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BSN-4C

Emergency Diagnostics

Common non-invasive diagnostics

● characteristics:
○ The test provides an indirect assessment of organ size, shape, and function. (this
test provide us an assessment of the structure of the organ.)
○ Easily reproducible (can duplicate the results.)
○ Safe and effective because it is non-invasive (not harmful at all for the patient.)
○ Test requires less complex equipment for recording (no need for high-end
technology in secuirng the results.)
○ Securing consent is not required. (usually in non-invasive procedure no need for
consent from the patient, though it is very important to explain the procedure to
the patient to lessen anxiety.)
● General nursing tasks
○ Decrease patient's anxiety and offer support. (it is very important to EXPLAIN the
procedure, and answer the questions from the patient.)
○ Use procedure that prevents specimen contamination.
Graphic students of heart and brain

Description Purpose

Electrocardiogram Diagnose abnormal cardiac rhythms and

- Graphic record of heart electrical coronary heart disease
activity.
- shows depolarization and
repolarization

Echocardiography (UTZ Cardiography) Diagnose valvular and other structural

- a graphic record of motions deformities
produced by cardiac structures
- high-frequency sound vibrations
are echoed through the chest wall

Electroencephalogram (EEG) Diagnose surface lesions or tumors of the

- a graphic record of brain's brain and presence of epilepsy
electrical potential
- generates physiological activity of
the brain

Echoencephalogram Diagnose:
- beam UTZ is passed through the 1. subdural hematomas,
head 2. intracerebral hemorrhage
- returning echoes are generally 3. tumors
recorded

Roentgenological Studies (X-rays)

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BSN-4C

Description Consideration

Chest X-ray Use lead shield to protect pregnant

- determine the size, the contour of women. (pregnant usually wear lead
the heart size apron.)
- size location and nature of
pulmonary lesions
- pulmonary vasculature

Kidney, Ureter, Bladder (KUB) No special consideration

- determine size, shape, and
position of the kidneys

Breast (Mammography) determine presence of tumor

- examination of the breast with or There should be now of the ff:
without injection of dye 1. no deodorant
- radio-opaque substance into the 2. Perfume
duct of mammary gland 3. powder, or
4. Ointment (produce that has
carbon oxalate.)
slight discomfort due to pressure

Nursing tasks: Roentgentological studies (fluroscopy)

● some preparation requires enema (before), laxative (after)

● there is a need for NPO 6-12 hours (making sure that there is evacuation of
gastric content.)
● usual allergy and allergic reactions are ascertained. (becasue we will be
utizliing specific substance that may have allergic reaction to the patient.)
● do allow patient to eat after the test
● implement increase oral fluid intake (OFI) (to alleviate dehydration due to
NPO.)
● evaluate stool for color and consistency
● signs and symptoms of complications are addressed

Roentgenological Studies (Fluoroscopy)

Upper GI (Barium Swallow) Determine the ff:

- ingestion of barium sulfate 1. patency of esophagus for varices,
- followed by fluoroscopic and x-ray 2. mobility of gastric wall
examination 3. presence of ulcer
4. patency of pyloric valve

Lower GI (Barium Enema) Determine the ff:

- rectal instillation of barium sulfate
- followed by fluoroscopic and x-ray
examination
- Done before the barium swallow
because they go hand-in-hand
1. contour and mobility of colon
2. presence of any space occupying
tumor done before Barium
Swallow
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Nursing tasks: PRE-PROCEDURE (for Barium swallow and Barium Enema)

○ No food after evening meal the evening prior to the test
○ Stool softener laxative and enema (in order to cleanse the bowerl.)
○ NPO after midnight
○ Defecate/cleanse the bowel (for sterility and to make sure the bowel is
clean before the procedure.)

Nursing tasks: POST-PROCEDURE (for Barium swallow and Barium Enema)

○ Increased fluids and offer food
○ Encourage rest periods
○ Evaluate stool color and consistency
○ Laxatives for 2 days or more (help in the elimination of the substance
introduced in the swallow and colon.)

