MMRS Kamalnayan Bajaj Nursing College Aurangabad

Lesson plan
on
lumbar puncture
GENERAL OBJECTIVE

At the end of my Lesson plan, student will acquire knowledge regarding Lumbar Puncture and they will

develop positive attitude towards nursing intervention providing in community as will as in hospital . And also

develop skill in quality care to community people.

SPECIFIC OBJECTIVE

At the end of my Seminar Student will be able to-

1) Introduction of Lumbar Puncture.

2) Definition of lumbar puncture

3) Discuss the indications of lumbar puncture

4) Enlist the contraindications of lumbar puncture.

5) Discuss the preparation of patient for lumbar puncture

 6) Explain the procedure of lumbar puncture

7) Discuss the complication of lumbar puncture.

Teaching
Sr. Specific
Time Content Learning A.V. Aids Evaluation
No. Objectives
Activity
1. 5 Introduction Teacher B After
Min.
Introduction
introducing introducing
of Lumbar L
A lumbar puncture (spinal tap) is a test used to
the the topic
diagnose certain health conditions. It's performed in
Puncture C
your lower back, in the lumbar region. During a Lumbar student
lumbar puncture, a needle is inserted into the space
Puncture K know about
between two lumbar bones (vertebrae) to remove a
sample of cerebrospinal fluid. This is the fluid that the Lumbar
B
surrounds your brain and spinal cord to protect them
Puncture
from injury.
O

A lumbar puncture can help diagnose serious

infections, such as meningitis; other disorders of the A

central nervous system, such as Guillain-Barre

syndrome and multiple sclerosis; bleeding; or cancers R

of the brain or spinal cord. Sometimes a lumbar

puncture is used to inject aesthetic medications or D

chemotherapy drugs into the cerebrospinal fluid.“The

procedure of taking fluid from the spine in the lower Student

back through a hollow needle, usually done for getting

diagnostic purposes”.
knowledge
Indication regarding

LP is essential or extremely useful in the diagnosis Lumbar

of Puncture

 Bacterial,

 Fungal,

 Mycobacterial,

 Viral central nervous system (CNS) infections

In certain settings, for help in the diagnosis of

 Subarachnoid Haemorrhage (SAH),

 CNS Malignancies,

 Demyelinating diseases,

Contraindications

Absolute contraindications for lumbar puncture are the

presence of infected skin over the needle entry site

 and the presence of unequal pressures between the

supratentorial and infratentorial compartments. The

latter is usually inferred from the following

characteristic findings on computed tomography (CT)

of the brain:

 Midline shift

 Loss of suprachiasmatic and basilar

cisterns

 Posterior fossa mass

 Loss of the superior cerebellar cistern

 Loss of the quadrigeminal plate cistern

1. 5 Enlisting the Relative contraindications for lumbar puncture Teacher B After enlisting
Min.
contraindication include the following: enlisting the
L
the student
of Lumbar  Increased intracranial pressure contraindicatio C know about

Puncture (ICP) n of Lumbar the

K
 Coagulopathy Puncture contraindication
B
 Brain abscess.

Contraindications
A

Absolute contraindications for lumbar puncture

R
are the presence of infected skin over the

needle entry site and the presence of Student D

unequal pressures between the supratentorial concentrating

and infratentorial compartments. The latter is toward the

usually inferred from the following contraindicatio

characteristic findings on computed n of Lumbar

tomography (CT) of the brain: Puncture

  Midline shift

 Loss of suprachiasmatic and

basilar cisterns

 Posterior fossa mass

 Loss of the superior cerebellar

cistern

 Loss of the quadrigeminal plate

cistern

1. 5 Enlisting the Teacher B After enlisting

Min.
contraindication Preparation of patient enlisting the the student
L
contraindicatio know about
of Lumbar Before your lumbar puncture (spinal tap),
C
n of Lumbar the
Puncture
your health care provider takes your medical
Puncture K contraindication

history, does a physical exam, and orders

blood tests to check for bleeding or clotting B

disorders. Your provider may also recommend O

a CT scan or MRI to determine if you have A

any abnormal swelling in or around your Student R

concentrating
brain D
toward the

contraindicatio
The smaller the needle used for the lumbar
n of Lumbar
puncture, the lower the risk that the patient
Puncture
will experience a post–lumbar puncture

headache. Data suggest an inverse linear

relation between needle gauge and headache

incidence, and some authors recommend

using a 22-gauge needle regardless of what

size needle is supplied with the kit.

The use of atraumatic needles has

been shown to significantly reduce the

incidence of post–lumbar puncture headache

(3%) when compared to the use of standard

spinal needles (approximately 30%). In

addition, it may lead to cost

savings. However, obtaining pressures can be

more difficult with atraumatic needles.

Prophylactic bed rest after lumbar

puncture has not been shown to be of

benefit and should not be recommended.

The overall risk of post dual puncture

headache (PDPH) does not appear to be

influenced by opening pressure, closing

 pressure, and volume of cerebrospinal fluid

removed in instances of high-volume removal.

