Diagnostics

Question 1

What is a lumbar puncture and what are its indications?

Answer 1

Also called a spinal tap, it is a procedure in which a small amount of CSF is withdrawn from the spinal canal and then analyzed. NEEDLE DOES NOT ENTER SPINAL CHORD

It is indicated for:

1) To detect/rule out some diseases (meningitis, MS, Syphilis)
2) reduce CSF Pressure
3) Administer medication or chemo directly into spinal fluid.

Question 2

What 3 longterm COMPLICATIONS are CONSIDERATIONS associated with a Lumbar Puncture?

Answer 2

1) BRAIN HERNIATION (rare) r/t increased ICP caused by an increase in blood, CSF, or tissue size in brain.
2) BLEEDING THAT COMPRESSES THE SPINAL CHORD r/t –> Pt w. bleeding disorders or who are taking anticoagulant
3) infection = like meningitis (rare)

**A manometer is used if ICP is a consideration to determine the opening pressure of the spinal chord.

Question 3

What are 3 pre-procedure Nursing Actions for Lumbar puncture?

Answer 3

1) Have pt remove all jewelry and only wear a hospital gown.
2) Have pt void BEFORE procedure.
3) Have pt assume sitting as CANNONBALL position or sidelying as LATERAL RECUMBANT

Question 4

What are 2 normal findings with lumbar puncture that the patient may report?

Answer 4

1) Feeling sensation of COLD as the site is cleansed in solution.
2) A NEEDLE PRICK when local anesthetic is injected.

Question 5

What can the nurse place in between the legs to prevent top leg from rolling forward? (Lumbar Puncture)

Answer 5

A PILLOW

Question 6

How can the nurse help the pt maintain position for a lumbar puncture?

Answer 6

1) Instruct Pt to breathe normally= don’t want pt to hyperventilate.
2) Nurse describes procedure step-by-step AS IT PROCEEDS

Question 7

Where is a Lumbar Puncture inserted?

Answer 7

In the subarachnoid space b/t 3rd and 4th or 4th and 5th LUMBAR INTERSPACE.

Question 8

How many samples are collected? (Lumbar Puncture)

Answer 8

3 test tubes.

Question 9

What is the PRIORITY nursing action POSTPROCEDURE for a lumbar puncture/spinal tap?

Answer 9

1) Prevent post-lumbar puncture headache, which is an indication of CSF leakage.

Question 10

What is a post-lumbar puncture headache indicate and how do you prevent it as the nurse?

Answer 10

Indicates CSF Leakage

Question 11

How to MANAGE post-Lumbar Puncture Headache? This headache can occur a few hours or several days post procedure.

Answer 11

1) Encourage increased fluid intake
2) Instruct patient to lie PRONE
3) Administer pain meds

Pt Teaching: Normal activities can resume AFTER PRESCRIBED bed rest.

Question 12

When is the post lumbar puncture MOST and LEAST severe?

Answer 12

Upon standing or sitting = SEVERE/WORSE

Laying down = LESS/DISSAPEARS

Question 13

What 2 Complications is the pt at risk for post procedure? - (Lumbar Puncture)

Answer 13

1) Risk of infection –if clotting doesnt form to seal site

2) Headache = CSF Leakage at site

Question 14

Post Procedure Complication management? (Lumbar Puncture) HINT: A patch

Answer 14

Prep pt for epidural blood patch to seal the hole in the dura if headache continues

Question 15

What hemodynamic COMPLICATION is a pt at risk for intraprocedure? HINT: think airway risk

Answer 15

Airway is more compromised = monitor for DECOMPENSATION

Question 16

Nursing Care Post Procedure - Name the 2 positions the nurse ensures the pt is in post Lumbar Puncture?

Answer 16

Prone following procedure.

Supine for 4-8 hours afterwards (Supine = lying on back) 1/2 my shift or all my shift the pt will be supine. Supine like a pine tree fallen on its back.

Question 17

Name 4 short-term complications of lumbar puncture?

Answer 17

1) temporary voiding problems
2) slight elevation in temperature
3) backache/spasms
4) STIFF NECK

Question 18

Name 3 out of 7 signs of CSF leakage?

Answer 18

Signs of CSF leakage includes 
1- positional headaches, 
2- nausea and vomiting, 
3- neck stiffness, 
4- photophobia (sensitivity to light), 
5- sense of imbalance, 
6- tinnitus (ringing in the ear),
7- phonophobia (sensitivity to sound).