MED-SURG III
GNS 222
D I AG N O S T I C S T U D I E S O F T H E N E RVO U S S Y S T E M
DIAGNOSTIC STUDIES OF THE
NERVOUS SYSTEM
• Diagnostic studies provide information to the
nurse in monitoring the patients condition and
planning appropriate interventions.
• The common diagnostic studies and the nurse’s
responsibility in particular diagnostic studies of
the nervous system are as follows:
1. Cerebrospinal fluid (CSF) analysis (lumbar
puncture)
2. Radiological tests
3. Electrographic studies
4. Ultrasound
CEREBROSPINAL FLUID (CSF)
ANALYSIS
• CSF is a clear fluid that is form in the third, fourth and
lateral ventricles of the brain.
• Samples are obtained either through lumbar
puncture or cisternal puncture and examined for
any increase or decrease in its normal constituents
and foreign substances such as pathogenic organism
and blood.
• Cisternal puncture, also known as a suboccipital
puncture, is a medical procedure where a needle is
inserted below the occipital bone (back of the skull) to
collect a sample of cerebrospinal fluid (CSF) from the
cisterna magna. It's an alternative to lumbar puncture.
CONT…
• The normal CSF values are;
• Specific gravity 1.007
• Ph 7.35
• Appearance clear,colorless
• RBCs none
• WBCs 0-8/nanoliter (0-0-008/L)
• Pressure 75 to 180mm H2O
• Protein lumber 15-45mg/dl
• cisternal 15-25mg/dl
• ventricular 5-15mg/dl
• Glucose 45-75mg/dl
• Micro-organisms none
• CSF is aspirated by needle insertion in L3-L4 OR L4-L5
interspace to assess many CNS diseases. Nurses
responsibility while obtaining sample through
lumber puncture includes:
• Assist the patient to assume and maintain lateral
recumbent position with knees flexed
• Ensure maintenance of strict aseptic technique
• Ensure labeling of CSF specimen properly
• Keep patient flat for at least a few hours depending on
physician’s preference
• Encourage fluids intake
• Monitor neurologic and vital signs
• Administer analgesics as needed.
RADIOLOGICAL TESTS
• 1. Skull and spine x-rays: the nurse explain that
procedure is non invasive and explain the position to be
assumed during x-ray.
• 2. Cerebral angiography: is a medical imaging
technique that uses X-rays and a special dye (contrast
material) to visualize the blood vessels of the brain.
• it involves the injection of contrast medium into the
arterial circulation which assists in determining etiology
of strokes, seizures, headaches etc.
• A catheter is inserted into the femoral artery and
advanced into the carotid and cerebral vessels. Serial
films are taken as the dye circulates through the cerebral
circulation.
• The nurse informs the patient that the procedure takes 1 to
2 hours.
• Keep patient NPO
• Explain that the patient will have hot flush when the dye is
injected.
• Administer premedication as ordered
• Explain need to be absolutely still during the procedure
• Monitor neurologic and vital signs every 15-30 minutes for
first hours
• Maintain pressure dressing and ice to injection site
• Maintain bed rest until patient is alert and vital signs are
stable
• Report any sign of change in neurologic status.
• 3. Computed tomography (CT) scan: computer
assisted x-ray is done to detect problems such as
hemorrhage, tumor, cyst, edema, infarction, brain
atrophy and hydrocephalus. In this procedure, the
nurse:
1. Explains the procedure is noninvasive (if no dye is
used)
2. Observe for allergic reactions and note puncture
site (if dye is used)
3. Explain appearance of scanner
4. Instruct the patient on need to remain absolutely
still during procedure.
CT SCAN
• 4.Myelography: refers to x-ray of spinal cord
and vertebral column after injection of dye into
subarachnoid space is used to detect spinal
lesions, e.g. ruptured disk, tumor. In this, the
nurse’s responsibilities are to:
1. Administer pre-procedure sedation as ordered
2. Instruct patient to empty bladder
3. Inform patient that test is performed with
patient on tilt in table that is moved during test
4. Encourage fluids intake
5. Monitor neurologic and vital signs
• 5. Magnetic resonance imaging (MRI):
Internal body parts are visualized by means of
magnetic energy.
• No invasive procedures are required unless
contrast material is used.
• Here, there is need for nurse to screen patient for
metal parts and pace maker in the body.
• Instruct the patient to be on knee to lie very still
for up to 1hour.
• Sedation may be necessary if patient is
claustrophobic.
• 6. Positron emission tomography (PET):
Measures metabolic activity of the brain regions
to assess cell death or damage by using
radioactive compounds. In this procedure, nurse:
1. Explain procedure to the patient
2. Explains that two IV lines will be inserted
(radioactive tracers)
3. Instruct patient not to take sedatives
4. Explain bladder before procedure
5. May be asked to perform different activities
during test.
ELECTROGRAPHIC STUDIES
• 1. Electroencephalography (EEG): In this, electrical
activity of the brain is recorded by scalp electrodes to
evaluate cerebral disease, CNS effects of systemic diseases
and brain death. In this procedure, the nurse:
1. Informs patient that the procedure is painless and without
danger of electric shock
2. Withhold stimulants
3. Informs that patient may be asked to perform various
activities such as hyperventilation during test.
4. Determines whether any medication should be withheld
e.g anti seizure medication
5. Resume medications after test
6. Assist patient to wash electrode paste out of hair
• 2. Electromyography: records the electrical
activity of muscle tissue.
• It is recorded by insertion of needle electrodes to
detect muscle and peripheral nerve disease.
• Here the nurse inform patient of slight discomfort
associated with insertion of needle.
ULTRASOUND
• 1. Carotid duplex studies: is a non-invasive
ultrasound test that assesses the carotid arteries,
which carry blood from the heart to the brain, by
using sound waves to create images and measure
blood flow. It helps identify conditions like
atherosclerosis, blockages, or narrowing of the
carotid arteries, which can increase the risk of
stroke.
• 2. Trans-cranial Doppler: same technology as
carotid duplex. But evaluates intracranial vessels
(brain's arteries, specifically the Circle of Willis).
• the nurse needs to explain the procedure to the
patient.
