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Diagnostic Tests
Tests, Purposes, Pre-ops, Post-ops
| Question | Answer |
|---|---|
| Phlebography | Lack of filling of a vein is indicative of venous occlusion due to a thrombus |
| Phlebography Pre-ops/Testing | Thrombi are identified as radiolucent areas in opaque-filled veins |
| Angiography(arteriography) | indicates abnormalities of blood flow due to arterial obstruction or narrowing |
| Angiography Pre-ops/Testing | Contrast dye is injected into the arteries and x-ray films are taken of the vascular tree |
| Angiography Post-op Care | Disadvantages include potential allergic reactions to dye, potential irritation,or thrombosis of the injection site |
| *Pulmonary Function Test | Detects impaired pulmonary function (follows the course of a dx and evaluates treatment repsonses) |
| *Pulmonary Function Pre-op/Testing | Explain purpose; no smoking 4hrs before;may withhold bonchodilator meds;asked to breathe into machine |
| *Pulmonary Function Post-Op | observe for dyspnea |
| *Bronchoscopy | Allows visualization of larynx, trachea, and mainstem bronchi; (possible to obtain tissue biopsy, apply meds, aspirate secretions for lab exams, aspirate a mucus plug causing airway obstruction, or remove aspirated foreign objects |
| *Bronchoscopy Pre-op/testing | explain procedure; maintain NPO 6hrs before test; ispect mouthfor infection; administer premedication-Valium,versed,demerol,atropine;remove dentures;prepare client for sore throat after procedure |
| *Bronchoscopy post-op | sit or lie on side, remain NPO until gag reflex returns; Observe for respiratory difficulties |
| *Bronchoscopy complications | hypotension, tachycardia, dysrhythmias, hemoptosis, dyspnea, hypoxia |
| *Thoracentesis | aspiration of fluid or air from pleural space; to obtain specimen for analysis, relieve lung compression, obtain lung tissue for biopsy, or instill meds in pleural space |
| *Thoracentesis pre-op | explain procedure; take vitals; shave area around needle insertion site; position pt sitting w/ arms on pillows on over-bed table or lying on side in bed |
| *Thoracentesis testing | expect stinging sensation w/ injection of local anesthetic and feeling of pressure from needle; NO MORE than 1,000ml fluid removed at one time |
| *Thoracentesis Post-op | auscultate BS and monitor vs frequently; check for leakage of fluid from site and pt tolerance; sterile dressing applied |
| Lung Biopsy | Removal of lung tissue for culture or cytology |
| Lung Biopsy Pre-op/testing | administer pre-meds (sedatives/analgesics); have pt hold breath midexpiration; preformed w/ fluoroscopic monitoring; position pt like in thoracentesis |
| Lung biopsy post-op | monitor vs and bs q4hrs for 24hrs; chest x-ray taken after procedure for complications (pneumothorax or pul hemorrage); sterile dressing applied |
| Magnetic Resonance Imaging (MRI) | provides detailed pictures of body structures |
| MRI pre-op/testing | asses pt for claustrophobia; remove all metal jewelry & metal objects; ask pt if has metal implants on body (pacemaker,clips) |
| *Respiratory/cardiac Angiography | evaluates specific areas of the arterial system |
| *R/C Angiography pre-op/testing | remove all jewelry; pt may experience nausea, flushing, warmth, salty taste w/ injection of dye |
| *R/C angiography post-op | assess for hematoma, distal pulses, skin temp, color, sensation in xtremeties; check vitals often |
| *R/C Angiography complications | Vessel injury, bleeding, allergic reaction to dye, cva/stroke |
| *Cardiac Catheterization (usually used with angiography) | introduction of catheter into chambers of heart to evaluate ventricular function and obtain chamber pressures |
| *Cardiac Cahteterization pre-op/testing | NPO 8-12hrs; signed consent; empty bladder; check pulse; explain pt may feel heat, palpitations, desire to cough when dye injected` |
| *Cardiac Catheterization post-op | monitor vs q15min for 2hrs, then q30min for 1hr, then q1hr for 3 hrs; check pulses, sensation, bleeding at insertion site q30min for 3 hrs; bed rest 6-8hrs with extremity with site straight |
| Cerebral Angiography | Identifies aneurysms, vascular malformations, narrowed vessels |
| Cerebral Angiography pre-op/testing | preprocedure sedation; skin prep and shaved site; mark peripheral pulses; pt lie flat; dye injected into femoral artery by needle/catheter; fluoroscopy and readiologic films taken after injection; may feel warmth or metallic taste with dye |
