Fundamental Nursing Skills and Concepts Chapter 13 Page 209 Diagnostic Examination • Procedure that involves physical inspection of body structures and evidence of their function. • Facilitate by use of technical equipment and techniques such as: • Radiography • Endoscopy Diagnostic Examination • Radionuclide imaging • Ultrasonography-high frequency sound waves- • Electrical graphic recordings • In order to figure out the test described, learn the root words and suffexes. Table 13-1 page 210. • A test involves physical data and comparing the results to normal findings. • Laboratory test-procedure that involves the examination of body fluids or specimens General Nursing Responsibilities • Pre-procedural care-consent must contain three elements: capacity, comprehension, and voluntariness. Box 13-2 page 210 • Clarify explanations, see what the patient understands. What is going to happen, the prep, the procedure and activities involved post the procedure. The nurse must repeat, simplify, clarify, or expand the original explanation. Find out how much of the physicians explanation the patient understands. General Nursing Responsibilities • Preparing clients-example NPO- modify diets. All affected departments must co-operate, pt. nursing, dietary. • Outpatient, must understand responsibilities. NPO, bath, any preps such as enemas. Some one to provide transportation. Arrive at test site early. Id self, and procedure at registration desk and provide insurance information. • The nurse will assist with gown, ID. bracelet, v/s, wt. and suggest to empty bladder. Monitor pts. condition that has to wait. Be sure to ask about routine meds taken or not. General Nursing Responsibilities • Obtaining equipment and supplies-@ bedside, obtain ahead of time, the equipment and supplies. Does the batteries work? Overhead lights? Clean room? Is it a well stocked room? Is equipment and supplies arranged for easy access by the examiner? • In other places, technician may be responsible for performing all necessary procedures, such as OR, Radiology, Scans. • Universal or Standard Precautions apply- gloves, goggles, masks, gowns. General Nursing Responsibilities • Arrange the examination room. If the patients room is to be used for the procedure, the nurse removes unnecessary articles and readies it for the procedure. • The nurse provides for privacy • Position and drape the client and stay with the client providing for physical and emotional support. During procedure • The nurse assists the examiner by positioning and draping-5 positions- page 213. Depends on type of exam, condition of patient and preference of examiner. Positions for Procedures • Dorsal recumbent position • Lithotomy position • Sims • Knee-chest position • Modified standing position During procedure • The nurse anticipates what is needed. • The nurse places needed items on the examiners dominant hand side with equipment that works, please. • The nurse hands one item @ a time. • If meds are held for withdrawl-the nurse reads the label or holds in such a way as to allow the doctor to read. Page 214 fig 13.3 • The nurse attends to the safety and comfort of the patient. Assisting • When assisting the examiner the nurse must be familiar with procedure and the equipment. • Place items on examiners dominant side or hand one @ a time. • Anesthesia to be used, nurse holds up vial, reads label concentration and name of med., examiner withdraws amount needed, without touching vial and therefore contaminating self. • Patient not to be left alone. • To summon help, use call light, telephone or yell if need be depending on severity of need. Assisting • Provide physical and emotional support: Nurse continuously observes patient for physical and emotional reactions and acts accordingly. Hold patients hand , offer words of encouragement to help with temporary discomfort. Assessments communicated to examiner, may shorten or modify the exam if patient unable to continue, “weak”, “fatigued”, has “pain”. Please convey your observations to the Doctor or examiner. Postprocedural Care • Attend to the client’s comfort and safety. Assess vital signs and client stability until stable, pt. cleaned, new gown applied, outputs, may need assistance with redressing. Escort to room. Instructions for follow-up care. • Care for specimens- collect in appropriate container, label the specimen- complete lab slip- deliver to lab ASAP. Nurse is responsible for speci-collecting, labeling, request form completion and delivery to lab. Samples of tissue or body fluids are specimens. Recording and Reporting Data Pg. 214 • Always record and report pertinent data. • V/S are re-checked until stable. • Patients are escorted to their rooms for follow-up or dismissal. • Dismissal slip should contain instructions with numbers to call for assistance. Adverse signs and symptoms should be listed. When to resume food, activities, and driving. Common Diagnostic Tests • Pelvic Examination-Physical inspection of the vagina and cervix, with palpation of the uterus and ovaries. • Papanicolaou test- Pap test- screens for abnormal cervical cells, status of reproductive hormone activity, normal or infectious microorganisms. Should be done on adult woman 3 years after the onset of vaginal intercourse but no later than 21 years of age. Recommendations listed on 214b. Pap tests results pg. 215 table 13-3. class I is negative, no abnormal cells. Is class V good or bad results? Common Diagnostic Tests • Radiography-X-Rays-electromagnetic energy passes through body structures leaving an image of dense tissue on special film. X-rays cannot be felt, but the rays are absorbed by cells. Repeated exposures can lead to cancer. Lead aprons or collars are used to shield parts of the body that should not be exposed. Radiology tech. use name tag or badges that are sensitive to the rays to let the tech. know how much they have been exposed to. • Magnetic Resonance Imaging-MRI- technique for producing an image by using atoms