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Diagnostic Tests

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					Special Examinations
          &
        Tests

  Nursing Fundamentals
       Chapter 13
Diagnostic Examination

• Is a procedure that involves physical
 inspection of body structures and evidence
 of their functions (making sure organs are
 working)

• Diagnostic exam is done with the use of
 equipment
Equipment

• Radiography (x-rays)
• Endoscopy (optical scopes)
• Radionucleide imaging (radioactive
  chemicals)
• Ultrasonography (high frequency sound
  waves)
• Electrical graphic recordings
Laboratory Tests

• Procedures that involve the examination of
  body fluids or specimens
• Laboratory tests involve comparing the
  components of a collected specimen with
  normal findings

• These are lab tests such as CBC or CMP or
 UA/C+S
Preprocedural Care

• Clarifying explanations –
• It is important that pts understand what
 procedure they will be having

• Pts should not sign forms for procedures
 unless they completely know what will
 happen
Informed Consent

• The consent given by a person after
 receiving full explanation including risks
 and benefits of a procedure that will take
 place
Informed Consent Must Include
• 3 elements:
• Capacity – indicates that the pt has the ability to
  make a rational decision about what will happen
  and its outcome

• Comprehension – indicates that the pt
  understands what was said about the procedure

• Voluntariness – indicates that the pt is acting on
  his own free will.
Preparing Clients For Tests
• Withholding food
• Nurse refers to written protocols for prep before
    tests
•   Directions are provided to the pt, nursing staff
    and other depts in the hospital and others
    involved in the test
•   Helping pt get into gowns and putting on ID
    bracelets and allergy bracelets, getting VS,
    telling pt to urinate
•   The completetion of all forms before pt
    undergoes the procedure
Obtaining Equipment & Supplies

• Nurses do it all
• We prepare the pt, we prep the room, we
  have pt sign the forms
• We explain procedures
• We prepare the equipment
• We take care of the pt and their family
Some equipment that may be
needed
• Packaged kits like:
• lumbar puncture kits, chest tube kits,
 foley kits, sterile equipment, canisters,
 tubes, syringes, evacuation bottles
Arranging the Examination Area
• The nurse removes unnecessary articles from
    the exam or procedural area
•   The nurse provides privacy by pulling the curtain
•   The nurse makes sure all equipment is present
    and stocked
•   The nurse covers the exam table with new paper
    or linens
•   The nurse arranges the equipment to be used
    for easier access
•   The nurse leaves sterile items wrapped or
    covered until just before their use
Positioning of the Patient
• Dorsal recumbent position – on back with
    knees bent
•   Lithotomy position – on back with feet in
    stirrups
•   Sim’s position – on belly with one leg sl. bent
•   Knee-chest position – on belly with knees
    bent
•   Modified standing position – standing up
    with upper body bent over a table
Which position are they in?
Assisting the Examiner
• The nurse must be familiar with all of the
    equipment
•   The nurse anticipates what the examiner will
    need next and provides it to him
•   The nurse holds supplies and containers for the
    examiner
•   The nurse holds med containers so the examiner
    can see the label
•   The nurse delegates to other nurses or
    assistants when help is needed
•   The nurse keeps the room in control
Providing Physical & Emotional
Support
• The nurse tends to the pt’s needs while
  awake and asleep
• If awake, nurse provides position changes,
  blankets, suctioning to mouth
• If asleep, nurse provides privacy and
  maintains safety of the pt
Postprocedural Care

• Once all tests and exams are completed,
 the nurse attends to the pt’s needs for
 safety, comfort, cares for specimens,
 assesses VS, records and reports the
 findings
Specimens
• Samples of tissue or body fluids

•   The nurse:
•   Collects the specimen
•   Labels the container with pt. Information
•   Attaches the proper requisition form
•   Places in refrig or on ice so it won’t decompose
•   Delivers the specimen to the proper place
Recording & Reporting
• The nurse records pertinent information
    about the pt during the exam or procedure
•   She records:
•   Date & time
•   Pre-exam assessments, preparation and VS
•   Type of test or exam the pt underwent
•   Where it was performed on the body
•   Response of the pt during and after the
    procedure
•   Type of specimen if any, obtained
•   Appearance, size or volume of specimen and
    where it was taken
Common Diagnostic
Examinations
• Pelvic examination
• Radiography
• Endoscopic examinations
• Radionuclide Imaging
• Ultrasonography
• Electrical Graphic Recordings
Pelvic Exams
• Pelvic exams with pap smears

