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DX PROCEDURE Computed tomography scan (also called a CT or CAT scan)

A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general Xrays.

INDICATION
CT remains the investigation for the diagnosis and management of many central nervous system diseases. Indications for CT imaging, CT angiography, and CT venography include: Urgent scan if any of the following (results within 1 hour): Glasgow Coma Scale (GCS) <13 when first assessed or GCS <15 two hours after injury Suspected open or depressed skull fracture Signs of base of skull fracture* Post-traumatic seizure Focal neurological deficit

NORMAL VALUES
Results are considered normal if the organs and structures being examined are normal in appearance.

ABNORMAL VALUES

ANALYSIS

NURSING INTERVENTIONS
Preparation of Client Ensure a signed consent form. Check hospital policy on withholding food and fluids. Clients are usually on NPO status (except for the medications ordered as part of the test) for 8 hours before the test if it is done in the morning. If the test is done in the afternoon, the client may have a liquid breakfast. Give medications up to 2 hours before test. Assess for possible reaction to iodine dye (by asking about allergy to seafood). Document any allergy and inform the physician and radiology department. Remove metal hairpins,

Abnormal results depend Risks of CT scans include: on the part of the body being studied. Talk to your Being exposed health care provider with to radiation any questions and Allergic reaction concerns. to contrast dye CT scans do expose you to more radiation than regular x-rays. Having many x-rays or CT scans over time may increase your risk for cancer. However, the risk from any one scan is small. You and your doctor should weigh this risk against the benefits of getting a correct diagnosis for a medical problem. Some people have allergies to contrast dye. Let

>1 episode of vomiting (SIGN guidance suggests 2 distinct episodes of vomiting) Coagulopathy + any amnesia or loss of consciousness since injury A CT scan is also recommended (within 8 hours of injury) if there is either: More than 30 minutes of amnesia of events before impact Or any amnesia or loss of consciousness since injury if: Aged 65 years Coagulopathy or on warfarin Dangerous mechanism of injury Road traffic accident (RTA) as a pedestrian RTA - ejected from car Fall >1 m or >5 stairs

your doctor know if you have ever had an allergic reaction to injected contrast dye. The most common type of contrast given into a vein contains iodine. If a person with an iodine allergy is given this type of contrast, vomiting, sneezing, itching, or hives may occur. If you absolutely must be given such contrast, your doctor may give you antihistamines (such as Benadryl) or steroids before the test. The kidneys help remove iodine out of the body. Those with kidney disease or diabetes may need to receive extra fluids after the test to help flush the iodine out of the body. Rarely, the dye may cause a life-

clips, and earrings. Client and Family Teaching (If applicable) Do not drink or eat anything before the test except for the ordered medications. You may be given an intravenous infusion. When the contrast dye is injected, you may feel warm and have a metallic taste in the mouth. The exam lasts from 30 to 90 minutes. Your head will be positioned in a cradle, and a wide rubber strap will be applied snugly across the forehead during the test (to keep your head immobilized). The CT scanner is circular with a round opening. You are strapped to a special table, and the scanner revolves around the body part to be examined. The scanner makes a clicking Noise. The test is painless. Someone is always

threatening allergic response called anaphylaxis. If you have any trouble breathing during the test, you should notify the scanner operator immediately. Scanners come with an intercom and speakers, so the operator can hear you at all times.

immediately available during the test

DX PROCEDURE

INDICATION

NORMAL VALUES
A normal EEG reading indicates that you have a normal pattern of brain activity. For example, if your brain is working normally, a brainwave pattern called an alpha rhythm should be seen when you are sitting quietly with your eyes closed. When you open your eyes, the alpha pattern should either disappear altogether or become less prominent. EEG results are often normal because recording a person's brain activity during the times it is abnormal is difficult. For example, someone with epilepsy will often have a normal EEG result because their brain activity only alters during an epileptic fit.

