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    RT 102 Diagnostic Proceedures

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    OT Procedures, Nuclear Medicine, and AND PHARMACOLOGY his list contains essential word parts and medical terms for this chapter. These terms are pronounced in the student StudyWARE™ and Audio CDs that are available for use with this text. These and the other important primary terms are shown in boldface throughout the chapter. Secondary terms, which appear in orange italics, clarify the meaning of primary terms. 3 2 a t albumin/o albumin, protein cale/i calcium, lime, the hee! ntesis surgical puncture to remove fluid creatin/o creatinine glycos/o glucose, sugar -graphy the process of producing a picture or record hemat/o blood, relating to the blood Iapar/o abdomen, abdominal wall -otomy cutting, surgical incision phleb/o vein radiation, x-rays -scope instrument for visual examination -scopy visual examination son/o sound ooooog Ooooo0o0000 -uria urination, urine Medical Terms ‘acetaminophen (ah-seet-ah-MIN-oh-fen) acupuncture (AK-que-punk-tyour) buminuria (al-byou-mih-NEW-ree-ah) mnalgesic (an-al-JEE-zick) yretic (an-tih-pye-RET-ick) arthrocentesis (ar-throh-sen-TEE-sis) wuscultation (aws-kul-TAY-shun) bacteriuria (back-tee-ree-YOU-ree-ah) bruit (BREW-ee) caleiuria (kal-sih-YOU-ree-ah) ‘compliance computed tomography (toh-MOG-rah-fee) contraindication creatinuria (kree-at-ih-NEW-ree-ah) echocardiography (eck-oh-kar-dee-OG- rab-fee) ‘endoscope (EN-doh-skope) Auoroscopy (floo-or-0S-koh-pee) Oooo000000000000 oo Pharmacology. Vocabulary Related to DIAGNOSTIC PROCEDURES, NUCLEAR MEDICINE, oooogoogoo000000000000K00 oooo00 oo OO GOooooooo0o0 oo glycosuria (glye-koh-SO0-ree-ah) hematocrit (hee-MAT-oh-krit) hematuria (hee-mah-T00-ree-ah) hyperthermia (high-per-THER-mee-ah) hypothermia (high-poh-THER-mee-ah) idiosyncratic reaction (id-ee-oh-sin-KRAT-ick) interventional radiology intradermal injection intramuscular injection intravenous injection ketonuria (kee-toh-NEW-ree-ah) laparoscopy (lap-ah-ROS-koh-pee) jhotomy position agnetic resonance imaging ophthalmoscope (ahf-THAL-moh-skope) otoscope (Oll-toh-skope) palliative (PAL-ee-ay-tiv) parenteral (pah-REN-ter-al) percussion (per-KUSH-un) perfusion (per-FYOU-zuhn) pericardiocentesis (pehr-ih-kar-dee-oh- sen-TEE-sis) phlebotomy ({leh-BOT-oh-mee) placebo (piah-SEE-boh) positron emission tomography prone position proteinuria (proh-tee-in-YOU-ree-ah) pyuria (pye-YOU-ree-ah) radiolucent (ray-dee-oh-LOO-sent) radiopaque (ray-dee-oh-PAYK) rale (RAHL) recumbent (ree-KUM-bent) rhonchi (RONG-kye) Sims’ position single photon emission computed tomography speculum (SPECK-you-lum) sphygmomanometer (sfig-moh-mah-NOM- eh-ter) stethoscope (STETH-oh-skope) stridor (STRYE-dor) subcutaneous injection (sub-kyou-TAY-nee-us) transdermal transesophageal echocardiography (trans- eh-sof-ah-IEE-aleck-oh-kar-dee-OG-rah-fee) ultrasonography (ul-trah-son-OG-rah-fee) urinalysis (you-rih-NAL-ih-sis) IB DIAGNOSTIC PROCEDURES A wide range of diagnostic tools are used to determine the patient’s general state of health and to look for spe- cific medical conditions, Basic Exami ion Procedures Basic examination procedures are performed during the assessment of the patient's condition. As used in medi- ine, the term assessment means the evaluation or appraisal of the patient’s condition. This information is used in reaching a diagnosis and in formulating a patient cae plan, Observation ‘The first step in a physical assessment is to observe the patient’s overall appearance, emotional affect, and ambulation, Mi Overall appearance includes a number of factors: how appropriately the patient is dressed, whether there is any body odor, or if there are signs of possible difficuldes with self-care. Mi Pmotional affect refers to the patient's expression, tone of voice, mood, and emotions. Affect means the ‘outward expression of emotion. Mi Ambulation means the way the patient walks, including gait, any unsteadiness, or possible difficulty. Pulse Vital Signs Vital signs are the four key indications that the body sys- tems are functioning. These signs, which are recorded for ‘most patient visits, are temperature, pulse, respiration, and blood pressure. The abbreviation \/SS stands for vital signs stable Temperature An average normal body temperature is 96.6°F (Fahren- +heit) or 37.0°C (Celsius). An oral body temperature of 100°F or higher is a fever A fever is most commonly caused by an infection, an ‘injury, or medications. 