• This is the physical inspection of the vagina and
    cervix with palpation of the uterus and ovaries
•   A physician, physician’s assistant or NP performs
    this
•   The pap smear (papanicolaou) is a specimen of
    cervical secretions for abnormal cervical cells,
    status of reproductive hormone activity and
    normal or infectious microorganisms within the
    vagina or uterus
Radiography
• Procedures with x-rays such as:
• MRI – magnetic resonance imaging is a technique for
    producing an image by using atoms subjected to a
    strong electromagnetic fields. There are no rays of
    radiation. No metal objects may enter an MRI room
    such as metal implants, pacemakers and staples
•   Contrast – a substance that adds density to a body
    organ or cavity such as barium or iodine. These make
    hollow body areas appear more distant. Some people
    have an allergy to these. Allergies to shell fish may not
    have the contrast
MRI
Radiography
• CT – computed tomography this type of
  scanning shows planes of tissue
• CT uses a contrast medium that is
  swallowed or injected IV that requires the
  use of fluoroscopy to view organs and
  structures. Contrast medium makes it
  possible to identify differences in tissue
  density when obtaining x-ray images from
  various angles and levels in the body
CAT Scan (AV)
Related Nursing Responsibilities
• For pts undergoing radiographic examination,
    nursing responsibilities include the following:
•   1. Assess VS to get a baseline before the test
    starts to help detect changes in pt’s condition
    during and after the procedure
•   2. Remove any metal clips, bra clips, religious
    medals, these produce a dense image that may
    be confused with tissue abnormality
Related Nursing Responsibilities
• 3. Application of a lead apron or collar to protect
    fetus and vulnerable body parts during x-ray
•   4. Ask the pt if he has allergies to seafood or
    iodine before the exam or procedure begins.
    Reactions of the dye range from N/V to shock
    and coma
•   5. Know the location of the emergency equip. if
    allergies or emergencies occur
•   6. Plan the schedule of pts carefully, schedule
    procedures with iodine before those that use
    barium
Related Nursing Responsibilities
• 7. Instruct the pt to drink a large amount of
    water after the exam involving iodine to
    promote its secretion
•   8. Check on bowel elimination and stool
    characteristics for at least 2 days after
    administration of barium or other oral contrast
    medium. Barium retention can lead to
    constipation and bowel obstruction.
    Administration of laxative is often prescribed
Endoscopic Examinations
• Endoscopy – visual examination of internal
    structures, this is performed using optical
    scopes. Endoscopes have lighted mirror-lens
    systems attached to a tube and are quite flexible
    so that they can be advanced through curved
    structures
•   If endoscopic exams will cause discomfort or
    anxiety, a light sedative is given such as
    conscious sedation. Pts end up having no
    memory of the procedure though they
    communicate and interact with staff during the
    procedure
Examples of Endoscopic
Examinations
• Bronchoscopy – inspection of the bronchi
• Gastroscopy – inspection of the stomach
• Colonoscopy – inspection of the colon
• Laparoscopy – inspection of the abd cavity
• Cystoscopy – inspection of the bladder

• Anything with the word”scopy” means the Dr. is
  using a scope, usually to investigate
Nursing Responsibilities During
Endoscopic Procedures
• 1. Nurse prevents aspiration. Nurse tells
  pt to withhold fluid 6-8 hrs before
  procedure in preop visit. The scope is
  passed into the upper airway or upper GI
  tract
• 2. If conscious sedation is used, nurse
  assesses VS, O2 sats, cardiac rhythm and
  has resuscitation equip. ready
Nursing Responsibilities During
Endoscopic Procedures
• 3. If topical anesthesia is used, nurse tells pt in preop
    visit to withhold fluids and food for 2 hrs before
    procedure and cannot eat until swallow, cough and gag
    reflexes return
•   4. Relieve the pt’s sore throat with ice, fluids, or gargles
    when safe to do so
•   5. Confirms that bowel preps or laxatives and enemas
    have been used before procedure begins
•   6. Reports difficulty in arousing the pt, sharp pain, fever,
    bleeding, N/V or difficulty urinating after any type of
    endoscopic procedure
Endoscope
Endoscopy
Radionucleide Imaging
• Radionuclides are elements whose molecular
    structure are altered to produce radiation
•   Radionuclides are injected into the body by IV
    route, tissues or organs absorb them. The pt is
    then put into a scanning device that detects
    radiation which creates an image of the size,
    shape and concentration of the organ containing
    the radionuclide dye
•   Hot spots where the radionuclide is intensely
    concentrated, shows up as a lit up spot
• A radioisotope is introduced into the body (usually by injection). The
   radiation it emits, detected by a scanner and recorded, reflects its
   distribution in different tissues and can reveal the presence, size,
   and shape of abnormalities in various organs.

