Diagnostic Tests

A. Skull and Spinal Radiography:

 Radiographs of the skull reveal the size and shape of the skull bones, suture separation in infants, fracture or bony defects,
erosion and calcification.
 Spinal radiographs identify fractures, dislocation, compression, curvature, erosion, narrowed spinal cord, and degenerative
processes.

PREPROCEDURE INTERVENTIONS:
1. Provide nursing support for the confused, combative or ventilator-dependent patient.
2. Maintain immobilization of the neck if a spinal fracture is suspected.
3. Remove metal items from body parts.
4. If the client has thick and heavy hair, this should be documented, because it could affect interpretation of the x-ray film.

POSTOPERATIVE PROCEDURES.
1. Maintain immobilization until results are known.

B. Computed Tomography (CT) Scan:

 A computed tomography scan is a type of brain scanning that may or may not require injection of a dye.
 It is used to detect intracranial bleeding, space-occupying lesions, cerebral edema, infarctions, hydrocephalus, cerebral atrophy,
and shifts of brain structures.

PREPROCEDURE INTERVENTIONS:
1. Obtain an informed consent if a dye is used.
2. Assesse for allergies to iodine, contrast dyes, or shellfish if a dye is to be use.
3. Instruct the client of the need to lie still and flat during the test
4. Instruct an intravenous line if prescribed.
5. Remove objects from the head, such as wigs, barrettes, earrings, and hairpins.

6. Assess for claustrophobia

7. Inform the client of possible mechanical noises as the scanning occurs.
8. Inform the client that there may be a hot flushed sensation and a metallic taste in the mouth when the dye is injected.
9. Note that some clients may be given the dye even if they report an allergy, they are treated with antihistamine and
corticosteroids before injection to reduce the severity of the reaction.

POSTOPERATIVE PROCEDURES.
1. Provide replacement fluids because diuresis from the dye is expected.
2. Monitor for an allergic reaction to the dye.
3. Assess dye injection site for bleeding or hematoma, and monitor the extremity for color, warmth, and the presence of distal
pulses.

C. Magnetic Resonance Imaging (MRI):

 Magnetic resonance imaging is a non-invasive procedure that identifies types of tissues, tumors, and vascular abnormalities
 It is similar to CT scanning but provides more detailed picture.
 They do not use the damaging ionizing radiation of x-rays

PREPROCEDURE INTERVENTIONS:
1. Remove all metal object from the client. Determine whether the client has a pacemaker, implanted defibrillator, or other
metal implants such as hip prosthesis or vascular clips because these client cannot have this test performed.
2. Remove intravenous fluid pumps during the test.
3. Provide precautions for the client who is attached to a pulse oximeter because it can cause a burn during testing if coiled
around the body or a body part.
4. Provide an assessment of the client with claustrophobia.
5. Administer medications as prescribed for the client with claustrophobia.
 6. Determine whether a contrast agent is to be used and follow the prescription related to the administration of food, fluids and
medications.
7. Instruct the client that he or she will need to remain still during the entire procedure.

D. Lumbar Puncture (LP):

 Insertion of a spinal needle through the L3-L4 interspace into the lumbar subarachnoid space to obtain cerebrospinal fluid (CSF),
measure the CSF or pressure or instill air, dye or medications.
 The test is contraindicated in client with ICP because the procedure will cause a rapid decrease in pressure in the CSF around the
spinal cord, leading to brain herniation.

PREPROCEDURE INTERVENTIONS:
1. Obtain an informed consent.
2. Have the client empty the bladder.

INTERVENTIONS DURING THE PROCEDURE:

1. Position the client in a lateral recumbent position and have the client draw the kneed up to the abdomen and the chin onto the
chest.
2. Assist with the collection of specimens (label the specimen in sequence – 3 specimens)
3. Maintain strict asepsis.

POSTPROCEDURE INTERVENTIONS:
1. Monitor vital signs and neurological signs that may indicate leakage of CSF.
2. Position the client flat as ordered.
3. Encourage oral fluid intake to replace CSF obtained from the specimen collection or from leakage.
4. Monitor intake and output.