Laboratory and diagnostic procedures part1

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  • echocardiogram and basic blood analysis. No special dietary restrictions are required for pericardiocentesis. The patient will receive an IV line for sedation Read more:
  • echocardiogram and basic blood analysis. No special dietary restrictions are required for pericardiocentesis. The patient will receive an IV line for sedation Read more:
  • echocardiogram and basic blood analysis. No special dietary restrictions are required for pericardiocentesis. The patient will receive an IV line for sedation Read more:
  • http://www.rcjournal.com/cpgs/ispircpg.html
  • http://www.rcjournal.com/cpgs/ispircpg.html
  • http://www.rcjournal.com/cpgs/ispircpg.html
  • Laboratory and diagnostic procedures part1

    1. 1. REDUCTION OF RISK POTENTIAL: LABORATORY AND DIAGNOSTIC PROCEDURES Mr. Jaime R. Soriano. RN. RM.
    2. 2. OBJECTIVES OF THE SEMINAR <ul><li>To identify different laboratory and diagnostic procedures according to body system. </li></ul><ul><li>To describe the appropriate preparation, teaching, and post test management for patients who are undergoing diagnostic and laboratory testing </li></ul>
    3. 3. DIAGNOSTIC AND LABORATORY PROCEDURES <ul><li>Indications and Purposes </li></ul><ul><li>Pre-test Preparation </li></ul><ul><li>What will the patient feel? </li></ul><ul><li>Post-test Management </li></ul><ul><li>Nursing Considerations </li></ul>
    4. 4. NERVOUS SYSTEM Skull and Spinal X-ray Lumbar Puncture CT Scan MRI Electroencephalography
    5. 5. SKULL X-RAY <ul><li>Radiographs of the skull: </li></ul><ul><li>ize </li></ul><ul><li>hape </li></ul><ul><li>uture separation </li></ul><ul><li>ome calcification </li></ul><ul><li>hows erosion and fracture </li></ul>S S S S S
    6. 6. SKULL X-RAY
    7. 7. SPINAL X-RAY <ul><li>Spinal radiographs: </li></ul><ul><li>bnormal spine and dislocation </li></ul><ul><li>one degeneration </li></ul><ul><li>ompression </li></ul><ul><li>eformed curvature </li></ul><ul><li>rosion </li></ul><ul><li>racture </li></ul>A B C D E F
    8. 8. SPINAL X-RAY
    9. 9. SKULL AND SPINAL X-RAY <ul><li>-clude metal items from body parts </li></ul><ul><li>-eassure nursing support </li></ul><ul><li>-ccurate documentation if with thick and heavy hair </li></ul><ul><li>-ou immobilize </li></ul>X R A Y
    10. 10. LUMBAR PUNCTURE
    11. 11. LUMBAR PUNCTURE <ul><li>Insertion of a spinal needle through the L3-L4 interspace into the lumbar subarachnoid space to obtain cerebrospinal fluid, measure CSF fluid or pressure, or instill air, dye, or medications. </li></ul>
    12. 12. LUMBAR PUNCTURE <ul><li>DIAGNOSTIC </li></ul><ul><li>Suspected meningitis </li></ul><ul><li>Subarachnoid hemorrhage </li></ul><ul><li>Hydrocephalus </li></ul><ul><li>Benign Intracranial hypertension </li></ul><ul><li>THERAPEUTIC </li></ul><ul><li>Spinal anesthesia </li></ul><ul><li>Chemotherapy </li></ul>
    13. 13. LUMBAR PUNCTURE <ul><li>CONTRAINDICATIONS </li></ul><ul><li>-coliosis </li></ul><ul><li>-CP unidentified </li></ul><ul><li>-oagulopathy </li></ul><ul><li>-yphosis </li></ul>S I C K
    14. 14. LUMBAR PUNCTURE <ul><li>PRETEST </li></ul><ul><li>orm of informed </li></ul><ul><li>consent </li></ul><ul><li>ree of urine bladder </li></ul><ul><li>etal position </li></ul>F F F
    15. 15. LUMBAR PUNCTURE <ul><li>INTRATEST </li></ul><ul><li>hrimp or Fetal position </li></ul><ul><li>pecimens to be collected </li></ul><ul><li>terile vials- 4 </li></ul><ul><li>trict asepsis </li></ul>S S S S