1m Temperature readings are named forthe location in which they re taken: oral (in the mouth), ural (in the ear), axillary (in the armpit), and rectal (in the rectum). Caution: oral and aural sound alike; however, they require different styles of thermometers and are taken in different locations. 1 Temperature readings vary slightly depending upon the location in which they are taken, 1 Hyperthermia (high-per-THER-mee-ah) is an extremely high fever (hyper- means excessive, therm ‘means heat, and -ia means pertaining to). Hypothermia (high-poh-THER-mee-ah) is an ‘abnormally low body temperature (hypo- means deficient, therm means heat, and -ia means pertaining to). (Ay Temporat ‘The pulse is the rhythmic pressure against the walls of an Mica artery that is caused by the beating of the heart. The pulse rate reflects the number of times the heart beats each minute and is recorded as pm (beats per minute). As shown in Figure 15.1, the pulse can be measured at dif- ferent points on the body. 1 The normal resting heart rate differs by age group. In (Cheatin adults, a normal resting heart rate is from 60-100 bpm. Generally heart rates are higher in children, and for a newborn the resting heart rate ranges from 100-160 bpm. Athletes, however, can have a normal resting heart rate of 40-60 bpm. {D) Radiat (€) Femoral (F) Popltaal (6) Docsalis pedis Respiration Respiration, which is also known as the respiratory rate (RR), is the number of complete breaths per minute. A single respiration consists of one inhalation and one exhalation (see Chapter 7). The normal respiratory rate for adults ranges from 12 to 20 respirations per minute, Blood Pressure Blood pressure is the force of the blood against the walls of the arteries. This force is measured using a sphygmoma- ‘nometer (sfig-moh-mah-NOM-eh-ter). When using manual style, as shown in Figure 15.2, a stethoscope is required to listen to the blood sounds. A digital sphygmomanometer is ‘automated and does not require the use of a stethoscope. Blood pressure is recorded as a ratio with the systolic (Gis-TOL-ick) over the diastolic (dye-ah-STOL-ick) reading. ‘The systolic is the first beat heard. The diastolic is the last beat heard. Memory aid: SSSS-systolic is like steam going up. DDDD-diastolic is as in going down (Figure 15.3). Pain ‘In certain settings, such as a hospital, pain is considered to be the fifth vital sign. Since this is a subjective symp- tom that cannot be measured objectively, it must be determined as reported by the patient. . ga pain rating scale, the patient is asked to describe his or her level of pain from 0 (no pain) to 10 (severe pain). Facial expressions are used to ask children to rate their pain (Figure 15.4). Acute pain, which comes on quickly, can be severe and lasts only a relatively short time. Tt can be caused by disease, inflammation, or injury to the tissues. ‘When the cause of the pain is diagnosed and treated, the pain goes away. I Chronic pain, which can be mild or severe, persists ‘over a longer period of time than acute pain and is, resistant to most medical treatments. It often causes severe problems for the patient, Auscultation ‘The term auscultation (aws-kul-TAY-shun) means listen- ing for sounds within the body and is usually performed through a stethoscope (auscult/a means to listen, and -tion means the process of) (Figure 15.5). Respiratory Sounds Respiratory sounds heard through a stethoscope provide information about the condition of the lungs and pleura as the patient breathes (see Chapter 7). Systoie BP (test beat hears) Diastolic BP (ast beat heard) FIGURE 15.3. Using a stethoscope, the systolic pressure is the frst sound heard and the diastolic pressure is the ast best heard. 