ADVANCE NURSING II

CARDIAC REASONS FOR CARDIAC

CATHETERIZATION
Cardiac catheterization is an invasive
procedure where by a specialized
catheter is inserted into the heart.
NB: 1. another name for cardiac
catheterization is called coronary
angiography
2. Since it’s an invasive procedure,
seek consent of your client.
3. The procedure is carried out using
a specialized catheter.
CATHETERIZATION
 To diagnose and treat various forms
of cardiovascular disease
 To establish or ascertain any
congenital problem
 To introduce/instill fluid or
medications into the heart and
vessels
 To redraw blood sample directly
from the heart for investigations or
analysis
 To measure cardiac output

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 To measure the pressure within  Right heart catheterization
various parts of the heart  Left heart catheterization
 To measure oxygen saturation of the
blood TYPES OF CATHETERS FOR THE
 To obtain clear picture of the cardiac PROCEDURE
structures and its functions  Flexible silicon rubber: use for a long
term catheterization
 Polyurethane: mostly for short term
INDICATIONS FOR CARDIAC use
CATHETERIZATION
NURSES RESPONSIBILITIES AFTER
 In a case or situations of cardiac THE PROCEDURE
stenosis  The nurse must flush the catheter to
 Thrombosis ensure patency
 Aneurysm  The nurse must assess the site for
 Cardiac tumors any abnormalities such as; bleeding,
 Congenital malformation hematoma etc.
FORMS OF CARDIAC
CATHETERIZATION

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 The nurse must palpate to see how
well the pulse is (close to the COMPLICATIONS OF CARDIAC
assessed point) CATHETERIZATION
 Checking of vital signs
 The nurse must check the capillary  Pneumothorax
of the affected extremities  Sepsis
 Look out for any tingling sensations  Phlebitis
and numbness  Thrombus formation
 Maintain bed rest for the patient for  Arrhythmias
about 2-6 hours  Hypovolemia
 Serve prescribed analgesics if there’s  Hematomas
severe pain  Bleeding
 Instruct the patient to report to the
facility if there is any sudden ELECTROCARDIOGRAM
discomfort (ECG)
 Give IVF when necessary An electrocardiogram (ECG) is a
 Ensure proper maintenance of form of diagnostic test performed
intake and output chart on individuals with cardiac
 Ensure safety of patient problems.

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 It also provides graphical
representations of the electrical
activities of the heart.
 The ECG uses an electrodes
 The electrodes are placed at a
specific point of the individual and is
connected to the ECG machine
which evaluates the electrical
activities/impulses of the heart.
 The electrodes has two(2) parts;
1. The adhesive part containing a
sticky material at the top of the
electrodes
2. Also contains another part built in
the electrodes which contains
substance that reduces electrical
impedes.
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NB: the nurse must make sure
that the sticky substance of the
part of the electrode sticks
properly to the skin in order give
an accurate reading.
If the electrodes does not appear
properly to the skin, it will alter
the ECG results. A wrong
representation of an ECG results
is called (an ARTIFACT)
INDICATIONS FOR
ELECTROCARDIOGRAM (ECG)
 In situations where there is
cardiac arrhythmias
 Use in pericardial injuries
 Use in conduction defect
 Use in myocardial infarction
or myocarditis
 Corpulmonary
 Use in ischemia of the heart
 Ventricular hypertrophy
 To detect electrolyte
imbalance
NURSES RESPONSIBILITIES
BEFORE THE PROCEDURE
NB: the nurse must note that
the interpretation of the ECG
depends on some factors.
These are; age, gender,
blood pressure and symptom
exhibited by the patient.
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 Explain procedure to the
patient
 Obtain informed consent
 Reassure patient to allay
anxiety
 Shaving of the area especially
the chest
 Remove all contraindicated
items e.g. bracelets,
jewelries, necklace etc.
 The nurse must prepare the
area and remove any oily
substance
 Depending on the machine
you are using, apply gel
 The nurse must ensure that
the machine is working
properly.
 NURSES RESPONSIBILITIES
AFTER THE PROCEDURE
 The nurse must remove the
electrodes
 The nurse must indicate on
the strip anything the patient
went through during the
procedure
 The nurse should allow the
patient rest for sometimes
 Note any complications after
the procedure
ECHO CARDIOGRAM
A diagnostic test use to
evaluate the actions of the
ventricles of the heart. Use
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to detect problems
associated with the
structures of the heart.
 Use to detect issues of
myocarditis etc.
 It consist of a pen- like probe
connected to the echogram
which passes over the chest
area where the heart is
located.
POSITIONS USE IN NURSING
PATIENT WITH CARDIAC
PROBLEMS
 High fowlers (45-90 degrees)
 An upright position
 Trendelenburg position
 NURSING PATIENT WITH INVESTIGATIONS
RESPIRATORY DISORDERS
(UNDER OBSERVATION)  Chest X-ray
 Ultra sound scan of the chest
 Observe the breathing  Culture and sensitivity test of
pattern of the patient the sputum
 Monitor vital signs: thus the  Examination
nurse checking the  Full blood count
respiration and evaluating
the kind of respiration or
breathing pattern the client TRACHEOSTOMY
is exhibiting. An artificial opening through
 Monitor intake and output the trachea.it is done at the
chart. 2nd and 3rd level of the
trachea ring (cartilage).
UNDER NUTRITION
PURPOSES OF
 Low fat diet TRACHEOSTOMY

