Diagnostics
1. Diagnostic Technologies of the Respiratory System(PPT)
2. Diagnostic Technology Used in the Cardiovascular System(PPT)
3. Diagnostic Technologies of the Digestive System(PPT)
4. Urinary System Diagnostic Procedures(PPT)
5. Diagnostic Procedures of the Reproductive System(PPT)
6. Diagnostics of the Nervous System(PPT)
7. Diagnostic Procedures of the Endocrine System(PPT)
8. Blood Chemistry(PPT)
Phlebography
Phlebography: involves injection of contrast media into the venous system through a dorsal vein in the foot.
B. Purposes of the Procedure
1. Useful for diagnosing isolated calf vein thrombosis or recurrent deep venous thrombosis (DVT)
2. This is a worthwhile procedure when there is a discrepancy between the clinical suspicion of deep venous thrombosis and the ultrasound result
C. Nursing Interventions Before the Procedure
1. Nothing per orem for 2-6 hours
2. Assess for allergy to seafoods and iodine.
3. Mild sedative is administered
4. Local anesthesia at the injection site
5. Procedure lasts 30-90 minutes
D. Nursing Interventions After the procedure
1. Monitor vital signs, level of consciousness, peripheral pulses
2. Assess puncture site for hematoma, bleeding
3. Bedrest for 6-8 hrs with the punctured extremity extended
4. Apply pressure dressing and small ice pack at the puncture site
5. Intravenous fluid for 6-8 hours to excrete contrast medium
Transesophageal Echocardiography (TEE)
Transesophageal Echocardiography (TEE) – provides a high resolution ultrasonic imaging of the posterior structures of the heart (e.g. left atrium, mitral valve and aorta) via the esophagus.
B. Purposes of the Procedure
1. Used to readily diagnose and quantify diseases of the aorta, such as aortic dissection
2. Indicated for defining the source of embolism
3. Atrial tumors and thrombi, patent foramen ovale, and aortic debris can be detected
4. Used to assess presence of vegetations for the diagnosis of infective endocarditis
5. Used during cardiac surgery to guide mitral valve repair and septal myectomy
6. Can evaluate suspected abnormalities of a metal prosthesis.
Transesophageal Echocardiography Findings
C. Nursing Interventions Before TEE
1. Ascertain history of esophageal surgery, malignancy, or allergy to anesthetics or sedatives
2. Nothing per orem for 4-6 hrs before the procedure
3. Encourage to void before the procedure
4. Remove dentures and other oral prosthetics
5. Administer sedatives as ordered
6. Keep suction and resuscitation equipment readily available
7. Cardiac monitoring is done during the entire procedure
8. Place patient in chin-to-chest position to facilitate passage of endoscope
Transesophageal Echocardiography Procedure
D. Nursing Interventions After TEE
1. Nothing per orem until gag reflex returns
2. Place in lateral or semi-Fowler’s position
3. Encourage to cough
4. Throat lozenges or rinses may be used to relieve throat soreness
5. Observe for signs and symptoms of complications, e.g. pharyngeal bleeding, cardiac dysrhythmias, vasovagal reaction, and transient hypoxemia
Echocardiography
Echocardiography
: a record of high-frequency sound vibrations that have been sent into the heart through the chest wall
: Cardiac structures return the echoes derived from the ultrasound. The motions of the echoes are traced on an oscilloscope and recorded on a film
B. Purposes of the Procedure
Clinical Usefulness:
> demonstration of valvular and other structural deformities (e.g. mitral stenoses)
> detection of pericardial effusion
> evaluation of prosthetic valve function
> diagnosis of cardiac tumors, asymmetric thickening of interventricular system
> diagnosis of ventricular hypertrophy (cardiomegaly)
Echocardiography Findings
C. Preparation of the Patient
1. No special preparation is required
2. Inform the client that the procedure is painless and takes approximately 30-60 minutes to complete
D. Procedure
1. The client has to remain still, in supine position slightly turned to the left side, with head of bed elevated to 15-20 degrees
2. Transducer is placed on the left sternal border and applied with ultrasonic gel to maintain airless contact between skin and transducer.
3. ECG is recorded simultaneously to time events within cardiac cycle
Echocardiography Procedure
Stress Testing or Exercise Testing
Stress Testing or Exercise Testing
: Assessment of the cardiac function by ECG, blood pressure, and pulse rate during sustained exercise on a treadmill, or a stationary bicycle
: the most sensitive non-invasive test in the diagnosis of coronary artery disease for the most number of patients.
