to original position but overshoots & bounces
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Motor strength: Testing lower extremities
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walk on heels, on toes to test dorsiflexion , plantar flexion & balance
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Muscle tone: Hypotonicity-
Hypertonicity- |
Muscle tone-
Hypotonicity- tone is decreased: muscles are soft , flabby or flaccid Hypertonicity- tone is increased; muscles resistant to movement, rigid or spastic Assess for abnormal flexion or extension posture |
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Muscle coordination
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- rapid alternating movements, point to point maneuvers , truncal balance –
Gait & Station- stand still, walk & walk in tandem Prioprioception- sense of body position Movement- check for fasciculation – involuntary twitches., tremors, tics, spasm |
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Prioprioception
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- sense of body position
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Testing of Unconscious Patient
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Test for response to painful stimuli-
reflex withdrawal of limbs, wincing, grimacing If no response - use deep pain rubbing the sternum; pressure to orbital rim ; squeezing sternocleidomastoid muscle |
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Responses to stimuli
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Localization-
Flexion withdrawal Abnormal flexion: decorticate posturing – damage in corticospinal tract near cerebral hemisphere Abnormal extension: decerebrate posturing- damage in upper brain stem No response |
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Decorticate posturing
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abnormal flexion (Indicates damage to corticospinal tract)
Arms adduct Wrists & fingers flex Legs extend with internal rotation Feet are plantar flexed Flexor Posturing Decorticate -*to the cord |
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Decerebrate posturing
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abnormal extension (Indicates damage to midbrain)
Neck is extended, jaw clenched Arms pronated & extended & close to sides Legs extended Extensor Posturing Decerebrate *Lots of E’s |
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Glasgow Coma Scale
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-Specific neuro assessment scale
Provides easy way to describe & track changes in pt status Based on Assessment and best score of: Eye opening Verbal response Motor response Range of 3-15 7 or less = coma Provides info on Lack of Consciousness only (LOC) |
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stereonognosis
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ability to perceive or the perception of material qualities (as shape) of an object by handling or lifting it : tactile recognition
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Superficial Sensation
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Touch & Pain – ID sharp & dull.
Light touch- wisp of cotton Temperature- 2 test tubes- 1 cold , 1 hot Done when pain & light touch responses are abnormal |
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Mechanical Sensation
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Vibration- tuning fork to assess for vibration on bony prominences- fingers or great toe. Assess from distal to proximal parts
Proprioception- ask pt what direction – fingers or toes are moved – up or down |
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Cortical Discrimination
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Stereognosis - ability to identify an object by feeling it
Identify familiar object in hand- coin, key, & paper clip Graphesthesia- number identification Draw a large number in pt. palm using blunt end, ask pt to ID Extinction phenomenon - asking whether one or two pricks are felt |
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Extinction
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Simultaneously stimulate corresponding areas on both side of body. Ask where pt feels your touch. Normally both stimuli are felt.
With lesions of sensory cortex, only one stimulus may be recognized. The stimulus on the side opposite the damaged cortex is extinguished. |
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Two-point discrimination
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With one point or two points simultaneously touch pt finger pads with the side of two pins or two ends of an opened paper clip.
Alternate the double stimulus irregularly with a one point touch. Find the minimal distance at which the pt can discriminate one from two points (normally <5mm on finger pads). *Lesions of the sensory cortex increase the distance between two recognizable points |
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Gerontological Considerations: Assess mental status carefully to distinguish delirium from dementia
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Normal changes may include:
Losses in strength and agility; changes in gait, posture and balance; slowed reaction times and decreased reflexes; visual and hearing alterations; deceased sense of taste and smell; dulling of tactile sensations; changes in the perception of pain; and decreased thermoregulatory ability |
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Reflex Activity
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Reflex testing- assess integrity of sensory & motor pathways
Prov informations about location & nature & progression of neurologic disorders Types: Normal reflexes- superficial or cutaneous reflexes Deep tendon or muscle stretch reflexes |
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Five Deep Tendon Reflexes
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1. Biceps
2. Brachioradialis 3 Triceps 4. Patellar 5. Achilles |
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Deep Tendon Reflexes (DTR) scale
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Range from 0 -4 Normal =2
4+ Very brisk, hyperactive with clonus (Rhythmic oscillations between flexion & extension) 3+ Brisker than average; possibly but not necessarily indicative of disease 2+ Average, normal 1+ Somewhat diminished, low normal 0 No response |
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Biceps (C5, C6)
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Flex arm to 45 degree angle
Palpate biceps tendon at antecubital fossa Put your thumb over the tendon Strike your thumb with the reflex hammer *Response- contraction of biceps muscle causes flexion of the elbow |
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Brachioradialis (C5, C6)
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Flex the client’s arm to a 45 degree angle rest on lap/abd
Rest forearm in your arm with client’s hand slightly pronated Strike tendon at about 1 – 2 inches from wrist with reflex hammer on dull side *Response: flexion of elbow, supination of forearm, flexion of fingers & hand |
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Triceps (C6-8 C7)
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Flex pt arm at elbow, palm toward body, pull it slightly across chest.
