DIAGNOSTIC EVALUATION

Computed Tomography Scan

• Makes use of narrow x-ray beam to scan body part in successive

layers
• Images provide cross-sectional views of the brain displayed on an
oscilloscope or TV monitor and is photographed and stored digitally
• Non-invasive and painless and has high degree in detecting brain
lesions
• May also detect possible brain tumors, brain infarction, displacement
of ventricles and cortical atrophy
 Computed Tomography Scan

Nursing Intervention:
• Teach patient about the need to lie quietly throughout the
entire procedure
• Assess for iodine/shellfish allergy
• Monitor for side effect of IV or inhalation contrast agents:
flushing, nausea, vomiting
CT SCAN
 Positron Emission Tomography (PET)
- Computer based nuclear imaging that produces
images of actual organ functioning.
- Radioactive gas or substance is inhaled or injected that emits positively
charged particles.
- It permits measurement of blood flow, tissue composition, brain
metabolism thus evaluates brain function.
- Useful in showing metabolic changes in the brain (Alzheimer’s
disease), locating lesions (tumor, epiliptogenic lesions), identifying
blood flow and oxygen metabolism in stroke pt and new therapies for
brain tumor.
Positron Emission Tomography (PET)
• Key nursing interventions include patient preparation,
which involves explaining the test and teaching the patient
about inhalation techniques and the sensations (dizziness,
light-headedness, headache) may occur.

• IV injection of radioactive substance produces similar side

effects.

• Relaxation exercises may reduce anxiety during the test.

PET Scan
 Magnetic Resonance Imaging (MRI)

• Uses a powerful magnetic field to

obtain images of different areas of
the body
• Can identify cerebral abnormality
earlier and more clearly than any
other diagnostic tests
• Useful in monitoring tumor’s
response to treatment, Dx of MS
 Nursing Intervention: MRI

• Relaxation techniques
• Advise pt that she can speak with the staff by means of a microphone
inside the scanner
• ALL metal objects and magnetic cards are removed (aneurysm clips,
ortho-hardware, pacemakers, artificial heart valves, IUD)
• Medication patches removed (cause burns)
• Sedation for claustrophobic pt
• Scanning process is painless, but the patient hears loud thumping of
magnetic coils as magnetic field is being pulsed.
 Myelography
 Myelogram is an Xray of spinal subarachnoid space taken with contrast
agent (through Lumbar Tap)
 Shows distortion of spinal cord or spinal dural sac caused by tumors,
cysts, herniated vertebral disks

Nursing Intervention
• Meal before procedure is omited
• After myelography, patient to lie in bed with head elevated up to 45º and
remain in bed for 3hrs
• Encourage increased fluid intake
• Monitor VS
Myelography
 CEREBRAL
ANGIOGRAPHY
• X-ray study of the cerebral circulation with contrast
agent injected to selected artery.
• Performed by threading a catheter through the femoral
artery in the groin and up to the desired vessel.
Uses: Vascular disease, aneurysms,

Digital Subtraction Angiography

- X-ray images of areas in question are taken before and after injection
of contrast agent (peripheral vein) and then compared
 CEREBRAL
ANGIOGRAM
 Nursing Intervention: CEREBRAL ANGIOGRAPHY
NURSING CARE PRE-TEST
1.) Check allergy to iodine
2.) Keep NPO after midnight or offer clear liquid breakfast only
3.) Explain that the client may have warm, flushed feeling and salty taste in mouth
during procedure
4.) Take baseline vital signs and neuro check
5.) Administer sedation if ordered
NURSING CARE POST-TEST
1.) Maintain pressure dressing over site if femoral or brachial artery used; apply ice as
ordered
2.) Maintain bed rest until next morning as ordered
3.) Monitor vital signs, neuro checks frequently; report any changes immediately
4.) Check site frequently for bleeding or hematoma; if carotid artery used; assess for
swelling of neck, difficulty swallowing or breathing
5.) Check pulse, color, and temperature of extremity distal to site used.
6.) Keep extremity extended and avoid flexion
 Electroencephalography (EEG)

• Represents a record of electrical activity

generated by the brain through electrodes
applied on the scalp

• Used to diagnose seizure disorders, coma

• Tumors, brain abscess, blood clots may
cause abnormal patterns in electrical activity

• Used in making a determination of BRAIN

DEATH
 Electroencephalography (EEG)

Nursing Intervention
 Withhold medications that may interfere with the results- anticonvulsants,
sedatives and stimulants
 Wash hair thoroughly before procedure
 Instruct adult client to sleep no more than 5 hrs the night before.
 Coffee, tea, chocolate and cola drinks are omitted
 Meal itself is not omitted because an altered glucose level alters brain wave
patterns
 It takes 45min-1hour; 12 hours for sleep EEG

 Standard EEG - water-soluble lubricant

 Sleep EEG - collodion glue for electrode contact (acetone for removal)
Electromyography (EMG)
- obtained by inserting needle electrode into the skeletal
muscle to measure changes in the electrical potential of
the muscles and the nerves leading to them.
Determine presence of neuromuscular disorders & myopathies.
 Lumbar Puncture and CSF examination
Spinal tap - a needle is inserted into the subarachnoid space through the 3rd and 4th
or 4th and 5th lumbar interface to withdraw spinal fluid

PURPOSES
1. Measures CSF pressure
(normal opening pressure 60-150mmH2O)
2. Obtain specimens for lab analysis, cytology, C&S
(protein - normally not present, sugar - normally present)
3. Check color of CSF (normally clear) and check for blood
4. Inject air, dye, or drugs into the spinal canal

- CSF pressure in lateral recumbent position is

70-200mm H20
 Lumbar Puncture and CSF
examination
CONTRAINDICATION
• INCREASED ICP
• COAGULOPATHY & DECREASED
PLATELETS
• SPINAL DEFORMITIES ( SCOLIOSIS,
KYPHOSIS)
 Lumbar Puncture Guidelines
NURSING CARE PRE-TEST
1.) Have client empty bladder
2.) Position client in a lateral recumbent position with head and neck flexed onto
the chest and knees pulled up.
3.) Explain the need to remain still during the procedure

NURSING CARE POST-TEST

1.) Ensure labeling of CSF specimens in proper sequence
2.) Keep client flat for 12-24 hours as ordered
3.) Force fluids
4.) Check puncture site for bleeding, leakage of CSF
5.) Assess sensation and movement in lower extremities
6.) Monitor vital signs
7.) Administer analgesics for headache as ordered
 CSF Analysis
• CSF should be clear and colorless
• Pink, blood-tinged, or glossy bloody CSF
indicates cerebral contusion, laceration or
subarachnoid hemorrhage
• Specimens are obtained for: cell count, culture
and glucose and protein testing
 Post Lumbar Headache
• Mild to severe, may occur few hours to several days after the
procedure.
• It is throbbing bi frontal or occipital headache, dull or deep in
character
• Cause: leak at puncture site, fluid continues to escape into the
tissues by way of the needle track from the spinal canal
• May be avoided if small-gauged needle is used and if pt remains
prone
after the procedure.
THANK YOU