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 To maintain patent airway
 To by-pass an obstruction
 It is done in patient with
aspiration problem
 It helps in secretion control
 It is required in patients who
need long term ventilation
 Use in suctioning.
PARTS OF TRACHEOSTOMY
TUBE
 Outer cannula:-which
contains the inner cannula
 Inner cannula
 Obturator: it guides the
insertion of outer cannula
into the trachea
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NB: made of polyurethane
INDICATIONS OF
TRACHEOSTOMY
 In respiratory failure
 Use in fracture of the larynx
 Use in airway obstruction
 Foreign body e.g. mucus.
 Tumors
 Severe burn of the neck
TRACHEOSTOMY CARE
The nurse must set a sterile
tray containing;
 Tracheostomy tube with
correct size and obturator
 Plaster
 Cannula
 Methylated spirit  Inspection of the site for
 Surgical gloves bleeding
 Sutures  There should be careful care
 Sterile gallipot of the stoma to prevent
 Povidine infection
 Sterile gauze  In order to prevent
 A local anesthetic agent e.g. infections, the nurse must
lidocaine clean all dry secretions in the
inner cannula
CARE OF TRACHEOSTOMY  To prevent infections,
(Purpose) change dressing frequently
 To maintain patent airway  Checking of vital signs
 To prevent infections especially respiration
 To maintain the integrity of  Observe for complications
the surrounding skin  The patient should be well
 Provide psychological hydrated
support.  Monitor intake and output
chart
NURSING CARE

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 Ensure that there is
humidification
 Fresh tube should be used to THORACENTHESIS
replace the old on Thoracenthesis is an invasive
 The nurse should ensure procedure which involves
mouth care puncturing of the wall of the
 Ensure that the patient takes chest with needle to redraw
nutritious food. or aspirate fluid. This
procedure uses a specialized
COMPLICATIONS OF aspiration needle.
TRACHEOSTOMY NB: The pleural space
shouldn’t contain fluid more
 Airway obstruction than 20mls.
 Hemorrhage
 Edema REASONS/PURPOSES FOR
 Perforated esophagus THORACENTHESIS
 Emphysema
 Aspiration of secretions
 Pulmonary infections

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 To bring comfort and relieve
patient from difficulty in
breathing
 To obtain a specimen for
investigations
 It is done clinically to reduce
pulmonary or respiratory
distress.
 To administer or instill
medications into the pleural
space
INDICATIONS
 Congestive heart failure
 Nephrotic syndrome
 Raptured esophagus
 Pulmonary perfusion
NB: it is contraindicated in
patients with
thrombocytopenia
SITES
The commonest site is between
the 4th, 5th and 6th intercostal
space, just below the inferior
angle of the scapula