Strike tricep tendon above elbow. Use direct blow from directly behind it. *Response: contraction of triceps muscle & extension at elbow |
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Patellar (L2-4)
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knee jerk
Flex knee to 90 degrees with lower leg hanging loosely Strike the patellar tendon just below patella with reflex hammer *Response: Contraction of quadriceps muscle causes extension of lower leg |
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Achilles Reflex (S1- 2)
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With client sitting with knees flexed at 90 degrees, hold ankle in neutral position
Strike Achilles tendon at ankle level *Response: Contraction of the gastrocnemius muscle causes plantar flexion of the foot. Watch & feel for plantar flexion at ankle. |
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ankle clonus
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Ankle clonus: a rhythmic contraction of the calf muscles following a sudden dorsiflexion of the foot, the leg being semiflexed.
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Meningeal Irritation from infection or subarachnoid hemorrhage tests
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(1) Nuchal Rigidity
(2) Brudzinski’s Sign (3) Kernig’s Sign |
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Nuchal Rigidity
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stiff neck
Flex neck by trying to have client put chin on chest or you place your hands behind pt head & flex pt neck forward until chin touches chest if possible. Normally, neck is supple & pt can easily bend head & neck forward. Pain and resistance signals nuchal rigidity, meningeal inflammation, arthritis, or neck injury. |
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Brudzinski’s Sign
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(Positive)
As you flex the neck, watch hips & knees in reaction to your maneuver. Normally, they should remain relaxes & motionless. Involuntary flexion of hips and knees when neck is flexed is +Brudzinski, suggests meningeal inflammation |
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Kernig’s Sign
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(Positive)
Begin by flexing the leg and hip with client supine and then try to straighten leg Pain in low back and resistance is a positive sign. When bilateral, it suggests meningeal irritation.(Compression of lumbosacral nerve root may also cause resistance & pain, but only one leg is usually involved |
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Clinical Applications
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The initial neurologic exam provides baseline for comparison.This usually includes assessment of LOC using Glasgow coma scale , 2) pupillary responses, focal motor & sensory abnormalities in 4 extremities and 4 ) brain stem function via assessment of protective reflexes – gag, cough, and corneal reflexes.
**Nurse needs to recognize trends in pt’s condition that requires further intervention |
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Computed Tomography of the Brain
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Computerized analysis of multiple tomographic xray films taken of the brain tissues at successive layers providing a three dimensional view of the cranial contents .
Used in: differential dx of intracranial neoplasms, cerebral infarct, ventricular displacement , cortical atrophy, cerebral aneurysm, , intracranial hemorrhage & hematoma, arteriovenous malformation , degenerative disease Done with or without contrast dye IV injection of iodinated contrast dye – can be done to visualize previous infarction, or pathologic process that destroy- bld brain barrier |
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CT scan Nursing Interventions
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Explain procedure – will be enclosed tunnel. If mildly claustrophobic pt is premedicated with antianxiety drugs
Written consent if required by the inst Assess allergies to iodine Remove wigs hair pins or clips, partial denture plates Assess for pacemakers NPO 4 hours before if oral contrast is administered Encourage patient to drink fluids to avoid renal complications and to promote excretion of dye after the procedure |
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CT of brain
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CT can be done to determine cerebral bld flow- ( CBF) Xenon CT Scan- pt inhale stable xenon gas mixed with O2 while in CT scanner. Computer converts images to CBF measurement in ml per 100 g of brain tissue per minute.