    16. 16. LUMBAR PUNCTURE <ul><li>POSTTEST </li></ul><ul><li>lat 12-24 hrs </li></ul><ul><li>or vital signs and LOC monitoring </li></ul><ul><li>orce fluid unless contraindicated </li></ul><ul><li>uncture site for bleeding, CSF leakage </li></ul><ul><li>erform CMS assessment </li></ul>F F F F F
    17. 17. LUMBAR PUNCTURE <ul><li>COMPLICATION </li></ul><ul><li>Spinal Headache </li></ul><ul><li>-lat </li></ul><ul><li>-luids </li></ul><ul><li>-ain Management </li></ul>F F F
    18. 18. CT SCAN <ul><li>Scans the following in successive layers by a narrow beam of x-rays: </li></ul><ul><li>ngiogram </li></ul><ul><li>elly and Pelvic </li></ul><ul><li>hest </li></ul><ul><li>’ heart </li></ul><ul><li>xtremities </li></ul>A B C D E
    19. 19. CT SCAN
    20. 20. CT SCAN <ul><li>PRETEST: </li></ul><ul><li>ssess allergies to iodine and seafoods </li></ul><ul><li>e sure to obtain informed consent </li></ul><ul><li>onscious sedation for claustrophobia </li></ul><ul><li>o remove jewelries and hair pins </li></ul><ul><li>xplain hot flushed sensation and metallic taste in the mouth when dye is injected </li></ul><ul><li>luids and hydration </li></ul><ul><li>ive instruction to lie supine with small pillow under the head </li></ul><ul><li>old if pregnant </li></ul><ul><li>t takes 20 minutes </li></ul>A B C D E F G H I
    21. 21. CT SCAN <ul><li>POSTTEST: </li></ul><ul><li>llergic reaction check </li></ul><ul><li>e sure to replace fluid </li></ul><ul><li>MS </li></ul><ul><li>istal pulse check </li></ul><ul><li>xtremity color check </li></ul><ul><li>ind bleeding and hematoma </li></ul>A B C D E F
    22. 22. MRI <ul><li>-RI is nonivasive </li></ul><ul><li>-eveals types of tissue, tumors and vscular abnormalities </li></ul><ul><li>-s similar to CT scan </li></ul>M R I
    23. 23. MRI
    24. 24. MRI <ul><li>PRETEST </li></ul><ul><li>-etal objects must be removed </li></ul><ul><li>-ssess for ineligibility and contraindications </li></ul><ul><li>-ive instruction to lie supine with small pillow under the head </li></ul><ul><li>-ormal audible humming, thumbing, grating, or knocking sounds </li></ul><ul><li>-ncourage conscious sedation for claustrophobia </li></ul><ul><li>-akes 45 to 60 minutes </li></ul><ul><li>-nformed consent </li></ul><ul><li>-ompletely enclosed in scanner </li></ul>M A G N E T I C
    25. 25. MRI <ul><li>POSTTEST </li></ul><ul><li>Resume normal activities </li></ul><ul><li>Fluids and hydration </li></ul>
    26. 26. MRI <ul><li>Ineligible to undergo MRI: </li></ul><ul><li>Automatic Internal Defibrillator </li></ul><ul><li>Cerebral Aneurysm Clip </li></ul><ul><li>Cochlear Implant </li></ul><ul><li>Hip Replacement </li></ul><ul><li>Knee Replacement </li></ul><ul><li>Non-removable dental prosthesis </li></ul><ul><li>Pacemaker </li></ul><ul><li>Prosthetic Valve Replacement </li></ul><ul><li>Soldiers </li></ul>
    27. 27. EEG
    28. 28. EEG <ul><li>graphic recording of electrical activity of the brain by several small electrodes placed on the scalp </li></ul><ul><li>To diagnose: </li></ul><ul><li>bnormal firing of electrical activity </li></ul><ul><li>rain tumors </li></ul><ul><li>ertain psychiatric disorders </li></ul><ul><li>egenerative disorders </li></ul><ul><li>nflammation of brain and spinal cord </li></ul>A B C D E
    29. 29. EEG <ul><li>PRETEST </li></ul><ul><li>ash the client’s hair </li></ul><ul><li>ssure that electrodes will not cause electric shock </li></ul><ul><li>timulants and depressants avoided for 24 to 48 hours </li></ul><ul><li>ypoglycemia prevention, do not omit breastfeeding </li></ul>W A S H
    30. 30. EEG <ul><li>POSTTEST </li></ul><ul><li>Wash the client’s hair </li></ul><ul><li>Maintain side rails and safety precaution, if the client was sedated </li></ul>
