1 lesson #16 specimen collection & diagnostic exams fundamentals of nursing

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LESSON #16

SPECIMEN COLLECTION

&DIAGNOSTIC EXAMS

FUNDAMENTALS OF NURSING

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DX health problemsIdentify the stage of diseaseMeasure the response to therapy

GUIDELINES FOR SPECIMEN COLLECTION

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Routine specimens obtained by nurses:UrineSputumStoolBloodDrainage


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Guidelines for the nurse: UNIVERSAL PRECAUTIONS

Obtain on time and within specific requirements

Wear gloves Proper handwashing Containers Labels Delivery Transporting


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Role of the nurse in performing specimen collection: Prepare the pt Know legal implications Know baseline VS Know developmental level of pt Assess understanding Determine abnormal findings Educate pt Know physician orders Have supplies ready Identify patient properly Label all paperwork, specimen containers Ensure delivery of specimens in timely manner Document pt response

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General principles for specimen collecting: Collect at correct time Labeled correctly with appropriate lab slip Avoid contaminating container Must have correct amount of sample Use medical/surgical asepsis when indicated Use universal precautions Know if pt has been prepped properly (NPO,

etc) Observe specimen collected for color, amount


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Spinal Tap (Lumbar Puncture) To dx cancer, meningitis, MS, bleeding around brain/spinal cord

Needle inserted at L2, L3, or L4 usually

Obtain fluid for testing Pt to remain supine 6-8 hours Monitor dressing at site

TESTS PERFORMED FOR NEUROLOGICAL SYSTEMS

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SPINAL TAP (LUMBAR PUNCTURE)

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SPINAL TAP (LUMBAR PUNCTURE)

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SPINAL TAP NURSING CONSIDERATIONS: PRE-TEACHING POSITIONING POST CARE

Flat in bed Encourage fluids unless contraindicated Assess puncture site Assess for SEVERE HEADACHE &

NEURO CHANGES


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ELECTROENCEPHALOGRAM (EEG) To detect abnormal brain waves To dx epilepsy, cerebral death/blood flow


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EEG nursing considerations: Pre-teaching Position: no special position Post care


Seizure EEG

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CEREBRAL ANGIOGRAPHY Radiopaque liquid is injected into carotid artery Arteries become visible on x-ray


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CEREBRAL ANGIOGRAPHY

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CEREBRAL ANGIOGRAPHY NURSING CONSIDERATIONS: Pre-teaching NPO 8-12 hours before test, DC anticoagulants

prior to exam Position: flat on back Post-care:

Bed rest 12-24 hours Extremity catheter inserted needs to remain

straight Assess for bleeding, neuro checks, dysphagia,

respiratory distress


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MYELOGRAM To dx spinal stenosis, spinal obstruction,

ruptured or herniated disc, spinal cord distortion, spinal cord tumors

Dye is injected (by lumbar puncture) into spinal canal which highlight lesions or defects on vertebral column

Pictures taken of bones and fluid-filled space between bones

CT sometimes done while dye is still in place


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MYELOGRAM

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MYELOGRAM NURSING CONSIDERATIONS: Pre-teaching Position: prone or tilt table Post care:

If oil based dye, pt is to lay flat for 8-12 hours Force fluids If water based dye, HOB elevated Force fluids Monitor VS, I&O, and neuro status Observe for fever, stiff neck, occipital headache, or

photophobia


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BRAIN SCAN Radioactive drugs are given Brain is scanned to pinpoint areas of

concentration of drug BBB serves as protectant shield unless

disease is present DX brain tumors, cerebral infarction,

headaches, seizure disorders


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BRAIN SCAN

BBB

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BRAIN SCAN NURSING CONSIDERATIONS:Pre-teachingPosition: supinePost care:

Monitor VS Force fluids


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MAGNETIC RESONANCE IMAGERY (MRI)Non-invasive test to detect brain and

spinal cord lesionsCannot be used on pts with pacemakersPts need to remove all jewelry, denturesAssess for internal metal (hips, knees,

head)Might need to pre-medicate


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MRI: 90 minutes in a big magnet…

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MRI NURSING CONSIDERATIONS: Pre-teaching:

Painless Will need to lie still Will hear humming and clicking sounds Will have access to rad tech through

microphone Most provide ear protection or music via

headphones Position: supine Post care: no special care required


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CAT (computerized axial tomography) SCAN Like a super x-ray Allows visualization of bony structures &

SOFT TISSUE Head is scanned in successive layers by

narrow x-ray beam Provides cross section of brain DX tumors, masses, brain infarction,

hydrocephalus


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CAT (computerized axial tomography) SCAN nursing considerations: Pre-teaching:

No hair pins or metal IV is using contrast (assess for allergies

to iodine) Consent Will hear clicking noise Must lie still


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CAT (computerized axial tomography) SCAN nursing considerations: Position: Supine Post care:

Monitor for S&S of allergic reaction if contrast is used

Encourage fluid intake Monitor for fluid overload due to

hypertonic solution


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PET (position emission tomography) SCANDX issues hidden behind the skullShow whether a tumor is benign (non-

cancerous) or malignant (cancerous) Help doctors determine the extent of

disease (staging) Illustrate metastatic disease (spread) Help doctors evaluate the effectiveness

of chemotherapy


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PET (position emission tomography) SCANPreparation for pt:

Need to empty bladder before exam due to length

No coffee, caffeine, or tobacco for 24 hours prior to procedure

Nursing mothers must pump and save milk for 24-48 hours


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PET SCAN IMAGES

PET Scan in lymphoma pt, including brain, chest & spleen involvement

Normal PET Scan

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LABORATORY EXAMINATION Complete blood count Sedimentation rate Blood culture & sensitivity (C&S) Cholesterol Triglycerides Potassium (K+) Lipoproteins Enzymes

TESTS PERFORMED FOR CARDIOVASCULAR SYSTEMS

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RADIOLOGICAL TECHNIQUESChest X-ray and fluoroscopy

Reveal changes in shape of heart and distortion of blood vessels

Coronary Angiography (cardiac cath) X-ray study of heart with injection of special dye

Outlines chambers of heart and blood vessels


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CORONARY ANGIOGRAPHY NURSING CONSIDERATIONS: Pre-teaching:

Consent form Assess for allergies for iodine NPO for 6-8 hours before procedure Catheter inserted into brachial or femoral artery Mark pedal pulses if femoral artery is used Takes 1-3 hours May feel burning when dye is injected


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CORONARY ANGIOGRAPHY NURSING CONSIDERATIONS:

Positioning: supinePost-care:

Monitor VS frequently Assess for hematoma or bleeding at catheter

site Bed rest X several hours Assess peripheral pulses distal to site Neuro checks


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CORONARY ANGIOGRAPHY

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ELECTROCARDIOGRAM (ECG OR EKG)Gives info concerning rhythm of heart

Gives info concerning state of cardiac muscle


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EKG or ECG NURSING CONSIDERATION:Pre-teaching:

Causes no discomfort for pt Electrodes placed on chest, may need to shave

Position: supinePost-care: clean electrode gel off


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ECG or EKG

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STRESS CARDIOGRAMDetermines level at which heart can work without symptoms or change in EKG

Done on treadmill, master’s two-step test, & bicycle ergometer


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STRESS CARDIOGRAM NURSING CONSIDERATION:

Pre-teaching:Consent formWear comfortable clothes and shoesStop if chest pain or SOB or fatigueTakes 30 minutesElectrodes on chest, may need to shave


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STRESS CARDIOGRAM

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ECHOCARDIOGRAM Gives info concerning valves, muscle,

pericardium, and chambers by use of echo technique

Nursing consideration: No discomfort Metal wand guided over chest wall Conduction jelly may feel cool

Position: supine or left side Post care: wash gel off skin


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ECHOCARDIOGRAM

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ROUTINE SPUTUM SPECIMENS:Collect early in the morning (to get secretions built up overnight)

Instruct pt to cough deeply to get sputum from lungs/bronchi

Use proper containers

TESTS PERFORMED FOR RESPIRATORY SYSTEMS

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ROUTINE SPUTUM SPECIMENS CONTINUED:

Do not contaminate inside/outside of container

Label correctlyUse proper asepsis precautionsCan use suction if pt unable to coughUsed to run C&S, Cytological tests (cancer),

and test for acid fast bacilli (TB)


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RADIOLOGY:CHEST X-RAY STUDIES

No prep needed Taken in different views:

A-P, lateral, oblique


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BRONCHOGRAMX-ray of bronchial tree outlined by dye

Fasting required until anesthesia has worn off


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BRONCHOGRAM NURSING CONSIDERATIONS: PRE TEACHING

Consent formNPO 6-8 hours Assess for iodine allergyGood oral care prior to examPharynx and trachea will be sprayed with topical anesthesia


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BRONCHOGRAM:

Position: various to coat bronchial tree with dye

Post care: Nebulization may be givenCheck gag reflex before giving anything by mouth


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BRONCHOGRAM

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BRONCHOSCOPYRemove foreign bodiesObtain biopsyRemove secretions for examination


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BRONCHOSCOPY NURSING CONSIDERATIONS:

PRE TEACHING: Consent NPO 6 hours before test Pre-op sedative will be given Good oral hygiene before test IV placed for emergency


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BRONCHOSCOPY: Position: neck hyper-extended Post care:

monitor VS Note swelling of face and neck SOB Expect blood tinged sputum Position on side until gag reflex returns SIDE NOTE: Also must check gag reflex after

ENDOSCOPY


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BRONCHOSCOPY

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THORACENTESIS Relief of respiratory restrictions due to

large quantities of pleural fluid Introduction of meds into pleural space Pre teaching:

Consent Local anesthetic agent used Large bore needle inserted into chest wall Pt must remain still


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THORACENTESIS Position: Sitting, leaning over bed side table with

arms crossed Post care:

VS q 15 min X 4 or until stable Auscultate breath sounds, reporting

immediately the following:Rapid breathingChange in breath soundsCyanosisTachycardia


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THORACENTESIS

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COLONOSCOPY

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PARACENTESIS

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INTRAVENOUS PYELOGRAM

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THE END!!!!

1 lesson #16 specimen collection & diagnostic exams fundamentals of nursing

Documents

specimen collectionguidelines

specimen collectionspinal

specimen collectionrole

etcobserve specimen

neurological systemstests

neurological systemsspinal

spinal obstruction

spinal canal