5 Discussion Technical Considerations Teacher B After

Min.
regarding discussing discussion
Complication prevention L
the student get
the
The following measures should be taken to help minimize C
technical knowledge
technical
complications of lumbar puncture:
considera- K regarding
considera-
 Explain the procedure, benefits, risks,
tion lumbar
tion in B
complications, and alternative options to the
puncture
lumbar patient or the patient’s representative, and O

puncture obtain a signed informed consent

A
procedure  Before performing the lumbar puncture, ensure R

that patients are hydrated so as to avoid a dry

D
tap

 Never allow a lumbar puncture or a pre–lumbar

puncture CT scan to delay administration of

intravenous (IV) antibiotics; meningitis can

usually be inferred from the cell count, antigen

detection, or both

 Avoid lumbar puncture in patients in whom the

disease process has progressed to the

neurologic findings associated with impending

cerebral herniation (ie, deteriorating level of

consciousness and brainstem signs that include

pupillary changes, posturing, irregular Student

respirations, and very recent seizure) getting

The smaller the needle used for the lumbar puncture, the knowledge

lower the risk that the patient will experience a post– regarding

lumbar puncture headache. Data suggest an inverse linear lumbar

relation between needle gauge and headache incidence, puncture

and some authors recommend using a 22-gauge needle

regardless of what size needle is supplied with the kit.

The use of atraumatic needles has been shown

to significantly reduce the incidence of post–lumbar

puncture headache (3%) when compared to the use of

standard spinal needles (approximately 30%). In addition,

it may lead to cost savings. However, obtaining pressures

can be more difficult with atraumatic needles.

Prophylactic bed rest after lumbar puncture

has not been shown to be of benefit and should not be

recommended.
The overall risk of post dual puncture headache (PDPH)

does not appear to be influenced by opening pressure,

closing pressure, and volume of cerebrospinal fluid

removed in instances of high-volume removal.

5 Explain Lumbar Puncture Procedure Teacher B After explain
Min.
the lumbar A lumbar puncture (spinal tap) is usually done explaining L
procedure

puncture in an outpatient facility or a hospital. Your health care the lumbar student able
C
procedure provider will talk to you about the potential risks, and any puncture to do the

discomfort you might feel during the procedure. K procedure

If a child is having a lumbar puncture, a B

parent may be allowed to stay in the room in some

O
cases. Talk to your child's health care provider about

whether this will be possible. A

Before the procedure

D
You may be asked to change into a hospital

gown, although in some cases you may have the

procedure while wearing your own clothing. There are a

few possible positions for a lumbar puncture (spinal tap).

Usually, you lie on your side with your knees drawn up

to your chest, or you sit and lean forward on a stable

surface. These positions flex your back, widening the

spaces between your vertebrae and making it easier for

your health care provider to insert the needle. Your back

Student
is washed with antiseptic soap or iodine and covered with
getting
a sterile sheet.
knowledge
For an infant or a young child, someone will
regarding
hold the child in position during the procedure.
Lumbar

Puncture
During the procedure

 A local anesthetic is injected into your lower back

to numb the puncture site before the needle is

inserted. The local anesthetic will sting briefly as

 it's injected.

 A thin, hollow needle is inserted between the two

lower vertebrae (lumbar region), through the spinal

membrane (dura) and into the spinal canal. You

may feel pressure in your back during this part of

the procedure.

 Once the needle is in place, you may be asked to

change your position slightly.

 The cerebrospinal fluid pressure is measured, a

small amount of fluid is withdrawn and the pressure

is measured again.

 The needle is removed, and the puncture site is

covered with a bandage.

 The procedure usually lasts about 45 minutes. Your

health care provider may suggest lying down after

 the procedure.

 Sometimes, an ultrasound may be used as a guide

during a lumbar puncture on infants and young

children. The ultrasound can help prevent inserting

the needle too far.

After the procedure

 Plan to rest. Don't participate in strenuous activities

the day of your lumbar puncture (spinal tap).

 You may return to work if your job doesn't require

you to be physically active.

 Discuss your activities with your health care

provider if you have questions.

 Take a pain medication.

 A nonprescription pain-relieving medication that

contains acetaminophen (Tylenol, others) can help

reduce a headache or back pain.

 If your headache becomes severe, call your health

care provider.
1. 5 Enlist the Complications Teacher B After
Min.
complication Possible lumbar puncture–related complications Enlisting enlisting the
L

include the following the complication

of lumbar
C
Post–spinal puncture headache student are
puncture  complication

Bloody tap K well know

 of lumbar
 Dry tap about the
puncture B

 Infection prevention
O
 Haemorrhage of

 Dysesthesia A complication

 Post–dural puncture cerebral herniation R

D
Student

getting

knowledge

regarding
 lumbar

puncture

1. 5 Summaries Summery Teacher B Student get

Min.
I would like to summaries my topic i.e. Lumbar summerin L
the
the lumbar
Puncture in that we seen firstly Introduction of g the knowledge
C
puncture
Lumbar Puncture in that A lumbar puncture (spinal tap) lumbar regarding

is a test used to diagnose certain health conditions after puncture K the lumbar

that we seen the definition , after that we seen the Puncture

B
Indications in that we seen the Bacterial, Fungal,
O
Mycobacterial, Viral central nervous system (CNS)

infections. Then we seen the contraindications in that A

Increased intracranial pressure (ICP) Coagulopathy

R
Brain abscess in that condition we can not performing
D
the this procedure after that we seen the preparation
of the patient for performing procedure, after that we

seen the steps of procedure in the we perform the

procedure, lastly we seen the complication of

procedure.

Conclusion

I would like to we seen the topic i.e. lumbar puncture

the knowledge regarding lumbar puncture are use

student in clinical practice in that they able to

performing the procedure and improving the clinical

skill and using this information in day to day practice