    31. 31. EEG <ul><li>Sleep Deprivation EEG </li></ul>
    32. 32. CARDIOVASCULAR SYSTEM Electrolytes Coagulation Studies Erythrocyte Studies White Blood Cell Count Serum Enzymes and Cardiac Markers Serum Lipids ECG CVP Pericardiocentesis
    33. 33. ELECTROLYTES <ul><li>SODIUM </li></ul><ul><li>-bsorbed from the small intestine and excreted in the urine in amounts dependents dependent on dietary intake </li></ul><ul><li>-ustains osmotic pressure and acid base balance </li></ul><ul><li>-s major extracellular cation </li></ul><ul><li>-ormal daily requirement is 15 mEq </li></ul>A S I N
    34. 34. ELECTROLYTES <ul><li>SODIUM </li></ul><ul><li>Nursing Consideration: </li></ul><ul><li>Drawing blood samples soon after an intravenous infusion of sodium chloride will increase the level, producing an inaccurate result. </li></ul>
    35. 35. ELECTROLYTES <ul><li>POTASSIUM </li></ul><ul><li>-romote cellular water balance, electrical conduction in muscle cells, and acid base balance </li></ul><ul><li>-btains K through dietary ingestion and the kidneys preserve or excrete K </li></ul><ul><li>-o evaluate cardiac, renal, and gastrointestinal function </li></ul><ul><li>- major intracellular cation </li></ul>O P T A
    36. 36. ELECTROLYTES <ul><li>POTASSIUM </li></ul><ul><li>Nursing Consideration: </li></ul><ul><li>-ccurate note if the patient is receiving K supplement </li></ul><ul><li>-lood should not be drawn from site where an IV infusion exists </li></ul><ul><li>-lenching and unclenching of hand can increase the level </li></ul><ul><li>-o identify elevated WBC and platelet counts </li></ul>A B C D
    37. 37. ELECTROLYTES <ul><li>CHLORIDE </li></ul><ul><li>-ighly abundant body anion in the extracellular fluid </li></ul><ul><li>-ounterbalance cations and buffer </li></ul><ul><li>-ets digestion and maintenance of osmotic pressure and water balance </li></ul>H C L
    38. 38. ELECTROLYTES <ul><li>CHLORIDE </li></ul><ul><li>Nursing Consideration: </li></ul><ul><li>-raw blood from an extremity that does not have normal saline infusing into it </li></ul><ul><li>-o not allow the client to clench and unclench his or her hand before drawing blood </li></ul><ul><li>-iarrhea and prolong vomiting will alter cholride results </li></ul>D D D
    39. 39. ELECTROLYTES <ul><li>MAGNESIUM </li></ul><ul><li>lotting mechanism </li></ul><ul><li>ontrols neuromuscular activity </li></ul><ul><li>ofactor that modifies activity of many enzymes </li></ul><ul><li>alcium metabolism </li></ul>C C C C
    40. 40. ELECTROLYTES <ul><li>MAGNESIUM </li></ul><ul><li>Nursing Consideration: </li></ul><ul><li>-rolong use of magnesium products will cause increased serum levels </li></ul><ul><li>-arenteral nutrition therapy or excessive loss of body fluids may decrease serum levels </li></ul>P P
    41. 41. ELECTROLYTES <ul><li>CALCIUM </li></ul><ul><li>- one formation </li></ul><ul><li>- n conversion of prothrombin to thrombin </li></ul><ul><li>- ransmission of nerve impulse </li></ul><ul><li>- n contraction ok skeletal and myocardial muscles </li></ul>B U T O
    42. 42. ELECTROLYTES <ul><li>CALCIUM </li></ul><ul><li>Nursing Consideration: </li></ul><ul><li>Instruct the client to eat a diet with a normal calcium level (800 mg/day) for 3 days before the test. </li></ul><ul><li>Instruct the client that fasting may be required for 8 hours before the test </li></ul>