| Cerebral Angiography post-op | neuro assessment q15-30 min until vs are stable; keep flat in bed 12-14hrs; check puncture site qhr; immobolize site for 6-8hrs; assess cms and temp of extremities; force fluids (good i&o's) |
| *Lumbar Puncture (LP) | insertion of needle into subarachnoid space to obtain specimen, relieve pressure, inject dye or medications |
| *LP pre-op/testing | informed consent; positioned in lateral recumbent fetal position at edge of bed |
| *LP post-op | neuro assessments q15-30min until stable; position flat for 2-3hrs; encourage po fluids; oral analgesics for HA; observe sterile dressing at site for bleeding or drainage |
| Electroencephalogram (EEG) | records electrical activity of brain (observes for seizure potential) |
| EEG pre-op/testing | done in a quiet room; painless; tranqs and stimulants (indluding caffeine,cola,tea,&cigarettes) withheld for 24-48hrs prior; may be asked to hyperventilate 3-4 min and watch bright flashing lights; kept awake night before test |
| EEG post-op | help client remove paste from hair; administer prescribed meds withheld before; observe for seizure in seizure-prone pts` |
| *Myelogram (x-ray) | visulizes spinal column and subarachnoid space |
| *Myelogram pre-op/testing | NPO for 4-6hrs before test; obtain allergy hx; phenothiazines,cns depressants, and stimulants withheld for 48hrs prior to test; table will be moved to various positions during test |
| *Myelogram post-op | neuro assessment q2-4hrs; when metriazmide h2o-soluble dye used, head should be raised 30-45degrees for 3hrs; oral analgesics for HA; encourage PO fluids; assess for distended bladder; inispect injection site |
| *Myelogram Complications | HA, fever, stiff neck, photophobia |
| *Liver Biopsy | samplying of tissue by needle aspiration |
| *Liver Biopsy Pre-op/Testing | administer vit k IM to decrease chance of hemorrhage; NPO am of exam-6hrs; sedative admin just before exam;teach client that he will be asked to hold his breath for 5-10seconds; supine position,lateral with upper arms elevated |
| *Liver Biopsy post-op | position on right side for 2-3hrs with pillow under costal margin(to apply pressure); vs often; check clotting time, platelets hematocrit; expect mild local pain and mild pain radiating to right shoulder; avoid heavy lifting for 1wk |
| *Liver Biopsy Complications | hemorrage, shock, report complaints of severe abd. pain immediately- may indicate perforation of bile duct and peritonitis |
| *Stomach/Esophagus Endoscopy | Visualizing esophagus &/or stomach by means of a lighted flexible fiberoptic tube; used to find potential ulcerations, tumors, or to obtain tissue or fluid samples |
| *Stomach/Esophagus Endoscopy pre-op/testing | maintain NPO at least 8 hrs before; teach pt about numbness in throat due to local anesthetic by spray or gargle |
| *Stomach/Esophagus Endoscopy post-op | maintain NPO until gag reflex returns; inform pt to expect sore throat for 3-4 days after |
| *Stomach/Esophagus Endoscopy Complications | vomiting of blood; respiratory distress |
| *Sigmoidoscopy/Proctoscopy | visual of the sigmoid colon, rectum, and anal canal |
| *Sigmoidoscopy/Proctoscopy pre-op/testing | laxative night before exam and enema or suppository morning of procedure; NPO at midnight |
| *Sigmoidoscopy/Proctoscopy Post-op | Allow client to rest; encourage fluids (2000-3000ml) |
| *Sigmoidoscopy/Proctoscopy Complications | Hemorrhage from perforation |
| *Colonscopy (contraindicated for pts on anticoagulant therapy) | visualization of the colon; used as a diagnostic aid, removes foreign bodies, polyps, or tissue for biopsy |
| *Colonscopy pre-op/testing | clear liquid diet 24-72hrs before; cathartic in evening for 2 days prior; enema on am of exam; golytely lavage solution to cleanse bowel; clear liquid diet noon day before |
| *Colonscopy post-op | allow to rest; must pass flatus before leaving; follow up x-rays; resume regular diet |
| *Colonscopy complications | passage of blood and abdominal pain, signs of perforation, hemorrhage, or respiratory distress |
| Gastric Aspirate | aspiration of gastric contents to evaluate for presence of abnormal constituents such as blood, abnormal bacteria, abnormal pH, or malignant cells |
| Gastric Aspirate pre-op/testing | NPO 8-12 hrs before test; NG tube used to aspirate stomach (normal gastric pH<4) content and sent for evaluation |
| Gastric Aspirate post-op | encourage fluids |
| Upper GI series Barium Swallow | ingestion of barium sulfate to determine patency and size of esophagus, size and condition of gastric walls, patency of pyloric valve, and rate of passage to small bowel |