 Empyema
PROCEDURE
 Pneumonia
 Tuberculosis perfusion  Explain the procedure to
(degeneration of the the patient
parenchyma cells)  Reassuring of the patient

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 Put the patient in a  Adhesive tape
comfortable position e.g.  Drainage tube(
upright, left or right lateral mainly chest tube)
position with the foot  Vital signs tray.
comfortably supported.
OR lie down with the
hands flexed. UNDER WATER
 Preparation of the patient SEAL
skin DRAINAGE
 Administer some local An invasive
anesthesia procedure which
 Set up a tray or trolley for involves the insertion
the task containing; of chest tube to get
 Sterile gloves rid of accumulated
 Methylated spirit fluid.
 Local anesthetic NB: the nurse must
agent note that there
 Sterile gauze and should be 20mls of
swabs fluid for lubrication.

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METHODS
 Wet drainage
system
 Dry drainage
system.
INDICATIONS FOR UNDER
WATER SEAL DRAINAGE
 Trauma to the lungs
 After thoracic or
cardiovascular surgery
 Disease of the chest or
thoracic cavity e.g. in
situation of hemathorax
and pneumothorax. Etc.
The tube is connected to
two large bottles.
The first bottle is the
collection chamber. And
the first bottle is
connected to the second
one. The first bottle is
empty where the fluid will
be drained or collected
and the second bottle is
the water seal chamber.
DIAGRAM

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GENERAL INSTRUCTIONS:
 Obtain consent from
patient
 The bottles should be
lower than the patient
 The patient should be
placed on a flat surface
 Ensure patency of the tube
 The nurse must note that
the tip of the tube should
be 2cm into the sterile
water in the second
chamber
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 Always mark the water
level
 Note the days and the
time of drainage
NURSES RESPONSIBILITIES
BEFORE THE PROCEDURE
 Explain procedure to
patient
 Provide privacy
 Check and record vital
signs( take note of the
respiratory status)
 Put patient in an
appropriate position
 Set up the tray containing;
 Needle holder
 Surgical blade
  Cannula  Chest X-ray can be done to check
 Local anesthesia proper position of the tube
 Forceps  Monitor the vital signs every 15
 Cleansing lotion minutes for 1hour
 Suture band  Auscultate the lungs( listening to
 Surgical gloves the sound of the lungs for at least
 Plaster every 4hours which is part of
 Gauze bandage physical assessment)
 Normal saline  Observe the client for any
 Mask abnormalities or complications
such as distended neck,
hypotension etc.
 The nurse should assist the doctor
 Observe the site particularly
to perform the insertion
bleeding and chest tube
 The nurse must dress the site
displacement.
NB: inform the doctor when there
NURSING CARE AFTER THE is displacement of the chest tube
PROCEDURE  Document and record the day and
time of chest tube insertion

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 Note the type of drainage  Empyema & emphysema
 Improve the airway clearance at
all times POSTURAL DRAINAGE
 Help the patient in an upright A procedure in which a patient is
position when coughing placed in different recognized
 Make patient comfortable at all positions to help in draining of
time fluid.
 Help the patient in mobility These are fluids accumulated in
exercise the bronchioles, and other organs
 Monitor intake and output of the respiratory system.
 Administer intravenous fluids
NURSING MANAGEMENT
COMPLICATIONS  The nurse must be familiar with
the procedure
 Hemorrhage  The nurse must auscultate the
 Organ perforation lungs
 Nerve damage  Education of the client
 Tube blockage
 Infections