    43. 43. COAGULATION STUDIES <ul><li>ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) </li></ul><ul><li>- mount of time it takes in seconds for recalcified plasma to clot after partial thromboplastin is added </li></ul><ul><li>-erformed for patient receiving heparin </li></ul><ul><li>-est for deficiencies and inhibitors of clotting factors </li></ul><ul><li>-ime: 20 to 36 seconds </li></ul>A P T T
    44. 44. COAGULATION STUDIES <ul><li>ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) </li></ul><ul><li>Nursing Consideration: </li></ul><ul><li>-spirate blood sample 1 hour before next scheduled heparin dose </li></ul><ul><li>-erform blood exraction from arm into which heparin is not infusing </li></ul><ul><li>-ransport specimen to the laboratory immediately </li></ul><ul><li>-ime: 1.5 to 2.5 times normal if on heparin therapy </li></ul>A P T T
    45. 45. COAGULATION STUDIES <ul><li>PROTHROMBIN TIME (PT) and INTERNATIONAL NORMALIZED RATIO (INR) </li></ul><ul><li>-rothrombin is a vitamin K dependent glycoprotein produced by the liver for fibrin clot formation </li></ul><ul><li>-o monitor response to warfarin sodium (Coumadin) </li></ul>P T
    46. 46. COAGULATION STUDIES <ul><li>PROTHROMBIN TIME (PT) and INTERNATIONAL NORMALIZED RATIO (INR) </li></ul><ul><li>Normal Values: </li></ul><ul><li>PT: </li></ul><ul><ul><li>9.6 to 11.8 secs (male) </li></ul></ul><ul><ul><li>9.5 to 11.3 secs (female) </li></ul></ul><ul><li>INR: </li></ul><ul><ul><li>2.0 to 3.0 (standard warfarin tx) </li></ul></ul><ul><ul><li>3.0 to 4.5 (high dose warfarin tx) </li></ul></ul>
    47. 47. COAGULATION STUDIES <ul><li>PROTHROMBIN TIME (PT) and INTERNATIONAL NORMALIZED RATIO (INR) </li></ul><ul><li>Nursing Considerations: </li></ul><ul><li>- baseline PT should be drawn before anticoagulation therapy </li></ul><ul><li>-e sure to apply direct pressure to the venipuncture site </li></ul><ul><li>-oncurrent warfarin therapy with heparin therapy can lengthen the PT </li></ul><ul><li>-iets high in green leafy vegetables can shorten PT </li></ul><ul><li>-xpect 1.5 to 2 times longer PT if on anticoagulation therapy </li></ul><ul><li>-or PT greater than 30 secs, initiate bleeding precautions </li></ul>A C B D E F
    48. 48. COAGULATION STUDIES <ul><li>CLOTTING TIME </li></ul><ul><li>-lient should not receive heparin 3 hours before specimen collection </li></ul><ul><li>-ong on any anticoagulation therapy </li></ul><ul><li>-n thrombocytopenia </li></ul><ul><li>-ime: 8 to 15 minutes </li></ul>C L O T
    49. 49. COAGULATION STUDIES <ul><li>PLATELET COUNT </li></ul><ul><li>Plug formation </li></ul><ul><li>Clot retraction </li></ul><ul><li>Coagulation factor activation </li></ul>
    50. 50. COAGULATION STUDIES <ul><li>PLATELET COUNT 150T – 400T cells/mm3 </li></ul><ul><li><PLT – thrombocytopenia (risk for bleeding) </li></ul><ul><li>>PLT – thrombocytosis (risk for clot) – prophylaxis of Anicoagulant - Lovenox </li></ul>
    51. 51. COAGULATION STUDIES <ul><li>PLATELET COUNT </li></ul><ul><li>Nursing Considerations: </li></ul><ul><li>B -leeding precautions should be instituted in clients with low platelet </li></ul><ul><li>M -onitor venipuncture site </li></ul><ul><li>C -hronic cold weather, high altitudes, and exercise increase platelet count </li></ul>
    52. 52. ERYTHROCYTE STUDIES <ul><li>ERYTHROCYTE SEDIMENTATION RATE (ESR)- 0 to 30 mm/hr </li></ul><ul><li>ndirectly measures how much inflammation is in the body. </li></ul><ul><li>pecial preparations not needed, but fatty meal may cause plasma alterations </li></ul><ul><li>ate at which erythrocytes settle out of anticoagulated blood in 1 hour </li></ul>E S R