Cholecystogram gallbladder disease with poor

- ingestion of organic iodine visualization, accurate if GI and liver
contrast medium function is intact, done before Upper &
- x-ray visualization for 12 hours Lower GI

Nursing tasks: PRE-PROCEDURE (for Cholecystogram)

○ Administer large amount of water with contrast capsule
○ Low fat meal before evening of x-ray
○ Oral laxative or stool softener after meal
○ No food allowed after contrast capsule

Nursing tasks: POST-PROCEDURE (for Cholecystogram)

○ Increase fluids and offer food
○ Encourage rest periods
○ Observe for any untoward reactions
○ Evaluate stool color and consistency

Intravenous pyelography Visualize the ureter, bladder, and kidney.

- Injection of radiopaque contrast
medium in the vein

Nursing tasks: PRE-PROCEDURE (for Intravenous pyelography)

○ Laxative in the evening prior to the test
○ NPO for 12 hours
○ Cleansing enema in the morning

Nursing tasks: POST-PROCEDURE (for Intravenous pyelography)

○ Increase fluids and offer food
○ Encourage rest periods
○ Observe for any untoward reactions
○ Evaluate stool color and consistency
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Computed Tomography (CT Scan) initial scan may be followed by contrast

- x-ray bean sweeps around the enhancement, followed by repeat scan.
body
- allows measures of various tissue
densities
- provides clear picture of structures
not visible with other test

Nursing tasks: PRE-PROCEDURE (for CT scan)

○ Instruct on having a meal before the test
○ Clear liquids up to 2 hours are permitted

Magnetic Resonance Imaging (MRI) provides clearer image compared to other

- produces cross sectional images test
by magnetic energy sources
- no contrast medium, takes 20
minutes to complete
- Lie still for 5-20 minutes

Nursing tasks: PREPARATION (for MRI)

○ Take food and medication unless for lower studies
○ Restricted to those with metals
○ Restricted to those with permanent pacemaker
○ Restricted to those pregnant

Ultrasound (sonogram) Diagnose the ff:

- Uses sound waves. 1. Thyroid
2. Liver
3. Uterus
4. Gallbladder
5. fetus
6. intracranial structures of the
neonate

Nursing tasks: PREPARATION (for Ultrasound)

○ Advise no to chewing gum
○ No x-ray
○ NPO hours for gallbladder UTZ
○ For lower abdomen and uterus, 32 ounces of H20

Pulmonary function studies

Vital Capacity (VC) normal- 4000-5000ml

- largest amount of air that can be If decreased then it can be considered as
expelled after maximal inspiration lung disease
If increased or decreased it can also be
considered as COPD

Forced expiratory volume (FEV) normal

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- percentage of vital capacity that 80-83% in 1 sec

can be forcibly expires in 1-3 90-94% in 2 sec
seconds 95-97% in 3 sec
decreased - airway obstruction

Sputum studies

Gross Sputum evaluations to ascertain quantity, consistency, color

- collection of sputum samples and odor.

Sputum Smear to determine cytological changes or

- smeared thinly in a slide for presence of pathogenic microorganisms
microscopic studies

Sputum culture Diagnostic pulmonary infection

- sampels are implanted or
inoculated into special media
- Use agar

Gastric content studies

Gastric Analysis increased acidity - duodenal ulcer

- aspiration of gastric contents of decreased acidity - pernicious anemia,
the fasting stomach stomach cancer
- analysis of free and total acid

Doppler Ultrasound

- Measures blood flow in the major sound varies with respiration and Valsalva
veins and arteries maneuver, no discomfort to the patient
- transducer is placed on the skin,
sending ultra-high frequency
sound

Glucose testing

Fasting Blood Sugar (FBS) Normal - 60 - 110mg/dL

- blood sample is drawn after 12 increased - hyperglycemia
hour (usually after midnight) decreased - hypoglycemia
fasting -water is allowed

2 Hour Post-Prandial (PPBS) determine glucose utilization

- blood is taken after meal

Nursing tasks: PREPARATION (for glucose testing)

○ Offer high carb 2-4 days
○ Fasting overnight
○ Blood samples is drawn 2 hours interval
○ No cigarette smoking, caffeine
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Common Invasive diagnostics

● Characteristics
○ Test directly records the size, shape and function of an organ
○ Enforce consent of the patient
○ Some results to morbidity
○ There might be death for someone
● General nursing tasks
○ BEFORE
■ Be ready for consent signing (the role of the nurse in the signing of
consent will be a witness, it is usually the doctor that secure the consent
form.)
■ Evaluate history of allergy
■ Formal procedure explanation
■ On NPO for 6-12 hours
■ Re-assess anxiety
■ Explain pre-procedure sedatives
○ AFTER
■ Assess and record vital sign
■ Food is not immediately given (not until GAG reflex return.)
■ The need to refer if needed
■ Encourage relaxation
■ Re-enforce use of warm compress

