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Adult Health I Test IV > Diagnostic Procedures > Flashcards

Diagnostic Procedures Flashcards

1
Q

liver function tests: indications

A

Suspected liver, pancreatic, or biliary tract disorder

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2
Q

liver function tests: considerations (pre/postprocedure)

A
  • Preprocedure: explain how blood is obtained and what info this will provide
  • Postprocedure: inform when and how results are provided
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3
Q

urine bilirubin (AKA urobilinogen): indications

A

Suspected liver or biliary tract disorder

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4
Q

urine bilirubin: preprocedure

A
  • Nursing actions: can be performed using a dipstick (urine bilirubin) or a 24 hour urine collection (urobilinogen)
  • Client edu: teach client how to collect urine
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5
Q

what does a positive/elevated finding indicate in regards to a urine bilirubin?

A

a positive or elevated finding indicates: possible liver disorder (cirrhosis, hepatitis), biliary obstruction, hemolytic anemia, or pernicious anemia

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6
Q

AST elevation indication

A

hepatitis or cirrhosis

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7
Q

ALT elevation indication

A

hepatitis or cirrhosis

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8
Q

ALP elevation indication

A

liver damage

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9
Q

amylase elevation indication

A

pancreatitis

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10
Q

lipase elevation indication

A

pancreatitis

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11
Q

total bilirubin elevation indication

A

altered liver function, bile duct obstruction, or other hepatobiliary disorder

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12
Q

direct (conjugated) bilirubin elevation indication

A

altered liver function, bile duct obstruction, or other hepatobiliary disorder

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13
Q

indirect (unconjugated) bilirubin elevation indication

A

altered liver function, bile duct obstruction, or other hepatobiliary disorder

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14
Q

albumin decrease indication

A

hepatic dz

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15
Q

alpha fetoprotein elevation indication

A

liver cancer, cirrhosis, hepatitis

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16
Q

ammonia elevation indication

A

liver dz

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17
Q

FOBT and stool samples

A
  • A stool sample is collected and tested for blood, ova and parasites (Giardia lamblia), and bacteria (c. diff)
    • Stool can also be assessed for changes in vimentin gene–>can predispose a client to cancer of the intestine
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18
Q

FOBT indications

A
  • GI bleeding
  • unexplained diarrhea
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19
Q

preprocedure nursing actions and client education for FOBT

A
  • Provide client with cards impregnated w/ guaiac that can be mailed to provider or w/ a specimen collection cup
  • If the cards are used, 3 samples are required
  • Instruct client about proper collection technique
  • Medication restrictions (anticoags, NSAIDs) for 7 days before testing starts
  • Dietary restrictions before obtaining samples: vitamin C rich foods, red meat, chicken, fish
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20
Q

preprocedure nursing actions and client education for stool for ova/parasites/bacteria

A
  • Provide client w/ a specimen cup
  • Instruct client about proper collection technique: time frame for submission to lab, need for refrigeration
21
Q

interpretation of findings of FOBT

A
  • At least 3 repeats of a positive guaiac FOBT confirms GI bleeding
  • A positive finding for blood is indicative of GI bleeding: ulcer, colitis, cancer
22
Q

what does a positive finding in a stool sample of _____ indicate?

  1. ova/parasites
  2. c. diff
  3. change in vimentin gene
A
  • A positive finding for ova/parasites is indicative of a GI parasite infection
  • A positive finding for c. diff is indicative of this opportunistic infection, which usually becomes established secondary to use of broad spectrum abx
  • A change in vimentin gene can be an indicator of colorectal cancer
23
Q

endoscopy

A
  • Allow direct visualization of body cavities, tissues, and organs thru the use of a flexible, lighted tube (endoscope)
    • Performed for diagnostic and therapeutic purposes
  • Can perform biopsies, remove abnormal tissue, and perform minor surgery, such as cauterizing a bleeding ulcer
    • A contrast medium can be injected to allow visualization of structures beyond the capabilities of the cope
24
Q

potential dx with endoscopy

A
  • GI bleeding
  • Ulcerations
  • Inflammation
  • Polyps
  • Malignant tumors
25
Q

client presentation that may indicate colonoscopy

A
  • Anemia (secondary to bleeding)
  • Abdominal discomfort
  • Abdominal distention or mass
26
Q