10 — > | @8&Ge08 : i : FIGURE 15.4 A pediatric pain scale such a the Oucher Pain Assesemant Tool utes facial expressions instead of numbers. (The Caucasion version of the Oucher, devel ‘oped and copyrighted by Judith E. Beyer, RN, Ph.D, 1983, Used with permission) @ Arale(RAHL), also known as a crackle, is an abnormal crackle-like lung sound heard through a stethoscope during inspiration (breathing in). I Rhonchi (RONG-kye) are coarse rattling sounds that are somewhat like snoring. These sounds are usually sin the bronchial airways (singular I Stridor (STRYE-dor) is an abnormal, high-pitched, musical breathing sound caused by a blockage in the throat or in the larynx (voice box). Heart Sounds The heartbeat heard through a stethoscope has two distinct sounds. These are known as the “lubb dup” or “lub dub” sounds. The lub sound is heard first. It is caused by the tricuspid and mitral valves closing between the atria and the ventricles. The dupp sound, which is shorter and higher pitched, is heard next, It is caused by the closing of the semilunar valves in the aorta and pulmonary arteries as blood is pumped out of the heart, A bruit (BREW-ee) is an abnormal sound or ‘murmur heard during auscultation of an artery. These sounds are usually due to a partially blocked, narrowed, or diseased artery. A thrill is an abnormal thythmic vibration felt when palpating an artery. (Note: the term bruit is also sometimes pronounced BROOT.) A heart murmur is an abnormal heart sound that is most commonly a sign of defective heart valves. Heart ‘murmurs are described by volume and the stage of the heartbeat when the murmur is heard. FIGURE 15.5 Auscultation is listening through a stetho- scope to sounds within the body. Abdominal Sounds Abdominal sounds, also known as howel sounds, are normal noises made by the intestines. Auscultation of the abdomen is performed to evaluate these sounds and to detect abnormalities. For example, increased bowel sounds can indicate a bowel obstruction. The absence of these sounds can indicate ileus, which is the stopping of intestinal peristalsis (see Chapter 8). Palpation and Percussion lH Palpation (pal-PAY-shun) is an examination tech- nique in which the examiner's hands are used to feel the texture, size, consistency, and location of certain body parts (Figure 15.6). 1 Percussion (per-KUSH-un) is a diagnostic procedure designed to determine the density of a body part by the sound produced by tapping the surface with the fingers. As shown in Figure 15.7, this is performed on the back to determine the presence of normal air content in the lungs. Basic Examination Instruments 1 An ophthalmoscope (ahf-THAL-moh-skope) is an instrument used to examine the interior of the eye (ophthalm/o means eye, and -scope ‘means instrument for visual examination) (Figure 15.8). An otoscope (OH-toh-skope) is an instrument used to visually examine the external ear canal and tympanic membrane (ot/o means ear, and -scope means instrument for visual examination) (see Chapter 11, Figure 11.15). A speculum (SPECK-you-lum) is an instrument used to enlarge the opening of any canal or cavity to facilitate inspection of its interior (see Chapter 14, Figure 14.15 A) A stethoscope (STETH-oh-skope) is an instrument used to listen to sounds within the body (steth/o ‘means chest and -scope means instrument for exami- nation) (Figures 15.2 and 15.5) IB RECUMBENT EXAMINATION POSITIONS Specific basic examination positions are used to examine different areas of the body. The term recumbent (ree- KUM-bent) describes any position in which the patient is lying down. This can be on the back, front, or side. In radiography, the term decubitus describes the patient lying in a recumbent position, ‘These are positions in which the patien face up: FIGURE 15.6 Palpation is an examination technique in Which the examiner's hands are used to feel the texture, size, consistency, and location of certain body parts. FIGURE 15.7 Percussion is a diagnostic procedure in Which the examiner's hands are used! to determine the density af a body area. ; & FIGURE 15.8 An ophthalmoscope is used to examine the interior ofthe eye. In the horizontal recumbent position, also known as the supine position, the patient is lying on the back, face up. This position is used for examination and ‘treatment of the anterior surface of the body and for xrays, I In the dorsal recumbent position, the patient is lying on the back, face up, with the knees bent. This position is used for the examination and treat- ment of the abdominal area and for vaginal or rectal ‘examinations, I In the lithotomy position (lih-THOT-oh-mee) the patient is lying on the back, face up, with the feet and legs raised and supported in stirrups. This pos ‘used for vaginal and rectal examinations and during childbirth, ‘These are positions