Neurological Disorders Q 7

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A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances?

  

     A. Vomiting continues.

     B. Intracranial pressure (ICP) is increased.

     C. The client needs mechanical ventilation.

     D. Blood is anticipated in the cerebrospinal fluid (CSF).

    

    

Correct Answer: B. Intracranial pressure (ICP) is increased.

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Sudden removal of CSF results in pressures lower in the lumbar area than the brain and favors herniation of the brain; therefore, LP is contraindicated with increased ICP. A head computed tomogram (CT) should be obtained before performing a lumbar puncture if there is a concern for increased intracranial pressure. Signs and symptoms of possible increased intracranial pressure include altered mental status, focal neurological deficits, new-onset seizure, papilledema, immunocompromised state, malignancy, history of focal CNS disease (stroke, focal infection, tumor), concern for mass CNS lesion and age greater than 60 years old.

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Option A: Vomiting may be caused by reasons other than increased ICP; therefore, LP isn’t strictly contraindicated. Contraindications to performing a lumbar puncture include skin infection near or at the site of lumbar puncture needle insertion, central nervous system (CNS) lesion or spinal mass leading to increased intracranial pressure, platelet count less than 20,000 mm3 (ideally the platelet count should be greater than 50,000 mm3), use of unfiltrated heparin or low-molecular-weight heparin in the past 24 hours, coagulopathies (i.e., hemophilia, von Willebrand disease) and vertebral trauma.

Option C: An LP may be performed on clients needing mechanical ventilation. Lumbar puncture (LP), also referred to as “spinal tap,” is a commonly performed procedure that involves obtaining and sampling cerebrospinal fluid from the spinal cord.

Option D: Blood in the CSF is diagnostic for subarachnoid hemorrhage and was obtained before signs and symptoms of ICP. It is the gold standard diagnostic procedure in the diagnosis of meningitis, subarachnoid hemorrhage, and certain neurological disorders. It is also used in the measurement of intracranial pressure and administration of medications or diagnostic agents.

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