X-Ray
X-Ray: determines bony fractures, curvatures, bone erosions, bone dislocations, and possible calcification of soft tissue that may damage the nervous system. Various orientations may be required for accurate imaging.
- Nursing Management: explain the procedures, importance of staying still, ensure understanding of radiologic exposure and its minimal risk, removal of hairpins, glasses, and hearing aids.
- Patients in traction or those who cannot walk may require a stretcher or aid in positioning.
Cerebral Arteriography/Angiography
Cerebral Arteriography/Angiography: the visualization of cerebral vessels, determining the presence of tumors, aneurysms, occlusions, hematomas, and abscesses.
- A radiopaque substance is injected into cerebral circulation via the carotid, vertebral, femoral, or brachial artery. Catheterization may be used.
- Digital Subtraction Angiography may be used, where an x-ray with and without a contrast dye are subtracted from one-another, removing bones and other background structures, allowing for easier visualization of blood vessels.
- Nursing Management: as it is invasive, a consent form is required.
- Check for allergies to iodinated contrast agents. Allergy manifests as dyspnea, nausea and vomiting, sweating, tachycardia, and numbness of extremities. Report to the physician at once if a reaction occurs. Administration of epinephrine, antihistamines, or corticosteroids may be required. Vessel injuries, bleeding, and a cerebrovascular accident may occur.
- Educate the client on the importance of not moving during the procedure.
- NPO 4 to 6 hours before the exam is required, with clear liquids permitted until the examination. Maintain hydration.
- Record vital signs (neurologic vital signs)
- Empty bladder for comfort and because the procedure may last for a considerable amount of time.
- After examination, re-examine vital signs, neurologic status, and neurovascular checks cross-referenced with pre-angiography signs. Enforce bed rest and continue to monitor VS and neuro checks.
- The extremity used for catheterization should be kept straight and immobilized during bed rest. Hematoma may form, and an ice bag may be applied intermittently to the puncture site.
- Check for the extremity’s skin color and temperature, pulses distal to the injection, and capillary refill.
- Inspect the puncture site for bleeding.
- Increase oral or IVF if not contraindicated.
Computed (Axial) Tomography
Computed Tomography (CT)/Computed Axial Tomography (CAT) Scans are used to detect intracranial and spinal cord lesions and to monitor effects of surgery or other therapies. Ionizing radiation is used to scan the body parts in successive layers. Contrast media may or may not be used. CVA and potentially its cause/form may be identified by CT Scans.
- No special preparations are required. Inform the patient to remain still during the scan.
- Nursing Management: contrast requires a consent form.
- If contrast is being used, check for risk factors and inform the physician.
- All metallic belongings should be removed from the patient. Hairpins, hairpieces, or wigs are also removed.
- Explain importance of not moving during examination.
- After the procedure, check for delayed allergic responses (if contrast is used). Check for I&O as consequential osmotic diuresis may require replacement of fluids.
Magnetic Resonance Imaging
The use of a powerful magnetic field to visualize body parts, including the nervous system. Being clearer than CT scans and not involving ionizing radiation, it is better suited for identifying brain tumors, CVA, and multiple sclerosis.
- Nursing Management: identify implants that contraindicate MRI scans, wherein the implants may be damaged or cause damage due to the magnetic fields.
- All metal items should be removed before the test. Some medications with foil also need to be removed.
- Assess for a history of claustrophobia which may interfere with the test.
Positron Emission Tomography
A PET scan is a computer-based nuclear imaging technique that produces images of actual organ functioning.