subjected to a strong electromagnetic field. Metal is a no-no. no pacemakers, metal implants, staples, screws, plates or bolts. Common Diagnostic Tests • Contrast Medium-substance that adds density to a body organ or cavity. Barium or iodine, makes it possible to identify variations, show borders or tissue density. Please be aware of allergic reactions. • Mild reaction-N/V, skin rash, itching. • A severe reaction, shock even death. • Ask the pt. if there is an allergy to shellfish. This will indicate if there is an allergy to iodine. Common Diagnostic Tests • Used a contrast media for a test? Then you need to assist the pt. to expel it. Large amount of fluid to promote urinary excretion. Intraveneous administration, increase fluid intake. Oral or rectal route, laxitive administration is needed, can lead to constipation and bowel obstruction. • Fluoroscopy-displays an image in real time with contrast media, (ie. Barium swallow) • CT scan- shows planes of tissue. Page 216. related nursing responsibilities Related Nursing Responsibilities • Assess vital signs before and after testing • Remove any metal items • Request a lead apron to shield a fetus or vulnerable body parts • Determine if the client is allergic to iodine • Know location of emergency equipment • Schedule iodine studies before the barium • Encourage large amounts of fluid to clear iodine • Check on bowel elimination for 2 days after barium studies Endoscopy • Visual exam of internal structure. Lighted mirror, lens system with collection device to gather tissues. Short acting anesthesia may be used. • What is a biopsy? (Sample of tissue) may be out patient basis. • PAGE 217 RELATED NURSING RESPONSIBILITIES. • BOX 13-4 EXAMPLES OF ENDOSCOPIC EXAMS Endoscopy • Visual examination of internal structures • Prevent aspiration withhold food and fluid or advise the client to do so before the procedure • Conscious sedation-monitor vital signs, breathing, oxygen saturation, and cardiac rhythm • Withhold food or fluids following procedure until gag reflex returns • Report any pain Radionuclide studies • Iodine or radioactive media is introduced to the body then picked up by scanning device to detect size, shape, function of structure. Visualizes areas within organs and tissues that are not possible with standard x-rays. Less exposure to radiation. Pregnant or breastfeeding women are not candidates for this procedure. • PET (positron emission tomography), combines radionuclide scanning and layered analysis. Contraindicated for pregnant women and nursing moms. ALLERGIES TO IODINE??? Always ask. Radionuclides • Inquire about women’s menstrual and obstetric history • Determine allergies • Have client wear a gown, robe, and slippers • Obtain an accurate weight • Inform client of radioactivity for 24 hours • Instruct premenopausal women to use effective birth control for a brief period Ultrasonography • Soft tissue examination that uses sound waves. Hand held transducer is used to project sound through the bodies surface which makes vibrations within the bodies tissues. Images are produced as the waves are reflected back toward the machine. Extremely safe. Related nursing responsibilities pg. 218 • Schedule abdominal and pelvic ultrasound before barium studies • Instruct clients undergoing abdominal ultrasonography to drink 5-6 full glasses of fluid 1-2 hours before the examination • Acoustic gel is used on area where transducer is placed Electrical graphic recordings • Encephalography-EEG-exam of the energy emitted by the brain, please shampoo before and after procedure. No caffeine for 8 hours before procedure. • Electrocardiography-ECG or EKG- exam of the electrical activity in the heart, electrodes attached to the skin. Transmit electrical activity to a machine that converts it into a series of waveforms are recorded for interpretation. Electrical Graphic Recordings • Clean skin and clip hair where electrode tabs are placed • Attach adhesive electrode tabs to skin • Do not attach to bones, scars, or breast tissue • Instruct client having EEG to shampoo hair before and after the test • Withhold coffee, tea, and cola for 8 hours before the test • If sleep deprived EEG, instruct client to stay awake after midnight before the examination Diagnostic Laboratory Tests • Paracentesis- puncturing the skin and withdrawing fluid from the abdominal cavity. This test is done to relieve abdominal pressure, and improve breathing. Nursing guidelines 13-1, pg. 219 • Lumbar puncture- inserting a needle into the lumbar vertebrae. Spinal fluid pressure is measured, fluid is withdrawn for lab. Used to dx. conditions that raise the pressure within the brain. Pg. 221. fig. 13.9. Diagnostic laboratory tests • Throat culture – to collect a specimen. 24-72 hours for growth of bacteria. After staining Gm (+) appears violet. Gm (-) appears red. Top pg. 222 nursing guidelines for collecting a specimen for a throat culture. Blood glucose- to check blood glucose levels always wear gloves. Measuring amount of glucose in capillary blood. Measured ½ hour before meals and at bedtime. The range is from 80-120 mg/dl. THE NURSE • Is to assist with positioning, draping, holding the patient, specimen collection, labeling and sending to the lab, making patient comfortable, teaching and documenting. • May need to obtain the permit as well. Nursing Implications • Anxiety • Fear • Impaired Adjustment • Decisional conflict • Health-seeking Behaviors • Powerlessness • Spiritual Distress GENERAL GERONTOLOGIC CONSIDERATIONS • Prevent fatigue- bedside commode, hands on assistance, co-ordinate with exam dept. so as to not have a long wait for the patient. • Prevent dehydration- offer fluids ASAP. • Drug therapy concerns- consult with physician, small amount of water with B/P and heart meds.??? • Lab results- may differ due to norms being taken on younger adults, so they may differ, therefore unless age specific norms are avaliable, results for older adults are subject to misinterpretation.