Day 2

Diagnostic Tests

Computer Tomography Scan - CT

Description X-rays computer

generated 3-D picture Distinguishes tissue

density Tumors

Machine moves around still patient

Non-invasive & painless

With or without contrast medium

Computer Tomography Scan - CT

Nursing Considerations Explain procedure

30-60 minutes Lying still

If contrast medium is used

for iodine & shellfish allergies

NPO (4 hrs) Push fluids after

procedure watch for S&S of ICP

Computer Tomography Scan - CT

Computer Tomography Scan - CT

Brain abscess Blood flow after pTA

Computer Tomography Scan - CT

Area of brain not getting blood flow

Computer Tomography Scan - CT

5 month old meningitis

Computer Tomography Scan - CT

Positron Emission Tomography (PET)

Description Computerized nuclear

imaging actual organ functioning

Via radioactive substances

Used to ID: Blood supply Metabolic activity

glucose

Positron Emission Tomography (PET)

Nursing Considerations Teach inhalation technique &

warn about unusual sensation that might occur Dizziness Lightheadedness Headaches

Pre-op No caffeine No smoke NPO

Post-op Push fluids

Blood flow and glucose uptake are measured by PET in order to identify seizure sites in the brain.  In 80% of patients there is an increase in blood flow and glucose metabolism during a seizure in the cerebral cortex. 

However, between seizure there tends to be a lower than normal glucose uptake and blood flow

Patients have a higher than normal blood flow to the basal ganglia on the opposite side to the effected limbs.  L-dopa reduces the blood flow to the basal ganglia but over time can increase the local metabolic rate.  There is also a lack of communication between the frontal and parietal and the frontal occipital lobes.

PET scans show in patients with mild Alzheimer's and in more advanced cases glucose metabolism is reduced in both the temporal and parietal lobes.  Patients with a greater amount of language dysfunction than problems with spatial sight display a significant reduction in metabolism in the left frontal, temporal and parietal lobes.  Cases with greater visual spatial impairment have a diminished glucose metabolism in the right parietal lobe

Magnetic Resonance ImagingMRI

Description Magnetic field + radio

waves Used to ID:

Edema Hemorrhage Tumors

Moved into a tube Claustrophobia

Takes 45-60 min Lay flat & motionless Noisy

Magnetic Resonance ImagingMRI

Nursing Considerations Remove all metal

Aneurysm clips Orthopedic hardware Pacemakers Heart valves Intrauterine devices

(IUD’s) Cochlear implants Watches, credit cards,

metal Relaxation techniques

CT scan MRI

Eye CA Pineal CA

Aneurysm 28yrs old Female smoker

Aneurysm 28yrs old Female smoker

Brain CA Brain CA

Brain Abscess Note herniation

Cerebral angiography

Description X-ray of cerebral

circulation with contrast agent

Used to ID Vascular disease Aneurysms

Tread catheter Femoral artery Aortic arch Carotid artery

Cerebral angiography

Nursing Considerations Pre-op

Well hydrated Mark peripheral pulses for iodine allergies contrast medium

injected feeling of warmth

Cerebral angiography

Nursing Considerations Post-procedure

Sand bag leg Bed rest over night VS and neuro checks Observe puncture site Distal pulses Bradycardia/hypotension

= vagal stim for difficulty breathing

ICP Monitor LOC

MRI 28yo female

Angiography

Myelography

Description X-ray of the spinal

sub-Arachnoid space

Injection of contrast medium

via lumbar puncture

Myelography

Nursing Considerations Explain NPO Post-procedure

Lie HOB 30 – 45

Bed rest x 3 hrs fluids

Bad signs H/A Temp Stiff neck Photophobia Seizures

Electroencephalography (EEG)

Description Measures electrical

impulses of the brain brain waves

Electrodes applied to the scalp

- 16 Used to diagnosis

Seizures Coma Brain death

Obtain an baseline Quiet & dark

Stimulation Flashing lights

Electroencephalography (EEG)

Nursing Considerations Duration: 1 hour seizures

sleep deprivation No anti seizure meds,

tranquilizers, stimulants, depressants

No caffeine OK to eat

Normal

Petite Mal Generalized Seizure

Electromyography

Description Needle electrodes put

into skeletal muscles Measure changes in

electrical potential of the muscle.

Used to diagnose Neuromuscular

disorders

Electromyography

Nursing Considerations

Explain not going to be

electrocuted Needle, like a IM

injection Muscles may ache

Lumbar Puncture

Description Puncture of lumbar

Subarachnoid space @ L 3-4 level Used to

Extract CSF Relieve ICP Test Spinal fluid

pressure Introduce

antibiotics radiopaque dyes anesthesia

Lumbar Puncture

Nursing Considerations

Pre-procedure Side lying with legs

pulled close to chin Do not move Painful – pressure Shooting pain down

leg 10 minutes

Lumbar Puncture

Post-procedure Bed rest Fluid (unless…) Observe for side

effects

Lumbar Puncture

Post-puncture headaches Duration

Hrs to days Cause

Unknown Tx. / prevention

Bed rest Quiet dark room Analgesics fluids