NL average = 55ml per 100 g per minute. CVA, ICP & intracranial bleeding - are asso. with decrease CBF Use also to determine brain death (CBF= 0) Helical (spiral, volume averaging) marked improvement over the standard CT Scan. This is faster & more accurate. Area is scan in < 30 seconds. |
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CT complications & contraindications
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Contraindications:
allergic reaction to iodine dye or shellfish; claustrophobic,; pregnant; unstable VS; Obese pt > 300 lbs. Complications: Allergic reaction, acute renal failure from dye; hypoglycemia & acidosis may occur in pt taking Glucophage & receive iodine dye |
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Magnetic Resonance Imaging- MRI
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Provides info about body’s biochemistry by placing pt in magnetic field. MRI is based on how hydrogen atoms behave when placed in magnetic field & when disturbed by radiofrequency signals
uses combination of radio waves and a strong magnetic field to view soft tissue ( does Not use x-rays or dyes) ; produces a computerized picture that depicts soft tissues in high –contrast color Area to be examined is placed inside a powerful magnetic field Provides graphic image of bone, fluid and soft tissues -very detailed |
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MRI Nursing interventions
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Written consent
No food restriction Empty bladder before the test Explain procedure- will have to remain perfectly still in the narrow cylinder-shaped machine . Assess for any metal contraindications-pacemaker, metal implants, surgical clips, dental bridges, hair clips, belts, credit cards |
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MRI: Nursing considerations
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Ferromagnetic implants in the body may become dislodged by the magnet –
Aneurysms clips, orthopedic hardware, ; pacemakers artificial heartvalves, intrauterine device- can malfunction, dislodge or heat up as they absorb energy Cochlear implant- can be inactivated by MRI |
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MRI alert
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Nursing alert- no patient care equipment- (eg. portable oxygen tank) that contain metal or metal parts. No IV pole, stethoscope, ventilators
Assess pt for medication patches with foil backing- ( nicotine) – may cause a burn |
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MRA- magnetic resonance angiography
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noninvasive procedure for viewing possible blockages in the arteries . Uses radio waves & magnetic field to visualize bld flow thru the arteries - E.g. cervical carotid artery, intracranial & venous structure
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MRS –spectroscopy
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study the distribution of chemicals in the body . E.g. Stroke , head injury, coma, Alzheimers dis, MS, HIV infection
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Positron Emission Tomography - PET
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The patient inhales or is injected with a radioactive substance
If brain is scanned, pt is asked to perform cognitive activities – i.e reciting Pledge of Allegiance to measure changes in brain activity during reasoning or remembering The computer can diagnose and determine level of functioning of an organ Exposure to radiation is minimal Radioactive chemicals are administered to the pt. Scan is done to determine anatomy & physiology; glucose metabolism, oxygenation, bld flow, tissue perfusion on a specific areas. Pathologic conditions- alteration in normal metabolic process |
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PET Nursing Interventions
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Written consent
No caffeine beverages 24 hours before test Do not take sedatives or tranquilizers before test Empty bladder before test After test have patient change position slowly : there is a chance of postural hypotension Increase fluids; Urinate frequently to aid removal of radioisotopes from the bladder |
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SPECT - Single Photon emission computed Tomography
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Modified version of PET. Uses less precise but more stable & more readily available isotopes to measure cerebral blood flow rather than metabolic activity, as is measured with PET. Radiopaque agent given to pt
Detects abnormally perfused areas of brain -Used to analyze bld flow in brain of pt with ischemic stroke, neurodegenerative dis- e.g.Parkinson dis. |
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EEG
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Graphic recording of electrical activity of brain. EEG electrodes placed on scalp to detect & record electrical impulses
To investigate epileptic states Evaluate trauma & drug intoxication Use as one of the criteria for defining death- “flat lines” |
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EEG Nursing Inventions
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- Explain procedure