• The isotopes used have short half-lives and decay before
   radioactivity causes any damage.

• Different isotopes tend to concentrate in particular organs (e.g.,
  iodine-131 in the thyroid). Radioactive substances are also
  implanted to treat small, early-stage cancers. This yields a slow,
  continuous dose that limits damage to normal cells while destroying
  tumour cells.
• Examples: computerized axial tomography; diagnostic imaging;
  positron emission tomography; radiation therapy; radiology
2 advantages of radionuclide
imaging
• It visualizes areas within organs and tissue
 that are not possible with standard x-rays

• It involves less exposure to radiation than
  with standard x-rays
• Radionuclides are not recommended in
  pregnant or breastfeeding women d/t the
  energy being released is harmful to the
  rapidly growing cells of an infant or fetus
Example of a radionuclide
examination
• PET scan – positron emission tomography
• Tomography is a radiographic technique that
    selects a level in the body and blurs out
    structures above and below that plane leaving a
    clear image of the selected anatomy
•   This test combines the technology of
    radionuclide scanning with the layered analysis
    of tomography
•   The images in PET scan are in color and indicate
    the degree of metabolism or blood flow
PET SCAN
Nursing Responsibilities r/t
Radionuclide Imaging
• 1. Inquire about a woman’s menstrual and
  obstetric history, this type of imaging can
  be harmful to baby or fetus
• 2. Inquire about allergies esp. iodine
  (shellfish), this is in the dye
• 3. Be sure pt doesn’t have any metal
  implants, these interfere with diagnostic
  findings
Nursing Responsibilities r/t
Radionuclide Imaging
• 4. Obtain an accurate weight because the
  dose of radionuclide is directly r/t weight
• 5. Inform the pt that he will be radioactive
  for < 24hrs but urine and stool can be
  flushed away safely
• 6. Instruct premenopausal women to use
  effective birth control for a short period
  during which radiation continues to be
  present
Ultrasonography

• This is a soft tissue exam that uses sound
  waves in ranges beyond human hearing
• A hand-held probe projects sound through
  the body’s surface, the sound waves cause
  vibrations within body tissues producing
  images as the waves are reflected back
  toward the machine
What do we use ultrasound for
•   To visualize:
•   The breast
•   Abdomen and pelvic organs
•   Male reproductive organs
•   Structures in the head and neck
•   Heart and valves
•   Structures of the eyes
•   Air-filled structures such as lungs or intestines,
    and dense structures do not image well
Nursing Responsibilities r/t
ultrasound
• Perform the ultrasound before any barium
  study in order to be able to see hollow
  structures
• Instruct pt to drink 5-6 glasses of water to
  fill the bladder so it can be seen (tell the
  pt not to urinate until after the test)
• Explain that gel is applied over the area
  where the tranducer will be placed to
  better conduct an image
Ultrasound
Electric Graphic Recordings

• These are machines that record electrical
  impulses from structures such as heart,
  brain and skeletal muscles
• Electrodes (wires) are attached to the
  skin. The electrodes transmit electrical
  activity to a machine that converts it into
  a series of waveforms
Examples of Electric Graphic
Recordings
• Electrocardiogram (ECG or EKG) – heart
 waves

• Electroencephalography (EEG) – brain waves

• Electromyography (EMG) – this attaches a
 wire directly to a muscle(s) and examines the
 energy produced by stimulated muscles
Nursing Responsibilities r/t
EKG/ECG
• 1. The nurse must clean the skin and clip
  the hair in the area where the electrode
  tabs will be placed to ensure adherence
  and to reduce discomfort of removal
• 2. The nurse will attach adhesive tabs to
  the skin where the electrode wires will be
  fastened (avoid attaching the adhesive
  tabs over bones, scars, or breast tissue)
EKG
Electrocardiography
Nursing Responsibilities r/t EEG
• Instruct pt to shampoo the hair the evening
    before the procedure to facilitate the firm
    attachment of the electrodes and shampoo the
    hair after the test is completed to remove the
    adhesive from the scalp
•   Withhold coffee, tea and cola to avoid the need
    to urinate frequently for 8 hrs before the
    procedure
•   If sleep deprived EEG is scheduled, instruct the
    pt to stay awake after midnight before the
    examination
Electroencephalography
Nursing Responsibilities r/t EMG
• Tell the pt that he will be instructed to contract
    and relax muscles during the examination
•   Explain that electrical current is applied to
    muscles during an EMG and that the sensation
    can be painful, a muscle electrode is inserted
    with a small-gauge needle in 10 or more
    locations but the experience is painless unless it
    touches a terminal nerve in the area (pts I know
    state that this test hurts and they have begged
    Dr. to stop the test)
Electromyography
Diagnostic Laboratory Tests
• These are any tests where a specimen of some
  type is collected and sent to a lab for results

