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Special Examinations

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Title: Special Examinations


1
Special ExaminationsTests
  • Nursing Fundamentals
  • Chapter 13

2
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

3
Equipment
  • Radiography (x-rays)
  • Endoscopy (optical scopes)
  • Radionucleide imaging (radioactive chemicals)
  • Ultrasonography (high frequency sound waves)
  • Electrical graphic recordings

4
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/CS

5
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

6
Informed Consent
  • The consent given by a person after receiving
    full explanation including risks and benefits of
    a procedure that will take place

7
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.

8
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

9
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

10
Some equipment that may be needed
  • Packaged kits like
  • lumbar puncture kits, chest tube kits, foley
    kits, sterile equipment, canisters, tubes,
    syringes, evacuation bottles

11
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

12
Positioning of the Patient
  • Dorsal recumbent position on back with knees
    bent
  • Lithotomy position on back with feet in
    stirrups
  • Sims 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

13
Which position are they in?
14
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

15
Providing Physical Emotional Support
  • The nurse tends to the pts 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

16
Postprocedural Care
  • Once all tests and exams are completed, the nurse
    attends to the pts needs for safety, comfort,
    cares for specimens, assesses VS, records and
    reports the findings

17
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 wont decompose
  • Delivers the specimen to the proper place

18
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

19
Common Diagnostic Examinations
  • Pelvic examination
  • Radiography
  • Endoscopic examinations
  • Radionuclide Imaging
  • Ultrasonography
  • Electrical Graphic Recordings

20
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, physicians 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

21
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

22
MRI
23
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

24
CAT Scan (AV)
25
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 pts 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

26
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

27
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

28
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

29
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 wordscopy means the Dr. is
    using a scope, usually to investigate

30
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

31
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 pts 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

32
Endoscope
33
Endoscopy
34
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

35
  • 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

36
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

37
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

38
PET SCAN
39
Nursing Responsibilities r/t Radionuclide Imaging
  • 1. Inquire about a womans 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 doesnt have any metal implants,
    these interfere with diagnostic findings

40
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
    lt 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

41
Ultrasonography
  • This is a soft tissue exam that uses sound waves
    in ranges beyond human hearing
  • A hand-held probe projects sound through the
    bodys surface, the sound waves cause vibrations
    within body tissues producing images as the waves
    are reflected back toward the machine

42
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

43
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

44
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45
Ultrasound
46
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

47
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

48
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)

49
EKG
50
Electrocardiography
51
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

52
Electroencephalography
53
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)

54
Electromyography
55
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

56
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

57
Paracentesis
58
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

59
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60
Thoracentesis
61
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

62
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63
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

64
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

65
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

66
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

67
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68
Cultures
69
Measuring Capillary Blood Glucose
  • A glucometer is the instrument that is used
  • Pts 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

70
Tips on measuring blood glucose levels
  • 1. Several glucose monitors are available. The
    nurse must become familiar with her facilitys
    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)

71
Glucometer
72
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

73
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

74
Arteriogram
75
Arteriography (AV)
76
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77
Colonoscopy
78
Sigmoidoscopy (AV)
79
Bronchoscopy (AV)
80
Cystoscopy
81
IVP
  • Intravenous pyelorogram dye
  • is used to examine the kidney
  • Pt must drink increased amount fluids after this
    test
  • is completed

82
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83
Liver Biopsy (AV)
84
The End
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