ABNORMAL VALUES
An abnormal EEG reading occurs when abnormal electrical brain activity is detected. Some people with epilepsy may have abnormal brain activity between attacks, not just when they are having seizures. A small number of people who do not have epilepsy may also have an abnormal EEG result. This may indicate that you have a different condition that is affecting your brain activity, such as encephalitis (brain inflammation that is often caused by infection). Your EEG results will help your doctor decide which course of treatment is best for

ANALYSIS
Brain electrical activity has a certain number of waves per second (frequencies) that are normal for different levels of alertness. For example, brain waves are faster when you are awake and slower when you are sleeping. There are also normal patterns to these waves. Abnormal results on an EEG test may be due to: Abnormal bleeding (hemorrhage) An abnormal structure in the brain (such as a brain tumor)

NURSING INTERVENTIONS
Client Preparation Explain the procedure, emphasizing the importance of cooperation. Withhold fluids, foods, and medications (as prescribed) that may stimulate or depress brain waves. These include anticonvulsants, tranquilizers, depressants, and caffeine-containing foods (e.g., coffee, tea, colas, and chocolate).Medications are Usually withheld for 24 to 48 hours before the test. Help the client wash the hair before the test. Client and Family Teaching The test takes about 1 hour. The test is painless and will be performed while sitting in a comfortable

Electroencephalogram The EEG is used as an aid to clinical medicine (EEG) and is a laboratory tool which, if utilized in its A procedure that records proper reference, may the brain's continuous help clarify many electrical activity by means puzzling clinical pictures. of electrodes attached to Wellestablished clinical the scalp. uses of the EEG are found in the fields of Neurology, Neurosurgery, Internal Medicine and Pediatrics. Altered consciousness such as stuporous, semi comatose or comatose states.
Seizure disorders especially atypical seizure variants in patients experiencing bizarre, distressing symptoms. Tumors

suspected tumor where focal slowing is found. Head Trauma injury where slowing or suppression of voltage production is due to a contusion or a subdural hematoma. Headaches such as with migraine syndrome, where there may be a suggestive EEG pattern. Brain Abscess differential diagnosis of diffuse versus focal inflammatory disease. Metabolic encephalopathy where characteristic diphasic slow waves may be present. Behavioral Disorders Psychiatric evaluations. Adolescent disorders such as

Therefore, further EEG testing, such as an ambulatory EEG, may need to be carried out. An ambulatory EEG involves recording your brain activity throughout the day and night, over a period of one or more days. This will enable doctors to assess your brain activity while you are having a seizure.

you. If you have epilepsy, the results may also help identify what is triggering your seizures so that you can take preventative measures. For example, if your EEG results show that your epilepsy is photosensitive (triggered by flashing lights), you can avoid situations where there is likely to be bright, flashing lights, such as nightclubs, discos and flickering television screens.

Attention problems Tissue death due to a blockage in blood flow (cerebral infarction) Drug or alcohol abuse Head injury Migraines (in some cases) Seizure disorder (such as epilepsy or convulsions) Sleep disorder (such as narcolepsy) Swelling of the brain (encephalitis) Note: A normal EEG does not mean that a seizure did not occur.

chair or lying on a stretcher. The electrodes are applied to the scalp with a thick paste. During the test, you will first be asked to breathe in and out deeply for a few minutes. Then, you will close your eyes while a light is flashed on them and, finally, you will lie quietly with your eyes closed. After the test, the nurse will help you wash the paste out of your hair.

ADD, ADHD, depression or anxiety issues. Below are several abbreviations for symptoms that should be considered for an EEG: Sz / TIA / COPD / ADD / ADHD / Syncope / Anxiety / Altered Mental Status / LOC / Ha / OCD / IED / Bi Polar / RLS / SBS / ETOH

DX PROCEDURE Magnetic resonance imaging (MRI)


A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

INDICATION
The following general rules are usually considered by a physician before ordering an MRI scan for a patient with back pain, neck pain or leg pain stemming from a spine problem. Indications for when to get an MRI scan include: After 4 to 6 weeks of leg pain, if the pain is severe enough to warrant surgery After 3 to 6 months of low back pain, if the pain is severe enough to warrant surgery If the back pain is accompanied by constitutional symptoms (such as loss of appetite, weight loss, fever, chills, shakes, or severe pain when at

NORMAL VALUES

ABNORMAL VALUES

ANALYSIS

NURSING INTERVENTIONS
Pretest: Positively identify the patient using at least two unique identifiers before providing care, treatment, or services. Patient Teaching: Inform the patient this procedure can assist in assessing organs and structures inside the chest. Obtain a history of the patients complaints, including a list of known allergens, especially allergies or sensitivities to latex, iodine, seafood, contrast medium, anesthetics, or dyes. Obtain a history of the patients cardiovascular and respiratory systems, symptoms, and results of previously