Evaluate cardiovascular system

Description Consideration

Angiography to check competent heart valves

- studying circulation through the heart, Diagnose the ff:
lungs and great vessels 1. septal defects
2. detects occlusion of coronary arteries

Cardiac Catheterization confirm diagnosis of heart disease and extent

- to study the hearts great vesse of disease, measure pressures, measure O2
content in blood sample

Right Heart Catheterization evaluates the patency of blood flow in the

- Catheter is insert by cutdown in the right side of the heart
antecubital vein to the superior vena
cava, right atrium, and ventricle, and
into the pulmonary cavity

Left Heart Catheterization evaluates the patency of blood flow in the left
- Catheter may be passed retrograde to side of the heart
the left ventricle through the brachial
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and femoral artery, to the left atrium

then to the left ventricle

Nursing tasks: PRE-PROCEDURE

○ Ascertain fatigue as common complain
○ There is feeling of fluttery sensation
○ Flushing and warm sensation is felt

Nursing tasks: POST-PROCEDURE

○ Monitor ECG pattern
○ Check for color and temperature extremities
○ Check peripheral extremities

Evaluate Respiratory system

Lung Scan determine lung perfusion when emboli and

- injection of radioactive isotope into the infarctions are suspected.
body, followed by lung scan →
produces graphic record of gamma
rays emitted by the isotopes in the
tissues

Pulmonary Angiography inspect the ff:

- introduction of fiberoptic scope into 1. tracheobronchial tree for pathologic
the trachea and bronchi changes
2. remove foreign bodies
3. mucus plugs

Thoracentesis used to remove fluid and occasionally air

- need puncture through the chest wall from the pleural space
and into the pleura

Evaluate Renal system

Renal angiogram Determine the ff:

- small catheter is inserted in the 1. Renal hypertension
femoral artery and passed to the aorta 2. Differentiate renal cyst from tumors
or renal artery

Cystoscopy Used for the following procedure:

- visualization of bladder, urethra, and 1. Inspect the bladder
prostatic urethra by insertion of 2. Collect urine sample
tubular, telescopic lens through 3. For biopsy
urinary meatus 4. Removal calculi
5. Treat lesions

Renal Biopsy For microscopic cell examination

- needle aspiration of tissue from the
kidney
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Evaluate Digestive system

Esophagoscopy and Gastroscopy determine patency of the alimentary tract

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

Proctoscopy determine growth of cells from the assessed

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

Peritoneoscopy determine size, location and shape of organs

- direct visualization of the liver and
peritoneum by means of
peritoneoscope inserted through an
abdominal wound

Liver Biopsy for tissue changes, or microscopic

- needle aspiration of tissue examination to facilitate diagnosis

Paracentesis Used to relieve excess fluid accumulation, for

- needle aspiration of fluid from the diagnostic studies.
peritoneal cavity.
- Check for signs of hypovolemic shock

Evaluate reproductive system in women system

Culdoscopy visualize uterus, fallopian tube, and peritoneal

- surgical procedure in which a contents
culdoscope is inserted into the
posterior vaginal culdesac

Breast biopsy for microscopic exam to differentiate among

- needle aspiration or incisional removal benign tumors, cysts
of breast tissue

Uterotubal Insufflation (Rubin’s Test) determine fallopian tube patency

- injection of carbon dioxide into the
cervical canal.

Evaluate neuro-endocrine system system

Cerebral Angiography localize lesions that are large enough to

- visualization of the brain vasculature distort cerebrovascular blood flow
after injection of a contrast medium
into the carotid or vertebral arteries

Myelogram used detect herniated or ruptured

- lumbar-puncture needle, contrast intervertebral disks, tumors, and cysts that
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medium is injected into the compress or distort spinal cord

subarachnoid space of the spinal
column
- Elevate the head

Lumbar Puncture evaluate CSF for infections and determine

- puncture of the lumbar subarachnoid presence of hemorrhage
space of the spinal cord with needle to
withdraw CSF
- Not done decrease in ICP.
- Knee chest position
- Right after the procedure, the position
is supine.