• Diagnostic lab tests include specimens such as:
• Blood, urine, stool, sputum, intestinal secretions,
  spinal fluid and drainage from wounds or
  infected tissue

• Lab manuals are always referred to for normal
  values by many staff members
Paracentesis
• This is a procedure for withdrawing fluid from
  the abdominal cavity to relieve pressure and to
  improve breathing which becomes labored when
  fluid crowds the lungs. At times, 1 liter or more
  may need to be removed. Specimen can be
  sent to the lab for microscopic examination

• A Physician is the only one to perform this with
  the assistance of a nurse
Paracentesis
Thoracentesis

• Needle is inserted into the thoracic cavity
 in order to remove fluid

• BIG CONCERN:
• Placing the needle in the pleural space
 causing a hemo or pneumothorax
Thoracentesis
Lumbar Puncture
• This involves the insertion of a needle between
    the lumbar vertebrae in the spine but below the
    spinal cord itself to remove CSF to test for
    microorganisms such as meningitis

• Pressure of spinal fluid can also be measured to
    detect malfunctioning shunt, tumor or other
    brain dysfunction
•   Fluid can be removed if contrast needs to be
    injected
•   Medication can be instilled into the spinal fluid
Nursing Responsibility r/t
Lumbar Puncture
• The nurse prepares the pt by explaining the
    procedure
•   The nurse prepares the area where the
    procedure will take place
•   The nurse holds the pt in a side lying position
    with knees bent as far to the chest as possible
    and with chin to chest (in a ball)
•   The nurse calms the pt throughout the
    procedure
Post-Lumbar Puncture

• The nurse instructs the pt to lay flat for up
  to 6-8 hrs to avoid the leakage of CSF
  which causes spinal headaches
Throat Culture

• A culture is an incubation of
  microorganisms and it is performed by
  collecting body fluids or substances
  suspected of containing infectious
  microorganisms that can be seen with a
  microscope
• The most common cause of throat
  infection is d/t streptococcal bacteria
Obtaining a Throat Culture
• The nurse obtains a specimen from the throat
    by either having the pt sit upright or having the
    pt lying down on their back
•   A cotton swab stick is placed in the back of the
    throat towards the tonsillar area and the area is
    swabbed back and forth
•   Rapid strep test is performed in an out-pt office
    and that same culture is sent off the to lab for
    further growth
Cultures
Measuring Capillary Blood
Glucose
• A glucometer is the instrument that is used
• Pt’s finger is poked, a drop of blood is put onto
    the strip and the strip is placed into the
    machine. Within 30 secs to 1 minute, the
    machine deciphers a blood glucose amount
•   Normal blood glucose is ???
•   Pts can perform this test at home and on self
•   Pts can then adjust their amount of insulin taken
    to better control blood glucose levels
Tips on measuring blood
glucose levels
• 1. Several glucose monitors are available.
  The nurse must become familiar with her
  facility’s meter. Allow pt to teach you
  about their glucometer for better learning
• Blood glucose should be measured up to
  30 minutes before eating a meal
• Always wear gloves when assisting a pt
  with blood glucose monitoring, (BSI)
Glucometer
NANDA Diagnoses
• Pts that undergo exams have much anxiety and
    many questions, you may find the following
    issues:
•   Anxiety
•   Fear
•   Impaired adjustment
•   Decisional conflict
•   Powerlessness
•   Spiritual distress
Arteriogram

• An arteriogram is an imaging test that
 uses x-rays and a special dye to see inside
 the arteries. It can be used to see arteries
 in the heart, brain, kidney, and many
 other parts of the body.

• The procedure is often called angiography
Arteriogram
Arteriography (AV)
Colonoscopy
Sigmoidoscopy (AV)
Bronchoscopy (AV)
Cystoscopy
IVP
• Intravenous
  pyelorogram – dye
   is used to examine
  the kidney

• Pt must drink
  increased amount
  fluids after this test
   is completed
Liver Biopsy (AV)
The End

				
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