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neuro #1

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1. patient going to have a myelogram, what nursing actions do you need to take to get them ready for that
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Terms in this set (73)
-before the procedure assess and document the patient's baselines of lower-extremity strength and sensation
-tell the patient that the procedure takes about 2 hours
-it may involve slight discomfort as the dura is entered
-he or she may be asked to assume a variety of positions during the procedure
-before the dye is injected, ask patients whether they have any allergies, specifically whether they have had any anaphylactic or hypotensive episodes from other dyes
AHN 664
assess the need to withhold metformin (Glucophage) if iodinated contrast dye is used for a diagnostic procedure because of the risk for metformin-induced lactic acidosis
-commonly used to identify lesions in the intramural or extradural compartments of the spinal canal by observing the flow of radiopaque dye through the subarachnoid space
-the most common lesion for which this test is used is a herniated or protruding intervertebral disk
-other lesions include spinal tumors, adhesions, bony deformations, and arteriovenous malformations
AHN 664
-observe the puncture site for any leakage of CSF
-assess the strength and sensation of the lower extremities
-headache is fairly common
-it may be accompanied by nausea and occasionally by vomiting
-the patient should be flat for a few hours
-the patient usually undergoes a CT scan 4 to 6 hours after a myelogram
AHN 664
-position the client in a lateral recumbent position and have the client draw the knees up to the abdomen and the chin onto the chest
-the prone position may be required for radiologically guided punctures
-the patient is usually positioned on the side with the knee and head flexed at an acute angle
-this allows for maximal lumbar lexicon and separation of the interspinous spaces
AHN 661
1. insert a spinal needle through the L3-L4 interspace into the lumbar subarachnoid space to check for CNS fluid or decrease pressure, or instill air, dye, or administer medications
2. the test is contraindicated in clients with ICP because the procedure will cause a rapid decrease in pressure within the CSF around the spinal cord, leading to brain herniation
3. may also be used in the treatment for idiopathic intracranial hypertension
-often performed as part of the diagnostic workup of the patient who may have a neurologic problem
-contraindicated in patients who might have increased ICP, since the withdrawal of fluid may cause the medulla oblongata to herniate downward into the foramen magnum
-done to obtain CSF for examination, to relieve pressure, or to introduce dye or medication
-common procedure, done in the patient's room or in the diagnostic imaging department
AHN 661