Diagnostic Procedures to Detect Cancer and their Nursing Management

● IMAGING TESTS
○ CT SCAN
Nursing Responsibilities:
1. Obtain informed consent that is properly signed.
2. Assess for any history of allergies to iodinated dye or shellfish if contrast media is to be used.
3. Ask the patient about any recent illnesses or other medical conditions and current medications being taken.
4. 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.
5. Instruct the patient to wear comfortable, loose-fitting clothing during the exam.
6. Provide information about the contrast medium. Tell the patient that a mild transient pain from the needle puncture and a
flushed sensation from an I.V. contrast medium will be experienced.
7. 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.
8. 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.
9. After the procedure, instruct the patient to resume the usual diet and activities unless otherwise ordered.
10. After the procedure, encourage the patient to increase fluid intake (if contrast is given). This is so to promote the excretion
of the dye.

○ MRI SCAN
Nursing Responsibilities:

1. Take the patient’s history and perform a thorough head-to-toe assessment. If she has metal objects in her body, such as
an aneurysm clip, orthopedic hardware, an implanted pacemaker, certain types of prosthetic heart valves, or an
intrauterine device, she can’t undergo MRI. Device electrodes and wires may overheat and burn tissues, and
electromagnetic fields may cause implants to malfunction. Implanted device movement may also occur.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 2. Remove drug patches with metal backings, which can cause burns. Tattoos containing metal particles can also problems.
3. Pregnancy is a relative contraindication for MRI. tell the radiologist if the patient might be pregnant or if she’s
breastfeeding.
4. Inform the radiologist if the patient has chronic kidney disease or requires dialysis. gadolinium-containing agents may
cause nephrogenic systemic fibrosis or nephrogenic fibrosing dermopathy.
5. Make sure that only MRI-compatible equipment is taken into the MRI room. Ferromagnetic objects can fly toward the
center of the MRI system like projectiles, endangering everyone.
6. In general, the patient won’t have food or drink restrictions and can continue to take her medications unless her health
care provider directs otherwise.
7. Explain to the patient what she can expect during the MRI, especially the importance of lying still. Warn her that the MRI
scanner will make loud banging and clicking noises but that earplugs or headphones will be available. Encourage her t
use relaxation techniques such as listening to music or meditating.
8. Reassure the patient that she shouldn’t experience any discomfort during MRI. she should inform the technologist
immediately if she feels anything unusual.
9. If she’s an outpatient and received sedation, give her discharge instructions ad make sure that someone drives her
home, according to facility policy; if she’s an inpatient, initiate safety precautions as indicated.

○ BREAST MRI
Nursing Responsibilities:
1. Take the patient’s history and perform a thorough head-to-toe assessment. If she has metal objects in her body, such as
an aneurysm clip, orthopedic hardware, an implanted pacemaker, certain types of prosthetic heart valves, or an
intrauterine device, she can’t undergo MRI. Device electrodes and wires may overheat and burn tissues, and
electromagnetic fields may cause implants to malfunction. Implanted device movement may also occur.
2. Remove drug patches with metal backings, which can cause burns. Tattoos containing metal particles can also problems.
3. Pregnancy is a relative contraindication for MRI. tell the radiologist if the patient might be pregnant or if she’s
breastfeeding.
4. Inform the radiologist if the patient has chronic kidney disease or requires dialysis. gadolinium-containing agents may
cause nephrogenic systemic fibrosis or nephrogenic fibrosing dermopathy.
5. Make sure that only MRI-compatible equipment is taken into the MRI room. Ferromagnetic objects can fly toward the
center of the MRI system like projectiles, endangering everyone.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 6. In general, the patient won’t have food or drink restrictions and can continue to take her medications unless her health
care provider directs otherwise.
7. Explain to the patient what she can expect during the MRI, especially the importance of lying still. Warn her that the MRI
scanner will make loud banging and clicking noises but that earplugs or headphones will be available. Encourage her t
use relaxation techniques such as listening to music or meditating.
8. Reassure the patient that she shouldn’t experience any discomfort during MRI. she should inform the technologist
immediately if she feels anything unusual.
9. If she’s an outpatient and received sedation, give her discharge instructions ad make sure that someone drives her
home, according to facility policy; if she’s an inpatient, initiate safety precautions as indicated.

