I. NERVOUS SYSTEM:
1. Cerebral Angiogram:
- Allows for visualization of cerebral blood vessels. A catheter is placed into an artery (usually in the
... [Show More] groin) and
threaded up the blood vessels in the brain, dye is injected, x-ray are taken.
Pre-procedure:
NPO 4-6 hrs prior.
Assess for allergy to iodine or shellfish .
Assess kidney function (BUN, creatinine) to determine if kidneys can excrete the dye.
Post-procedure:
Check insertion site for bleeding, check extremity distal to puncture site (pulses, capillary, refill,
temperature, color)
2. EEG:
- Analyzes electrical activity in the brain. It is used to identify seizure activity, sleep disorders, behavioral changes.
1 hrs.
- Pre-procedure patient instructions:
Wash hair prior to procedure
Arrive sleep-deprived (as this increases chance of seizures)
No NPO is needed . Avoid stimulates, sedative medications 12-24hrs before procedure.
Flashing light, hyperventilate (to increase electrical activity)
3. Intracranial pressure (ICP) monitoring: RANGE 10-15 mmHg.
- Inserted into cranial cavity in the OR to measure pressure. HUGE RISK OF INFECTION.
GCS score of 8 or less or coma
SYMTOMP:
Irritability (early sign!),
Restlessness, headache, decreased LOC
Pupil abnormalities, abnormal breathing ( EX: Cheyne Stokes)
Abnormal posturing.
4. Lumbar Puncture: Cerebral Spinal Fluid (CSF)
- Used to diagnose multiple sclerosis, syphilis, meningitis, infection in CSF.
Pre-procedure:
VOID
Position pt in cannonball position on their side, or have pt stretch over table while sitting.
Post-procedure:
Pt should lay flat for several hrs→ (bedrest)
If the dura puncture site does not heal, CSF may leak, RESULTING IN HEADACHE (give pain
meds, increased fluid intake).
Epidural blood patch can be used to seal off the hole.
Slightly elevated temp
Difficulty VOIDING
5. MRI:
Allergy shellfish/iodine
Hx of claustrophobia
Remove all jewelry
No metal (pacemaker, orthopedic joints, artificial heart valves, IUDs, aneurysm clips).
Earplugs can be provided, as MRIs are loud.
6. Pain
Nociceptive pain Neuropathic pain
- Damage/inflammation of tissues ( NOT part of CNS).
- Throbbing, aching, and localized.
- 3 types:
Somatic:
Visceral: internal organs.
Cutaneous: skin, subcutaneous tissue.
- Damaged nerves.
- Shooting, burning, “pins and
needles”
- MEDS: antidepressants, muscle
relaxants.
7. Analgesics:
Non-opioid Opioid (meperidine)
- Mild → moderate pain
- Acetaminophen NOT exceed 4g/day.
- Monitor for salicylism w/aspirin (SX:
tinnitus, vertigo)
- WITH FOOD
- RISK OF BLEEDING
- Cause ringing of the ears
- Moderate→ severe
- S.E: constipation, hypotension, urinary
retention, N/V, sedation, respiratory
depression.
- Naloxone is antidote .
- Administer around the clock (vs PRN)
- Instruct the client to void at least q4h to
decrease the risk of urinary retention
REPORT:
- Oversedation (sleep through the day)
Risk for respiratory depression.
8. Meningitis:
- Prevention:
MCV4 vaccine is given to students living in dorms
- SX:
Headache, nuchal (neck) rigidity, photophobia, N/V, positive Kerning’s and Brudzinski’s signs, fever,
altered LOC, tachycardia, seizures.
Weight loss
- Diagnosis:
CFS analysis
Bacteria will have cloudy CSF, decrease glucose content.
Viral will have clear CSF.
Elevated WBC and protein for both types.
- Nursing care:
DROPLET precautions until antibiotics are administered for 24hrs.
Quiet room, low light, HOB 30, monitor increased ICP.
Avoid coughing/sneezing, seizure precaution.
AVOID photophobia.
- MEDS :
Antibiotics, anticonvulsants (EX: phenytoin)
9. Seizures:
- Uncontrolled electrical discharge of neurons in brain
Epilepsy= chronic seizure [Show Less]