Chapter 14 F Lab Testing for Neurologically Impaired Patients Study Notes

  • Introduction to Lab Testing for Neurologically Impaired Patients

  • Discussion begins with a personal and humorous moment about financial concerns and a check for $8.40.

  • Overview of Blood and Urine Tests

  • Focus on lab tests necessary for assessing neurologically impaired patients.

  • Importance of urine testing including urine culture and urine analysis (UA).

  • Urine Culture

  • Essential to perform urine culture on all confused patients.

    • A urine culture is more expensive than a basic UA:

  • Cost ranges from $100 to a few hundred dollars depending on the lab used.

  • A simple UA can indicate the presence of a urinary infection.

  • Urine Drug Screen (UDS)

  • Also known as urine tox screen.

  • Crucial for detecting if a patient is under the influence of drugs, especially when showing confusion or impairment.

    • Discussion of recent trends in drug use:

  • PCP resurgence in the early 2000s after a decline since the 1970s.

  • PCP is known to cause hallucinations and irrational behaviors, leading to incidents like extreme physical activities (e.g., attempting to fly).

  • Risks Associated with Substance Use

    • Discussion highlights dangerous trends in drug use, including:

  • PCP being mixed with marijuana.

  • The dangers of drug dealing and adultering substances, e.g., PCP in pre-rolled blunts.

  • Anecdotal Case Study

  • An example of an incident involving a man intoxicated on PCP at a hotel who harmed himself while acting irrationally due to PCP-induced hallucinations.

  • Importance of Toxicology Screens

  • Urine toxicology is emphasized as a primary assessment tool to understand confusion in patients.

  • Description of a female patient who exhibited dangerous behavior while under the influence of PCP and other drugs.

  • Other Relevant Drug Information

  • Some drugs, like dextromethorphan (main ingredient in common cold medications), can cause hallucinations without showing up in standard drug screenings.

  • Mention of other substances that can be dangerous when used for recreational purposes (e.g., morning glory seeds).

  • Educational Resources for Drug Knowledge

  • Information provided on using educational websites such as arrowid.org for tracking different substances and their effects, plus the community's understanding of drug slang.

  • Noteworthy Drug Combinations and Effects

  • "Cheese": A mixture of heroin and Benadryl that enhances the sedative effects and mitigates itching from heroin use.

  • Explanation of the detrimental impact of illicit drugs globally, emphasizing the opioid crisis and its presence in various countries.

  • Medical Assessment for Neurological Conditions

  • Discussion on the necessity of conducting a thorough medical clearance for patients with altered mental statuses before assuming psychiatric issues.

    • Essential components of medical clearance:

  • Urine toxicology screen.

  • Complete blood count (CBC) and chemistry profile.

  • Imaging studies (such as scans) for head injuries or potential heavy metal poisoning.

  • Blood Gases and Meningitis Testing

  • Blood gas tests used to assess hypoxia-related disorientation.

    • CSF (Cerebrospinal Fluid) testing through lumbar puncture:

  • Used to check for infections like meningitis.

  • Details on how, why, and when lumbar punctures are performed, including risks associated with intracranial pressure.

  • Lumbar Puncture Procedure

    • A detailed description of the lumbar puncture procedure:

  • Involves inserting a needle below the L4-L5 vertebrae to collect CSF.

  • Typically done with either a 3-inch or 5-inch needle depending on patient size.

  • Risks and Patient Care Post-Procedure

  • Patients must lie flat post-procedure to prevent post-lumbar puncture headaches caused by CSF leakage.

  • Signs of complications include leakage at the puncture site, which requires continued assessment.

    • Instructions for managing discomfort post-lumbar puncture:

  • Suggestions for rest, hydration, and pain management.

  • Blood patch procedure explained as a solution for severe headaches due to CSF leakage.

  • Diagnostic Imaging in Neurology

    • Overview of various imaging techniques:

  • CT scans are standard for diagnosing strokes before considering contrast.

  • PET scans for assessing metabolic activity.

  • MRI and MRA for examining structural conditions including tumors and vascular issues.

  • EEG and Functional Testing

  • Emphasis on the role of EEG (electroencephalogram) in evaluating brain activity, seizure disorders, and sleep studies.

  • Mention of the importance of EEGs in trauma and brain death assessment.

  • Assessment Protocols and Guideline Summary

    • Summary of the necessary assessments for neurological conditions including:

  • EMG for testing neuromuscular junction responses.

  • Angiograms and Doppler examinations for blood flow analysis.

  • The importance of recognizing and reporting suspected child abuse cases based on physical signs of injuries and conditions.

  • Conclusion and Wrap-Up

  • Recognition that all nursing professionals, whether in office settings or emergency rooms, must be vigilant regarding signs of abuse and implications of neurological conditions stemming from substance abuse.

  • Class continues after a break, scheduled for 09:15.