○ X-RAYS AND OTHER RADIOGRAPHIC TESTS

Nursing Responsibilities:
1. Remove all metallic objects. Items such as jewelry, pins, buttons, etc can hinder the visualization of the chest.
2. No preparation is required. Fasting or medication restriction is not needed unless directed by the health care provider.
3. 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.
4. 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.
5. 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.
6. Instruct the patient to cooperate during the procedure. The patient is asked to remain still because any movement will
affect the clarity of the image.
7. Note that no special care is required following the procedure
8. If the test is facilitated at the bedside, reposition the patient properly after the procedure.

○ MAMMOGRAPHY
Nursing Responsibilities:
1. There are no food, fluid, activity, or medication restrictions unless by medical direction.
2. Inform the patient that the best time to schedule the examination is 1 wk after menses when breast tenderness is
decreased.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 3. Inform the patient not to apply deodorant, body creams, or powders on the day of the procedure, as these products
may contain aluminum, which can be misinterpreted as calcifications in the breast tissue.
4. Explain the procedure and what to expect after.
5. Allow the patient to express concerns and fears about the procedure.
6. Prepare the patient. Just before the test, give the patient a gown to wear that opens in the front, and ask her to remove
all jewelry and clothing above the waist.

○ NUCLEAR MEDICINE SCANS

■ Bone Scans
Nursing Responsibilities:
1. Assess the client’s understanding of the procedure, providing an explanation, clarification, and emotional support
as needed.
2. Radioactive material (technetium-99m phosphate) is injected intravenously for 2 to 3 hours so that it
concentrates in the bone.
3. Observe the injection site for redness or swelling. If a hematoma forms, apply warm soaks to the area.
4. Have the client drink four to six glasses of water in the 2- to 3- hour waiting period before the procedure to
facilitate the renal clearance of any circulating radioactive material.
5. The client is not restricted to foods or fluids prior to the exam.
6. Have the client empty the bladder prior to testing; a full bladder will mask the pelvic bones and make the client
uncomfortable.
7. The scan takes about 30 to 60 minutes to complete. The client must remain still during the scanning.
8. Inform the patient that he may be active during the waiting period.
9. Inform the patient that a sedative should be ordered and administered to any client who may have difficulty lying
quietly.
10. Educate the client to remove jewelry or any metal objects that may hide X-ray visualization of the bones.
11. Inform the patient that the scanner machine moves over the body and detects radiation emitted by the skeleton.
X-ray films are prepared, showing a two-dimensional view of the skeleton. He may have to be repositioned
several times.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 ■ PET Scans
Nursing Responsibilities:
1. Because PET can show cellular glucose uptake, drinking glucose-containing liquids and eating can interfere with
the results.
2. Patients will be asked not to eat anything for several hours before the scan.
3. Check the patient’s blood glucose, which should e below 150 mg/dL.
4. If the glucose is too high, the scan may need to be rescheduled.
5. Patients with diabetes will receive special instructions before the scan to ensure adequate glucose control.

■ Thyroid Scans
Nursing Responsibilities:
1. Instruct the patient to fast for 8 to 12 hr. prior to the procedure. Protocols may vary among facilities.
2. Ensure that this procedure is performed before other radiographic procedures using iodinated contrast medium.

■ MUGA Scans
Nursing Responsibilities:

1. Instruct the patient to fast, restrict fluids (especially those containing caffeine), and abstain from the use of
tobacco products for 4 hr prior to the procedure.
2. No other radionuclide scans should be scheduled within 24 to 48 hr before this procedure. Protocols may vary
among facilities.
3. Instruct the patient to wear comfortable clothes that can be easily removed, as you may be asked to wear a
hospital gown during the test.

