Diagnostic Procedures Flashcards
1
Q
liver function tests: indications
A
Suspected liver, pancreatic, or biliary tract disorder
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
3
Q
urine bilirubin (AKA urobilinogen): indications
A
Suspected liver or biliary tract disorder
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
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
6
Q
AST elevation indication
A
hepatitis or cirrhosis
7
Q
ALT elevation indication
A
hepatitis or cirrhosis
8
Q
ALP elevation indication
A
liver damage
9
Q
amylase elevation indication
A
pancreatitis
10
Q
lipase elevation indication
A
pancreatitis
11
Q
total bilirubin elevation indication
A
altered liver function, bile duct obstruction, or other hepatobiliary disorder
12
Q
direct (conjugated) bilirubin elevation indication
A
altered liver function, bile duct obstruction, or other hepatobiliary disorder
13
Q
indirect (unconjugated) bilirubin elevation indication
A
altered liver function, bile duct obstruction, or other hepatobiliary disorder
14
Q
albumin decrease indication
A
hepatic dz
15
Q
alpha fetoprotein elevation indication
A
liver cancer, cirrhosis, hepatitis
16
Q
ammonia elevation indication
A
liver dz
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
18
Q
FOBT indications
A
- GI bleeding
- unexplained diarrhea
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
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?
- ova/parasites
- c. diff
- 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
- Fast (water only) for 8-10 hour before the test and NPO for first 2 hour of testing
- 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
