lesson 8 Flashcards
Diagnostic examination
Perform by a healthcare provider at Pt bedside or specially equipped room for therapeutic or diagnostic purposes
inform consent required for some precedures ( Invasive or risky procedur
Nursing Responsibilities
- Confirm patient understanding
- Assessing Pt knowledge about the procedures
- Preparing Pt for the test
- Caring for patient after test
General guidelines
- Know pt base line and vital signs
- Assess the presence of tattoos
*Know normal values of test performed - Follow facility protocol for collecting specimen
- Be familiar with emergency equipment Ex…. Crash cart, Oxygen and AED and their location.
In Patient teaching
- The nurse answer the pt question that may need clarification, if pt doesn’t understand anything about the procedure CALL THE PROVIDER to explain.
2.The nurse need to tell patient if they’re NPO or if breakfast will be held until after their procedure
3.Special room or piece of equipment is required for the test - Medication needed before or during the test
Specimen Collection
- Collect specimen in appropriate container, at correct time, and appropriate Amount.
- Lable specimen properly with pt identification, fill in lab reignition and specimen cup before specimen is in to avoid contamination.
- Deliver specimen to lab within the recommended time to ensure proper storage
- Wear gloves when collecting specimen of blood and other body fluids.
- Wash hands and other skin surfaces immediately and thoroughly if contaminated
LABLE SHOULD!!! INCLUDE PT’S NAME, AGE, SEX, ID, DATE OF COLLECTION, TEST ORDERED, TIME OF COLLECTION, INTIAL OF THE PERSON WHO COLLED THE SPECIMEN
STOOL TESTS
*Check for blood in the stool
Also called occult test/Guaiac or Hemotest
Why is stool tested
The test is done when Gi bleeding is suspected
* Specimen often tested for occult(hidden) blood are vomitus, gastric secretion and stool
* Stool specimen cannot be contaminated with urine or toilet tissue
How many series of stool is taken
A series of 3 stools is taken to increase the chances of detecting blood in stool or helps present false:
(Stools have blood but not shown)
false+ (don’t have blood but shown in test)
Blue =
Blood in stool
What should be avoided 3 days prior to stool specimen collection?
- Dental procedures
- Eating of meat (iron-liver mean}
- Eating Beans
- Medications such aspirin, Colchicine, gout meds, NSAIDS, steroids,
- Raw fruits, and vegetables
*Antiacid e.g., Tums
Vitamin C supplement and fruit juice with vitamins C - Iron supplement
*Vitamin E - Remember no urine or tissue in urine
Collecting a stool Specimen/ OVA AND PARASITES
Is taken to identify parasites, ova and bacteria mainly found in children.
What steps are taken to prevent ova from dying
Nurse wear gloves to collect specimen and take specimen to lab within 30 min of collection to prevent ova from dying.
ANY CULTURE LOOKING FOR LIVING THING MUST BE TAKEN RIGHT AWAY
If specimen is not taken directly to lab
Store it in the fridge away from food or in a ice box
Stool Abnormalities
Melena- is (BLACK BLOOD) found in Stool, usually sticky and indicates BLEEDING IN THE UPPER GI
Hematochezia- Fresh/frank blood in stool (RED) indecates bleeding in the lower GI
Urinary Test can be
Sterile or clean
Sterile urine
Is taken directly from the bladder
If catheter isn’t present, nurse put it in to obtain urine. then take it out when done
If there is a presence of catheter, take it directly from the tube or pot
NEVER!!!! take it from Catheter bag.
Clean Urine
Is to pee out urine directly into a specimen cup
Urine Specimen collection (Random)
Routine urinalysis (Not Sterile)
Collect during normal voiding or catheter pot. Use clean specimen cup.
Screening and diagnosing.is for fluid electrolytes disturbances, UTI, presence of blood and other and other metabolic problem.
URINE SPECIMEN COLLECTION
Clean/midstream
Not sterile *
needed for testing culture and sensitivity
Urine is to be collected midstream meaning when you start peeing don’t stop. After a small amount is voided in the toilet, then you place the specimen cup to collect the desired amount.
then the remainder of urine goes in the toilet
URINE SPECIMEN COLLECTION
Sterile specimen
Never collect sterile urine from catheter bag. urine is collected from the catheter pot or directly
from the Kidney.
URINE SPECIMEN COLLECTION*
Timed urine specimen
- Timed period begins after the patient urinate and the end after pt final void.
