A nurse is assessing a client for changes in the level of consciousness using the Glasgow Coma Scale. The client opens his eyes when spoken to, speaks incoherently, and moves his extremities when pain is applied. Which of the following is the correct scoring by the nurse using the Scale that indicates the client has a moderate head injury?

An intraventricular catheter (ventriculostomy) is a device used to monitor intracranial pressure (ICP) and drain excess cerebrospinal fluid (CSF) in clients with severe brain injury. While it provides valuable real-time data on ICP, it also carries a significant risk of infection because it involves direct access to the brain's ventricles. Meningitis or ventriculitis can occur if strict aseptic technique is not maintained. Nurses must closely observe for signs of infection, such as fever, change in mental status, or purulent drainage from the catheter site.

Rationale for Correct Answer:
B. Infection: Ventriculostomy catheters provide a direct route for pathogens into the central nervous system. This places the client at risk for life-threatening infections like meningitis or ventriculitis, which require immediate recognition and intervention.

Rationale for Incorrect Answers:

A. Headache: While headaches can occur with increased ICP or CSF drainage, they are not specific to ventriculostomy-related complications. Headaches are common and nonspecific and not considered a direct complication of the catheter itself.

C. Aphasia: Aphasia is a neurologic deficit related to brain injury, particularly in the dominant hemisphere, but it is not a complication of ventriculostomy. It reflects damage from the trauma itself, not the monitoring device.

D. Hypertension: Hypertension may occur as a compensatory response to increased ICP (as part of Cushing’s triad), but it is not a direct complication of the ventriculostomy catheter. It signals a systemic or neurologic response, not an issue with the catheter.

Key Takeaways:
• Infection is the most serious and common complication of ventriculostomy use.
• Nurses must maintain sterile technique and monitor closely for signs of CNS infection.
• Other symptoms like headache or hypertension may relate to the injury, not the catheter itself.

A myelogram is an invasive diagnostic procedure used to visualize the spinal cord, nerve roots, and surrounding subarachnoid space using contrast dye injected into the spinal canal via lumbar puncture. Because of this, the preparation and positioning for a myelogram closely resemble those of a lumbar puncture, including obtaining informed consent, checking for allergies to contrast dye, and proper positioning during and after the procedure.

Rationale for Correct Answer:

A. Lumbar puncture: A myelogram requires injection of contrast dye into the subarachnoid space through a lumbar puncture. Therefore, preparation (e.g., client positioning, sterile technique, consent, allergy screening) and aftercare (e.g., monitoring for headache or CSF leak) are very similar to a standard lumbar puncture.

Rationale for Incorrect Answers:
B. MRI: MRI is a noninvasive imaging procedure that uses magnetic fields and does not involve puncturing the spinal canal or injecting contrast into the CSF unless performed with special contrast protocols.
C. Cerebral angiography: This procedure involves injection of contrast dye into cerebral arteries, typically via a femoral catheter, and does not involve accessing the spinal canal.
D. EEG: EEG is noninvasive and involves placement of electrodes on the scalp to monitor electrical activity in the brain. It does not use contrast dye or invasive techniques.

Key Takeaways:
• Myelogram preparation is most similar to a lumbar puncture due to shared technique and spinal access.
• Contrast dye is used in both procedures, requiring allergy assessment and informed consent.
• Other tests like EEG, MRI, and cerebral angiography differ significantly in terms of invasiveness and preparation.