SPECIAL EXAMINATIONS AND TEST

SPECIAL EXAMINATIONS AND TESTDiagnostic examinations – is a procedure that involves physical infection of body structures and evidence of their functions. It is facilitated

by the use of technical equipment and techniques .

Radiography (X-RAYS)-

Examples: chest x-ray (anterior,posterior,lateral views – detects pneumonia,broken ribs, lung tumors)

Upper gasto-intestinal x-ray – aids in dignosis of ulcers, gatrointestinal tumors, narrowing of the esophagus.

Endoscopy (Visual examination of the inner

structures using Optical scopes)

Examples:brochoscopy- inspection of bronchi Gastrophy – inspection of stomach Colonoscopy- Inspection of colonesophagstroduodenoscopy- inspection of the esophagus,stomach and duodenum. laparoscopy –inspection of the abdominal cavity Cystoscopy- inspection of the urinary bladder

Related Nursing Responsibilities

If conscious sedation( no memory of having the test trough the client can communicate during the procedure).To prevent aspiration withhold food and fluids or advise the client to do so for at least 6 hours before any procedure in which an endoscope is inserted into the upper gastrointestinal tract.Have oxygen resuscitation equipment readily available.If topical anesthesia is used to facilitate the passage of an endoscope into the airway or upper gastrointestinal tract, withhold food or fluids for at least 2 hours after the procedure and until swallow, cough and gag reflex return.Relieve the client’s sore throat with ice chips. fluids or gargles when it is safe to do.Confirm the bowel preparation using laxatives and enemas has been completed before endoscopic procedures of the lower intestines.Report difficulty in arousing a client or any sharp pain fever, unusual bleeding, nausea, vomiting or difficulty with urination after any Endoscopic examinations

Radionucleic Imaging

Are elements whose molecular structures are altered to produce radiation.Ex. 131 (radioactive iodine)99 T c ( radioactive technetium)- usually injected through intravenous route, particular tissues or organs absorbs them.A scanning device to detect radiation creates an image of the size, shape and concentration of the organ containing radionuclide.

RELATED NURSING ACTIVITIES:

Inquire about women’s menstrual and obstetric history, notify the nuclear dept. if client is pregnant or breastfeeding.Ask about allergy history because iodine commonly used.Assist the client with gown, robe and slippers . Make sure no metal objects internally and externally.Obtain accurate weight because the radionuclide is computed according to height.Inform the client of brief period(24 HOURS) that he or she is radioactive but body fluids such as urine stool and emesis can be flushed away.Instruct premenouposal women to use effective birth control for the short period during radiation continues to be present

Nursing Responsibilites:

For best visualization schedule abdominal and pelvic ultrasonography before any examinations that use barium.Instruct clients undergoing abdominal ultrasonography tp drink 5 to 6 full glasses of fluid approximately 1 to 2 hours before the test. To ensure full bladder they should not urinate after the test is completed.Explain that acoustic gel is applied over the abdomen where the transducer place.

Electrical Graphics Recordings:

Machines can record electrical impulses from structure such as heart, brain and skeletal muscles.These test are identified by the prefix “electro” as in electrocardiography (ECG/EKG) Activity of the heart.Electroencehalography (EEG) Examination of the energy emitted by the brain.Electroyography (EMG) examination of the energy produced by stimulated muscles.

Nursing responsibilities for ECG:

Clean the skin and clip hair in the area where electrode tabs will be places to ensure adherence and reduce discomfort on removal.Attach the adhesive electrode tabs to the skin where the electrode wires will be fastened.Avoid touching the adhesive tabs over bones, scars and breast tissue.

FOR EEG

Instruct the client to shampoo the hair in the evening before the procedure to facilitate firm attachment of the electrodes. He /She Should shampoo the hair after the test to remove adhesive from the scalp.Consult with physician about withholding scheduled medications especially those that affect neurologic activity.If a sleep-deprive EEG is scheduled the client that he/she must stay awake after the midnight before the examination.

For EMG

Tell the client he/she will be instructed to contract and relax certain muscles during examinations.Explain the electrical current is applied to muscles during EMG but the sensation is not usually painful.A muscles electrode is inserted with a small-gauge in 10 or more locations but the experience is painless unless it touches a terminal nerve in the area.

By learning root words and suffixes ( word endings ), which are primarily of latin and greek origin. It is possible to decipher many unfamiliar names of diagnostic examinations and test.

Suffix Meaning Examples DescriptionGraphy - to record - angiography -test, that records an image of blood vesselsGram - An image - angiogram - the actual image recorded angiographyScopy - To see - sigmoidoscopy - test in which the lower intestine is inspectedScope -Examination - Sigmoidoscope - a tube with a light and lens for instrument looking within the lower intestineCentesis - To puncture - Thoracentesis - Procedure which a needle is used to puncture the thorax withdraw flui Metry - To measure - Pelvimetry - Procedure in which the pelvis is measuredMeter - Instruments for - Glucometer – instrument for measuring obtaining glucose measurements

Laboratory test

- is a procedure that involves the examinations of the body fluids or specimens. It involves comparing the components of a collected specimen with normal findings. A diagnostic examination or may not include the collections of specimens

Diagnostic Laboratory Tests:

BloodUrineStool/fecesSputumIntestinal secretionsSpinal fluidDrainage from woundsDrainage from infected tissue

Collecting Specimen Culture:

:A culture( incubation of microorganism)

is performed by collecting body fluid or substances suspected of containing infectious microorganisms, growing the living microorganisms in a nutritive substance and examining their characteristics with a microscope

Cultures are performed commonly on:

UrineStool/fecesWound drainageThroat secretionsGram staining (process of adding dye to a microscopic specimen).The gram stain helps to determine whether bacteria are gram-positive if the bacteria appear violet after staining.Gram-negative are those that repel the violet dye but appear red. The color of counter stain.Streptococci are round, grown in chains and are gram –positive.