in which the patient is face down or on his/her side: 1 Ina prone position, the patient is lying on the abdo- men face down. The arms may be placed under the head for comfort. This position is used for the exami- nation and treatment of the back and buttocks. I In the Sims’ position, the patient is lying on the left side with the right knee and thigh drawn up with the left arm placed along the back. This position is used in ‘the examination and treatment of the rectal area. I In the knee-chest position, the patient is lying face down with the hips bent so that the knees and chest rest on the table. This position is also used for rectal ‘examinations. BB LABORATORY TESTS When a laboratory test is ordered stat, the results are needed immediately, and the tests have top priority in the laboratory. Stat comes from the Latin word meaning immediately. Blood Tests ‘When used in regard to laboratory tests, the term profile ‘means tests that are frequently performed as a group on automated multi-channel laboratory testing equipment. Obtaining Specimens A phlebotomist (flch-BOT-oh-mist) is a medical pro- fessional who is trained to draw blood from patients for various laboratory tests and other procedures (Figure 15.9). FIGURE 15.9 A phlebotomist draws a blood sample from a patient for testing. 1 Phlebotomy (fleh-BOT-oh-mee), also known as veri- puncture, is the puncture of a vein for the purpose of drawing blood (phleb means vein, and -otomy means a ‘surgical incision) An arterial stick is the puncture of an artery, usually ‘on the inside of the wrist, to obtain arterial blood. Arterial blood differs from venous blood mostly in the concentration of dissolved gases it contains. A capillary puncture is the technique used when only ‘a small amount of blood is needed as a specimen for a blood test. Named for where it is performed, a capil- Jary puncture is usually known as a finger, hrecl, or an earlobe stick. Complete Blood Cell Counts A complete blood cell count (CBC) is a series of tests performed as a group to evaluate several blood condi- tions. Blood disorders are discussed in Chapter 5. Il Erythrocyte sedimentation rate (ESR) (eh-RITH- rob-site), also known as a sed! rate, isa test based on the speed with which the red blood cells separate from the plasma and fall to the bottom of a specialized test tube. An elevated sed rate indicates the presence of inflammation in the body. Normal range is <15-20 mm/hr (millimeters per hour) for adults under 50, and <20-30 mm/hr for adults over 50. 1 The term hematocrit (hee-MAT-oh-krit) describes the percentage, by volume, of a blood sample occupied by red cells (hemat/o means blood, and -crit means to separate). This test is used to diagnose abnormal states of hydration (fluid levels in the body), polycythemia (excess red blood cells), and anemia (deficient red blood cells). A platelet count measures the number of platelets in a specified amount of blood and is a screening test to evaluate platelet function, It is also used to monitor changes in the blood associated with chemotherapy and radiation therapy. These changes include thyombocyrosis (an abnormal increase in the number of platelets) and /irombo- eytopenia (an abnormal decrease in the number of platelets). 1 A red blood cell count (RBC) is a determination of the number of erythrocytes in the blood. A depressed count can indicate anemia or a hemorrhage lasting ‘more than 24 hours. A total hemoglobin test (Hb) is usually part of a complete blood count (hem/o means blood, and -globin means protein). Elevated Hb levels indicate a higher than normal hemoglobin concentration in the plasma due to polycythemia or dehydration. Low Hb indicates lower than normal hemoglobin concentra- tion due to anemia, recent hemorrhage, or fluid retention. A white blood cell count (WBC) is a determination of the number of leukocytes in the blood. An elevated count can be an indication of infection or inflammation. A white blood cell (WBC) differential count tests to see what percentage of the total white blood cell count is composed of each of the five types of leukocytes. This provides information about the patient's immune system, detects certain types of leukemia, and determines the severity of infection, Urinalysis Urinalysis (you-rih-NAL-ih-sis) is the examination of the physical and chemical properties of urine to determine