LP
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LP
LP
LP
verb An abbreviation of a back-formation of the noun lumbar puncture, lumbar punctate; as in to lumbar puncture (LP) a patient.lipoprotein
(lip?o-pro'ten?, prot'e-in) [ lipo- + protein]Lipoproteins are classified as very low-density (VLDL), low-density (LDL), intermediate-density (IDL), and high-density (HDL). Increased levels of LDL and total cholesterol directly raise one's chances of having coronary heart disease (CHD). For this reason LDL has been referred to colloquially as “bad” cholesterol. By contrast, increased levels of HDL (“good” cholesterol) are linked with a lowered risk of CHD. The National Cholesterol Education Program has designated 70–100 mg/dl or less as a desirable level of LDL in those already affected by CHD; for people without CHD, a desirable level of LDL is 100 mg/dl or less.
See: atherosclerosis; coronary artery disease; hyperlipoproteinemia; statin; cholesterol for tableEtiology
Elevated levels of lipoproteins usually are the result of a diet too rich in fats, saturated fats, and cholesterols. Genetic disease also plays a part in some patients with extremely high lipoprotein levels.
Symptoms
High lipoprotein levels may cause no symptoms until patients develop arterial blockages. If arteries become blocked by lipoproteins, ischemic symptoms may develop.
Treatment
Abnormal lipoprotein levels become normal in many patients who consume less dietary fat and increase their exercise. When lipoproteins do not reach expected levels despite diet and exercise, medications to improve lipoprotein profiles are prescribed. These include drugs such as niacin, bile-acid binding resins, and the statins.
lipoprotein (a)
Abbreviation: Lp(a)alpha lipoprotein
High-density lipoprotein.high-density lipoprotein
Abbreviation: HDLintermediate-density lipoprotein
Abbreviation: IDLlipoprotein lipase
Abbreviation: Lp(a)low-density lipoprotein
Abbreviation: LDLLp(a) lipoprotein
oxidized low-density cholesterol lipoprotein
small, dense low-density lipoprotein
very low-density lipoprotein
Abbreviation: VLDLlipoprotein (a)
Abbreviation: Lp(a)lipoprotein lipase
Abbreviation: Lp(a)puncture
(pungk'chur) [L. punctura, prick]puncture of the antrum
Patient care
The antrum is irrigated with the prescribed solution (often warm normal saline solution) according to protocol. The character and volume of the returned solution and the patient's response to treatment are carefully monitored and documented. Ice packs are applied as prescribed for edema and pain; these are replaced by warm compresses as healing progresses. Assessments are made for chills, fever, nausea, vomiting, facial or periorbital edema, visual disturbances, and personality changes, which may indicate the development of complications.
arterial puncture
cerebrospinal puncture
cisternal puncture
CAUTION!
This procedure may be lethal if not done by one skilled in this technique.diabetic puncture
Bernard puncture.exploratory puncture
heel puncture
CAUTION!
The puncture should be made in the lateral or medial area of the plantar surface of the heel, while avoiding the posterior curvature of the heel. The puncture should go no deeper than 2.4 mm. Previous puncture sites should not be used.)
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lumbar puncture
Abbreviation: LPCAUTION!
Postprocedure headache occurs in about half of all patients who undergo lumbar puncture. Rarely reported complications of the procedure include cerebral herniation, epidural infection, epidural bleeding, paraparesis, and subdural bleeding.Procedure
Informed consent for the procedure is obtained except in dire emergencies when clinical judgment prevails. Appropriate equipment is gathered: sterile gloves and mask for the operator, skin antiseptic (povidine-iodine solution), local anesthetic (1% lidocaine), and a lumbar puncture tray containing sterile gauze sponges, fenestrated drape and towel, needles and syringe for anesthesia, spinal needles, 4 collection tubes, 3-way stopcock and manometer; and a small adhesive bandage.
The procedure and expected sensations are explained, and the patient is asked to remain still when positioned and to breathe normally. The patient is typically placed on his or her left side at the right edge of the bed or examining table with knees drawn up to the abdomen and chin down to the chest, or in a sitting position with legs over one side of the table and buttocks at the other, bending head and chest toward the knees. Either of these positions exposes the back to the operator and provides spinal flexion, allowing easy access to the lumbar subarachnoid space. The assisting nurse holds the patient appropriately to secure this position (one arm around the neck, the other around the knees, or holding both shoulders bent forward). Draping provides warmth and privacy. Next, the patient's skin is prepared with antiseptic solution, and a sterile fenestrated barrier is placed over the proposed puncture site. Local anesthetic is injected, and then the spinal needle, with its stylet in place, is slowly advanced between the vertebra into and through the dura and arachnoid membranes. The stylet that fills the needle is removed, and initial measurements are made of the opening intracranial pressure (ICP) with a manometer. When the procedure is performed for diagnosis, about 8 to 10 ml of fluid are collected and sent promptly to the clinical laboratory for analysis of cell count, glucose, protein levels, cultures stains, and special studies. The closing pressure should then be read, the needle removed, and a small impervious adhesive dressing applied, sometimes with collodion to prevent CSF leakage. See: illustration
Complications
Pain at the puncture site, infection, bleeding, neurological injury, death, and post–spinal tap headaches are all potential complications. Of these, postural headache, caused by chronic leakage from the puncture site, is the complication most often brought to the attention of health care professionals. It may be treated with the injection of a small amount of the patient's own blood epidurally, to form a blood patch. See: cerebrospinal fluid
Patient care
The nurse assists the operator throughout the procedure by numbering and capping specimen tubes for laboratory examination and by applying jugular vein pressure as directed. Reassurance and direction are provided to the patient throughout the procedure, and the patient is assessed for adverse reactions (elevated pulse rate, pain radiating into the limbs, pallor, clammy skin, or respiratory distress).