Normal Results Abnormal Findings MRI should reveal no evidence of MRI is excellent for pathology in visualizing disease bone, muscles, of the spinal canal and joints. and cord and for identifying primary and metastatic bone tumors. Its beneficial in anatomic delineation of muscles, ligaments, and bones. The image show superior contrast of body tissues and sharply defines healthy, benign, and malignant tissues.

rest) that may indicate that the pain is due to a tumor or an infection For patients who may have lumbar spinal stenosis and are considering an epidural injection to alleviate painful symptoms For patients who have not done well after having back surgery, specifically if their pain symptoms do not get better after 4 to 6 weeks.

performed laboratory tests and diagnostic and surgical procedures. Obtain a history of renal dysfunction if the use of GBCA is anticipated. Ensure the results of BUN, creatinine, and eGFR (estimated glomerular filtration rate) are obtained if GBCA is to be used. Determine if the patient has ever had any device implanted into his or her body, including copper intrauterine devices, pacemakers, ear implants, and heart valves. Obtain occupational history to determine the presence of metal in the body, such as shrapnel or flecks of ferrous metal in the eye (which can cause retinal hemorrhage). Note any recent procedures that can

interfere with test results, including examinations using barium- or iodinebased contrast medium. Record the date of the last menstrual period and determine possibility of pregnancy in perimenopausal women. Obtain a list of the patients current medications, including herbs, nutritional supplements, and nutraceuticals Review the procedure with the patient. Address concerns about pain related to the procedure and explain that no pain will be experienced during the test, but there may be moments of discomfort. Reassure the patient that if contrast is used, it

poses no radioactive hazard and rarely produces side effects. Inform the patient the procedure is performed in an MRI department, usually by an HCP who specializes in these procedures, with support staff, and takes approximately 30 to 60 min. Inform the patient that the technologist will place him or her in a supine position on a flat table in a large cylindrical scanner. Tell the patient to expect to hear loud banging from the scanner and possibly to see magnetophosphenes (flickering lights in the visual field); these will stop when the procedure is over. Sensitivity to social and cultural issues, as well as concern for modesty,

is important in providing psychological support before, during, and after the procedure. Explain that an IV line may be inserted to allow infusion of IV fluids, contrast medium, or sedatives. Instruct the patient to remove jewelry and all other metallic objects from the area to be examined prior to the procedure. There are no food, fluid, or medication restrictions unless by medical direction.

Intratest: Ensure that the patient has removed all external metallic objects from the area to be examined prior to the procedure. If the patient has a history of allergic reactions to any

substance or drug, administer ordered prophylactic steroids or antihistamines before the procedure. Have emergency equipment readily available. Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided. Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results. Observe standard precautions, and follow the general guidelines in Appendix A: Patient Preparation and Specimen Collection. Supply earplugs to the patient to block

out the loud, banging sounds that occur during the test. Instruct the patient to communicate with the technologist during the examination via a microphone within the scanner. If an electrocardiogram or respiratory gating is to be performed in conjunction with the scan, apply MRI-safe electrodes to the appropriate sites. Establish an IV fluid line for the injection of emergency drugs and of sedatives. Administer an antianxiety agent, as ordered, if the patient has claustrophobia. Administer a sedative to a child or to an uncooperative adult, as ordered. Place the patient in the supine position on an examination table. If contrast is used,

imaging can begin shortly after the injection. Ask the patient to inhale deeply and hold his or her breath while the images are taken and then to exhale after the images are taken. Instruct the patient to take slow, deep breaths if nausea occurs during the procedure. Monitor the patient for complications related to the procedure (e.g., allergic reaction, anaphylaxis, bronchospasm). Remove the needle or catheter and apply a pressure dressing over the puncture site. Observe/assess the needle/catheter insertion site for bleeding, inflammation, or hematoma formation. Post-test:

A report of the results will be sent to the requesting HCP, who will discuss the results with the patient. Observe for delayed allergic reactions, such as rash, urticaria, tachycardia, hyperpnea, hypertension, palpitations, nausea, or vomiting. Instruct the patient to immediately report symptoms such as fast heart rate, difficulty breathing, skin rash, itching, chest pain, persistent right shoulder pain, or abdominal pain. Immediately report symptoms to the appropriate HCP. Instruct the patient in the care and assessment of the injection site. Instruct the patient to apply cold

compresses to the puncture site as needed to reduce discomfort or edema. Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patients lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Reinforce information given by the patients HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family. Depending on the results of this procedure, additional testing may be performed to evaluate

or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patients symptoms and other tests performed. Related Monographs Related tests include AST, BNP, blood gases, blood pool imaging, BUN, chest x-ray, CT cardiac scoring, CT thorax, CRP, CK and isoenzymes, creatinine, echocardiography, exercise stress test, Holter monitor, myocardial infarct scan, myocardial perfusion heart scan, myoglobin, pleural fluid analysis, PET scan of the heart, and troponins. Refer to the

Cardiovascular and Respiratory systems tables at the end of the book for related tests by body system.

DX PROCEDURE Ultrasound (also called sonography).

INDICATION

NORMAL VALUES

ABNORMAL VALUES

ANALYSIS

NURSING INTERVENTIONS
Preparation of the Client No special preparation is indicated; however, barium in the bowel may interfere with results. If both studies are ordered, The renal ultrasound should be scheduled first. Client and Family Teaching This test is noninvasive and does not use radiation. You should feel no discomfort. Food, fluids, and ordered medications are not restricted prior to this test. The test takes approximately 30 to 60 minutes to complete. During this time, you need to remain relatively still.

A diagnostic imaging technique that uses highfrequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

A conductive paste or gel (which may be cold) is applied to your back and flank to allow sound wave transmission. Then a transducer is passed over the skin, producing pictures of the reflected sound waves. COMPUTED TOMOGRAPHY (CT SCAN) OF THE KIDNEY Preparation of the Client Verify the presence of a signed informed consent. Check for allergies to iodine, X-ray contrast dye, and seafood. Inform the radiology department if such an allergy exists. Prepare the client as ordered: NPO 4 hours prior to examination; laxatives and/or

enemas may be ordered to remove gas, fecal material, or retained barium from the bowel.

Client and Family Teaching o The test requires 30 to 60 minutes to complete, and you must o lie still during the procedure. o Lie flat on your back during the test while a doughnut-shaped o Scanner revolves around your body. This can cause a sensation Of claustrophobia. The machine emits loud clicking sounds as o it rotates. o The radiology technician is not in the room, but you can communicate o Through an intercom system at all times. o If contrast medium is used, you may

experience a flushing sensation o and nausea as it is injected.

INDICATION DX PROCEDURE Ultrasound (also called sonography).


Ultrasound examinations can help to diagnose a variety of conditions and to assess organ damage following illness. Ultrasound is used to help physicians evaluate symptoms such as: pain swelling infection hematuria (blood in urine) Ultrasound is a useful way of examining many of the body's internal organs, including but not limited to the: heart and blood vessels, including the abdominal aorta and

NORMAL VALUES

ABNORMAL VALUES

ANALYSIS

NURSING INTERVENTIONS

A diagnostic imaging technique that uses highfrequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

Normal Results The pelvic structures or fetus are normal. Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

An abnormal result may be due to many conditions. Some problems that may be seen include: Birth defects Cancers of the uterus, ovaries, vagina, and other pelvic structures Infection, including pelvic inflammatory disease Nocancerous growths of the uterus and ovaries (such as cysts or fibroids) Twisting of the ovaries Some problems or conditions that may be found specifically in pregnant women include: Ectopic pregnancy More than one fetus (twins, triplets, etc.)

Preparation of the Client A radiologist, a No special physician specifically preparation is trained to supervise indicated; however, and interpret radiology barium in the bowel examinations, will may interfere with analyze the images and results. If both send a signed report to studies are ordered, your primary care The renal physician or the ultrasound should physician who referred be scheduled first. you for the exam, who Client and Family will share the results Teaching with you. In some cases This test is the radiologist may noninvasive and discuss results with you does not use at the conclusion of radiation. You your examination. should feel no discomfort. Follow-up examinations Food, fluids, and are often necessary, ordered medications and your doctor will are not restricted explain the exact prior to this test. reason why another The test takes exam is requested. approximately 30 to Sometimes a follow-up

its major branches


liver gallbladder spleen pancreas kidneys bladder uterus, ovaries, and unborn child (fetus) in

Miscarriage
Placenta previa Placental abruption

pregnant patients eyes thyroid and parathyroid


glands scrotum (testicles)

brain in infants hips in infants Ultrasound is also used to: guide procedures such as needle biopsies, in which needles are used to extract sample cells from an abnormal area for laboratory testing. image the breasts and to guide biopsy of breast cancer (see the Ultrasound-Guided Breast Biopsy page.