the presence of abnormal elements. Routine urinalysis is performed to screen for urinary ‘and systemic disorders. This test utilizes a dipstick, This is a plastic strip impregnated with chemicals that react with substances in the urine and change color when abnormalities are present (Figure 15.10). I Microscopic evamination of the specimen is per- formed when more-detailed testing of the specimen is necessary, for example, to identify casts. Casts are fibrous or protein materials, such as pus and fats, that are thrown off into the urine in kidney disease. (Note: The term cast is also used to describe a rigid dressing, traditionally made of gauze and plaster, used to immobilize a bone that has been fractured.) Conditions and Drug Use Identified Through Urinalysis i Albuminuria (al-byou-mih-NEW-ree-ah) is the pres- ence of the protein albumin in the urine. High test levels are a sign of impaired kidney function (albumin 's albumin or protein, and -uria means urine). Albwinin is a form of protein found in most body tissues. Ml Bacteriuria (back-tee-ree-YOU-ree-ah) is the pres- ence of bacteria in the urine (bacteri means bacteria, and -uria means urine). 1 Calciuria (kal-sih-YOU-ree-ah) is the presence of cal- cium in the urine (calci means calcium, and -uria ‘means urine). Abnormally high levels can be diagnostic for hyperparathyroidism as described in Chapter 13. Lower-than-normal levels can indicate osteomalacia, which is discussed in Chapter 3. 1 Creatinuria (kree-at-ih-NEW-ree-ah) is an increased concentration of creatinine in the urine (creatin ‘means creatinine, and -uria means urine). Creatinine is a waste product of muscle metabolism that is nor- mally removed by the kidneys. The presence of excess creatinine is an indication of increased muscle break- down or a disruption of kidney function, HA drug-screening urine test is a rapid method of identifying the presence in the body of one or more drugs of abuse such as cocaine, heroin, and marijuana. ‘These tests are also used to detect the use of performance-enhancing drugs by athletes. I Glycosuria (glye-koh-S00-ree-ah) is the presence of glucose in the urine (glycos means glucose, and -uria ‘means urine). This condition is most commonly caused by diabetes. 1 Hematuria (hee-mah-T00-ree-ah) is the presence of blood in the urine (hemat means blood, and -uria means urine). This condition can be caused by kidney stones, infection, kidney damage, or bladder cancer. 1 Ketonuria (kee-toh-NEW-ree-ah) is the presence of ketones in the urine (keton means ketones, and -uria ‘means urine). Kerones are formed when the body breaks down fat and their presence in urine can indi cate starvation or uncontrolled diabetes. 1 Proteinuria (proh-tee-in-YOU-ree-ah) is the presence of an abnormal amount of protein in the urine (pro- tein means protein, and -uria means urine). This condition is usually a sign of kidney disease. 1 Pyuria (pye-YOU-ree-ah) is the presence of pus in the urine (py means pus, and -uria means urine). When. pus is present, the urine is turbid in appearance. ‘Turbid means has a cloudy or smoky appearance. HA urine culture and sensitivity tests, also known as a urine C and Sis a laboratory test that is used to identify the cause of a urinary tract infection and to determine which antibiotic would be the most effective ‘tweatment IB ENDOSCOPY Endoscopy (en-DOS-koh-pee) is the visual examination of the interior of a body cavity (endo means within, and -scopy means visual examination). These procedures are usually named for the organs involved. Endoscopic surgery is a surgical procedure that is, performed through very small incisions with the use of an endoscope and specialized instruments. These proce- dures are named for the body parts involved, for example, arthroscopic surgery, which is discussed in Chapter 3. Endoscopes An endoscope (EN-doh-skope) is a small flexible tube with @ light and a lens on the end (endo means within and -scope is an instrument for visual examination). ‘These fiber-optic instruments are named for the body parts they are designed to examine. For example, a hys- teroscope is used to examine the interior of the uterus, while a laparoscope is used to examine the interior of the abdomen (Figure 15.11). Laparoscopic Procedures Laparoscopy (lap-ah-ROS-koh-pee) is the visual exami- nation of the interior of the abdomen with the use of a laparoscope that is passed through a small incision in the abdominal wall (lapar/o means abdomen, and -scopy ‘means visual examination). FIGURE 15.11 A laparoscope is used to examine the interior of the abdomen. A hysteroscope is used to examine the interior ofthe uterus. Laparoscopic surgery involves the use of a laparo- scope plus specialized instruments inserted into the abdomen through small incisions (Figure 15.11). A laparoscope is used for several purposes: Explore and examine the interior of the abdomen. ll Take specimens to be biopsied. 