Question

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

a. the client needs mechanical ventilation
b. vomiting continues
c. intracranial pressure, ICP, is increased
d. blood is anticipated in the cerebral spinal fluid (CSF)

Answer 1

c. intracranial pressure is increased

*Sudden removal of CSF results in pressures lower in the lumbar region than the brain and favors herniation of the brain; therefore, LP is contraindicated with increased ICP. Vomiting may be caused by reasons other than ICP, so LP is not strictly contraindicated. LP may be performed on a client needing mechanical ventilation.*Blood in the CSF is diagnostic for subarachnoid hemorrhage, and was obtained before signs and symptoms of increased ICP.

Answer 2

Lumbar puncture is contraindicated in a subarachnoid hemorrhage patient when intracranial pressure is increased, as it can lead to brain herniation.

Step-by-step explanation:

A lumbar puncture (LP) is contraindicated in a client with a subarachnoid hemorrhage when the intracranial pressure (ICP) is increased. Performing LP in the presence of increased ICP can lead to brain herniation, a potentially deadly complication due to the pressure gradient created between the cranial and spinal compartments. Therefore, it is crucial to avoid lumbar puncture in patients suspected of having elevated ICP related to subarachnoid hemorrhage or other conditions. While the presence of blood in the CSF, the need for mechanical ventilation, and ongoing vomiting are concerning, they do not constitute absolute contraindications for LP.