General Nursing Resposibilities

When clients undergo diagnostic examinations and laboratory tests nurses have specific responsibilities before, during and after the procedures.

CLARIFYING EXPLANTIONS

In some cases, a signed consent form is requires before the performance of examinations or tests. To be legally sound, consent must contain three elements.Capacity- indicates that the client has the ability to make rational decisions: If not spouse,parent must do so.Comprehension –indicates that the client understands the physicians explanations of the risks,benefits and alternatives that are available. Voluntariness - indicates that the client is acting on his or own free will without coercion or threat of intimidation

General nursing responsibilities for examinations and tests

Determine the client understands of the procedureWitness the clients signature on a consent formTeach or follow test preparation requirementsObtains equipments and suppliesArrange the examination areaPosition and drape the clientAssists the examinerProvide the client with the client physical and emotional supportCare for the specimensRecord and report appropriate information

Preparing Clients:

Some examinations and tests require special preparation of the client such as withholding food and fluids or modifying the diet.Because preparations requirements vary among health care agencies, the nurse refers to written protocols in the agency’s manual rather than relying on memory.Once he or she understands the specific requirements for a test, the nurse provides directions to the client, nursing staff and other hospital requirements such as the dietary department, involve the test.Everyone involved must cooperate to ensure test. The nurse reports any incorrect test preparations promptly because the procedure may need to be cancelled and rescheduled.Because many tests examinations are done on an outpatient basis, the nurse must understand the client’s responsibilities and instruct him or her accordingly.Regardless of the type of examination or test, the nurse helps the client to change into an examination gown, applies an identification bracelet, takes vital signs, and suggests theat the client empty the bladderThe nurse continues to monitor the condition of waiting clients who can experience adverse effects from fatique delayed food consumption or medical symptoms.

Client and Family TeachingPreparation for Special Examinations Or Tests

Call (specify the number) If he or she does not clearly understand or cannot follow any test preparation instructions.Refrain from eating or drinking anything for at least 8 hours before a test or examinations that requires fasting state.Follow exactly as directed all dietary specifications for eating or omitting certain foods.Check with physician about taking or readjusting the time schedule for taking prescribed medications on the day of the test or examinations.Dress caually and in layers so that he or she can remove or add items of clothing to maintain comfort in the test environment

Bathe or shower as usual on the day of the test or examinations.Dress casually and in layers so that he or she can remove or add items of clothing to maintain comfort in the test environment.Ask a friend or family member to provide transportation to and from the site if there is a potential for drowsiness , linkering pain or weakness after the procedure.Arrive at least 30 minutes before the test is scheduled.Identify himself or herself at the information or appointment desk upon arrivalBring information to verify insurance or Medicare coverage.

Obtaining Equipment And Supplies

If an examination or test is performed at the bedside or in an examination room on the nursing unit. The nurse obtains equipment and supplies ahead of time.Nurses are relieve of this responsibility if the examination or test is carried out in other locations or when a special technician performs the procedure.Some items that are nurses may need are in packed kits( such as lumbar puncture kit) Kept in clean utility room or obtained from a central supply department (Also called materials management in some health care agencies).If using packaged kit, the nurse checks the list of contents to determine what, if any, additional items are needed.Clean gloves, goggles,masks and gowns are required to prevent direct contact with blood or body secretions.

Arranging the Examinations Area

the procedure is performed at the bedside the nurse remove the unnecessary articles from the area and provides privacy.Many nursing units contain an examination room that is clean, well lit and stocked with frequently used equipment.The nurse covers the examination table with a sheet or paper dispensed from a roll. A lined receptacle is nearby for disposal of soiled linens. The nurse arranges equipment and supplies for easy access by the examiner. Sterile items remain wrapped or covered until just before their use.Before the examiner arrives, nurses checks the instruments that require electric power, batteries or lights so that they can replace nonfunctioning equipment.

Procedural Responsibilities

During the examination or test, the nurse positions and drapes the client . Provides the examiner with technical assistance and supports the client physically and emotionally.Positioning and DrapingAssisting the ExaminerProviding Physical and Emotional Support

Positioning and Draping

Dorsal Recumbent

Lithotomy Position

Sim’s Position

Knee-Chest Position

Modified Standing Position

Assisting the Examiner

The nurse must be familiar with the examination equipment and the order of its use.The nurse places instruments and equipment on the side of the examiner’s dominant hand if possible.If not, the nurse anticipates what the examiner will need during the procedure and hands one item at a time to the examiner.If the skin and underlying tissues require local anesthesia, the nurse holds a container of the medication as the physician withdraws some of its contents.The nurse always carefully checks the drug name and concentration on the label.A second method for ensuring use of the correct drug is to hold the container so that the examiner can read the label.If the nurse is responsible for performing the test or examination he/she cannot leave the client to obtain equipment and supplies.If the nurse needs assistance or additional equipment the nurse summons help with the telephone or call light in the examination room.

Providing Physical and Emotional Support

Any examination or test, the nurse continuously observes the clients physical and emotional and responds accordingly.example”: comfort measures are in order if the client is cold or in pain. holding hands and offering words of encouragement help the client to endure temporarily discomfort

Postprocedural Care

After completion of examinations and test, the nurse attends to the clients comfort and safety , cares for specimens and records and reports pertinent data.

Attending to client

-helps the client position of comfort-checks/rechecks vital signs to verify that the client conditions is stable.The nurse cleans the client any substances that caused soiling outpatients to dress in their own clothingThe nurse escorts clients to their rooms of to the discharge area and provide instruction for follow –up- care when it’s safe to do so.