Neurological Disorders

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Neurological Disorders
(Diagnostic Studies)

Learning Outcomes
* Discuss the various diagnostic studies used in clients with neurological problems

Diagnostic Studies
A. X-ray of the skull and spine
- used to rule out fractures, dislocations and curvatures of the spine

1. Preprocedure:
* explain the purpose of the procedure; instruct the client to lie still

2. Post procedure:
* no follow up is needed

B. Lumbar Puncture (LP)
- insertion of a spinal needle through the L3-L4 into the subarachonoid space to obtain cerebrospinal fluid for laboratory analysis to measurepressure or instill medications

1. Preprocedure:
* Obtain a written consent
* Instruct the client to empty the bladder
* Instruct the client to lie still during the procedure

2. Procedure:
* Assist the client to assume a lateral recumbent position with knees flexed

3. Post procedure:
* Instruct the client to lie flat, generally 4-8 hrs. to prevent spinal headache * Encourage fluids
* Monitor the puncture site for leakage of CSF and hematoma

C. Cerebral Angiography (CA)
- the x-ray study of the cerebral vascular system following an injection of contrast medium into the femoral artery

1. Preprocedure:
* Explain the procedure
* Obtain a written consent
* Assess for allergies t iodine
* NPO for 8-12 hrs
* Inform the client that a warm sensation may be experienced with injection of the dye * Instruct the client to lie still during the procedure
* Inform the client that groin discomfort may be felt when the groin puncture is made

2. Procedure:
* Administer sedation as prescribed

3. Postprocedure:
* Maintain the client on bed rest generally 8-12 hrs
* Monitor the puncture dressing
* Monitor the VS
* Apply pressure to the puncture site with a sandbag
* Encourage fluids
* Assess the extremity for skin color, temperature, and capillary refill assess the area distal to the injection site.

D. Myelogaphy
-air contrast or water contrast X-ray study inserted into the subarachnoid space of the spine.

1. Preprocedure:
* explain the procedure
* obtain written consent
* assess allergies to iodine
* NPO for 2-4 hrs
* instruct the client that a warm sensation may be felt with the injection of the dye * instruct the client to void
* instruct the client to lie still during the procedure
* inform the client that during the procedure the table will be titled up and down to the facilitae injection of the dye * hold phenothiazines for tricyclic antidepressant, which may lower the seizure threshold.

2. Procedure:
* Administer sedation as prescribed

3. Postprocedure:
* elevate the head of the bed 60 degrees if a water-soluble agent was used, otherwise 30 to 45 degrees. * monitor the client for headaches, fever, still neck, or photophobia, which may indicate meningitis * wait 48 hrs before restarting phenothiazine or tricyclic antidepressant * maintain the client on bed rest generally for 8-12 hrs

* Encourage fluids
* Monitor urine output

E. Positron emission tomography (PET)
-Nuclear scan that has an advantage over the Ct or MRI because it not only provides information on the blood flow, oxygen uptake, glucose transport, but also information on the function of the brain.

1. Pre procedure:
* explain the procedure
* instruct the client t void
* assess for allergy to iodine
* instruct the client to lie still during the procedure
* instruct the client to avoid caffeine, smoking an alcohol for 24 hrs. * obtain baseline VS and neurological assessment.

2. Procedure:
* administer sedation as prescribed
* may offer relaxation tapes or mental relaxation exercised to facilitate lying still.

3. Postprocedure:
* instruct the client to wash hands after voiding and bowel movement because...
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