Nervous System Diagnostic Tests - Medical-Surgical - Nervous System | @LevelUpRN

Summary

Cathy from Level Up RN provides an overview of various diagnostic tests for the nervous system, including cerebral angiogram, EEG, intracranial pressure monitoring, lumbar puncture, and MRI. Each test comes with specific pre-procedures and considerations, which Cathy explains in detail. She also offers a short quiz towards the end to reinforce learning.

Highlights

• Cathy focuses on cerebral angiograms and shares pre-procedure tips such as NPO status and allergy checks. 🧠
• Nursing care steps are crucial during EEG setups to ensure accuracy, particularly avoiding stimulants before the test. 🧑‍⚕️
• For intracranial pressure monitoring, Cathy highlights the invasive nature and its critical indications like patients in comas. 🏥
• The importance of positioning and recognizing CSF leak signs are emphasized in the lumbar puncture segment. 🚨
• MRI protocols are shared, highlighting when to provide earplugs or anti-anxiety medications. 🔍

Key Takeaways

• Always check for an allergy to contrast dye before a cerebral angiogram and assess kidney function to help excrete it. 🩺
• An EEG requires a clean scalp and ideally a sleep-deprived patient for accurate results; no need for NPO. 😴
• Intracranial pressure monitoring carries a high risk of infection and is used when the Glasgow Coma Scale is under 8. 🚑
• Proper positioning during a lumbar puncture helps obtain a good sample and reduces potential complications; watch out for CSF leaks post-procedure. 💉
• MRIs are loud and require removal of any metal objects due to strong magnetic fields; consider anti-anxiety meds for claustrophobic patients. 🧲

Overview

In this Level Up RN video, Cathy delves into the world of diagnostic tests related to the nervous system. She kicks off by explaining the cerebral angiogram, a procedure essential for visualizing cerebral blood vessels and detecting blockages or abnormalities. The prep involves ensuring the patient is NPO and checking for allergies to contrast dye, a vital step considering potential kidney issues.

Following the angiogram, Cathy dives into the specifics of EEGs, explaining how these tests are important for identifying seizures and sleep disorders. She explains the fascinating setup of the procedure, including why patients should arrive sleep-deprived and avoid sedatives or stimulants, which could interfere with the results. Interestingly, unlike some other tests, there's no need for NPO here!

Rounding out her comprehensive overview, Cathy talks about ICP monitoring, lumbar punctures, and MRIs. Each test comes with its nuances—whether it's the invasive nature of ICP monitoring or the sound sensitivity requiring earplugs during an MRI. Her practical tips and procedural insights aim to prepare and reassure those studying or preparing for these tests.