1 Perform surgical procedures such as the endoscopic removal of a diseased gallbladder (see Chapter 8) i CENTESIS Centesis (sen-TEE-sis) is a surgical puncture to remove excess fluid or to remove fluid for diagnostic purposes Note: Centesis is used alone as a noun or as a suffix in conjunction with the combining form describing the body part being treated. I Abdominocentesis (ab-dom-ih-noh-sen-TEE-sis) is the surgical puncture of the abdominal cavity to remove fluid (abdomin/o means abdomen, and -centesis means a surgical puncture to remove fluid). Hl Amniocentesis, which is a diagnostic test performed during pregnancy, is discussed in Chapter 14. 1 Arthrocentesis (ar-throh-sen-TEE-sis) is a surgical puncture of the joint space to remove synovial fluid for analysis to determine the cause of pain or swelling in a joint (arthr/o means joint, and -centesis means a surgical puncture to remove fluid). 1 Cardiocentesis (kar-dee-ch-sen-TEE-sis), also known as cardiopuncture, is the puncture of a chamber of the heart for diagnosis or therapy (cardi/o means heart, and -centesis means a surgical puncture to remove fluid). I Pericardiocentesis (pehr-ih-kar-dee-oh-sen-TEE-sis) is the puncture of the pericardial sac for the purpose of ‘removing fluid (peri- means surrounding, cardi/o ‘means heart, and -centesis means a surgical puncture to remove fluid). This procedure is performed to treat pericarditis (see Chapter 5). BB IMAGING TECHNIQUES Imaging techniques are used to visualize and examine internal body structures. The three most commonly used techniques are compared in Table 15.1. TABLE 15.1 Imaging Systems Compared | Method How It Works Radiography (xray) Uses xradiation (xrays) passing through the patient to ‘expose a film or create a digital image that shows the body in profile. In the resulting film, hard tissues are light, soft tissues I are shades of gray, and air is black. Computed tomography (CT) Uses xradiation (x-rays) with computer assistance to produce | multiple cross-sectional views of the body. Hard tissues are. light, and soft tissues appear as shades of gray. Magnetic resonance imaging (MRI) Uses a combination of radio waves and a strong magnetic field to produce images. Hard tissues are dark, and soft tis sues appear as shades of gray. Contrast Medium A contrast medium is administered by swallowing, via an enema, or intravenously to make specific body structures visible. Specialized substances are used depending on the imaging systems and the body parts to be enhanced, These media are either radiopaque or radioly ent. lH Radiopaque (ray-dee-oh-PAYK) means that the sub- stance does not allow x-rays to pass through and appears white or light gray on the resulting film. Radiopaque is the opposite of radiolucent. 1 Radiolucent (ray-dee-oh-L00-sent) means that the substance, such as air or nitrogen gas, does allow serays to pass through and appears black or dark gray on the resulting film, Radiolucent is the opposite of radiopaque. I An intravenous contrast medium is injected into a vein to make the flow of blood through blood vessels and organs visible (intra- means within, ven means vein, and -ous means pertaining to). This technique, which is usually named for the vessels or organs involved, is illustrated i Barium Barium (chemical symbol Ba) is a radiopaque contrast medium used primarily to visualize the gastrointestinal tract (Figure 15.12). It is administered orally as @ bar- iw swallow for an upper GI study. It is administered rectally as a bariwan enema for a lower GI study. Radi- ography and fluoroscopy are used to trace the flow of the barium. Radiology Conventional radiology creates an image of hard-tissue intemal structures by the exposure of sensitized film to -

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