■ Gallium Scans
Nursing Responsibilities:
1. Prepare as for a bone scan.
2. Radioactive material, gallium-67, is injected intravenously 24 to 72 hours prior to the examination.
3. Gallium is used because of its high affinity for soft-tissue abscesses.
4. Inform patient that after a gallium scan, X-ray films m

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 ○ ULTRASOUND
Nursing Responsibilities
1. If indicated, ensure that the woman’s bladder is full by forcing fluids and instructing her not to void. If she is NPO, a Foley
catheter may be inserted into the bladder and sterile water instilled. The catheter is then clamped to prevent the water
from leaving the bladder. The full bladder lifts the pelvic organs higher into the abdomen and improves visualization.
2. Explain to the woman that she will be allowed to empty her bladder as soon as possible.
3. Coat the abdomen with ultrasonic transducing gel. The gel provides a better image when the scanner is applied to the
abdomen. For vaginal ultrasound, a transducer is covered with a condom or vinyl glove, coated with transducing gel, and
introduced into the vagina.
4. Explain the procedure to the woman, indicating that she can watch the procedure and ask questions about the images on
the screen. If appropriate, point out landmarks on the screen.

● ENDOSCOPY
○ BRONCHOSCOPY
Nursing Responsibilities:
1. Secure informed consent
2. Obtain medical history.
3. Check for NPO status. Withheld food and fluids for 6 to 12 hours prior to the exam to decrease the risk of aspiration.
4. Monitor vital signs. Obtain baseline vital signs and inform the practitioner of any abnormal findings.
5. Monitor vital signs. Obtain baseline vital signs and inform the practitioner of any abnormal findings.
6. Administer preoperative medications as ordered. Explain to the patient that an IV sedative such as Propofol may be
given as an anesthetic agent.
7. Prepare for local anesthesia. If the bronchoscopy is not conducted under general anesthesia, inform the patient that a
topical anesthetic (e.g., Lidocaine) will be sprayed on the pharynx to prevent coughing and gagging as the scope is
passed down through the throat.
8. Reassure the patient that airway blockage won’t occur.
9. Prepare emergency resuscitation equipment at the bedside. Laryngospasm and respiratory distress may occur following
the procedure.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 10. During the procedure, position the client. Place patient in a sitting or supine position and provide supplemental oxygen
as ordered.
11. Provide assistance with the diagnostic procedure and/or treatment. Assist with tissue specimen collection for testing.
Other procedures may be performed as needed such as removal of foreign body, bronchoalveolar lavage, placement of
a bronchial stent, and aspiration of retained secretions.
12. Secure specimen. Send the properly labeled specimen to the laboratory immediately.
13. After the procedure, observe the patient’s sputum and report for any excessive bleeding.
14. Watch out for signs of bronchial spasm or bronchial perforation such as facial crepitus, hypoxemia, hemorrhage, and
chest tightness.
15. Monitor vital signs
16. Place the conscious patient in a semi-Fowler’s position while for an unconscious patient, place on one side with the head
of the bed slightly raised.
17. Maintain NPO status until the anesthesia has worn off and the gag reflex has returned.
18. Provide an emesis basin, and instruct the patient to spit out saliva rather than swallow it.
19. Relieve anxiety and provide comfort measures.

○ COLONOSCOPY
Nursing Responsibilities:
Before the procedure:
1. Secure an informed consent.
2. Obtain a medical history of the patient.
3. Provide information about the procedure.
4. Ensure that the patient has complied with the bowel preparation.
5. Establish an IV line. Inform the patient that an IV line will be started and a sedative will be administered before the
procedure.
6. Provide reassurance. Assure the patient that the colonoscope is well lubricated to ease its insertion, that it initially feels
cool, and that he may feel an urge to defecate when it’s inserted and advanced.
7. Instruct the patient to empty the bladder prior to the procedure to provide comfort.
8. Instruct the patient to remove all metallic objects from the area to be examined.
9. Instruct the patient to cooperate and follow directions.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 During the procedure:
1. Assist with patient positioning as necessary. Place the patient on the examination table in a left lateral decubitus
position with a sheet draped over the body.
2. Administer medications as ordered.
3. Instruct the patient to bear down.
4. Change the position of the patient. When the scope is advanced through the sigmoid. The patient’s position is changed
to supine to allow passage into the transverse colon.
5. Encourage the patient to take slow, deep breaths.