2.In most cases it a 24hrs specimen collection
3.Discard the first pee and keep the second one
4.Store the collected void in the fridge
Routine Urinalysis
PH 4.6 to 8.0
Protein is not supposed to be in urine its presence kidney function indicates kidney function damaged
Glucose (not normally) present in urine except in Pt with poorly controlled diabetics
Ketones (not normally) present in the urine, but pt with dehydration, starvation, or excess aspirin use have ketones
Specific gravity compares the urine concentration to water
low specific gravity indicates diluted urine
High specific gravity indicates concentrated urine
Residual Urine/Postvoid Residual
The measurement is taken after Pt has voided by using bladder scanner or inserting a straight urinary catheter to determine how much urine was left in the bladder.
perfume within 10min after void. Should be less than 50cc
Complete blood count (CBC)
Blood components
Plasma 55%
Platelets 1%
Red blood cells 45%
RBC female 4.4 to 5.4
male 4.7 to 6.1
WBC 5000 to 10,000 more infection less
neutropenic
Iron females 60 to 160
Male 80 to 180
Platelets150,000 to 400,000 (helps clotting blood)
HGB females 12 to 16
Male 14 to 18
HCT Female 37% to 47%
Male 14% to 52%
Blood Clotting test/Coagulation
aPTT 30 to 30 seconds to clot(1.5 to 2.5 times the control value if receiving herprin therapy)
Pt 11 to 12.5 seconds
INR normal range 0.8 to 11
D-dimer
a test that show how fast blood is clotting, important test to on blood thinners
Blood Glocose Level
Normal non diabetic fasting blood glucose level is 70-100 when checking for blood sugar level.
Make sure there is blood flow on the finger or generate blood flow.
use the side of the finger because it less painful(lateral side)
place the punching device perpendicular to the site
Wipe away first drop of blood
Hold the test strip next to the blood on finger
Collecting Sputum
Secrection from the lungs
Best way to get spetum is to cough it up, but if its not possible use nasptracheal suction trachea
Sputum should be collected early in the morning
Prior to collectiong sputum pt should not have breakfast, brush teeth, use non alcohol based mouthwash.
Test Perform On Sputum
Tuberculosis
Pneumonia
Obtaining Culture
Never collect from old drainage or old dressing.
Clean with saline before obtaining specimen
Swap new drainage
Sterile procedure
Throat swap, swap the pharynex
Phelebotomy
Drawing blood from veins
Imaging
- MRI for soft tissue screens for metal in the body e.g bullets,wires,clips,pacemaker
- CT raysndone before test check for iodine allergy
- X Ray for broken bones
iodine dye allergy
if contrast media (subtances that change the way x-ray interat with the body) is used assess for iodine allergy,
ASK for allergy with Shellfish or Seafood.
Asses for delay reaction to dye after the procedure dyspenea, rashes, tachycardia, Urticaria
S&S of allergy mild flushing, itching, uriticaria, low blood pressure high pulse
Barium swallow preop
- Upper Gi study, examanation of the mouth, esopphagus, stomach and small intestines using an oral liquid swallowed to the outline the GI
- Pt should be NPO for 6-8hours
- Pt should not smoke the evening before procedure
- asses for allergy to barium not iodine
No informed consent required
Post Barium swallow
- Pt should rink a lot of water 3liters
- Can cause consipation so pt need laxative and eat food with high fibers or edema
- Encourage pt to ambulate
- Asses abdomanl girth, abdominal tenderness, abdominal distention,nausea and vomiting the presence of this indicate Barium Impaction
- Asses the stool to determine if the barium is completly elimnated from the body
- stool would be white or c lay when barium is coming out
No Inform Consent required
Blood clotting test/coagulation
Aptt 30 to 40 second (1.5 -2.5 times the control value if receiving heparin therapy)
7pt. 11to 12.5
*INR 0.8 to 11
D-dimer less than 0.4
a test to show how fast blood is clotting, important test to people on blood thinner
D-dimer less than 0.4
a test to show how fast blood is clotting, important test to people on blood thinner
Blood Glucose Level
Normal nondiabetic fasting blood glucose level 70-100 when checking for glucose level
1.Make sure there is blood flow to the finger or generate blood flow.
