Report signs of increased intracranial pressure or herniation such as decreased level of consciousness, unequal pupils, or vomiting.
Before you read
Test yourself first: 3 questions
Question 1 of 3
After an arterial blood gas is drawn from the radial artery, what is the nurse's priority intervention at the puncture site?
Answer: A. Because the sample is from an artery under high pressure, the priority is to apply firm direct pressure to the puncture site for at least 5 minutes (longer if the client is anticoagulated) to prevent hematoma formation and bleeding. This is essential before applying a pressure dressing or documenting.
Question 2 of 3
A client diagnosed with a lumbar herniated disc reports radiating pain down the posterior leg. Which finding is consistent with sciatic nerve (L5-S1) involvement?
Answer: A. A herniated lumbar disc compressing the nerve root produces radicular pain, numbness, or tingling radiating along the dermatome down the buttock and posterior leg, often with a positive straight-leg raise test and possible weakness. Pain confined to the upper arm reflects cervical, not lumbar, pathology.
Question 3 of 3
A nurse is monitoring a client at risk for DIC after septic shock. Which early sign should prompt the nurse to notify the provider?
Answer: A. DIC begins with abnormal clotting that consumes platelets and factors, then progresses to bleeding. Early subtle signs include oozing from IV sites and puncture sites, petechiae, and unexpected bruising. Recognizing these early bleeding signs allows prompt intervention before life-threatening hemorrhage. Increased urine output and improved color are not warning signs of DIC.
Keep the streak going with more questions like these, each with a full rationale.
What is lumbar puncture?
It is used to diagnose meningitis, subarachnoid hemorrhage, and other neurologic conditions. Memory aid: LP = lie flat after to prevent a spinal headache.
Key points to remember
- The needle is placed below the spinal cord (around L3-L4) to avoid neurologic injury.
- The patient is positioned in a side-lying fetal (knees-to-chest) curve to open the vertebral spaces.
- Increased intracranial pressure or papilledema is a contraindication because of the risk of brain herniation.
- Post-procedure spinal (post-dural-puncture) headache is the most common complication and worsens when upright.
- Lying flat after the procedure and good hydration help prevent or relieve the spinal headache.
- Normal CSF is clear and colorless; cloudy fluid suggests infection and bloody fluid suggests hemorrhage.
Nursing priorities
- Verify consent and have the patient empty the bladder before the procedure.
- Position the patient on their side curled into a fetal position and help them hold still.
- Label CSF tubes in order and send them promptly to the lab.
- Keep the patient lying flat as ordered afterward and encourage increased fluid intake.
- Monitor neurologic status, the puncture site, and for headache after the procedure.
Labs & values
Patient teaching
- Lie flat for the time ordered after the test to lower the chance of a headache.
- Drink plenty of fluids, including caffeinated drinks, to help prevent a spinal headache.
- Report a severe headache that gets worse when you sit or stand up.
- Tell the nurse if you notice leg weakness, numbness, or trouble urinating.
Red flags: report now
- Report signs of increased intracranial pressure or herniation such as decreased level of consciousness, unequal pupils, or vomiting.
- Report clear drainage from the puncture site that may indicate a CSF leak.
- Report numbness, tingling, leg weakness, or loss of bladder control.
- Never perform an LP when increased intracranial pressure is suspected without imaging clearance.
References
Clinical references for this topic
