Presented by:Amal Alharbi & Sarah Alzahrani

Diagnostic procedures

Under supervision of:D/ Dalia Salah

College of Nursing- Qassim university

INTRAVENOUS PYELOGRAM (IVP)

is most frequently performed to evaluate the calyces and pelvis of the kidneys, ureters, and urinary bladder when abnormalities of these organs are suspected.

An abdominal flat plate (KUB) film is taken, an iodi-nated contrast medium such as diatrizoate sodium or diatrizoate meglumine is injected, and then serialfilming is performed.

INDICATIONS:

• Suspected diseases or abnormalities of the kidneys, ureters, or bladder as a result of structural defects or tumors

• Determination of tumors, stones, or strictures causing partial or complete obstruction.

• Determination of glomerular disorders revealed by the rate of dye Excretion.

• Diagnosis of renal artery obstruction .

• Determination of changes in the size, shape, and position of the kidneys, caused by pathology.

• Determination of the results of trauma on the urinary organs, such as hematoma or lacerations.

• Diagnosis of congenital abnormalities such as absence of one kid-ney, abnormal connection of the two kidneys in the shape of a horseshoe,

displaced kidneys in the abdomen, or double ureters.

• Determination of the cause of renal hypertrophy, such as hy-dronephrosis or polycystic kidney disease.

Preparation:

• Medications can be taken prior to your test. Pills should be taken with only a small amount of water.

• On the day before your examination ONLY clear liquids may be taken (water, apple juice, grape drink, soup, tea or coffee without milk or cream).

Be sure to drink a sufficient amount of fluid.

• Do not eat or drink anything after midnight.

NURSING CARE AFTER THE PROCEDURE

• Continue IV fluids or provide oral fluids to promote hydration.

• Monitor IV site for hematoma or infiltration, and discontinue or change site, if appropriate.

• Reaction to iodinated contrast medium: Note and report anxiety, warmth, flushing, itching, sweating, nausea, or vomiting.

• Administer ordered antihistamines or steroids.

• Renal failure: Note and report anuria, oliguria, increased BUN and creatinine, and fluid intake.

Dual x ray (DEXA)• A dual energy X-ray absorptiometry (DEXA) scan, is a com-

montechnique used to measure bone density. This completely pain-less procedure is easily performed and exposes the pa-tient to minimal radiation.

Preparation:

• No prior radionuclide studies for 2 weeks

• No barium contrast studies for 2 weeks

• No metal in clothing (i.e. zippers)

INDICATIONS:

• Evaluation of osteoporosis and risk of fracture.• Suspected metabolic bone disease.

NURSING CARE AFTER THE PROCEDURE

• Perform neurological checks and vital signs and compare with baselines.

• Complications and precautions: Note and re-port

suspected fracture or injury to the cervical spine or neck pain.

MAMMOGRAPHY:• Mammography is the process of using low-energy X-rays to

examine the human breast, which is used as a diagnostic and screening tool.

Indications :

• Early detection of malignant tumors of the breast.• Previous surgery for breast cancer, history of cancer involv-

ing other organs, or both Family • Evaluation of lumps or areas of thickening tissue detected

by health-care practitioner on clinical examination.• Determination of cause of painful breasts.• Diagnosis of breast cancer.

Preparation:

• Instruct the patient to avoid using underarm deodorant or powder the day of the exam.

• Explain that the test takes about 15 minutes.• Explain to the patient that she may be asked to wait while

the films are checked.• When scheduling the test, inform the staff if patient has

breast implants.• Make sure the patient has signed an appropriate consent

form.• Note and report all allergies.

NURSING CARE AFTER THE PROCEDURE

• Make the patient feel comfortable after the procedure.• Teach the client and provide brochures outlining the procedure and the signs and Symptoms to report.

• Prepare to educate the patient about her diagnosis.• Prepare the patient for further testing or surgery, as indicated.• Stress the importance of regular mammography, depending on the client’s age.

Bone marrow aspiration • A bone marrow aspiration removes only the marrow. These

tests are often done to find the reason for many blood dis-orders and may be used to find out if cancer or infection has spread to the bone marrow.

Indications:

• To diagnose thrombocytopenia, leukemia, granu-lomas, anemias, and primary and metastatic tu-mors.

• To determine the causes of infection.• To help stage disease. • To evaluate chemotherapy.• To monitor myelosuppression.