| Upper GI series Barium Swallow pre-op/testing | maintain NPO after midnight; inform pt that stool will be light-colored after procedure |
| Upper GI series Barium Swallow post-op | encourage fluids; laxatives to prevent constipation; stool will be white from barium |
| Lower GI series Barium Enema | Instillation of barium (radiopaque substance) into colon via rectum for x-rays to view for tumors, polyps, strictures, upcerations, inflammation, or obstructions of colon |
| Lower GI series Barium Enema pre-op/testing | low-residue diet for 1-2 days; clear liquid diet and laxative evening before test; cleansing enemas until clear morning of test |
| Lower GI series Barium Enema post-op | cleansing enema after exam to remove barium and prevent impaction; x-rays may be repeated after barium is expelled |
| Paracentesis | needle aspiration of fluid in abdominal cavity used for diagnostic exam of ASCITIC fluid and tx of massive ASCITES resistant to other therapy |
| Paracentesis pre-op/testing | pt in SEMI-FLOWERS position or sitting upright on edge of bed; empty bladder prior to procedure to avoid accidental perforation |
| Paracentesis post-op | check vs frequently for shock and/or infection; report elevated temp &/or abdominal pain to physician; observe for s/sx of hypovolemic shock |
| Culdoscopy | visualization of ovaries, fallopian tubes, uterus, via lighted tube inserted into vagina |
| Culdoscopy pre-op/testing | local anesthetic and/or light sedation; knee-chest position during |
| Culdoscopy post-op | position on abdomen after; avoid douching and intercourse for 2 wks; observe for vaginal bleeding |
| *Laparoscopy | visualizing of pelvic cavity through and incision beneath the umbilicus to view structures |
| *Laparoscopy pre-op/testing | CO2 introduced to enhance visual; general anesthesia; foley cath inserted for bladder decompression |
| *Laparoscopy post-op | out of bed after procedure; reg diet |
| *Cytoscopy | direct visualization by cystoscope of bladder and urethra |
| *Cytoscopy pre-op/testing | bowel prep; force fluids; teach pt to deep-breathe to decrease discomfort; NPO |
| *Cytoscopy post-op | monitor character and volume of urine; check for abd distention, urinary frequency, fever; urine usually pink-tinged; adb or pelvic pain indicates trauma; provide antimicrobial prophylaxis |
| cystourethrogram | x-ray study of bladder and urethra |
| cystourethrogram pre-op/testing | explain procedure to pt: catheter inserted into urethra, radiopaque dye injected, pt voids, x-rays taken during void |
| cystourethrogram post-op | advise client to report any sx |
| *Intravenous Pyelogram | provides x-ray visualization of kidneys, ureters, and bladder |
| *Intravenous Pyelogram pre-op/testing | bowel prep; NPO after midnight; check allergies to shellfish or iodine, chocolate, eggs, milk; burning or complaints of salty taste may occur during injection of dye |
| *Intravenous Pyelogram post-op | postprocedure x-rays usually done |
| *Intravenous Pyelogram Complications | pt should be alert to signs of dye reaction: edema, itching, wheezing, dyspnea (medical er) |
| *Kidney Biopsy | kidney tissue obtained by needle aspiration for pathological evaluation |
| *Kidney Biopsy pre-op/testing | NPO 6-8hrs; x-ray taken prior to procedure; skin is marked indicate lower pole of kidney(fewer blood vessels); position: prone and bent at diaphragm, pt instructed to hold breath during needle insertion |
| *Kidney Biopsy post-op | pressure applied to site for 20min; prone position; pressure dressing applied; check vs q15-30min for 1hr; client kept flat in bed; bedrest for 6-8hrs; intake 3,000/day |
| *Kidney Biopsy complications | Obersve for hematuria and site bleeding |
| *Schilling test | Diagnoses vitamin B12 deficiency (pernicious anemia) |
| *Schilling test pre-op/testing | Radioactive vitamin B12 is administered to the pt; then a few hrs later give a nonradioactive B12; low vale excreted in urine indicated pernicious anemia (normal is >10% of dose excreted in 24 hrs) |
| *Schilling test post-op | Vitamin B12 (cyancobalamin injection for life) |
| *Arterial Blood Gases (ABG's); need to know - how to obtain a specimen? | 1st check allen test-checks collateral circulation; arterial blood is OBTAINED IN A HEPARINIZED SYRINGE ater venipuncture |
| *ABG post-op | apply pressure to site for 5 min to prevent hematoma (15min if pt is receiving anticoagulants); send specimen on ice and occlude needle to avoid air; note on lab slip if pt is room air or on O2 |
| *ABG complications | check arm for swellling, discoloration, pain, numbness, tingling |
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