Chapters

• 00:00 - 00:30: Introduction The chapter introduces Cathy from Level Up RN, who will cover diagnostic tests related to the nervous system. These include cerebral angiogram, EEG, intracranial monitoring, lumbar puncture, and MRI. The chapter also mentions a quiz at the end to test the reader's knowledge on key facts covered, and suggests using Level Up RN medical-surgical flashcards for better understanding.
• 00:30 - 02:00: Cerebral Angiogram The chapter titled 'Cerebral Angiogram' provides an explanation of the cerebral angiogram procedure. It is a medical imaging technique used to visualize the cerebral blood vessels, allowing for the detection of blockages or abnormalities. During the procedure, a catheter is inserted into the artery, typically at the femoral artery in the groin area, and is navigated through the blood vessels up to the brain. The chapter also touches on important nursing care considerations, such as ensuring the patient is NPO (nothing by mouth) for four to six hours before the procedure.
• 02:00 - 03:30: Electroencephalogram (EEG) The chapter titled 'Electroencephalogram (EEG)' discusses important pre-procedural considerations for patients undergoing a procedure involving contrast dye. It emphasizes the necessity of checking for any allergies to the contrast dye, as it's a crucial element in the procedure. Additionally, assessing the patient's kidney function is vital. This is done by evaluating the patient's creatinine and BUN levels, as impaired kidney function can affect the kidney's ability to excrete the dye, potentially leading to renal issues.
• 03:30 - 04:30: Intracranial Pressure (ICP) Monitoring This chapter focuses on Intracranial Pressure (ICP) Monitoring, discussing the steps involved in monitoring a patient's condition after a cerebral angiogram. The process includes assessing the insertion site for bleeding, advising the patient to keep their leg straight, and checking for blood flow distal to the insertion site by assessing pulses and capillary refill.
• 04:30 - 06:00: Lumbar Puncture The chapter discusses the procedure of a lumbar puncture, emphasizing patient care post-procedure. It advises monitoring the patient's temperature and color, and encouraging increased fluid intake to help excrete contrast dye. The chapter then transitions to discussing an EEG test, which aids in identifying seizures or sleep disorders, and can be used for patients with altered mental status, such as encephalopathy.
• 06:00 - 07:30: Magnetic Resonance Imaging (MRI) This chapter provides a brief overview of the preparation and procedures involved in conducting an MRI, specifically focusing on EEG (Electroencephalogram) setups that seem to be incorrectly noted under MRI. Before the procedure, nurses should ensure that patients wash their hair to help electrodes adhere to the scalp properly. Additionally, patients are advised to arrive sleep-deprived, which aids in the more accurate diagnosis of conditions like epilepsy. Proper patient preparation is emphasized to ensure the effectiveness of the procedure.
• 07:30 - 08:30: Quiz The chapter titled 'Quiz' discusses EEG procedures, highlighting that stimulants or sedative medications might be used prior to the procedure, but not NPO (nil per os). It contrasts EEG with cerebral angiograms by noting that anesthesia, which requires NPO, is used only in the latter. Techniques such as hyperventilation or strobe lighting might be employed during EEGs to trigger seizure activities.
• 08:30 - 09:00: Conclusion The chapter, titled 'Conclusion,' discusses important considerations for informing patients about potential risks prior to undergoing medical procedures. It highlights intracranial pressure (ICP) monitoring as a significant focus, describing it as an invasive technique performed in an operating room to measure the cranial cavity's pressure. The risk of infection is underscored, with particular indications for the procedure including patients in a coma, as indicated by the Glasgow Coma score.

Nervous System Diagnostic Tests - Medical-Surgical - Nervous System | @LevelUpRN Transcription