B. Purposes of the Procedure
1. Identify ischemic heart disease
2. Evaluate patients with chest pain
3. Evaluate effectiveness of therapy
4. Develop individual fitness program
C. Preparation of the Patient
1. Obtain an informed consent
2. Attempt to allay the anxiety of the patient
3. Patient should have adequate sleep the night before the test
4. Ensure that the client does not drink coffee, tea, and alcohol on the day of the test
5. Ensure that the client does not smoke nor take nitroglycerine, 2 hours before test
6. Eat a light breakfast / lunch at least 2 hours before the test
7. Wear comfortable, loose-fitting clothes that buttons in front
8. Wear low-heeled, rubber-soled pair of shoes
D. Procedure
1. Ask the client to report dizziness, chest pain, dyspnea, fatigue, or nausea if experienced during the test.
2. Continually observe the client, the vital signs, and the ECG during the test
3. Ensure ready access to emergency cardiac drugs and equipment (e.g. defibrillator)
4. Observe the client after the test and reinforce any medical instructions as required.
5. Evaluate the client’s response to procedure
Procedure During A Stress Test
Findings as Treadmill Exam
Electrocardiography (ECK, EKG)
Electrocardiography (ECG, EKG)
: a graphical representation of the electrical activity of the heart as reflected by changes in electrical potential at the skin surface.
: It is the first diagnostic test done when cardiovascular disease is suspected.
B. Purposes of the Procedure
Clinical usefulness: evaluation of conditions that interfere with the normal electrophysiological function such as:
> disturbance of rhythm
> disorders of cardiac muscle
> enlargement of chambers of the heart
> presence of myocardial infarction
> electrolyte imbalance
Preparation of the Patient
> Inform the client that the procedure is painless. He will not experience electrocution or shock.
> Instruct client to lie still while the ECG is being done.
Procedure
ECG is obtained by placing leads on various parts of the body and recording the electrical impulse as tracing on a strip of paper or on the screen of the oscilloscope.
Normal ECG findings :
Rate: 60-100 beats / minute
P wave: 0.04 – 0.11 seconds (represent atrial depolarization)
PR interval: 0.12 – 0.20 seconds (time of impulse transmission from the sinoatrial node to the atrioventricular node)
QRS Complex: 0.05 – 0.10 seconds (represents ventricular depolarization)
ST segment: represents the plateau phase of the action potential
T wave: should not exceed 5 mm amplitude (represents ventricular repolarization
Cardiac Catheterization
Cardiac Catheterization
: introduction of a catheter into the heart via a peripheral blood vessel to measure oxygen concentration, saturation, and tension in the various chambers of the heart.
: a highly invasive procedure not performed routinely except in cases wherein the patient is experiencing limiting or escalating symptoms of cardiac dysfunction or myocardial ischemia
: used only when objective measures (such as stress test or echocardiography) suggest that the patient has a high risk of progressing deterioration, myocardial infarction, or other adverse events.
B. Purposes of the Procedure
1. Used to accurately characterize the extent and severity of coronary artery disease
and thereby help in deciding the most appropriate plan for medical, surgical, or
catheter-based treatment.
2. Utilized to assess oxygen levels, pulmonary blood flow, cardiac output, heart
structures, and coronary artery visualization
C. Preparation of the Patient
1. Obtain an informed consent; the client should be aware of the procedure’s purpose, its possible complications, and the sensations it causes (e.g. urge to cough, nausea,heat)
2. Provide psychosocial support.
3. Determine the presence of allergies, particularly to iodine / seafoods.
4. Obtain baseline vital signs.
5. Keep the patient on nothing per orem for 6-8 hours before the procedure.
6. Have client void.
7. Administer sedatives as ordered prior to the procedure.
8. Mark distal pulses.
9. Do cardiac monitoring.
10. Inform client that he may experience warm or flushing sensation as the contrast medium is injected. “Fluttering” sensation is felt, as the catheter enters the chambers of the heart.
Heart Catheterization Laboratory
D. Procedure
1. Percutaneous femoral approach: small diameter (2-3mm), hollow plastic tubes or catheters are inserted into the femoral artery (for left heart catheterization) and the femoral vein (for right heart catheterization).
2. Done under local anesthesia.
3. The catheter is advanced under fluoroscopic into the central aorta, where pressure is measured and recorded.
4. Next, the catheter is advanced in retrograde fashion across the aortic valve into the left ventricle, where pressure is measured.