Preparation:

• Explain the procedure to the patient. A mild sedative will be given 1 hour before the test, if ordered.

• Tell the patient the test usually takes only 5 to 10 minutes and that more than one bone marrow specimen may be required.• Let him know a blood sample will be collected before the biopsy for laboratory testing.• Make sure the patient has signed a consent form.• Check the patient for hypersensitivity to the local anes-

thetic.

NURSING CARE AFTER THE PROCEDURE

• Care and assessment after the procedure include assisting the client to lie on the biopsied side.• For sternal punctures, place the client in the supine position or other position of comfort.• Provide bed rest for at least 30 minutes after the procedure.• Assess puncture site every 10 to 15 minutes for bleeding. Ap-

ply an ice bag to the puncture site to alleviate discomfort and prevent

bleeding.• Assess for infection at the site; note any redness, swelling, or drainage.• Administer analgesics to alleviate discomfort.

duplex ultrasound • A duplex ultrasound is a test to see how blood moves

through your arteries and veins.

Indications:

A duplex ultrasound can help diagnose the following con-ditions:

• Abdominal aneurysm• Arterial occlusion• Blood clot• Carotid occlusive disease (See: Carotid duplex)• Renal vascular disease• Varicose veins• Venous insufficiency

Preparation:

• Usually, there is no preparation for a duplex ultrasound.

• If you are having an ultrasound of your stomach area, you may be asked not to eat or drink after midnight.

• Tell the person doing the ultrasound exam if you are taking any medicines, such as blood thinners. These might affect the results of the test.

NURSING CARE AFTER THE PROCEDURE

• Note and report neurological symptoms such as dizziness, syncope, or blurred vi-sion. Protect from injury if symptoms occur.• Administer or resume ordered medication

regimen.

MRI Scans

Indications for MRI Scans Brain

Indications include stroke, temporal lobe epilepsy, infection, inflamma-tion, tumour, multiple sclerosis (MS), dementia, post-trauma, meta-bolic disorders, congenital malformations.

Spinal cord

• Indications include myelopathy, inflammation, infection, tumour, con-genital malformation, postoperative investigation and post-trauma.

•  

Pregnancy

Indications for the placental position and invasion, as well as review-ing foetal anomalies, particularly cerebral.

Musculoskeletal (MSK)

Indications include all MSK system: joints for derangement, in-fection, inflammation, post-trauma, tumour and vascular pathologies. 

Abdomen and pelvis

tumours, vascular pathologies, infection, inflammation, congen-ital abnormalities and metabolic disorders. Used for detection of local invasion of rectal, prostatic and cervical carcinomas

Cardiac

• Indications include ischemia, tumour, infiltrative diseases, congenital malformation and cardiomyopathy 

How you prepare

• Patient may be asked not to eat or drink anything for 4 - 6 hours before the scan.

• Asked patient if they are afraid of close spaces or claustro-phobia and inform the doctor.  Patient may be given a medicine to help them feel sleepy and less anxious.

• Before the test, asked the patient if they have the following:

Pregnancy History of kidney problems Skin tattoos Artificial heart valves

Vascular stent or stent graft History as a metal worker Allergy to iodine, or gadolinium History of diabetes

•  Asked patients to remove the following:

Items such as jewelry, watches, credit cards, and hearing

aids - may be damaged.

Pens ,pins, and eyeglasses

After the procedure

1) After an MRI scan, you can resume your normal diet, activity, and medications.

2) If patient is sedated, patient is transferred to the recovery room for continue monitoring.

3) Prior to allowing the patient to leave the MRI facility, the patient should be alert, oriented, and have stable vital signs.

CT scan

Indications of CT scan• Chest (thorax). lungs, the heart, the esophagus , or the major blood vessel (aorta) or the tissues in the center of the chest.• Abdomen . cysts, abscesses, infection, tumors, an aneurysm, enlarged lymph nodes, foreign objects, bleeding, inflammatory bowel disease, and appendicitis.• Urinary tract. Is called a CT urogram . This type of scan can find kidney stones , bladder stones, or blockage of the urinary tract . • Liver. tumors, bleeding from the liver , and liver diseases. A CT

scan of the liver can help determine the cause of jaundice.

