Diagnostic Tests for
Neurologic Functions
JESTHER B. BAUTISTA, RN, RTRP
LORMA College of Nursing
http://youtube.com/AtYourSIRvice
Skull x-ray
•X-rays of the skull reveal the
size and shape of the skull
bones, suture separation in
infants, fractures or bony
defects, erosion, or calcification
Spinal x-ray
•Spinal x-rays identify fractures,
dislocation, compression, curvature,
erosion, narrowed spinal cord, and
degenerative processes
Pre-procedure
• Provide nursing support for the confused, combative, or ventilator-dependent
client
• Maintain immobilization of the neck if a spinal fracture is suspected
• Remove metal items from body parts
• If the client has thick and heavy hair, this should be documented, because it
may affect interpretation of the x-ray film
Post-procedure
•Maintain immobilization until
results are known
CT Scan
• A type of brain scanning that may or
may not require an injection of a dye
• Used to detect intracranial bleeding, space
occupying lesions, cerebral edema,
infarctions, hydrocephalus, cerebral
atrophy, and shifts of brain structures
Pre-procedure
• Obtain a consent if a dye is used
• Assess for allergies to iodine, contrast dyes, or shellfish if a dye is used
• Instruct the client in the need to lie still and fiat during the test
• Instruct the client to hold his or her breath when requested
• Initiate an IV if prescribed
Pre-procedure (cont.)
• Remove objects from the head, such as wigs, barrettes, earrings, and
hairpins
• Assess for claustrophobia
• Inform the client of possible mechanical noises as the scanning
occurs
Pre-procedure (cont.)
• Inform the client that there may be a hot, flushed sensation and a
metallic taste in the mouth when the dye is injected
• Note that some clients may be given the dye even if they report an
allergy, and are treated with an antihistamine and corticosteroids
prior to the injection, to reduce the severity of a reaction
Post-procedure
• Provide replacement fluids because diuresis from the dye is
expected
• Monitor for an allergic reaction to dye
• Assess dye injection site for bleeding or hematoma, and monitor
extremity for color, warmth, and the presence of distal pulses
MRI
• A noninvasive procedure that identifies
types of tissues, tumors, and vascular
abnormalities
• Similar to the CT scan but provides
more detailed pictures and does not
expose the client to ionizing radiation
Pre-procedure
• Remove all metal objects from the client
• Determine if the client has a pacemaker, implanted defibrillator, or metal
implants such as a hip prosthesis or vascular clips because these clients
cannot have this test performed
• Remove IV fluid pumps during the test
Pre-procedure (cont.)
• Provide precautions for the client who is attached to pulse oximetry
because it can cause a burn during testing if coiled around the body
or a body part
• Provide an assessment of the client with claustrophobia
• Administer medication as prescribed for the client with
claustrophobia
Pre-procedure (cont.)
• Determine if a contrast agent is to be used, and follow the
prescription related to the administration of food, fluids, and
medications
• Instruct the client that he or she will need to remain still during
the procedure
Post-procedure
• Client may resume normal activities
• Expect diuresis if a contrast agent was used
Lumbar
Puncture
• Insertion of a spinal needle through
L3-L4 interspace into the lumbar
subarachnoid space to obtain
cerebrospinal fluid (CSF), measure CSF
fluid or pressure, or instill air, dye, or
medications
Lumbar
Puncture
• Contraindicated in clients with
increased intracranial pressure,
because the procedure will cause a
rapid decrease in pressure within the
CSF around the spinal cord, leading
to brain herniation
Pre-procedure
•Obtain consent
•Have the client empty the bladder
•Skin prep
During the
procedure
• Position the client in a lateral recumbent
position and have the client draw knees up
to the abdomen and chin onto the chest
• Assist with the collection of specimens (label
the specimens in sequence)
• Maintain strict asepsis
Post-procedure
• Monitor vital signs and neurological signs
• Position the client flat as prescribed
• Force fluids
• Monitor I & 0
Myelogram
•Injection of dye or air into the
subarachnoid space with serial X-rays
or CT scan to detect abnormalities of
the spinal cord and vertebrae
Pre-procedure
• Obtain a consent
• Provide hydration for at least 12 hours before the test
• Assess for allergies to iodine
• If the client is taking a phenothiazine, hold the medication because this
medication lowers the seizure threshold
• Premedicate for sedation as prescribed
Post-procedure
• Vital signs and neurological assessment frequently as prescribed
• If a water-based dye is used, elevate the head 15 to 30 degrees
for 8 hours as prescribed
• If an oil-based dye is used, keep the client flat 6 to 8 hours as
prescribed
• If air is used, keep the head lower than the trunk as prescribed
Post-procedure
•Administer analgesics for headache or back ache as
prescribed
•Force fluids
•Monitor I & 0
•Assess for bladder distention and voiding
Cerebral Angiography
•Injection of contrast through the
femoral artery into the carotid
arteries to visualize the cerebral
arteries and assess for lesions
Pre-procedure
• Obtain a consent
• Assess the client for allergies to iodine and shellfish
• Encourage hydration for 2 days before the test
• NPO 4 to 6 hours prior to the test as prescribed
Pre-procedure
• Obtain a baseline neurological assessment
• Mark the peripheral pulses
• Remove metal items from the hair
• Administer premedication as prescribed
Post-procedure
• Monitor neurological status and vital signs frequently until stable
• Monitor for swelling in the neck and for difficulty swallowing and
notify the physician if these symptoms occur
• Maintain bed rest for 12 hours as prescribed
• Elevate the head of the bed 15 to 30 degrees only if prescribed
Post-procedure
• Keep the bed flat if the femoral artery is used, as prescribed
• Assess peripheral pulses
• Immobilize the puncture site for 12 hours as prescribed
• Apply sandbags and a pressure dressing to the injection site as prescribed
• Place ice on the puncture site as prescribed
• Force fluids
Electroencephalography
(EEG)
•A graphic recording of the
electrical activity of the
superficial layers of the
cerebral cortex
Pre-procedure
• Wash the client’s hair
• Inform the client that electrodes are attached to the head and that
electricity does not enter the head
• Withhold stimulants, antidepressants, tranquilizers, and anticonvulsants for
24 to 48 hours prior to the test as prescribed
Pre-procedure
•Allow the client to have breakfast if prescribed
•Premedicate for sedation as prescribed
During the Procedure
Post-procedure
• Wash the client’s hair
• Maintain side rails and safety precautions if the client
was sedated
Caloric testing
(Oculovestibular
Testing)
Caloric testing (Oculovestibular
Testing)
•Provides information about the function of the vestibular
portion of the eighth cranial nerve and aids in the
diagnosis of cerebellum and brainstem lesions
Procedure
• Patency of the external canal is confirmed
• Cold or warm water is introduced into the external auditory canal
• Stimulation of the auditory canal with warm water produces a horizontal nystagmus
toward the side of the irrigated ear when the vestibular eighth cranial nerve is normal
• Stimulation of the auditory canal with cold water produces a horizontal nystagmus away
from the side of the irrigated ear if the brainstem is intact