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 It should be always performed in
order to prevent aspiration,
nausea and vomiting
 Before the procedure the nurse
should prescribe a bronchodilator
 Instruct the patient to be in a
specific position for at least 10-15
minutes before change over
 Encourage the patient to cough
slowly.
BRONCHOSCOPY
A procedure where by the larynx,
trachea and others are visualized
using a fiber optic bronchoscope.
It has a light source at the end
and is connected to a monitor.
PURPOSES FOR BRONCHOSCOPY
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 The purposes are mainly
diagnostic
 For therapeutic purpose
 To collect secretions for
analysis
 To visualize tumors
 To find out the source of
hemoptysis
 To visualize foreign bodies
NURSES RESPONSIBILITIES
BEFORE PROCEDURE
 Seek consent from patient
 Ensure nil per Os (NPO) 4-8
hours before the procedure
 Reassure patient
 Administer pre-op
medications
 Ensure all dentures do not  Educate the patient about
enters the respiratory tract the procedure concerning
 Give an anesthetic agent bloody stained sputum
 Check vital signs

NURSES RESPONSIBILITIES NURSING CARE OF A

AFTER PROCEDURE PATIENT WITH GASTRO
 Maintain NPO until cough INTESTINAL DISORDERS
reflex resumes
 Give some ice cubes NASO GASTRIC TUBE (NG
 Observe the patient for TUBE) INSERTION
complications e.g. lethargy A procedure in which a
and confusion rubber tube made of silicon
 Monitor vital signs especially is pass through the nasal
respiration cavity, through the
 Look out for dyspnea, esophagus then to the
hemoptysis e.tc. stomach.
 Report any abnormalities

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 PURPOSES FOR NG TUBE
INSERTION
 Ton decompress the stomach
 Use to prevent nausea and
vomiting after major surgical
procedure
 For continuous drainage of
the stomach
 Evacuation of the gastric
content
 Use to permit or give
nutritional support
 To obtain specimen of the
gastric content
 For instillation of drugs
INDICATIONS
 Intestinal obstruction
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 Indicated in an unconscious
patient
 Indicated in premature
babies
 Indicated in patient who has
undergo mouth surgery
CONTRAINDICATION
 Facial trauma or fracture
 Problems of the trachea
 People having esophageal
varices
 Patient with the
abnormalities of the
EAR,NOSE and THROAT
 Strictures
EQUIPMENTS NEEDED
 NG tube
 Lubricant  Place the patient in a semi
 Gallipot for solution fowlers position to facilitate
 Glass of water to aid in the passage of the tube
swallowing  Inspect the nostrils for
 Syringe patency
 Litmus paper  Measure the NG tube
 Gloves  Instruct the patient to
 Stethoscope swallow the tube
 Tape ( plaster)  Give oral hygiene morning
 Gauze and evening
 Spatula NURSING MANAGEMENT
 Kidney dish  Ensure that there is no
obstruction
PROCEDURE  Ensure that the tube is
 Wash your hands and secured properly
organize your equipment’s  Keep an accurate records of
 Explain the procedure to the all the intake and output(
patient color of the fluid, date and
 Provide privacy time of fluid collection)

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 The nurse must irrigate the  Sinusitis.
tube
 Provide oral care
 Apply Vaseline GASTROSTOMY
 Limit talking A surgical procedure which
 Monitor for complications an incision is made into the
e.g. fluid deficit stomach aids in feeding. A
 Look out for pulmonary specialized form of food
complications (formula) is given to the
 Record the vital signs patient
PURPOSES
COMPLICATIONS  Administration of
 Aspiration medications
 Collapse of the lungs  Feeding of a patient
 Tissue trauma
 Fluid volume deficit( INDICATIONS
dehydration)  Congenital abnormalities
 Sore throat  Dysphagia
 Nose bleeding

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 Patient who cannot take in  Ensure proper intake of
enough food fluids
 Esophageal stricture  Ensure proper maintenance
 Surgical procedure of the of the tube
upper GIT  Look out for signs of
 Indicated in comatose infections
patient  Educate the patient on how
to care for the skin around
TYPES the stoma
 Temporal  Educate them on signs and
 Permanent for feeding symptoms of infections
 Teach them what to do
NURSING CARE about tube dislodgement
 Reassurance and emotional  Teach them how to cover the
support tube with clothes
 Help the patient adjust to it  Record the type of feed to
 Explain the procedure to the the patient
patient  State the type of specimen