• Pancreas. tumor or inflammation of the pancreas (pancreatitis).• Gallbladder and bile ducts. used to check for blockage of the

bile ducts.• Adrenal glands. tumors or enlarged adrenal glands.• Spleen. used to check for an injury to the spleen or the size of the

spleen.• Pelvis.. For a woman, these include the uterus, ovaries, and fal-

lopian tubes. • For a man, the pelvic organs include the prostate gland and the seminal vesicles.• Arm or leg. A CT scan can look for problems of the arms or legs, including the shoulder, elbow, wrist, hand, hip, knee, ankle, or foot.

How To Prepare• Before the test, asked the patient if they

have the following:o pregnant.o Are allergic to any medicines, including iodine dyes.o Have a heart condition, such as heart failure.o Have diabetes. o Have had kidney problems.o Have asthma.

Post Test• Instruct the patient to resume usual diet, fluids, medications, and activity• Monitor vital signs and neurological status every 15 min for 1

hr, then every 2 hr for 4 hr.• Monitor temperature every 4 hr for 24 hr. Monitor intake and

output at least every 8 hr. • Observe for delayed allergic reactions, such as rash, urticaria, tachycardia, hyperpnea, hypertension, palpitations, nausea, or vomiting.• Instruct the patient in the care and assessment of the site.• Recognize anxiety related to test results.

Endoscopy • Endoscopic procedures are named for the organ or body area to be examined or treated, including the:

• larynx, trachea, bronchi, pleurae, mediastinum, pericardium, esophagus, stomach, duodenum, pancreas, bile ducts, liver, colon, rectum/sigmoid colon, bladder, urethra, ureters, prostate, vagina, cervix, uterus, fetus, fallopian tubes, ovaries, and joints.

preparation• Explain to the client:• The location for the procedure and the person performing it.

• The method by which the examination will be performed (direct or indirect)

• That discomfort will be minimized by local or general anesthesia

• That there are no fluid and food restrictions before the procedure

• That a sedative or antianxiety agent can be administered before the procedure to promote relaxation.

post interventions • patients who have been sedated may be asked to wait for an hour or

two while their sedative wears off.  • These patients also should not drive themselves home.

Some patients may experience a mild sore throat following an upper endoscopy.

 • Bloating and cramping are sometimes reported after a lower en-

doscopy. •  • The physician will inform the patient about when it will be safe to eat

and drink again, as well as provide a time frame for resuming normal activity.

• In most cases, patients are urged to rest and eat lightly for the re-mainder of the day following the endoscopy.

Stress test

Indications• Suspected CAD in the presence of chest pain and other symp-

toms

• Diagnosis of heart abnormalities such as tachycardia, bradycar-dia, and

arrhythmias during exercising as revealed by ECG changes

• Determination of hypertension as a result of exercise

• Detection of peripheral arterial occlusive disease (intermittent claudication) revealed by leg pain or cramping during exercise

• Evaluation of effectiveness of medication regimens: antianginals .

Preparation:• Food, fluids, and smoking are avoided for at least 4 hours before the test.

• Instruct the client to wear comfortable shoes and clothing for the exer-cises

• Inform the client that a total time of 45 to 90 minutes is needed to com-plete the procedure.

• Instruct the client to discontinue specific medications that interfere with test results before the study.

• Obtain baseline vital signs and ECG to use as a comparison in evaluating the study.

NURSING CARE AFTER THE PROCEDURE

• Provide a period of rest and monitor vital signs and ECG in 3-, 10-, and 30-minute intervals.

• Remove the electrodes and paste and cleanse the skin sites.

paracentesis

Indications:• Emergency room visit or hospital admission

• Local signs or symptoms of peritonitis:

• Abdominal pain or tenderness, vomiting, diarrhea, paralytic ileus

• Systemic signs or symptoms of infections:

• Fever, hypotension, leukocytosis, acidosis, hypothermia

• Hepatic encephalopathy

• Renal failure

• worsening of liver function

Preparation:

• Prior to a paracentesis the doctor must be informed regarding the intake of any medication, allergies to any medication, including anesthetics, bleeding prob-lems or intake of medications for blood thinning and pregnancy . The bladder must be emptied prior to the procedure.

Post intervention:

• Rest in bed for about 2 hours after the procedure and limit your physical activity

• You may remove your dressing/bandage

• Do not be alarmed by a small amount of blood on your bandage.

• You may shower tomorrow.

• Resume your regular diet today,

Sources:

• http://www.nlm.nih.gov/• Nurse’s manual of laboratory and di-

agnostic tests.• http://www.uphs.upenn.edu/ • http://www.cc.nih.gov • http://www.medicalhealthtests.com