Which action does the nurse take when there is reduced urinary output in a comatose child?

LP
Spinal needle is inserted between L3-L4 or L4-L5 vertebral spaces into subarachnoid space; CSF pressure is measured, and sample is collected.
Diagnostic—Measures spinal fluid pressure, obtains CSF for laboratory analysis
Therapeutic—Injection of medication
Contraindicated in patients with increased ICP or infected skin over puncture site.

Subdural tap
Needle is inserted into anterior fontanel or coronal suture (midline to pupil).
Helps rule out subdural effusions
Removes CSF to relieve pressure
Place infant in semi-erect position after subdural tap to minimize leakage from site; prevent child from crying if possible. Check site frequently for evidence of leakage.

Ventricular puncture
Needle is inserted into lateral ventricle via coronal suture (midline to pupil).
Removes CSF to relieve pressure
Risk of intracerebral or ventricular hemorrhage.

EEG
EEG records changes in electrical potential of brain.
Electrodes are placed at various points to assess electrical function in a particular area.
Impulses are recorded by electromagnetic pen or digitally.
Detects spikes, or bursts of electrical activity that indicate the potential for seizures
Used to determine brain death
Patient should remain quiet during procedure; may require sedation.
Minimize external stimuli during procedure.

Nuclear brain scan
Radioisotope is injected intravenously and then counted and recorded after fixed time intervals.
Radioisotope accumulates in areas where blood-brain barrier is defective.
Identifies focal brain lesions (e.g., tumors, abscesses)
Positive uptake of material with encephalitis and subdural hematoma
Visualizes CSF pathways
Requires IV access; patient may require sedation.
In normal children or noncommunicating hydrocephalus, no retrograde filling of ventricles occurs.
Areas of concentrated uptake of material are termed hot spots.

Endocephalography
Pulses of ultrasonic waves are beamed through head; echoes from reflecting surfaces are recorded graphically.
Identifies shifts in midline structures from their normal positions as a result of intracranial lesions
May show ventricular dilation
Simple, safe, rapid procedure.
Fontanel must be patent.

RTUS
Similar to CT but uses ultrasound instead of ionizing radiation.
Allows high-resolution anatomic visualization in variety of imaging planes
Produces images similar to CT scan.
Especially useful in neonatal CNS problems.
Anterior fontanel must be patent.

Radiography
Skull films are taken from different views—lateral, posterolateral, axial (submentoventricular), half-axial.
Shows fractures, dislocations, spreading suture lines, craniosynostosis
Shows degenerative changes, bone erosion, calcifications
Simple, noninvasive procedure.

CT scan
Pinpoint x-ray beam is directed on horizontal or vertical plane to provide series of images that are fed into computer and assembled in image displayed on video screen.
CT uses ionizing radiation.
Visualizes horizontal and vertical cross section of brain in three planes (axial, coronal, sagittal)
Distinguishes density of various intracranial tissues and structures—congenital abnormalities, hemorrhage, tumors, demyelinating and inflammatory processes, calcification
Requires IV access if contrast agent is used.
Patient may require sedation.
Rapid.

MRI
MRI produces radiofrequency emissions from elements (e.g., hydrogen, phosphorus), which are converted to visual images by computer.
Permits visualization of morphologic feature of target structures
Permits tissue discrimination unavailable with many techniques
MRI is noninvasive procedure except when IV contrast agent is used.
No exposure to radiation occurs.
Patient may require sedation.
Parent or attendant can remain in room with child.
MRI does not visualize bone detail or calcifications.
No metal can be present in scanner.

PET
PET involves IV injection of positron-emitting radionucleotide; local concentrations are detected and transformed into visual display by computer.
Detects and measures blood volume and flow in brain, metabolic activity, and biochemical changes within tissue
Requires lengthy period of immobility.
Minimum exposure to radiation occurs.
Patient may require sedation.

DSA
Contrast dye is injected intravenously; computer “subtracts” all tissues without contrast medium, leaving clear image of contrast medium in vessels studied.
Visualizes vasculature of target tissue
Visualizes finite vascular abnormalities
Safe alternative to angiography.
Patient must remain still during procedure; may require sedation.

SPECT
Involves IV injection of photon-emitting radionuclide; radionuclides are absorbed by healthy tissue at different rate than by diseased or necrotic tissue; data are transferred to computer that converts image to film.
Provides information regarding blood flow to tissues; analyzing blood flow to organ may help determine how well it is functioning
Requires lengthy period of immobility.
Minimum exposure to radiation occurs.
Patient may require sedation.

Which of the following is a nursing intervention to reduce the risk of increasing intracranial pressure ICP in an unconscious child?

Which measurement scale does the nurse use to assess the level of consciousness in a child?

Which diagnostic tests does the nurse evaluate to confirm the presence of bacterial meningitis in a child who shows symptoms of infection?

Which diagnostic tests does the nurse evaluate to confirm the presence of bacterial meningitis?