nursing actions for endoscopy

A
  • Verify consent form is signed
  • Assess V/S and allergies
  • Evaluate baseline labs and report unexpected findings
    • Evaluate CXR, ECG, and ABGs
  • Evaluate medical hx for inc risk for complications
  • Age: influences client’s ability to understand procedure, tolerance of positioning, and compliance w/ pretest preparation
  • Current health status: consider conditions and meds that can affect the client’s tolerance of and recovery from procedure
  • Cognitive status: determine understanding of procedure and baseline mental status
  • Support system: determine whether a support person will assist the client after procedure
  • Recent food/fluid intake: can affect the ability to visualize key structures and inc risk for aspiration
    • Notify provider if dietary restrictions not followed
  • Medications: NSAIDs, warfarin, aspirin inc risk of complications
  • Previous radiographic exams: any recent exams using barium can affect the ability to view structures
  • Notify provider if contrast has recently been used
  • Electrolyte and fluid status: imbalances secondary to repeated enemas can affect bowel prep, esp in older adults
  • Ensure client follows proper bowel prep (laxatives, enemas)
    • Inadequate bowel prep can result in cancellation/delays and can lead to client experiencing extended periods of NPO or being on a liquid diet
27
Q

postprocedure for endoscopy

A
  • Monitor for V/s and assess for complications
  • if biopsy performed, food restrictions may be used
28
Q

colonoscopy: what is it? anesthesia? position?

A
  • Use a flexible fiberoptic colonoscope which enters thru the anus to visualize the rectum and sigmoid, descending, transverse, and ascending colon
  • Anesthesia: moderate sedation is used
    • Midazolam (an opiate such as fentanyl) and/or propofol
  • Positioning: left side with knees to chest
29
Q

colonoscopy prep

A
  • Bowel prep
  • Can include laxatives, such as bisacodyl and polyethylene glycol
  • Should not use polyethylene glycol in older adults b/c can cause F&E imbalances
    • Can also inhibit the absorption of some medications
  • Clear liquid diet: avoid red, purple, orange
    • NPO after midnight
  • Client should avoid aspirin, anticoags, and antiplatelet meds
30
Q

colonoscopy postprocedure

A
  • Notify provider of severe pain (possible perforation) or indication of hemorrhage
  • Monitor for rectal bleeding, V/S, respiratory status
    • Maintain open airway
  • Resume normal diet as prescribed
  • Inc fluid intake
  • Inc flatulence due to air instillation in procedure
  • Do not drive/use equipment for 12-18 hours after procedure
31
Q

EGD: what is it? anesthesia? position

A
  • Insertion of endoscope thru mouth into esophagus, stomach, and duodenum to identify or treat areas of bleeding, dilate an esophageal stricture, and diagnose gastric lesions or celiac dz
  • Anesthesia: moderate sedation per IV access
    • Topical anesthetic to depress the gag reflex
  • Atropine to dec secretions
  • positioning: left side lying with HOB elevated
32
Q

EGD: prep and postprocedure

A
  • Preparation:
    • NPO 6-8 hours
    • Remove dentures prior to procedure
  • Postprocedure:
    • Monitor V/S, resp status
    • Maintain open airway until client is awake
    • Notify provider of bleeding, abdominal or chest pain, and any evidence of infection
    • w/ hold fluids until return of gag reflex
    • d/c IV fluid therapy when the client tolerates oral fluids w/o n/v
    • Instruct client not to drive or use equipment for 12-18 hours
    • Use throat lozenges if sore throat persists
33
Q

ERCP: what is it? anesthesia? positioning?

A
  • Insert endoscope thru mouth into biliary tree via duodenum
  • Allows visualization of biliary ducts, gall bladder, liver, and pancreas
  • X-rays taken after contrast medium is injected into common duct
  • Anesthesia: moderate sedation by IV access
    • Topical anesthetic to depress gag reflex
    • Atropine to dec secretions
  • Positioning: initially semi prone w/ repositioning throughout procedure
34
Q

ERCP: prep and post procedure

A
  • Preparation:
    • NPO 6-8 hr
    • Remove dentures prior to procedure
    • Explain procedure and need to change positions during procedure
  • Post procedure:
    • Monitor V/S and respiratory status
    • Maintain open airway until client is awake
    • Notify HCP of bleeding, abdominal or chest pain, and any evidence of infection
    • w/hold fluids until return of gag reflex
    • d/c IV fluid therapy when client tolerates oral fluids w/o n/v
    • Do not use equipment or drive for 12-18 hours after procedure
    • Use throat lozenges if sore throat persists
35
Q

M2A: what is it? anesthesia? position?

A
  • Swallow capsule w/ a glass of H2O for video enteroscopy to visualize the entire small bowel over an 8 hour period
    • Not used to view colon
  • Anesthesia: none
  • Positioning: return to normal activity during study
36
Q

M2A: prep and postprocedure

A
  • Preparation:
    • Fast (water only) for 8-10 hour before the test and NPO for first 2 hour of testing
      • Normal eating 4 hours after swallowing capsule
    • Abdomen is marked for location of sensor
      • 8 lead sensors are placed and connected to a data recorder which captures images of small intestine
  • Postprocedure:
    • After 8 hours, client returns the recorder to download images
    • Evacuate the capsule in stool
37
Q

sigmoidoscopy: what is it? anesthesia? position?