2. Use the side of the finger because it less painful (lateral side)
3.Place the punching device 7perpendicular 9to the site
4.Wipe away the first drop of blood
5. Hold test strip next to blood on finger
Collecting Sputum (Secreting from the lungs)
- Best way to get sputum is cough it up but it’s not possible use nasotracheal suction Trachea
- Sputum should be collected in the morning
- Prior to collecting sputum Pt should NOT have breakfast, brush teeth, use nonalcohol based mouth wash
No Presence of saliva in sputum
Test Performed on sputum
- Tuberculosis
- Pneumonia
Obtaining Culture
- Never collect culture from old drainage or old dressing
2.Clean with saline before obtaining specimen - Swap new drainage
STERILE PROCEDURE
THROAT SWAP, SWAP PHARYNX
Phlebotomy
Drawing blood
Imaging
MRI for soft tissue scream for metal in the body e.g., bullets, wire, clips, pacemakers
CT, X rays are done in layer (Before test check for iodine allergy
X RAY
for bones
Barium enema (lower GI series)
It is done to visualize the postion, movement and filling of the colon
1. Pt dont need inform consent
2. Pt on low residue diet, clear liquid diet at least 2 days before the procedure
3. Pt NPO after midnight before procedure
4. Laxative or bowl cleansing agent given the night before the procedure
5. Barium edema not done when pt has an obstruction or suspected obstruction, perforation, active GI bleed, diarrhea, inflammation of the colon
WHITE STOOL IS NORMAL POST PROCEDURE
Invasive Test**
Lower GI endoscopy
Colonoscopy and Proctosigmoidoscopy
1. Test colon cancer, visualization of the distal colon sigmoid colon
2. Preoperative nursing, INFORM CONSENT NEEDED
3. Pt needs to be NPO after midnight
4. Prepare the bowel by ensuring that bowel cleansing agent (golytely) is complety taken by patient
5. Mild sedative is usually given
6. Vital signs are taken before and during procedure especially because vagal stimulation increase which has the patential of causing bradycardia.
7. Make sure the patient isn’t on blood thinners
8. After procedure check vital signs are checked frequently after the test
9. Asses for bleeding. Small bleeding is exspected, excessive bleeding should be reported to the MDS
10. Explain to pt cramping or flatulence is common after precedure
11.Pt should not drive immediately after procedure
12.Keep pt NPO until bowl sounds return or able to pass gas.
Liver Biopsy
- Liver in the Right uper quadrant (RUQ)
- Liver biopsy have a high risk of bleeding
- It’s done to diagnose cirrhosis, hepatitis and other related diseases like cancer
- It can be Open Biopsy or Needle Biopsy
Before Biopsy
- Explain the procedure to pt
- Informed consent is needed
- Keep pt NPO for 6-8hrs
- Obatain base line vital signs
- Check CBC
- Check coagulating before procedure
- Pt needs to empty bladder before procedures
- Sedative is provided to calm and relax pt
- Place Pt in the proper postion with right arm behind the head and ask them to remain still.
- During procedure pt placed on the left side
After Biopsy Procedure
- Pt remain on bed restt for 24hrs
- Asses for vital signs
- Place pt on the right side for the first 2hrs after procedure to prevent possibility of bleeding a small pillow or towel maybe rolled up under the biopsy site
- Check dressing frequently
- Pt is advised to avoid coughing,straining, sneezing for the first couple of hours after procedure
- asses for pain and give medication
- Montor for complication after liver biopsy e.g hemprrhage, pneumothorax puncturing of the bladder
Paracentesis
Removing fluid out of the body cavity in this case Abnormal. Due to the presence of fluid in dyspnea(labored breathing) is present. Before procedure informed consent is Needed.
Ask Pt to void before procedure
1. After procedure montitor for vitals
2. Maintain bed rest
3. Monitor the amount, color, consistency of fluid being removed.
4. Apply pressure dressing at punctured site.
Bronchoscopy
- Purpose is to look what is in your airway
- Pt can breath during the procedure reassure them
- Informed Consent is Needed
- Check for allergies to anesthetic
- Remove dentures and check for loose teeth
- NPO 4 to 8hrs
- Premedicated with local anesthetic
After Procedure - Monitore air way
- chech for gag reflex and ability to swallow prior to reassuming oral intake
- Client not discharged from recovery room until adequate cough reflex and respirtory effort are present
Complication for Bronchoscopy
- Laryngospasam
- pneumothorax
- Aspiration
Thoracentesis
1.Draining Thoracic cavity
2.Informed Consent is Needed
3.Local anesthetic applied ( conscious sedation)
4.Ultrasound guided needle
5.Postion upright on the side of the bed
6.Lean over bed table
7.Remain absolutly still to avoid any accidental needle damange to the lungs, during the procedure do not cough,or talk unless instructed by provider
