Diagnostic Evaluation For Patients With Altered Neurologic Function

di agnostic tests used to dx pts T altered neurologi functionpremonopausal women advised to practice effective contraception before andfor several days after any dx procedure using contrast.breastfeeding stop temporarily as recommended by nuclearmedicine department1.CT scanuses harrow xray beam to scan body parts in successive layersImaging provides cross. fectional views of the brain distinguising differencesIn tissue densities of the skall ,cortex, subcortion simetures, and ventncles.IV contrast used= highlights differences further(usually 1st done u/out contrast, then with, If needed.)patient must lle n/head STILL. movement MISTONS the image.QUICKpamesuses small amount of radiationdegree of defecting lesions. (brain lesoms have a M fferent tissuedensity than the surrounding normal braw tissue)abnormalities that can be detected on a CT:tumor Imasseshemorrhage-cortical atrophyinfarctiondisplacement of ventricleswursing Ih tementionseducating pt about need to lie still.assess for 10dine/shellfusly allergy(if contrast Is used.)Kidney function meeds to be checked - b/c contrast IS excretedthrough the Kidneys.- IV 11 me placementNPO 4hrs before testflud Intake after test (to flush out contrast and facilitate clearence throughKidneys.)2.MRIuses powerful magnitic field to obtain images of differentareas of the body. magnitie field causes the hydrogen muclei (protons)WIIN the body to all gn like small magnets in a magnetic field.protons emit signals7converted to Images.can be done WHh or without contrastcan identify a cerebral abnomality earlier and more clearly than otherdx tests.provides In fo about chemical changes w/in lells (monitor tumors response to tx.lost-useful in diagnosis of : brain tumor, stroke, MS.does 0 involve ionizing radi ation.takes about 1hrt (limited use during emergency situations.)Nursing Internentionsmake sure patient doesnt have metal dences (carmai implantable dences)assess for aneurysm clips, orthopedic hardware, artificial hear t valves,intrauterine dences.remove all metal /credit cards (medication patches (can (ause bums.)pt must be able to II. flat /still. MRI tube IS namow.(wide r people may 0 ftt.)painless but and thomping 18 heardopen MRI machines available ibut images 0 as detailed as regularmachines.microphone Inside slamer to communicate T Staff outside3.PE T SCAN -produces images of actual organ functioningpt inhales radioactive gas or is injected T/radwautive substance that emitspositively charged particles.oncitinne comban : T. 1-101e trans found in the londli and result in bamma rays that produce 2-dimensional views at vanouslevels of the brain.permits measurement of blood flow tissue composition, and branmetabolism.measures glucose actuity in brain, and can detect changes in gumose use-(AD)useful In: in the brain, locating lesions (tumors,epileptogenic lessons.) Identifying bloo d flow and 02 metabolism inpts T stroke. #Nursing intermentionsexplain inhalation techniques and sensations (dizzness, lightheadedness,HA.)in injection produces the same effects4.SPE CT three dimensional imaging technique that uses radionuclides andinstruments to defect single photons.perfusion study that captures a moment of cerebral blood of low at the timuof injection of a radionudide.Gamma photos are emitted from a radopharmacentical agent gmento the patient and are detected by a rotating gamma camura or camerasallows areas behind overlying structures or background to be newed,greatly the contrast between normal and abnormal tissue.useful in:detecting the extent and location of abnormally perbused areasof thebrain-STOKICAN 1 be seen before It becomes visible on act Sean.localization of senzuredetection oh tumor procercention evaluation of perfusion before and after neurosurgical procedures.Nursing interventionspregnancy and breast feeding are contraundications to SPECT.monutor for allergic reaction to the radiopharmaceutical agentbefore and after the procedure.5.cerebral angrographyxray study of the cerebral circulation w/a contrast agent infectedinto a selected arteryused to: determine vessel patency, Identify prescence of collateralcirculation provide detail on vascular anomolies that can be usedin planming internentions.performed by threading a catheter through the femoral artery inthe noun or the radial artery of