A
  • Scope is shorter than a colonoscope, allowing visualization of the anus, rectum, and sigmoid colon to test for colon cancer, investigate for a GI bleed, diagnose or monitor inflammatory bowel dz
  • Anesthesia: none required
  • Positioning: on left side
38
Q

sigmoidoscopy: prep and postprocedure

A
  • Preparation:
    • Bowel prep (laxatives like bisacodyl, cleansing enema, or sodium bisphosphate enema)
    • Clear liquid diet at least 24 hours before procedure
    • NPO after midnight
    • Client must avoid meds as indicated by the provider
  • Postprocedure:
    • Monitor V/S and respiratory status
    • Monitor for rectal bleeding
    • Resume normal diet as prescribed
    • Encourage inc fluid intake
    • Instruct client that there can be inc flatulence due to air instillation during the procedure
39
Q

list the possible complications of GI diagnostic procedures

A
  • oversedation
  • hemorrhage
  • aspiration
  • perforation of GI tract
40
Q

oversedation as complication of GI procedures

A
  • use of moderate sedation places client at risk for oversedation
  • Manifestations:
    • Difficult to arouse
    • Poor respiratory effort
    • Evidence of hypoxemia
    • Tachycardia
    • Elevated or low BP
  • Nursing actions:
    • May have to administer antidotes for sedatives administered prior to and during procedure
    • Administer O2 and monitor V/S
    • Maintain open airway
    • Notify provider ASAP
  • Client edu:
    • Driving and major decision making are restricted until the effects of sedation have worn off
    • Varies w/ the type of agent use
41
Q

hemorrhage as a complication of GI diagnostic procedures

A
  • Manifestations:
    • Bleeding
    • Cool and clammy skin
    • hypoTN
    • Tachycardia
    • Dizziness
    • Tachypnea
  • Nursing actions:
    • Assess site for hemorrhage
    • Monitor V/S
    • Monitor diagnostic test results: Hgb and Hct
  • Client edu: report fever, pain, and bleeding
42
Q

aspiration as a complication of GI diagnostic procedures

A
  • Using moderate sedation or topical anesthesia can affect the gag reflex
  • Manifestations:
    • Dyspnea
    • Tachypnea
    • Adventitious breath sounds
    • Tachycardia
    • Fever
  • Nursing actions:
    • Keep client NPO until gag reflex returns
    • Ensure client is awake and alert prior to food/fluid consumption
    • Notify HCP if delay in return of gag reflex
  • Client Edu: report respiratory congestion or compromise to HCP
43
Q

perforation of the GI tract as the complication of diagnostic procedure

A
  • Manifestations:
    • Chest or abdominal pain
    • Fever
    • n/v
    • Abdominal distention
  • Nursing actions:
    • Monitor tests for infection including inc WBC
  • Client edu:
    • Report fever, pain, and bleeding to the provider
44
Q

GI series

A
  • Done w/ or w/o contrast to help define anatomic or functional abnormalities
  • Includes radiography imaging of esophagus, stomach, and entire intestinal tract
  • Upper GI imaging done by having the client drink barium
    • For small bowel follow through, barium is traced thru the small intestine to the ileocecal junction
  • A barium enema is done by instilling radiopaque liquid into rectum and colon
45
Q

potential dx for a GI series

A
  • Gastric ulcers
  • Peristaltic disorders
  • Tumors
  • Varices
  • Intestinal enlargements or constrictions
46
Q

client presentation that could indicate a the need for a GI series

A
  • Abdominal pain
  • Altered elimination habits: constipation, diarrhea
  • GI bleeding
47
Q

GI series: preprocedure

A
  • Nursing Considerations:
    • Inform the client about meds, food and fluid restrictions (clear liquid and/or low residue diet, NPO after midnight), and avoid smoking or chewing gum (inc peristalsis)
    • Assess client’s understanding of bowel prep (laxatives, enemas) so image will not be distorted by feces
    • Barium enema studies must be scheduled prior to upper GI studies
    • Assess for contraindications to bowel prep: possible bowel perforation or obstruction, inflammatory disorder
  • Client edu:
    • Restrict food/fluids for bowel prep
48
Q

GI series: postprocedure

A
  • Nursing Actions:
    • Monitor elimination of contrast material, and administer laxative if prescribed
    • Inc fluid intake to promote elimination of contrast material
  • Client edu:
    • Instruct the client to monitor elimination of contrast material and to report retention of contrast material (constipation) or diarrhea accompanied by weakness
    • Discuss need for OTC meds to prevent constipation resulting from barium
    • Stools will be white 24-72 hours until barium clears
      • Client should report fullness of abdomen, pain, or delay in return to brown stool

Adult Health I Test IV (10 decks)

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