Anticipate patient’s fears about electrocutions; test cannot “read the mind: or detect senility Hair should be clean- no oil, spray or lotion before test Consult with M.D. about meds – Anticonvulsant shld be given unless contraindicated by the physician ( Pagana, 2003) ( Pagana 2006- Held 24-48 hours) Do not administer sedatives or hypnotics ( cause abnormal waves on EEG – (Pagana, 2003) ( 2006- Hold) No smoking or caffeinated beverages before the test Eat full meal before the test –hypoglycemia may alter brain waves Stress need for restful sleep before the test sleep deprivation may cause abnormal brain waves Remove electrode paste with acetone or witch hazel Wash hair and scalp after test- |
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Lumbar puncture L3 - L5
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Lumbar puncture- spinal tap
Done under local anesthesia a puncture is made at the junction of the L3 through L5 lumbar vertebrae to obtain a specimen of cerebrospinal fluid (CSF) CSF pressure measured Used to inject medications- spinal anesthesia LP contraindicated with intracranial lesion or > ICP.. With removal of fld intraspinal pressure is decreased and brain herniate through foramen magnum |
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Lumbar puncture Nursing interventions
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Written consent
Monitor vital signs Have patient empty bowel and bladder Position the patient- thighs and legs flexed Hold manometer straight –level Label and number specimens Post procedure: Keep patient supine 4-8 hours ( Brunner- 2-3 hrs lie prone) Observe for headache and nuchal rigidity Observe for mobility of extremities, pain, ability to void Monitor site for leakage |
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Cerebrospinal fluid
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Cerebrospinal fluid- microscopic examination of the fluid for
WBC- increase indicates infection Glucose- low indicates bacterial infection C&S –to identify organisms and treatment Protein – elevated in brain tumors and degenerative diseases Blood- indicates hemorrhage |
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Lumbar puncture Complications
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Post op headache
Lessens or disappears when lying down Headache caused by leakage of CSF Tx: BR, analgesics, hydration Epidural blood patch- bld obtain from antecubital vein injected to seal the hole |
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Myelography
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- contrast materials is injected into subarachnoid space. Spinal tap is done, CSF is removed.
-visualize intradural nerve roots in selected pt. if MRI cannot be done |
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Cerebral angiography (arteriography)
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Femoral artery- in the groin --> desired vessels. Other sites- carotid artery or retrograde injection of contrast agent into brachial artery
illuminates the cerebral circulation. Contrast medium is injected into an artery (usually the femoral) & xrays are taken sequentially as the contrast medium flows with the blood for visualizing carotid, vertebral, & cerebral circulation. The test is used for dx of vascular aneurysms, malformations, displacements, & occluded or leaking blood vessels Radiographic dye is injected into pt cerebral circulation via a catheter & then xrays are taken **Assess for iodine allergies Tell pt they will feel warmth in the face, eyes, jaw, teeth, & metallic taste Assess neuro status as a baseline to compare subsequent assessment . Stroke maybe precipitated by cerebral angiography. |
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Cerebral angiography (arteriography) Nursing interventions
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Written consent
NPO past midnight Monitor extremity for adequate circulation- pain tenderness bleeding temperature and color- Pedal pulses and vital signs q 1 hour Provide sandbag & pressure dressing for 10 minutes to puncture site Bedrest for several hours Force fluids- to increase excretion of dye Assess VS, puncture site, color & pulses on extremity used for catheter insertion |
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Noninvasive Flow studies
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Carotid doppler, ultrasonography- - evaluate arterial bld flow- check for stenosis, occlusion or plaques
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Invasive Testing of Function
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Oculovestibular reflex or caloric test- done in unconscious pt to determine presence of brain stem function.
Ice cold water is instilled into auditory canal . Eyes move in conjugate manner toward the irrigated side then back to midline – intact brain stem function No nystagmus pattern- with brain stem death |
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Peripheral Nerve Studies
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EMG-Electromyography
Assess electrical activity of a skeletal muscle Needle electrodes in skeletal muscles used to dx neuromuscular disorders In myasthenia gravis there is decrease in amplitude of the electrical waveform Decrease in number of muscle fibers able to contract in peripheral nerve damage |