• 00:00 - 00:30 Hi, I'm Cathy, with Level Up RN. In this video,  I will be covering diagnostic tests associated   with the nervous system. Specifically, I  will be talking about a cerebral angiogram,   and the EEG, intracranial monitoring  in lumbar puncture, as well as an MRI.   At the end of the video, I'm going to give  you guys a little quiz to test your knowledge   of some of the key facts I'll be covering in  this video. So definitely stay tuned for that.   And if you have our Level Up RN medical-surgical  flashcards, definitely pull those out so you can
• 00:30 - 01:00 follow along with me. First up, we have a cerebral  angiogram, which allows for visualization of the   cerebral blood vessels to check for blockages or  other abnormalities. So during this procedure,   a catheter is placed in the artery, usually  at the femoral artery there at the groin,   and is threaded up through the blood vessels  to the brain. So in terms of nursing care,   pre-procedure, you want to make sure your  patient has been NPO for four to six hours or
• 01:00 - 01:30 per facility policy. You want to check for an  allergy to contrast dye, which is definitely used   in this procedure. And you also want to assess  for kidney function by assessing the patient's   creatinine and the BUN levels. So if the patient  has impaired kidney function, then this will   impact their ability to excrete that contrast  dye, which could be a problem for their kidneys.
• 01:30 - 02:00 In addition, you want to assess and mark  the pulses distal to where the insertion   site will be so that you can easily check those  pulses after the procedure, after the patient   has undergone their cerebral angiogram. You want  to first check the insertion site for bleeding.   You want to advise the patient to keep their leg  straight. And then you want to check for blood   flow distal to that insertion site. So you're  going to check for pulses, capillary refill,
• 02:00 - 02:30 temperature, as well as color. And then you  want to encourage your patient to increase their   fluid intake to help excrete that contrast dye. Next up, we have an electroencephalogram, or EEG.   This is a test that is used to identify  seizures or sleep disorders. It can also be   used on patients who have altered mental status,  such as encephalopathy. During the procedure,
• 02:30 - 03:00 electrodes are placed on the patient's scalp, and  the electrical activity of the brain is recorded.   In terms of nursing care, prior to the  procedure, you want to have a patient   wash their hair because those electrodes are  not going to stick well to a greasy scalp. You   also want to advise your patient to arrive sleep  deprived because sleep deprivation will make it   easier and more accurate to diagnose epilepsy.  You should also advise your patient to avoid
• 03:00 - 03:30 stimulants or sedative medications prior to the  procedure. In addition, NPO is not required for an   EEG. So it is required for a cerebral angiogram,  which we just talked about, because that procedure   uses anesthesia. Anesthesia is not used with an  EEG, so NPO is not required. During the procedure,   hyperventilation or strobe lighting may be used  to increase the likelihood of seizure activity.
• 03:30 - 04:00 So you'll want to give your patient a heads-up  about that possibility prior to the procedure.   Next, we have ICP monitoring, or intracranial  pressure monitoring. This is a very invasive   procedure where a device is inserted into the  patient's cranial cavity to measure their ICP.   It is done in the OR, and it  carries a huge risk of infection.   Indications for this procedure include the patient  being in a coma, which means their Glasgow Coma
• 04:00 - 04:30 Scale Score will be under eight. So normal ICP is  between 10 and 15mmHg. Signs and symptoms that a   patient has increased ICP can initially include  symptoms such as restlessness, irritability,   and a headache. But as that ICP increases, it  can cause decreased level of consciousness,
• 04:30 - 05:00 pupil abnormalities, abnormal breathing patterns  such as Cheyne Stokes and BOS respiration   patterns. It can also cause abnormal posturing,  such as the cerebrate or decorticate posturing.   The next diagnostic test that I want to cover  is a lumbar puncture. During this procedure,   a cerebral spinal fluid sample is obtained from  the patient's spinal canal, and it's analyzed.
• 05:00 - 05:30 So this may be done if we suspect the patient has  meningitis, a subarachnoid hemorrhage, or other   neurological disorder. So pre-procedure, we want  to have the patient empty their bladder, and then   we should position the patient on their side in a  fetal position, or alternatively, we can have them   sit up and kind of lean over a table. So either  way, we want the patient's back to be arched.   After the procedure, we should have the patient  lay flat for several hours and increase their
• 05:30 - 06:00 fluid intake. We also need to monitor for signs of  a CSF leak, which can include a severe headache.   So, if necessary, the patient can get what's  called an epidural blood patch. So this is   where a sample of the patient's blood is injected  into that epidural space, where it clots and kind   of seals off the area and prevents that leak. The last diagnostic test I want to cover in this
• 06:00 - 06:30 video is an MRI, or magnetic resonance imaging.  So this is an imaging procedure that uses strong   magnetic fields and radio waves to make images  of internal structures of the body. It provides   better soft-tissue contrast than a CAT scan.  So prior to the procedure, you want to assess   your patient for a history of claustrophobia,  and if needed, you may need to give them an
• 06:30 - 07:00 anti-anxiety medication. You should have them  remove all their jewelry and you should assess for   contraindications, which include metal implants.  So definitely check for things such as artificial   joints or a pacemaker. And then, finally, you  need to give them some earplugs. We don't need to,   but you should, because MRIs are very loud. All right. You guys ready for your quiz?   I actually had a hard time picking only three  questions because there's a lot of important
• 07:00 - 07:30 information on these flashcards that I just  reviewed. But here we go. Question number one. NPO   is required prior to an EEG. True or false?  The answer is false. NPO is not required.   Question number two. How should a patient  be positioned for a lumbar puncture?   Answer. They should either be positioned on  their side in a fetal position or stretched
• 07:30 - 08:00 over a table such that their back  is arched. Question number three.   Irritability is an early sign of increased  intracranial pressure. True or false?   The answer is true. Okay. I hope  this video has been super helpful.   If so, be sure to like it and leave me a  comment. Take care and good luck with studying.  I invite you to subscribe to our channel  and share a link with your classmates and
• 08:00 - 08:30 friends in nursing school. If you found value  in this video, be sure and hit the like button,   and leave a comment and let us know  what you found particularly helpful.