E. Nursing Interventions Post-Catheterization
1. Maintain bed rest for the prescribed number of hours.
2. Monitor vital signs, especially peripheral pulses distal to the insertion site.
3. Monitor electrocardiogram, note for dysrhythmias.
4. To prevent bleeding, apply pressure dressing and a small sand bag or ice over the puncture site.
5. Immobilize affected extremity in extension.
6. Do not place the client’s bed in Fowler’s position if the femoral artery approach was used.
7. Monitor extremities for color, temperature and tingling.
8. Observe for nausea, vomiting, flushing and rash (signs and symptoms of hypersensitivity reaction to contrast media).
Cardiac Catheterization Findings
Angiography
Angiography
: involves introduction of contrast dye into the vascular system to outline the heart and blood vessels
: used to visualize the patency of an artery
Purposes of the Procedure
> Used in the detection of artery stenoses
> Utilized for the detection of congenital anomalies of the coronary circulation, coronary arteriovenous fistulas, and patency of coronary artery bypass grafts
> Used to determine the location, severity, and morphology of stenotic lesions. The resulting information is used to plan either bypass surgery or catheter-based interventions
Coronary Angiography Result
Preparation of the Patient:
> Inform the client of the risks involved in this procedure (allergic reaction, embolus, cardiac dysrhythmia).
> Obtain a signed informed consent.
>Ask the patient about allergies to iodine or shellfish
> Determine the location and strength of peripheral pulses.
> Administer mild sedative as ordered before procedure
Procedure:
1. Angiography is performed with the patient awake but sedated. This is usually performed on an outpatient basis, with the patient discharged 4 to 6 hours after the procedure.
2. Placement of the catheter tip into the arteries is carried out under fluoroscopic guidance, and contrast agent is injected by hand during recording of the radiographic image.
Angiography
Post-procedure Care:
> Observe the client for complications.
> Check the injection site for bleeding and inflammation, assessing circulatory status of the extremities, and enforcing bed rest.
> Evaluate client’s response to procedure.
VI. Sputum Smear Test
A. Definition of the Procedure
Sputum Smear Test : sputum is obtained for evaluation of gross appearance, for microscope examination, for gram staining and culture to identify the predominant organisms and cytologic examination.
B. Purpose of the Procedure
a. direct smear : shows presence of white blood cells and intracellular (pathogenic) and extracellular (non-pathogenic) bacteria.
b. sputum culture : to make the diagnosis, to determine sensitivity and to serve as a guide for drug treatment.
c. sputum cytology (Papanicolau method) : used to identify non-invasively the presence of malignancy
C. Preparation of the Patient
1. Teach patient the proper way of expectoration
2. If the sputum is not spontaneously being produced, make the patient inhale an irritating aerosol, such as hypertonic saline (sputum induction)
D. Procedure B
1. Early morning sputum is to be collected
2. Rinse mouth with plain water
3. Use sterile container
4. Sputum specimen for culture and sensitivity is collected before the first dose of antibiotics
5. For Acid Fast Bacilli (AFB) staining, collect sputum specimen for 2 consecutive mornings (3 specimens).
Spirometry
A. Definition of the Procedure
Spirometry : series of test used to detect problems in the performance capabilities of the pulmonary system
B. Purpose of the Procedure
1. Used to measure amounts of gas exchanged between the client and the atmosphere
2. Used in the diagnosis of chronic airflow limitation such as emphysema and bronchitis
C. Preparation of the Patient
1. Explain procedure to the client to allay anxiety and promote compliance at time of test.
2. Notify the respiratory therapist of all medications the client is receiving that affect respiratory function
3. Evaluate client’s response to procedure.
Spirometer
Spirometry Procedure
D. Procedure
1. Vital capacity : the maximum volume of air that can be exhaled after a maximum inhalation.
Reduced in chronic obstructive pulmonary disease
2. Tidal volume : the volume of air inhaled and exhaled with normal quiet breathing
3. Inspiratory Reserve Volume : the maximum volume of air that can be inhaled following a normal quiet exhalation.
4. Expiratory reserve volume : the maximum volume of air that can be exhaled following a normal quiet inhalation.
5. Functional residual capacity : the volume of air that remains in the lungs after normal, quiet exhalation.
6. Residual Volume : the volume of air that remains in the lungs after forceful exhalation
Spirometry Result
