Common Diagnostics Procedures Non Invasive Procedures Characteristics: 1.

It provides an indirect assessment of organ size, shape, and / or function 2. It is safe 3. It is easily reproducible 4. It requires less complex equipment for recording 5. It does not require the written consent of patient or guardian General Nursing Tasks: 1. Decrease patients anxieties and offer support by  Explain purpose and procedure of test  Acknowledge questions regarding safety of the procedure  Remain with the patient while the procedure is going on 2. Use procedure in the collection of specimens that avoids contamination A. Graphic studies of Heart and brain 1. Electrocardiogram (ECG)

4. Echoencephalogram

Beam of ultrasound is passed though the head, and returning echoes are graphically recorded. Used to detect subdural hematomas, intracerebral hemorrhage, or tumors.

B. Roentgenological studies (X-ray) 1. Chest

used to determine size, contour of the heart; size, location, and nature of pulmonarylesions: pleural thickening and effusions: pulmonary vasculature: disorder of thoracic onesand soft tissues

used lead shield to protect pregnant woman 2. Kidney, Ureter, and Bladder (KUB)

used to determine size, shape, and position of kidney, ureter and bladder No special consideration

Graphic record of electrical activity generated by the heart during depolarization and depolarization Diagnose abnormal cardiac rhythms and coronary heart disease

3. Breast (Mammography)

Examination of the breast with or without the injection of the radiopaque substance into the duct of mammary gland. No deodorant, perfume, powder, or ointment in underarm area on the day of X-ray (contains Calcium oxalate) May be uncomfortable due to the pressure on the breast. (uses two x-ray plates)

2. Echocardiography (ultrasound cadiography)

Graphic record of motions produced by cardiac structure as high frequency sound vibrations are echoed through chest wall into the heart Used to demonstrate valvular or other structural deformities, detect pericardial effusion, diagnose tumors and cardiomegaly, evaluate prosthetic valve function.

C. Roentgenological studies (FLUOROSCOPY) requires the ingestion or injection of a contrast medium to visualize the target organ Additional Nsg. Task:  Administration of enemies or cathartics before the procedure and laxative after.  Keeping the patient NPO 6-12 hours before examination  Ascertain patients allergy and allergic reactions  Observing for allergic reactions to contrast medium  Providing fluid and food after procedure to prevent dehydration

3. Electroencephalogram (ECG)

Graphic record of the electrical potentials generated by the physiological activity of the brain Used to detect surface lesions or tumors of the brain and presence of epilepsy

 Observe stool for color and consistency until barium passes 1. Upper GI (Barium Swallow)

3. Cholecystogram

ingestion of barium sulfate or meglumine diatrizoate (Gastrografin [white and chalky substance], followed by fluoroscopic and x-ray examination) used to determine patency and caliber of the esophagus and to detect esophagealvarices, mobility of gastric wall, presence of ulcer, filling defects due to tumor,patency of pyloric valve and presence of structural abnormalities

ingestion of organic iodine contrast medium (Telepaque) followed in 12 hour by x-ray visualization gallbladder disease is indicated with poor or no visualizationof the bladder accurate only if GI and liver function is intact

perform before barium swallow and barium enema Patients preparations: administer large amount of water with contrast capsule low-fat meal before evening before x-ray oral laxative of stool softener after meal no food allowed after contrast capsule increased fluid intake, food and rest observe for any untoward reactions

2. Lower GI (Barium Enema)

rectal instillation of barium sulfate followed by glouroscopic and x-ray examination used to determine contour and mobility of colon and presence of any spaceoccupying tumors. Perform before upper GI

After care:

4. Intravenous Pyelography (IVP) injection of a radiopaque contrast medium in the vein of the client to visualize ureter, bladder and kidney Patients preparations:

Patients preparations:

no food after evening meal the evening before the test -stool softener laxatives and enema suppositories to cleanse the bowel before the test NPO after midnight before the test increased fluid intake, food and rest laxatives for at least two days or until stools are normal in color and consistency

After care:

Laxative in the evening before the examination NPO for 12 hours Cleaning enema morning of the procedure -increased fluid intake, food and rest; observe for any untoward reactions

After care:

D. Computed Tomography (CT)

an x-ray beam sweeps around the body, allowing measuring of various tissue densities. Provides clear radiographic deficition of structures that are not visible by other techniques.

advise client not to chew gum or smoke before the procedure no x-ray for gallbladder studies; NPO for 8 hours for lower abdomen and uterus ; 32 ounces of water PO 30 minutes before the procedure

initial scan may be followed by contrast enhancement using an injection of contrast agent iodine via vein, followed by a repeat scan. Patients preparations:

G. Pulmonary function studies Ventilatory studies use of incentive spirometer to determine how well the lung is ventilating. 1. Vital capacity (VC) largest amount of air that can be expelled after maximal inspiration Normal = 4000 5000 mL. Decrease = indicate lung disease Increase or decrease = indicate chronic obstructive lung disease 2. Forced expiratory volume (FEV) percentage of vital capacity that can be forcibly expired in 1, 2, or 3 seconds. Normal = 80 83% in 1 sec 90 94% in 2 sec 95 97% in 3 sec Decrease = indicate expiratory airway obstruction H. Sputum Studies 1. Gross sputum evaluations collection of sputum samples to ascertain quantity, consistency color and odor 2. Sputum smear sputum is smeared thinly on a slide so that it can be studied microscopically.

instructions for eating before test vary clear liquids up to 2 hours before the procedure are permitted

E. Magnetic resonance imaging (MRI) noninvasive technique that produces cross sectional images by exposure to magnetic energy sources. It uses no contrast medium; takes 30-0 minutes to complete. Patient may still for periods of 5-20 minutes at a time. Patients preparations:

patient can take food and medications except for low abdominal and pelvic studies (food and fluid withheld) 4-6 hr to decrease peristalsis) those who have metal implants those with permanent pacemakers those who are pregnant

Restrictions

used to determine cytological changes or presence of pathogenic microorganism

F. Ultrasound (sonogram) uses sound waves to diagnose disorders of the thyroid, kidney, liver, uterus, gallbladder, fetus and intracranial structures of the neonate. Patients preparations:

3. Sputum culture sputum samples are implanted or inoculated into special media. used to diagnosed pulmonary infection Examination of the gastric contents 1. Gastric analysis aspiration of the contents of the fasting stomach analysis of free and total acid

I.

y y

Gastric acidity increase: duodenal ulcer Gastric acidity decrease: pernicious anemia an cancer of the stomach

Common Diagnostics Procedures Invasive Diagnostics Procedures Characteristics: 1. it directly records the size, shape and function of an organ; 2.it requires the written consent of the patient or guardian; 3.it may result in morbidity and occasionally death. General Nursing Task: 1. Before procedure:  have patient sing permit to procedure  ascertain and repot any patient history of allergy or allergic reaction  explain procedure briefly and accurately  explain that contrast medium might cause flushing or warm feeling  keep patient NPO 6-12 hour before procedure if anesthesia is to be used  allow patient to verbalize concerns  administer preprocedure sedatives, as ordered If procedure done at bed side: y remain with patient and offer reassurance y assist with optimal positioning of patient y observe for indication of complications shock, pain and dyspnea 2. After procedure:  observe and record vital signs  check injection or biopsy sites for bleeding, infection, tenderness, or thrombosis report untoward reaction to the physician apply warm compress to ease discomfort, as ordered If tropical anesthesia is used during procedure: y do not give food or fluid until gag reflex returns y encourage relaxation by allowing patient to discuss experience and verbalize feelings.

J. Doppler ultrasound

measures blood flow in the major veins and arteries. The transducer of the test instrument is placed on the skin, sending ultra-high-frequency sound. sound varies with respiration and valsalva maneuver no discomfort to the patient.

K. Glucose Testing

to detect disorder of glucose metabolism, such as diabetes.

1. Fasting blood sugar (FBS) blood sample is drawn after a 12 fast (usually midnight). Water is allowed. Normal blood glucose ; 60 120 mg/dL Diabetic patient = 126 mg/dL 2. 2 hr postprandial (PPBS) blood is taken after meal Patients preparations:

offer a high-carbohydrate diet for 2-4 days before testing patient fast overnight eats a high-carbohydrate breakfast blood sample is drawn 2 hr interval no cigarette smoking and caffeine for these may increase glucose level

A. Procedures to evaluate the cardiovascular system 1. Angiography

3.Angiography (Arteriography)

intravenous injection of radiopaque solution or contrast for the purpose of studying its circulation through the patients heart, lungs and great vessels. Used to check the competency of the heart valves, diagnose congenital septal defects, study heart function and structure before cardiac surgery, detect occlusions of coronary arteries.

Injection of a contrast medium in to the arteries to study the vascular tree. Used to determine obstructions or narrowing of peripheral arteries.