After the procedure, the nurse assesses vital signs and neurological status, particularly observing for signs of paralysis, weakness, or loss of sensation in the lower extremities. If CSF pressure is elevated, the patient’s neurological status should be assessed every 15 min for 4 hr, if normal, every hour for 2 hr, then every 4 hr or as ordered. The puncture site should be checked hourly for 4 hr, then every 4 hr for 24 hr, assessing for redness, swelling, and drainage. To decrease the chance of headache, oral intake (for spinal fluid replacement and equalization of pressures) is encouraged, and the patient should remain in bed in a supine position or with the head elevated no more than 30° for 4 to 24 hr (per operator or institutional protocol). The patient should not lift his or her head but can move it (and himself or herself) from side to side. Noninvasive pain relief measures and prescribed analgesia are provided if headache occurs.
Quincke puncture
See: Quincke, Heinrichspinal puncture
Lumbar puncture.sternal puncture
tracheoesophageal puncture
Abbreviation: TEPventricular puncture
lumbar puncture
Abbreviation: LPCAUTION!
Postprocedure headache occurs in about half of all patients who undergo lumbar puncture. Rarely reported complications of the procedure include cerebral herniation, epidural infection, epidural bleeding, paraparesis, and subdural bleeding.Procedure
Informed consent for the procedure is obtained except in dire emergencies when clinical judgment prevails. Appropriate equipment is gathered: sterile gloves and mask for the operator, skin antiseptic (povidine-iodine solution), local anesthetic (1% lidocaine), and a lumbar puncture tray containing sterile gauze sponges, fenestrated drape and towel, needles and syringe for anesthesia, spinal needles, 4 collection tubes, 3-way stopcock and manometer; and a small adhesive bandage.
The procedure and expected sensations are explained, and the patient is asked to remain still when positioned and to breathe normally. The patient is typically placed on his or her left side at the right edge of the bed or examining table with knees drawn up to the abdomen and chin down to the chest, or in a sitting position with legs over one side of the table and buttocks at the other, bending head and chest toward the knees. Either of these positions exposes the back to the operator and provides spinal flexion, allowing easy access to the lumbar subarachnoid space. The assisting nurse holds the patient appropriately to secure this position (one arm around the neck, the other around the knees, or holding both shoulders bent forward). Draping provides warmth and privacy. Next, the patient's skin is prepared with antiseptic solution, and a sterile fenestrated barrier is placed over the proposed puncture site. Local anesthetic is injected, and then the spinal needle, with its stylet in place, is slowly advanced between the vertebra into and through the dura and arachnoid membranes. The stylet that fills the needle is removed, and initial measurements are made of the opening intracranial pressure (ICP) with a manometer. When the procedure is performed for diagnosis, about 8 to 10 ml of fluid are collected and sent promptly to the clinical laboratory for analysis of cell count, glucose, protein levels, cultures stains, and special studies. The closing pressure should then be read, the needle removed, and a small impervious adhesive dressing applied, sometimes with collodion to prevent CSF leakage. See: illustration
Complications
Pain at the puncture site, infection, bleeding, neurological injury, death, and post–spinal tap headaches are all potential complications. Of these, postural headache, caused by chronic leakage from the puncture site, is the complication most often brought to the attention of health care professionals. It may be treated with the injection of a small amount of the patient's own blood epidurally, to form a blood patch. See: cerebrospinal fluid
Patient care
The nurse assists the operator throughout the procedure by numbering and capping specimen tubes for laboratory examination and by applying jugular vein pressure as directed. Reassurance and direction are provided to the patient throughout the procedure, and the patient is assessed for adverse reactions (elevated pulse rate, pain radiating into the limbs, pallor, clammy skin, or respiratory distress).
After the procedure, the nurse assesses vital signs and neurological status, particularly observing for signs of paralysis, weakness, or loss of sensation in the lower extremities. If CSF pressure is elevated, the patient’s neurological status should be assessed every 15 min for 4 hr, if normal, every hour for 2 hr, then every 4 hr or as ordered. The puncture site should be checked hourly for 4 hr, then every 4 hr for 24 hr, assessing for redness, swelling, and drainage. To decrease the chance of headache, oral intake (for spinal fluid replacement and equalization of pressures) is encouraged, and the patient should remain in bed in a supine position or with the head elevated no more than 30° for 4 to 24 hr (per operator or institutional protocol). The patient should not lift his or her head but can move it (and himself or herself) from side to side. Noninvasive pain relief measures and prescribed analgesia are provided if headache occurs.