Which of the following are true regarding the preparation of a client for a lumbar puncture? (Select all that apply.)
A. Positioning of the client for a lumbar puncture is very important.
B. The usual preparation includes a shower with an antiseptic soap.
C. A common complication is puncture of the spinal cord during this procedure.
D. This procedure should not be initiated if the client has suspected or actual intracranial hypertension.
E. An LP or spinal tap is used to obtain CSF for laboratory examination.
F. The client needs to maintain a nothing-by-mouth status for at least 2 hours prior to the LP.G. A blood glucose sample must be drawn 30 to 60 minutes prior to the LP for comparison with the CSF glucose level.
A, D, E, G
Rationale: Positioning is important to provide for maximal separation of the vertebrae; the client may be side-lying in a fetal position, with the head and knees close together, or sitting, bent over a bedside table. The usual preparation includes a skin antiseptic applied by the physician after draping the client to provide a sterile field. The spinal cord usually terminates at the second lumbar vertebra and therefore is not touched by the needle. An LP measures CSF pressure; CSF analysis by the laboratory is used to help differentiate CNS and peripheral nerve syndromes. A serum glucose close to the time of CSF sample procurement is needed to interpret the CSF result (e.g., is the elevation in CSF due to hyperglycemia or an infectious process?).
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