After the procedure:

1. Observe the patient closely for signs of bowel perforation. Signs of bowel perforations such as severe abdominal pain,
nausea, vomiting, fever, and chills must be reported immediately.
2. Obtain and record the patient’s vital signs.
3. Instruct patient to resume a normal diet, fluids, and activity as advised by the health care provider.
4. Provide privacy while the patient rest after the procedure.
5. Monitor for any rectal bleeding.
6. Encourage increased fluid intake. Fluids must be given to replace fluid lost during the preparation of the procedure.

○ CYSTOSCOPY
Nursing Responsibilities:
Before:
1. Assess the patient’s understanding of the procedure and answer any queries.
2. Obtain informed consent.
3. Withhold blood-thinning medications.
4. Provide instruction for fasting and non-fasting preparation. Unless a general anesthetic has been ordered, inform the
patient that he doesn’t need to restrict food and fluids.
5. Establish an IV line. To allow infusion of fluids, anesthetics, sedatives or emergency medications.
6. Prepare the patient. Instruct patient to empty the bladder prior to the procedure and to change into the hospital gown
provided.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 7. Administer sedation and other medications as ordered. Preoperative medications are given 1 hour before the test.
Sedative decreases the spasm of the bladder sphincter, reducing the patient’s discomfort.
After:
1. Monitor and record vital signs.
2. Assess the patient’s ability to void at least 24 hours after the procedure.
3. Observe the color of urine. Pink-tinged urine and burning or mild discomfort when urinating may be experienced for a
few voiding after the procedure.
4. Encourage increased fluid intake as indicated. Fluids will help flush the bladder to decrease the amount of bleeding and
to reduce the risk of infection.
5. Encourage deep breathing exercises. These exercises may relieve the patient from bladder spasms.
6. Provide warm sitz baths and administer mild analgesics as ordered. These may relieve urinary discomfort and promote
muscle relaxation.
7. Watch out for signs of serious complications (sepsis, bladder perforation, hematuria). Persistent, severe flank pain,
elevated temperature over 101° F, chills, bright red blood or clots in the urine, painful urination, or urinary retention
must be reported immediately to the HCP.

○ LAPAROSCOPY
Nursing Responsibilities:
1. Inform the patient that a laxative and cleansing enema may be needed the day before the procedure, with cleansing
enemas on the morning of the procedure. There are no activity or medication restrictions unless by medical direction.
2. Instruct the patient that to reduce the risk of aspiration related to nausea and vomiting, solid food and milk or milk
products are restricted for at least 6 hr and clear liquids are restricted for at least 2 hr prior to general anesthesia,
regional anesthesia, or sedation/analgesia (monitored anesthesia).
3. The patient may be asked to be NPO after midnight. The American Society of Anesthesiologists has fasting guidelines for
risk levels according to patient status.
4. Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and
medications with known anticoagulants, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 to the procedure. The number of days to withhold medication is dependent on the type of anticoagulant. Note the last
time and dose of medication taken. Protocols may vary among facilities.
5. Patients on beta-blockers before the surgical procedure should be instructed to take their medication as ordered during
the perioperative period.

○ MEDIASTINOSCOPY
Nursing Responsibilities:
1. There are no activity restrictions unless by medical direction.
2. Instruct the patient to fast and restrict fluids for at least 8 hr prior to general anesthesia. The American Society of
Anesthesiologists has fasting guidelines for risk levels according to patient status.
3. Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and
medications with known anticoagulants, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior
to the procedure. The number of days to withhold medication is dependent on the type of anticoagulant. Note the last
time and dose of medication taken. Protocols may vary among facilities.
4. Ensure that this procedure is performed before an upper gastrointestinal study or barium swallow.