Problems with the baby's growth or the fluid level around the baby Shortened cervix, which increases the risk for preterm delivery or late miscarriage Structural problems in the baby Tumors of pregnancy, including gestational trophoblastic disease

60 minutes to exam is done because a complete. suspicious or During this time, questionable finding you need to remain needs clarification with relatively still. additional views or a A conductive paste special imaging or gel (which may technique. A follow-up be cold) is applied examination may be to necessary so that any your back and flank change in a known to allow sound wave abnormality can be transmission. detected over time. Then a transducer Follow-up examinations is passed over the are sometimes the best skin, producing way to see if treatment pictures of the is working or if an reflected sound abnormality is stable waves. over time. COMPUTED TOMOGRAPHY (CT SCAN) OF THE KIDNEY Preparation of the Client Verify the presence of a signed informed consent. Check for allergies to iodine, X-ray contrast dye, and seafood. Inform the radiology department if such an allergy exists.

diagnose a variety of heart conditions and to assess damage after a heart attack or diagnose for valvular heart disease. Doppler ultrasound images can help the physician to see and evaluate: blockages to blood flow (such as clots). narrowing of vessels (which may be caused by plaque). tumors and congenital vascular malformation. With knowledge about the speed and volume of blood flow gained from a Doppler ultrasound image, the physician can often determine whether a patient is a good candidate for a procedure like angioplasty.

Prepare the client as ordered: NPO 4 hours prior to examination; laxatives and/or enemas may be ordered to remove gas, fecal material, or retained barium from the bowel.

Client and Family Teaching o The test requires 30 to 60 minutes to complete, and you must o lie still during the procedure. o Lie flat on your back during the test while a doughnut-shaped o Scanner revolves around your body. This can cause a sensation Of claustrophobia. The machine emits loud clicking sounds as o it rotates. o The radiology technician is not in the room, but you can

communicate o Through an intercom system at all times. o If contrast medium is used, you may experience a flushing sensation o and nausea as it is injected.

DX PROCEDURE PET Scans

INDICATION
PET and PET/CT scans are performed to: detect cancer. determine whether a cancer has spread in the body assess the effectiveness of a treatment plan, such as cancer therapy. determine if a cancer has returned after treatment. determine blood flow to the heart muscle. determine the effects of a heart attack, or myocardial infarction, on areas of the heart. identify areas of the heart muscle that would benefit from a procedure such as angioplasty or coronary artery bypass surgery (in combination with a myocardial perfusion scan).

NORMAL VALUES
Normal Results A normal result means there were no problems seen in the size, shape, or position of an organ. There are no areas in which the tracer has abnormally collected.

ABNORMAL VALUES
Abnormal results depend on the part of the body being studied. Abnormal results may be due to: Change in the size, shape, or position of an organ Cancer Infection Problem with organ function For more information see: Brain PET scan
Breast PET scan

ANALYSIS

NURSING INTERVENTIONS

A diagnostic imaging technique that uses highfrequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

Heart PET scan Lung PET scan

A radiologist, who is a Preparation of the Client physician with No special specialized training in preparation is PET and other indicated; however, imaging tests, will barium in the bowel analyze and interpret may interfere with the results of your results. If both PET scan and then studies are ordered, send a report to your The renal personal physician. It ultrasound should usually takes a day or be scheduled first. so to interpret, report, Client and Family and deliver the Teaching results. Contact your This test is personal physician for noninvasive and information on the does not use results of your exam. radiation. You should feel no discomfort. Food, fluids, and ordered medications are not restricted prior to this test. The test takes approximately 30 to 60 minutes to

evaluate brain abnormalities, such as tumors, memory disorders and seizures and other central nervous system disorders. to map normal human brain and heart function.

complete. During this time, you need to remain relatively still. A conductive paste or gel (which may be cold) is applied to your back and flank to allow sound wave transmission. Then a transducer is passed over the skin, producing pictures of the reflected sound waves. COMPUTED TOMOGRAPHY (CT SCAN) OF THE KIDNEY Preparation of the Client Verify the presence of a signed informed consent. Check for allergies to iodine, X-ray contrast dye, and seafood. Inform the radiology department if such an allergy exists. Prepare the client

as ordered: NPO 4 hours prior to examination; laxatives and/or enemas may be ordered to remove gas, fecal material, or retained barium from the bowel.

