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DIAGNOSTIC TEST

YANISA H. MOKSIR

Diagnostic Test
EKG

Procedure

Place the patient in a


supine or semi-Fowlers
position
Expose the chest,
ankles, and wrists
Place electrodes on the
inner aspects of the
wrists, on the medial
aspect of the lower
legs, and on the chest
After all the electrodes
are in place, connect
the leads wires
Press the start button
and input any require
information
Make sure that all
leads are represented in
the tracing. If not,
determine which
electrode has come
loose, reattached it, and
restart the tracing.
All recording and other

Normal Range

Cardiac range is 60 to
100 bpm
Cardiac rhythm is
normal sinus rhythm
P wave precedes each
QRS complex
PR interval lasts 0.12
to 0.20 second
QRS complex lasts
0.06 to 0.10 second
ST segment is not more
than 0.1 mV
T wave is rounded and
smooth and positive in
lead 1, 2, V3, V4, V5
and V6
QT interval duration
varies but usually lasts
0.36 to 0.44 seconds

Interpretations for
Abnormalities

Nursing Responsibilities

Heart rate < 60 bpm is Before the Procedure:


Explain to the patient
bradycardia
Heart rate > 100 bpm is
the need to lie still,
tachycardia
relax, and breathe
Missing P wave may
normally during the
indicate
procedure

Note current cardiac


atrioventricular (AV)
block, atrial
drug therapy on the test
arrhythmia, or
request form as well as
junctional rhythm
other pertinent clinical
A short PR interval
information, such as
may indicate a
chest pain or pacemaker
Explain that the test is
junctional arrhythmia;
a prolonged PR interval
painless and takes 5
may indicate an AV
to10 minutes
block
During the Procedure:
A prolonged QRS
Place the patient in a
complex may indicate
supine or semi-Fowlers
intraventricular
position
conduction defects;
Expose the chest,
missing QRS
ankles, and wrists
complexes may
Place electrodes on the
indicate an AV block or
inner aspects of the
ventricular asystole
wrists, on the medial

nearby electrical
equipment should be
properly grounded
Make sure that
electrodes are firmly
attached

ST-segmant elevation
of 0.2 mV or more
above above the
baseline may indicate
myocardial injury; STsegment depression
may indicate
myocardial ischemia or
injury
T wave inversion in
leads 1, 2, and V3 to
V6 may indicate
myocardial ischemia;
peaked T waves may
indicate T wave
hyperkalemia or
myocardial ischemia;
variation in T wave
amplitude may indicate
electrolyte imbalances
A prolonged QT
interval may suggest
life-threatening
ventricular
arrhythmias.

aspect of the lower legs,


and on the chest
After all the electrodes
are in place, connect the
leads wires
Press the start button
and input any require
information
Make sure that all leads
are represented in the
tracing. If not,
determine which
electrode has come
loose, reattached it, and
restart the tracing.
All recording and other
nearby electrical
equipment should be
properly grounded
Make sure that
electrodes are firmly
attached

After the Procedure:


Disconnect the
equipment, remove the
electrodes, and remove
the gel with a moist
cloth towel

Diagnostic Test
Arterial Blood Gas

Procedure
Explain the arterial blood
gas analysis evaluates
how well the lungs are
delivering oxygen to the
blood and eliminating
carbon dioxide.
Tell the patient that the
test requires a blood
sample.
Explain who will
perform the arterial
punctue, when it will
occur, and where the
puncture site will be;
radial, brachial, or

Normal Range

PaO: 80 to 100 mmHg


PaCO: 35 to 45 mm
Hg
pH: 7.35 to 7.45
OCT: 15% to 23%
SaO: 94% to 100%
HCO: 22 to 26 mEq/L

Interpretations for
Abnormalities

If the patient is having


recurrent chest pain or
if serial ECGs are
ordered, leave the
electrode patches in
place

Nursing Responsibilities

Before the procedure:


Low PaO, OCT and
Explain that arterial
SaO levels and a high
blood gas analysis
PaCO may result from
evaluates how well the
conditions that impair
lungs are delivering
respiratory function,
oxygen to the blood
such as respiratory
and eliminating carbon
muscle weakness or
dioxide
paralysis, respiratory

Tell the patient that the


center inhibition (from
test requires a blood
head injury, brain
sample. Explain who
tumor, or drug abuse),
will perform the
and airway obstruction
arterial puncture, when
(possibly from mucus
it will occur, and where
plugs or a tumor).

femoral artery.
Inform the patient that he
need not restrict food and
fluids
Instruct the patient to
breathe normally during
the test, and warn him
that he may experience a
brief cramping or
throbbing pain at the
puncture site.