B. Procedure to evaluate the respiratory system 1.Lung scan

2.Cardiac catheterization

insertion of a radiopaque catheter into a vein to study the heart great vessels. Used to confirm diagnosis of heart disease and determineextent ofdisease, measure pressures in the heart chamber and great vessels, obtain estimate of cardiac output, and obtain blood samples to measure oxygen content. k Right heart catheterization catheter is inserted througha cut-down in the antecubital vein into the superior vena cava, through the right atrium and ventricle and into the pulmonary activity. Left-heart catheterization- catheter maybe passed retrograde to the left ventricle through the brachial and femoral artery, it can be passed through the left atrium after right-heart catherization by means of a special needle that punctures the septa; or it may be passed directly into the left ventricle by means of a posterior puncture.

injection of radioactive isotope into the body, followed by lung scintiscan, which produces a graphic record of gamma rays emitted by the isotopes inthe tissues used to determine lung perfusion when pulmonary emboli and infarctions are suspected.

2.Pulmonary angioghraphy

x ray visualization of the pulmonary vasculature after the injection of a radiopaque contrast medium. used to evaluate pulmonary disorders such as pulmonary embolism, lung tumor and aneurysms, and changes in the pulmonary vasculature due to such conditions as emphysema.

3. Bronchoscopy

introduction of a fiberoptic scope into the trachea and bronchi used to inspect tracheobronchial tree for pathological changes, remove foreign bodies or mucous plugs causing airway obstruction, and apply chemotherapeutic agents.

Specific nursing considerations: 1. Preprocedure patient teaching: a.Fatigue is a common complaint due to lying still for 3 hr b.Feeling of fluttery sensation while the catheter is passed back into the left ventricle c.Flushed, warm feeling may occur when contrast medium is injected. 2. Postprocedure observations: a.monitor ECG pattern for arrhythmias b.check extremities for color and temperature, peripheral pulses for quality.

a. Prebronchoscopy interventions: Oral hygiene Postural drainage as indicated b. Postbronchoscopy interventions: Instruct patient not to swallow oral secretions Save expectorated sputum for laboratory analysis NPO till gag reflex returns Observe for subcutaneous emphysema and dyspnea Apply ice collar to reduce throat discomfort 4. Thoracentesis

Needle puncture through the chest wall and into the pleura

used to remove fluid and occasionally air from the pleural space Nursing considerations: a.Position : high fowlers position or sitting upon edge of the bed, with feet supported on the chair. b.If the patient is unable to sit up turn unto unaffected side C. Procedures to evaluate the renal system 1. Renal angiogram

3.Peritoneoscopy

direct visualization of the liver and peritoneum by means of a peritoneoscope inserted through an abdominal stab wound.

4.Liver biospsy

small catheter is inserted into the femoral artery and passed into the aorta or renal artery, radiopaque fluid is in stilled, and serial films are taken.

Used to diagnose renal hypertension and pheochromocytoma and differentiate renal cyst from tumors. Postangiogram nursing actions:  Check pedal pulse for signs of decreased circulation. 2.Cystoscopy Visualization of bladder, urethra, and prostatic urethra by insertion of a tubular, lighted, telescopic lens (cystoscope) through the urinary meatus. -Used to directly inspect the bladder; collect urine from the renal pelvis; obtain biopsy specimens from bladder and urethra; remove calculi; and treat lesions in the bladder, urethra, and prostate. Nursing actions following procedure: Observe for urinary retention Warm sitz baths to relieve discomfort 3.Renal biopsy needle aspiration of tissue from the kidney for the purpose of microscopic examination. D. Procedures to evaluate the digestive system: 1. Esophagoscopy and gastroscopy

needle aspiration of tissue for the purpose of microscopic examination; used to determine tissue changes, facilitate diagnosis, and provide information regarding a disease course. Nursing action:  Place patient on right side and position pillow for pressure, to prevent bleeding. 5.Paracentesis needle aspiration of fluid from the peritoneal cavity used to relieve excess fluid accumulation or for diagnostic studies. a. Specific nursing actions before paracentesis:  Have patient void - to prevent possible injury to bladder during procedure  Position sitting up on side of bed, with feet supported by chair.  Check vital signs and peripheral circulation frequently throughout procedure  Observe for signs of hypovolemic shock may occur due tofluid shift from vascular compartment following removal ofprotein rich ascitic fluid. b. Specific nursing actions following paracentesis:  Apply pressure to injection site and cover with sterile dressing.  Measure and record amount and color of ascitic fluid; send specimens to lab for diagnostic studies.

visualization of the esophagus, the stomach, and sometimes the duodenum by means of a lighted tube inserted through the mouth.

2.Proctoscopy

visualization of rectum and colon by means of a lighted tube inserted through the anus.