Diagnostic Procedures

1. CT Scan
 also known as CT scanning computerized tomography is a painless, non-invasive diagnostic
imaging procedure that produces cross-sectional images of several types of tissue not clearly
seen on a traditional X-ray.
 CT scans may be performed with or without contrast medium. A contrast may either be an
iodine-based or barium-sulfate compound that is taken orally, rectally, or intravenously which
can enhance the visibility of specific tissues, organs, or blood vessels. The duration of the
procedure will depend on the area being scanned.

 
(A) three hours and (B) five hours after symptom onset, with development of intraventricular
haemorrhage and secondary obstructive hydrocephalus.

NURSING RESPONSIBILITIES
BEFORE THE PROCEDURE:
 Informed Consent - Obtain an informed consent properly signed.
 Look for allergies - Assess for any history of allergies to iodinated dye or shellfish if contrast
media is to be used.
 Get health history - Ask the patient about any recent illnesses or other medical conditions and
current medications being taken. The specific type of CT scan determines the need for an oral or
I.V. contrast medium
 Check for NPO status - Instruct the patient to not to eat or drink for a period amount of time
especially if a contrast material will be used.
 Get dressed up - Instruct the patient to wear comfortable, loose-fitting clothing during the
exam.
 Instruct the patient to remain still - During the examination, tell the patient to remain still and
to immediately report symptoms of itching, difficulty breathing or swallowing, nausea,
vomiting, dizziness, and headache.
 Inform about the duration of the procedure - Inform the patient that the procedure takes from
five (5) minutes to one (1) hour depending on the type of CT scan and his ability to relax and
remain still.
AFTER THE PROCEDURE:
 Diet as usual - Instruct the patient to resume the usual diet and activities unless otherwise
ordered.
 Encourage the patient to increase fluid intake (if a contrast is given) - This is so to promote
excretion of the dye.

https://nurseslabs.com/computed-tomography-ct-scan/#nursing_responsibilities_for_ct_scan

2. CTA ( CT Angiography)
 Computed tomography angiography (CTA) uses an injection of contrast material into your blood
vessels and CT scanning to help diagnose and evaluate blood vessel disease or related
conditions, such as aneurysms or blockages.
 uses a CT scanner to produce detailed images of both blood vessels and tissues in the brain,
contrast material is injected through a small catheter placed in a vein
 identify a small aneurysm or arteriovenous malformation (AVM)—an abnormal connection
between blood vessels—inside the brain or elsewhere
 detect atherosclerotic (plaque) disease in the carotid artery of the neck, which may limit blood
flow to the brain and cause a stroke

PROCEDURE:
1. Prior to, or on the day of the procedure, you may be asked to complete a questionnaire to ensure
your safety during this procedure
2. A nurse or technologist will insert an intravenous (IV) catheter into a vein, usually in your arm
or hand, a small amount of blood is withdrawn through the catheter 
3. The technologist begins by positioning you on the CT exam table, usually lying flat on your
back. Straps and pillows may be used to help you maintain the correct position and remain still
during the exam
4. During scanning, the table is positioned at the start point of imaging and will then move through
the opening of the machine as the actual CT scanning is performed. A single scan takes
approximately one to two minutes, but multiple scans may be required
5. You may be asked to hold your breath during the scanning. Any motion, including breathing and
body movements, can lead to artifacts on the images. This loss of image quality can resemble the
blurring seen on a photograph taken of a moving object.
NURSING RESPONSIBILITES:
1. Informed consent - asked to sign a consent form that will detail the risks and side-effects
associated with contrast media injected through an intravenous (IV) line (small tube placed in a
vein).
2. Look for allergies - Always let your radiologist know if you have any history of allergies or an
allergy to contrast material. If you have any history of allergic reactions, you may be given medicine
to lessen the risk for an allergic reaction before the test.
3. For female patients, ask if she is pregnant - If you are pregnant or think you may be pregnant,
please check with your doctor before scheduling the exam.
4. EAT/DRINK: If your study was ordered without contrast, you can eat, drink and take your
prescribed medications prior to your exam. If your doctor orders a CT scan with contrast, do not eat
anything three hours before your CT scan. You are encouraged to drink clear liquids. You may also
take your prescribed medications prior to your exam.
5. If diabetic, tell the patient to eat light breakfast or lunch three hours prior to the procedure
6. Get dress - instruct the patient to wear patient gown
7. Monitor vital signs
8. Inform the patient - that he will feel warm sensation when the contrast material is injected, and
you may notice a metallic taste for a brief period.
9. Instruct the patient to hold breath during the procedure

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/computed-
tomography-angiography-cta

3. MRI ( Magnetic resonance imaging)

 It is an imaging test that uses powerful magnets and radio waves to create images or pictures of
your body in detail. . 