Client and Family Teaching o The test requires 30 to 60 minutes to complete, and you must o lie still during the procedure. o Lie flat on your back during the test while a doughnut-shaped o Scanner revolves around your body. This can cause a sensation Of claustrophobia. The machine emits loud clicking sounds as o it rotates. o The radiology technician is not in the room, but you can communicate

o Through an intercom system at all times. o If contrast medium is used, you may experience a flushing sensation o and nausea as it is injected.

DX PROCEDURE Spinal tap (also called a lumbar puncture)


INDICATION
Suspected CNS infection Suspected subarachnoid hemorrhage Therapeutic reduction of cerebrospinal fluid (CSF) pressure Sampling of CSF for any other reason

NORMAL VALUES
Protein Glucose 15-45 mg/dl 50-80 mg/dl < 5 mm3

ABNORMAL VALUES
Normal CSF is a clear watery fluid, but the presence of many cells, extra protein or blood can alter its appearance. Cells, either lymphocytes in larger than normal numbers, or pus cells, can cause turbidity, and this can indicate the presence of an infection. Fresh blood in the CSF may be due to injury to a vertebral vein by the LP needle, and the sample will become clear as it continues to drip from the needle (Sharief, 2000). Continuous blood contamination indicates bleeding into the subarachnoid space, usually due to a very recent (usually within hours) ruptured aneurysm in

ANALYSIS
The spinal fluid samples are sent to a laboratory for analysis. Lab technicians check for a number of things when examining spinal fluid, including: General appearance. Spinal fluid is normally clear and colorless. If it's cloudy, yellow or pink in color, it may indicate infection. Protein (total protein and the presence of certain proteins).Elevated levels of total protein greater than 45 milligrams per deciliter (mg/dL) may indicate infection or another inflammatory condition. Specific lab values may vary from medical facility to medical facility.

NURSING INTERVENTIONS
Lumbar puncture is a strict aseptic technique requiring full sterile procedures. Encourage patients to drink well before and after the procedure. Positioned the patient carefully, laying on one side in a curled up position with the lumbar spine exposed (knees drawn up to the chest). Moving the patients back closer to the edge of the bed will make access to the lumbar spine easier. Support the patient in this position throughout the procedure. A small local sterile dressing is

A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.

WBC

RBC

0-5

Opening pressure Clarity, color

5-20 cm

Clear and colorless

the head, possibly within the Circle of Willis (Blows, 2001). A continuous yellow stain to the fluid (xanthochromia) is usually due to an older subarachnoid bleed that has had time for the red cells to settle out, leaving other blood plasma components such as proteins and other cells in the CSF. High protein counts may be due to infection of the meninges (meningitis) or the brain (encephalitis), or due to brain tumours or multiple sclerosis (Sharief, 2000). Other changes of CSF contents as a result of central nervous system infections are reduced or absent glucose levels and a disturbance of the

White blood cells. Spinal fluid normally contains up to 5 mononuclear leukocytes (white blood cells) per microliter. Increased numbers may indicate infection. Specific lab values may vary from medical facility to medical facility. Sugar (glucose). A low glucose level in spinal fluid may indicate infection or another condition. Microorganisms. The presence of bacteria, viruses, fungi or other microorganisms can indicate infection. Cancer cells. The presence of abnormal cells in spinal fluid such as tumor or immature blood cells can indicate certain types of cancer.

applied to the spinal site after removal of the needle. Headache is a common complaint following lumbar puncture. The patient should lay flat for 6-12 hours afterwards, as sitting up may make any headache worse. In myelograms, the patients head should be kept raised for up to 24 hours afterwards to prevent contrast medium in the spinal canal from entering the skull. This may caused seizures if it passes around the brain (Blows, 2002).

lactate levels these being bigger changes seen in bacterial rather than viral infections. Increased CSF pressure is indicative of raised intracranial pressure due to SOLs such as tumours or intracranial bleeds. It is also seen in hydrocephalus (excess CSF covering the brain in some children) (Blows, 2001).