Low readings may


result from bronchiole
obstruction caused by
asthma or emphysema,
from an abnormal
ventilation-perfusion
ration caused by
partially blocked
alveoli or pulmonary
capillaries, or from
alveoli that are
damaged or filled with
fluid because of
disease, hemorrhage,
or near drowning.
When inspired air
contains insufficient
oxygen, PaO, OCT,
and SaO decrease but
PaCO may be normal.
Such findings are
common in
pneumothorax,
impaired diffusion
between alveoli and
blood (caused by
interstitial fibrosis, for
example), or an
arteriovenous shunt

the puncture site will


be; radial, brachial, or
femoral artery
Inform the patient that
he need not restrict
food and fluids
Instruct the patient to
breathe normally
during the test, and
warn him that he may
experience a brief
cramping or throbbing
pain at the puncture
site

During the procedure:


Wait at least 20
minutes before
drawing arterial blood
when starting,
changing, or
discontinuing oxygen
therapy; after initiating
or changing settings of
mechanical ventilation;
or after extubation
Use a heparinized
blood gas syringe to
draw the sample

that permits blood to


bypass the lungs.
Low OCT- with
normal PaO, SaO,
and, possibly, PaCO
values- may result
from se4vere anemia,
decreased blood
volume, and reduced
hemoglobin oxygencarrying capacity.

Perform arterial
puncture, place it on
ice immediately, and
prepare to transport it
for analysis
Before sending the
sample to the
laboratory, note on the
laboratory request
whether the patient was
breathing room air or
receiving oxygen
therapy when the
sample was collected
Note the flow rate of
oxygen therapy and
method of delivery. If
on a ventilator, note the
fraction of inspired
oxygen, tidal volume
mode, respiratory rate,
and positive-end
expiratory pressure
Note the patients
rectal temperature

After the procedure:


After applying
pressure to the

puncture site for 3 to 5


minutes or until
bleeding has stopped,
tape a gauze pad
firmly over it
If the puncture site is
on the arm, dont tape
the entire
circumference; this
may restrict circulation
If the patient is
receiving
anticoagulants or has a
coagulopathy, apply
pressure to the
puncture site longer
than 5 minutes if
necessary
Monitor vital signs
and observe for signs
of circulatory
impairment, such as
swelling,
discoloration, pain,
numbness, and
tingling in the
bandaged arm or leg

Diagnostic Test
Central Venous Pressure

Procedure

Physician will apply


topical anesthetic to
insertion site, then use
a needle and syringe
with negative pressure
to access the
subclavian or internal
jugular vein.
Next the physician will
insert a guide wire
through the needle,
remove the needle,
then insert a dilator
over the guide wire.
Last, the physician will
remove the dilator and
insert the central
venous catheter over
the guide wire. Then
the guide wire is
removed.

Normal Range
2 to 6 mm Hg

Interpretations for
Abnormalities

Nursing Responsibilities

Elevated:
Overhydration which
increases venous return
Heart failure or PA
stenosis which limit
venous outflow and
lead to venous
congestion
Positive pressure
breathing, straining
Decreased:
Hypovolemic shock
from hemorrhage, fluid
shift, dehydration
Negative pressure
breathing which occurs
when the patient
demonstrates
retractions or
mechanical negative
pressure which is
sometimes used for
high spinal cord
injuries

Before the procedure:


Wash hands
Prepare pressurized
and heparinized flush
solution
Flush pressurized
closed transducer
tubing with luerlok
connections and ports
Done sterile gloves,
mask, protective gown
During the procedure:
Assist with skin
preparation
Position in
trendelenburg position
Assist physician with
flushing central venous
catheter ports with
sterile solution and
capping ends with luerlok caps
Instruct patient to take
a deep breath and hold
it prior to the insertion
procedure

Monitor cardiac
monitor and
hemodynamic wave
form during catheter
insertion

After the procedure:


Observe waveform and
perform dynamic
response test
Record central venous
mean pressure and
waveform
Apply sterile
transparent occlusive
dressing over insertion
site
http://www.rnceus.com/hemo/cvp.htm
http://shadwige.sites.truman.edu/hemodynamic-monitoring-front-page/pulmonary-artery-catheters/central-venous-pressure-cvp/

Diagnostic Test
Pulmonary Capillary
Wedge Pressure

Procedure

Normal Range

The doctor will make a Pulmonary capillary wedge


pressure: 2-15 mm Hg
small cut to allow the
PAC to enter through a
vein.
An introducer
sheatha hollow tube
will be placed into
the vein first. This
allows for the catheter
to enter your body
more easily.
The catheter is then
directed through the
veins and into the right
side of the heart.
The doctor will then
measure the blood
pressure in the
pulmonary artery (the
artery that carries
blood from the lungs to
the heart).

Interpretations for
Abnormalities

Nursing Responsibilities

Before the procedure:


The patient will be
asked to not eat or
drink anything for at
least 8 hours before the
procedure
Asked patient to tell
the doctor if having
any allergies, if taking
or have taken blood
thinners in the recent
past, other prescribed
or OTC medications
Asked patient to
remove jewelries prior
to procedure
Let the patient sign for
consent

Elevated pulmonary
capillary wedge
pressure suggests
failure of left
ventricular output and
mitral stenosis
(>20mmHg)

During the procedure:


The heartbeat will be
monitored closely

A blood sample may be


taken to check blood
oxygen levels, or heart
medications may be
administered to check
your hearts response.

http://www.healthline.com/health/swan-ganz-right-heart-catheterization#Overview1 http://en.wikipedia.org/wiki/Pulmonary_wedge_pressure

using an
electrocardiogram
machine (EKG)
Patient will be awake
during the procedure