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 COMPLICATIONS
 Bleeding from the site
 Infections
 Reactions to the medication
GASTRIC LAVAGE
 A procedure in which the
stomach is washed out. It is
also the process of cleaning
the content of the stomach.
Also known as GASTRIC
IRRIGATION
 A specific amount of normal
saline is introduced into the
stomach
PURPOSES
 To eliminate poisonous
substances from the stomach
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 To intubate a patient
 Emptying the stomach
 For diagnostic purposes
CONTRAINDICATION
 Individuals with bleeding
problem or disorders
 Severe acid intake
PROCEDURE
 Set a trolley with
requirements
 Explain the procedure to the
patient
 Provide privacy
 Remove any dentures
 Put patient in an upright
position
 Protect the bed lining with OSTOMY: this is an opening
mackintosh into the abdominal wall.
 Wear gloves STOMA: an opening created
 Lubricate the NG tube into abdominal wall by
ostomy.
COMPLICATIONS
 Aspiration TYPES
 Hypoxia  TEMPORAL: relieving
 Bradycardia obstruction by resection of
 Epistasis bowel/divert fecal stream to
permit healing of a portion
COLOSTOMY  PERMANENT
Colostomy an operation in  Usually in conjunction
which artificial opening is with abdomino p-
made into colon on anterior erineal resection
abdominal wall to purposely  Bringing proximal end
eliminate faces. out through abdominal
wall and sutured as
permanent opening for

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 elimination.( after
resection of sigmoid
colon)
 DOUBLE BARREDED
COLOSTOMY
 This is where two
stoma are created and
regulated on the
surface of the abdomen
PURPOSES OF COLOSTOMY
 Elimination of feces
 Use in palliative measure
 Serve a temporal measure to
divert fecal stream
PREPARATION
 Reassure patient to allay
anxiety
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 Educate them on outcome
 Adaptation of lifestyle
 Management of life style
PHYSICAL PREPARATION
 Check vital signs
 Maintain and ensure NPO
 Take away contraindicated
items
 Observe the site
 Clean the bowel with Luke
warm water using cleansing
enema
 Serve diet high in calories to
nourish the body
 24hours to the procedure,
the patient should be served
with watery or liquid foods
 Give a prescribed IV fluids to
the patient
POST OP MANAGEMENT
 Inspect the site for bleeding
and swelling
 Monitor vital signs
 Restrict food intake or
feeding
 Irrigate the stoma by 5th -6th
day after the procedure
 Monitor intake and output
 Encourage fluid diet
 Asses the skin around the
stoma
 Observe the area and keep it
clean
OTHER CARE
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 Restrict food that cause a lot
of gas
 Monitor complications
 Serve adequate nutritious
diet
 Help the patient identifies a
food that causes irritation
IRRIGATING THE
COLOSTOMY
 To remove a blockage
 To drain the colon and its
content
 To establish regular pattern
of evacuating the feces
 To clean the intestinal tract
ITEMS NEEDED
 a jar which contains fluid,
usually normal saline
 tube
 clamp
 irrigating pan
 receptacle
 colostomy bag
PARACENTHESIS
ABDOMINIS
A procedure in which fluid is
been redrawn from the
peritoneal cavity (a serous
membrane lining the
abdomen folded over viscera
NB: accumulation of fluid in
the abdomen is called
Ascites
In order to achieve
paracenthesis, an incision is
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made into the abdominal
wall then into the cavity
under sterile techniques.
PURPOSES
 To drain exudates from the
peritoneum
 Primary use for diagnostic
purpose
 To instill/administer
medications
 To relieve pressure on the
abdomen
 Performed together with
peritoneal dialysis
SITE FOR THE PROCEDURE
The commonest site is the
midline between the
 symphysis pubis and the  Antiseptic solution
umbilicus.  Anesthetic agent
 Cotton wool swabs
INDICATIONS  Sterile specimen bottle
 Indicated in liver cirrhosis  Tape measure
 In advanced congestive  Mackintosh
heart failure  Resuscitation tray
 Chronic pericarditis
 Cancer of the abdominal  Explain procedure to the
organs patient
 Ask the patient to empty
PROCEDURE the bladder
Set up a specialized tray  Weight the patient
containing; before the procedure
 Trocar begins
 Syringe  Ensure privacy
 Drainage tube  Let the patient lie down
 Needle in a supine position and
 Sterile gloves