the wrist up to the desired vessel.Xray images are obtained as the contrast agent flows through thevessels.Artenal access may also be used for interventional procedures, such asplacing coils in an aneurysm or arteriovenous malformation.Nursing interestionsCheek BUN and creatinine to ensure the Kidneys will be able to excretethe contrast arentHydrate nell prior (clear limins permetted up to time of the test.)vold before testpempheral pulses marked T felt -tip pen.remain still during angrogram.educate on feelings during contrast injection : warmth in face, behind the eyes, the jaw, teeth,tourge,lips, and a metallic tasteIf 48mg femoral artery: groin hair IS chpped local anesthetic gmen.Catheter inserted fiushed and filled T/contrast.If using radial artery: meds used to relax and dilate the vessel toallow the catheter to pass.Flumostopy used to guideneuro check before and after} to assess for embollsm N artenaldissection.s/s embollsm/arrenal dissetion:change in Lvcunilateral weaknessmotor/sensony deficitsspeech disturbancespost sx care: obscme injection site for bleeding or hematoma formation.prior marked pulses are monitored frequently.monutor extremity color Itemp (for r/o embolism)Fluidsmontor for allergic reactionsmonutor for hypotension.6.myelography xray of the spinal subrachnoid space taken abter theInfection of a contrast agent Into the spinal subrachnoid Space throughn lumb ar puncture.= w ater based contrast agent disperses unward through the CSF andoutlines the spinal Subrachnoid space and shows any distortion of thespinal cord or Spinal dural sac caused by tumors, cysts, herniatedvertebral discs and other lessons. often followed by CT Scan- hursing imentionseducationmade aware that changes in position can be made duning the procedureS/p myelography pt lies In bed T 1 HOB 30-45°position IS recommended for 4-24 hrs after testingFluids -to post lumbar HAT.momitor VSmonitor roidingcomplications N/V, HA, fever, stiff neek, senzuses, paralysis of one side ofthe body, changes in LOC.7.noninvasive carotid flow studiesultrasound Imagery and doppler measurements of artenal blood flowto evaluate carotid and deep orbital circulation.-graph produced I hall cales blood velocity.blood velouty: can indicate stenosis or partial obstruction-noninvasive8.Transcramal Dombler ultrasound Imagery also.records the blood flow velouties of the intraeramel vessels.Helpfur In assessing Vasospams, altered cerebral blood flowfound IN owluswe vascular disease, other cerebral bathologues, death.9.EEG (electro-enecphalogram) records the electrical activity of the brainUseful fw dx and evaluating sinure disorders, coma or organicbrain syndrome. Also used to make determination of brain death- Tumors bram abscesses blood clots and infection may cause abnormalpatterns in electrical acturyt.-For baseline recording-patient lies queetly t/eyes closed-mans be asked to humenventilato 13 -4mins) n look w a brissatifiashing light for photic stimulation< -sleep GEG maybe recorded after sedation b/c some abnormal brainwaves are seen only when the patient IS asleep.- scarp or nasophanyngeal electrodes can both be used,-Depth recording of EEG IS used to identify patients that maybenefit from 8x exasion of epileptogenic foci.Nursing internentionsdeprive pt of seen the myst before-to chance of induring sumresHold anticonvulsants, tranquilizers, stimulants, depressants for 24 48hrs.coffee tea, chocolate, cola dnnkscan eat -b/c I glucose can also alter results.test takes 45-60mins /sur EEG (2hours.lie quietlyeleeto myographyInsert needle electrodes Mto the skeletal muscles to measure changesIn the electrical potential of the muscles.Helpful in determining:presence of and myopathiesHeeps distingussh weakness d It neuropi Thy vs. weakness fromother causes.Nursang-Interestionsful pt that sensation of IM injections when needle IS inserted intomuscle is nomal and expectedumbar punitime and examination of CSFmsert needle into subrachnoid space to withdraw CSF testused to examine the CSF, VCSF pressure, determine presence larience ofblood and admin meds intrathecally.CSF should be clear, colorless.must be sent to the lab right away blc if left sitting can alter results.post lumbar HA-can ocuur hrs-days after. dlt CsFleakage at puncture site.S/S: throbbing bifrontal or occeptal HA.worse when standing or sittingTX: lie supine, meds, fluids cafferne.