Nursing Responsibilities:
a.  Before the procedure
 Patient may be asked not to eat or drink anything for 4 - 6 hours before the scan.
 Asked patient if they are afraid of close spaces or claustrophobia and inform the doctor. Patient
may be given a medicine to help them feel sleepy and less anxious, or the doctor may suggest an
"open" MRI, in which the machine is not as close to the body
 Asked patients to remove the following:
 Items such as jewelry, watches, credit cards, and hearing aids - may be damaged.
 Pens, pocketknives, and eyeglasses - may fly across the room.
 Pins, hairpins, metal zippers, and similar metallic items - can distort the images.
 Removable dental work should be taken out just before the scan.

 Because the MRI contains strong magnets, metal objects are not allowed into the room with
the MRI scanner.
 It is important to inform the health care provider of any pregnancy or suspected pregnancy
prior to the procedure.

b.  During the procedure

 Patient will be asked to remain perfectly still during the time the imaging takes place, but
between sequences some minor movement may be allowed. The MRI Technologist will advise
accordingly.
 When MRI procedure begins, patient may breathe normally, however, for certain examinations it
may be necessary for you to hold your breath for a short period of time. 
 Monitoring is indicated to patients who are great potential for change in physiologic status
(respiratory rate, oxygen saturation, temperature, heart rate and  blood pressure) during the
procedure or whenever a patient requires observations of vital physiologic parameters due to an
underlying health problem.

c.  After the procedure

 There is no recovery time, unless you were given a medicine to relax. After an MRI scan, you
can resume your normal diet, activity, and medications.
 If patient is sedated, patient is transferred to the recovery room for continue monitoring.

 Prior to allowing the patient to leave the MRI facility, the patient should be alert, oriented, and
have stable vital signs. A responsible adult should accompany the patient home. Written
instructions that include an emergency telephone number should be provided to the patient.

4. Chest X-ray
 painless, non-invasive test uses electromagnetic waves to produce visual images of
the heart, lungs, bones, and blood vessels of the chest. 

Nursing Responsibilities:

Before Chest X-ray

 Remove all metallic objects - Items such as jewelry, pins, buttons etc can hinder the
visualization of the chest.
 No preparation is required - Fasting or medication restriction is not needed unless directed by
the health care provider.
 Ensure the patient is not pregnant or suspected to be pregnant - X-rays are usually not
recommended for pregnant women unless the benefit outweighs the risk of damage to the mother
and fetus.
 Assess the patient’s ability to hold his or her breath - Holding one’s breath after inhaling
enables the lungs and heart to be seen more clearly in the x-ray.
 Provide appropriate clothing - Patients are instructed to remove clothing from the waist up and
put on an X-ray gown to wear during the procedure.
 Instruct patient to cooperate during the procedure - The patient is asked to remain still
because any movement will affect the clarity of the image

After Chest X-ray

 Provide comfort -  If the test is facilitated at the bedside, reposition the patient properly
Medications:
1. Mannitol IV bolus
- to treat the symptoms of Elevated Intracranial or Intraocular Pressure.

Classification: Osmotic diuretics.

Dosage: The usual adult dosage ranges from 50 to 200g, but in most instances an adequate response
will be achieved at a dosage of approximately 100g

Possible side effects of Mannitol IV?

 Dehydration
 Anuria - kidneys aren't producing urine
 Intracranial bleeding
 Headache/ Fever
 Blurred vision
 Nausea and vomiting
 Chest pain
 Pulmonary edema
 Thirst
 Tachycardia
 Hypokalemia (increases the risk of digoxin toxicity)

Nursing considerations
1. Vital signs
2.  Intake and output
3. Central venous pressure
4. Pulmonary artery pressure
5. Signs and symptoms of dehydration (e.g. poor skin turgor, dry skin, fever, thirst)
6. Signs of electrolyte imbalance/deficit (e.g. muscular weakness, paresthesia, numbness,
confusion, tingling sensation of extremity and excessive thirst)

2. Heparin(SQ) - post operative

- It is used to decrease the clotting ability of the blood and help prevent harmful clots from
forming in blood vessels.

Classification: Anti coagulant (“blood thinner”)

Dosage: 1000units/mL
- Prophylaxis of postoperative thromboembolism: 5,000 units by deep subcutaneous injection 2 hr
before surgery and q 8–12 hr thereafter for 7 days or until patient is fully ambulatory.

Common side effects:

 easy bleeding and bruising;

 pain, redness, warmth, irritation, or skin changes where the medicine was injected;
 itching of your feet; or
 bluish-colored skin.
Nursing responsibilities:

Monitor for bleeding (in unusual places):

 Bleeding at the gums

 Dark, tarry stool “melena”
 Positive stool guaiac
 Reddish, pink urine “Hematuria”
 Vomiting blood or coffee ground appearance “hematemesis”
 Bruising for no cause
 Nosebleeds
 Tachycardia and hypotension
 Severe headache (bleeding in brain)
 Monitor CBC (hbg and hct)

 Subcutaneous administration
1. Site: fatty tissue of the abdomen….stay at least 2 inches away from the belly button and 1
inch away from scars (won’t absorb the medication)
2. Always rotate sites (see where the last nurse administered the injection in the chart and ask the
patient)
3. Don’t rub or massage the area!