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 raise the head end of the  Check renal function
bed afterwards
NB: the procedure is  Wash and dry your
performed by the hands, then document
physician, assisted by
the nurse NURSING PROBLEMS
 The abdomen should be  Tachycardia
prepared aseptically  Shock usually cause by a
 Administer local shift in the abdominal
anesthetic agent pressure
 Wait for the full effect of  Signs of infections
the anesthesia  Cannula dislodgement
 Keep reassuring the  Pain
patient  Pallor
 Monitor vital signs  Nausea
 The client must be kept  Synopsis
warm to prevent shock
 Make client comfortable AFTER CARE
In bed

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 Observe the client for
signs of shock
 Look out and asses the
level of pain
 Measure the abdominal
girth
 Monitor vital signs
 Check for leakages
 Educate the client about
caring for the wound,
lifting of heavy objects
etc.
COMPLICATIONS
 Pain
 Synopsis
 Shock (usually
hypovolemic shock)
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 Infections(local or
systemic)
 Respiratory distress
 Bleeding excessively
 Injury to other
peritoneal organs
 Peritonitis
 Hepatic coma
MANAGEMENT OF
ASCITIS
 Educate the client on
dietary restrictions
 Daily weighing
 Monitor intake and
output chart
 Avoid the use of NSAIDS
 Educate them on skin
care
 Teach the client the
complications of ascites
BARIUM MEAL
A procedure in which a
radio opaque substance
called barium is given to
a client to swallow.
It usually use for the
diagnosis of
gastrointestinal
disorders of the upper
GIT.
INDICATIONS
 Esophageal varices
 Tumours of the upper
GIT
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 In situations of strictures
 Indicated in peptic ulcer
diseases
 Hiatal hernias
PROCEDURE
 Explain procedure to the
patient to allay anxiety
 Arrange with the patient
 Tell the patient to fast
before the
commencement of the
procedure
 Ensure that the patient is
given a laxative 24hours
before the procedure to
clean the digestive tract.
 Accompany the client to
the radiologic
department
AFTER PROCEDURE
 Administer a laxative
again
 Observe the patient for
regularity of bowel
elimination
 Encourage them to take
in a lot of fluids
COMPLICATIONS
 Constipation
 Fecal impactation
NB: Barium swallow is
for upper GIT
BARIUM ENEMA
A procedure in which a
barium is given in a form
of enema where it enters
the rectum then into the
large intestines.
INDICATIONS
 Colon obstructions
 Occult stool
 Inflammatory bowel
diseases
 Suspected bowel
cancers
 Appendicitis
 Hernia
 Intussusception

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 Fistulas radiologic
 Chronic stenosis department
 Chron’s diseases
 Diverticulitis NURSES
 Volvulus RESPONSIBILITIES
NURSES AFTER PROCEDURE
RESPONSIBILITIES  Make patient
BEFORE comfortable in bed
PROCEDURE  Resume patients
 Explain procedure diet(light diets)
to patient  Observe for
 Give patient time to regularity of the
clear the colon bowel
 In the morning of  Educate the client
the test, give a luke- to take in a lot of
warm water as an fluids
enema  Provide cleansing
 Then take the enema for the client
patient to the

