Examinations and Special Test

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Diagnostic Examination
–    Procedure that involves physical inspection of body structures and evidence of their function.
–    Facilitate by use of technical equipment and techniques such as:
–    Radiography (x-rays)
–    Endoscopy
–    Radionuclide imaging
–    Ultrasonography (high frequency sound waves)
–    Electrical graphic recordings
–    Laboratory test
–    See table 13.1 (P. 210)General Nursing Responsibilities
–    Nursing responsibilities before, during and after the procedure. (See Box 13-1, P. 210)
–    Preprocedural care- include: consent must contain
–    Preparing clients (NPO, V/S, Bath, Shaving, illness, Dress, emotion support, instruction test)
–    Obtaining equipment and supplies
–    Arrange the examination room
–    Position and drape the clientPositions for Procedures

 

–    Dorsal recumbent position
–    Lithotomy position
–    Sim’s position
–    Knee-chest position
–    Modified standing position
–    See Table (13-2, P. 312)

Postprocedural Care
–    Attend to the client’s comfort (position)
–    Assess vital signs and client stability
–    Care for specimens (samples of tissue or body fluids) “See P. 214”
–    Record and report data

Common factors that invalidate examination or test results
–    Incorrect diet preparation.
–    Failure to remain fasting.
–    Insufficient bowel cleaning.
–    Drug interaction.
–    Inadequate specimen volume.
–    Failure to deliver specimen in a timely manner.
–    Incorrect or missing test requisition.

Common Diagnostic Tests
–    Pelvic Examination-Physical inspection of the vagina and cervix, with palpation of the uterus and ovaries.
–    Radiography-X-Rays
–    Magnetic Resonance Imaging (MRI)
–    Contrast Medium-substance that adds density to a body organ or cavity
–    Fluoroscopy-displays an image in real time

Related Nursing Responsibilities
–    Assess vital signs before and after testing
–    Remove any metal items
–    Request a lead apron to shield a fetus or vulnerable body parts
–    Determine if the client is allergic to iodine
–    Know location of emergency equipment
–    Encourage large amounts of fluid to clear iodine
–    Check on bowel elimination for 2 days after barium studies

Radiography
–    General  term for procedures that use x ray.
–    Chest x ray (anterior, posterior or lateral views) used to detects pneumonia, broken ribs and lung tumors.
–    Upper gastrointestinal x-ray (barium swallow, meal) aids in diagnosis of ulcer, GI tumors, narrowing of esophagus.
–    Lower gastrointestinal x-ray (lower GI or barium enema).
–    Cholecystography (x-ray of the gallbladder) gallstones
–    Angiography (x-ray of blood vessels)
–    Myelography (x-ray of spinal canal) spinal tumor, rupture.
Endoscopy
–    Visual examination of internal structures
–    Prevent aspiration withhold food and fluid or advise the client to do so before the procedure
–    Conscious sedation-monitor vital signs, breathing, oxygen saturation, and cardiac rhythm
–    Withhold food or fluids following procedure until gag reflex returns
–    Report any pain

Ultrasonography
–    Soft tissue examination that uses sound waves
–    Schedule abdominal and pelvic ultrasound before barium studies
–    Instruct clients undergoing abdominal ultrasonography to drink 5-6 full glasses of fluid 1-2 hours before the examination

Electrical Graphic Recordings
–    Clean skin and clip hair where electrode tabs are placed
–    Attach adhesive electrode tabs to skin
–    Do not attach to bones, scars, or breast tissue
–    Instruct client having EEG to shampoo hair before and after the test
–    Withhold coffee, tea, and cola for 8 hours before the test
–    If sleep deprived EEG, instruct client to stay awake after midnight before the examination

Paracentesis
–    Is a procedure for withdrawing fluid from the abdominal cavity.
–    Explain procedure.
–    Vital signs, weight.
–    Prepare equipment (gloves, mask, paracentesis kit).
–    Empty bladder.
–    Sitting position.
–    Measure the volume of fluid withdraw.
–    Anesthesia, Label specimen.
–    Documentation.
Nursing Implications
–    Anxiety
–    Fear
–    Impaired Adjustment
–    Decisional conflict
–    Health-seeking Behaviors
–    Powerlessness
–    Spiritual Distress

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