○ THORACOSCOPY
Nursing Responsibilities:
1. Secure informed consent
2. Obtain medical history.
3. Check for NPO status. Withheld food and fluids for 6 to 12 hours prior to the exam to decrease the risk of aspiration.
4. Monitor vital signs. Obtain baseline vital signs and inform the practitioner of any abnormal findings.
5. Monitor vital signs. Obtain baseline vital signs and inform the practitioner of any abnormal findings.
6. Administer preoperative medications as ordered. Explain to the patient that an IV sedative such as Propofol may be
given as an anesthetic agent.
7. Prepare for local anesthesia. If the bronchoscopy is not conducted under general anesthesia, inform the patient that a
topical anesthetic (e.g., Lidocaine) will be sprayed on the pharynx to prevent coughing and gagging as the scope is
passed down through the throat.
8. Reassure the patient that airway blockage won’t occur.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 9. Prepare emergency resuscitation equipment at the bedside. Laryngospasm and respiratory distress may occur following
the procedure.
10. During the procedure, position the client. Place patient in a sitting or supine position and provide supplemental oxygen
as ordered.
11. Provide assistance with the diagnostic procedure and/or treatment. Assist with tissue specimen collection for testing.
Other procedures may be performed as needed such as removal of foreign body, bronchoalveolar lavage, placement of
a bronchial stent, and aspiration of retained secretions.
12. Secure specimen. Send the properly labeled specimen to the laboratory immediately.
13. After the procedure, observe the patient’s sputum and report for any excessive bleeding.
14. Watch out for signs of bronchial spasm or bronchial perforation such as facial crepitus, hypoxemia, hemorrhage, and
chest tightness.
15. Monitor vital signs
16. Place the conscious patient in a semi-Fowler’s position while for an unconscious patient, place on one side with the head
of the bed slightly raised.
17. Maintain NPO status until the anesthesia has worn off and the gag reflex has returned.
18. Provide an emesis basin, and instruct the patient to spit out saliva rather than swallow it.
19. Relieve anxiety and provide comfort measures.
20.

○ UPPER ENDOSCOPY
Nursing Responsibilities:
1. Schedule at least 2 days after barium swallow or upper gastrointestinal series.
2. Ensure the informed consent is signed prior to premedication.
3. Encourage questions and provide answers and support.
4. Withhold food and fluids for 6 to 8 hours before the procedure.
5. Remove dentures and eyewear. Provide mouth care.
6. Instruct the patient not to eat or drink anything for 6 to 8 hours before the procedure.
7. Inform the patient that the procedure is somewhat uncomfortable but requires only 20 to 30 minutes to complete.
8. Educate the patient that a local anesthetic will be used in his throat and he will be given a sedative during the
procedure.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B

 9. After the procedure, instruct the patient that he will be allowed to eat and drink as soon as his gag reflex returns and he
will be able to swallow.
10. Inform the patient that he may experience mild bloating, belching, or flatulence following the procedure.
11. Instruct the patient to contact his physician immediately if he develops any of the following: difficulty swallowing;
epigastric, substernal, or shoulder pain; vomiting blood or black tarry stools; or fever.

● Biopsy and Cytology

Nursing Responsibilities:
1. Explain the purpose of the test. Each cytologic test will have different implications for each patient.
2. Explain the procedure. Explain where the test will be performed and who will be performing it. Tell the patient how the
specimen will be obtained.
3. Describe what discomfort, if any, to expect during the procedure.
4. If local anesthesia is used, explain that it may alleviate some discomfort, but that the patient will remain alert. If general
anesthesia is used, explain that the patient will not be conscious of the procedure and that foods and fluids are not
permitted after midnight before the test.
5. Explain any other special care, positioning, or restrictions that will follow the procedure and explain why they are necessary.
6. provide the outpatient with written instructions, and, if sedation will be used, advise him to have someone accompany him
for transportation.
7. Inform the patient when the test results will be available, since this patient may be especially anxious.

Prepared by: Noronisa D. Cabugatan NSG125 Cellular Aberration - B