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 INDICATIONS
 In the diagnosis of
peptic ulcer
 Indicated in pyloric
FRACTIONAL stenosis
TEST MEAL  In a case of
A procedure in which a pernicious anemia
gastric juice is been  To investigate
analyzed to purposely whether the client
find out the amount of is having gastric
HCL produced in the cancer or tumors
stomach.
Usually this test is PROCEDURE
performed when the Usually the test is
client is fasting. After carried out early in
that, samples of the the morning
gastric juice is taken at a  Explain procedure
specific intervals. to the client

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 Let the client be on  Aspirate 5mls of the
NPO for at least stomach content
12hours every 15minutes
 On the morning of (Residual juice)
the ;procedure,
pass NG tube NB: finding bile in
 Aspirate gastric the gastric juice
content about indicates that there
20mls and place it is a problem with
in a specimen bottle the pylorus
then label  Gastric content
 The first gastric containing mucus
content (resting indicates gastritis
juice). After that the
client is given a test LIVER BIOPSY
meal usually 7% An invasive
alcohol to trigger procedure in which
the release of HCL a specialized needle
is inserted into the

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 liver to collect a CONTRAINDICATIO
tissue of the liver as NS
a sample for  Bleeding problems
analysis.  Ascites
 Jaundice
INDICATIONS  People having
 Liver cirrhosis infections in the
 Hepatitis pleural space
 Drug reaction  People who are
 In suspected liver anxious or delirious
traumas
 In an unexplained PATIENT CARE
jaundiced  Explain procedure
 In unexplained to the patient
hepatomegaly  Skin preparation
 Liver enzyme level(  Seek informed
elevated) consent
 Clotting profile
 Ensure NPO

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 Administer sedative  24hours after
 Place the patient in biopsy, encourage
supine or left lateral patient to walk but
position should avoid
 Administer either strenuous activities
local or general
anesthesia COMPLICATIONS
 Place the sample in  The nurse should
a specimen bottle make sure that
 Add some amount there is no
of formalin to the complications
sample to avoid POTENTIAL
decomposition COMPLICATIONS
 Apply dressing to  Hemorrhage
the site  Hemothorax
 Make patient lie  Peritonitis
down for some time
at least 1-2 hours NEUROLOGIC
 Check vital signs DISORDERS

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 (NEUROLOGIC A medical
EXAMINATION) procedure which
Generally there involves the
should be a trolley redrawal of
containing; cerebrospinal fluid
 A touch light from the
 An oroscope subarachnoid space.
 A tuning fork
 Tongue depressor CONSTITUENTS OF
 Patella hammer THE CSF
 Sugar and vinegar  Water
for taste  Mineral salts
 A brand new needle  Protein
for sense of touch  Urea
 BP apparatus  Etc.
 Neurologic chart
INDICATIONS
LUMBAR PUNTURE

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 Indicated in people  For diagnostic
with cerebrospinal purposes
meningitis  To instill
 Indicated in medications
suspicion of  To measure the
subarachnoid pressure of the CSF
hemorrhage  To introduce a radio
 Therapeutic relief of opaque substance
psuedotumor for spinal imaging
cerebri
 Suspicion of central FUNCTIONS OF THE
nervous system CSF
disease such as  It act as a shock
Guillain-Barre absorber
syndrome and  For lubrication
carcinomatous  Provide nutrients to
meningitis the brain
 Etc.
PURPOSES

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 NB: turbid CSF NURSES
indicates presence RESPONSIBILITIES
of infection  Explain procedure
to the patient
ITEMS NEEDED FOR  Seek informed
LUMBAR PUNTURE consent
A sterile tray  Provide privacy
containing;  Assist the patient to
 Antiseptic agent assume a desire
 Syringe and needle position
 Sterile gloves  Administer an
 Sterile dressing pack anesthetic agent
 Sterile specimen  Observe for
bottle leakage(usually
 Plaster from the puncture
 Protective site)
mackintosh  Look for neurologic
signs

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 Encourage fluid
intake
 documentation
 labeling of
specimen

COMPLICATIONS
 infections
 hemorrhage
 leakage of CSF
 inflammation of the
arachnoid

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Crewz