    53. 53. ERYTHROCYTE STUDIES <ul><li>RED BLOOD CELLS </li></ul><ul><li>-esults in the delivery of oxygen to the body tissues </li></ul><ul><li>-lood diseases diagnosis </li></ul><ul><li>-irculate for 120 days and are removed from the blood via the liver, spleen, and bone marrow </li></ul><ul><li>-pecial preparation not needed </li></ul>R B C S
    54. 54. ERYTHROCYTE STUDIES <ul><li>RED BLOOD CELLS 4.5-5.5 million/mm3 </li></ul><ul><li><RBC – Anemia (Faitgue, SOB) </li></ul><ul><li>>RBC – Polycythemia (erythrocytosis) – management phlebotomy </li></ul>
    55. 55. ERYTHROCYTE STUDIES <ul><li>HEMOGLOBIN and HEMATOCRIT </li></ul><ul><li>Hemoglobin is the main component of erythrocytes and serves as the vehicle for transporting O2 and CO2 </li></ul><ul><li>Normal Values: </li></ul><ul><ul><li>14 to 16.5 g/dl (male) </li></ul></ul><ul><ul><li>12 to 15 g/dl (female) </li></ul></ul>
    56. 56. ERYTHROCYTE STUDIES <ul><li>HEMOGLOBIN and HEMATOCRIT </li></ul><ul><li>Hematocrit represents red blood cell mass and is an important measurement in the identification of anemia or polycythemia </li></ul><ul><li>Normal Values: </li></ul><ul><ul><li>42% to 52% (male) </li></ul></ul><ul><ul><li>35% to 47% (female) </li></ul></ul>
    57. 57. WHITE BLOOD CELL COUNT <ul><li>WHITE BLOOD CELL </li></ul><ul><li>Immune defense system of the body </li></ul><ul><li>WBC 5,000-10,000 cells/mm3 </li></ul><ul><ul><li><WBC – leukopenia (risk for infection) </li></ul></ul><ul><ul><li>>WBC – leukocytosis (infection/inflammation) </li></ul></ul><ul><ul><li>>100,000 – incapable of phagocytosis (leukemia) </li></ul></ul>
    58. 58. WHITE BLOOD CELL COUNT <ul><li>WHITE BLOOD CELL </li></ul><ul><li>Nursing Consideration: </li></ul><ul><li>SHIFT TO THE LEFT: increased number of immature neutrophils is present on the blood </li></ul><ul><li>SHIFT TO THE RIGHT: cells have more than usual number of nuclear segments, found in liver disease, Down syndrome, pernicious anemia, and megaloblastic anemia </li></ul>
    59. 59. CARDIAC MARKERS <ul><li>CREATINE KINASE (CK) </li></ul><ul><li>Found in: </li></ul><ul><li>CK-MB (Cardiac)--- 0% to 5% </li></ul><ul><li>CK-BB (Brain)--- 0% </li></ul><ul><li>CK-MM (Muscles)--- 95% to 100% </li></ul>
    60. 60. CARDIAC MARKERS <ul><li>CREATINE KINASE (CK) </li></ul><ul><li>R: 6 hours </li></ul><ul><li>P: 18 hours </li></ul><ul><li>N: 2 to 3 days </li></ul>
    61. 61. CARDIAC MARKERS <ul><li>CREATINE KINASE (CK) </li></ul><ul><li>Nursing Considerations: </li></ul><ul><li>CK-MM: Avoid strenuous physical activity for 24 hours before the test </li></ul><ul><li>Avoid ingestion of alcohol for 24 hours before the test </li></ul><ul><li>Invasive procedures and intramuscular injections may falsely elevate CK levels </li></ul>
    62. 62. CARDIAC MARKERS <ul><li>LACTASE DEHYDROGENASE (LDH) </li></ul><ul><li>R: 24 hours </li></ul><ul><li>P: 48 to 72 hours </li></ul><ul><li>N: 7 to 14 days </li></ul>
    63. 63. CARDIAC MARKERS <ul><li>LACTASE DEHYDROGENASE (LDH) </li></ul><ul><li>Nursing Considerations: </li></ul><ul><li>LDH isoenzyme levels should be interpreted in view of the clinical findings </li></ul><ul><li>Testing should be repeated on 3 consecutive days </li></ul>
    64. 64. CARDIAC MARKERS <ul><li>TROPONIN </li></ul><ul><li>- and I </li></ul><ul><li>-egulatory protein found in striated muscle </li></ul><ul><li>-n bloodstream when an infarction causes damage to the myocardium </li></ul>T R O
    65. 65. CARDIAC MARKERS <ul><li>TROPONIN I </li></ul><ul><li>>1.5 ng/ml… MI </li></ul><ul><li>R: 3 hours </li></ul><ul><li>N: 7 to 10 days </li></ul>
    66. 66. CARDIAC MARKERS <ul><li>TROPONIN T </li></ul><ul><li>>0.1 to 0.2 ng/ml… MI </li></ul><ul><li>R: 3 hours </li></ul><ul><li>N: 7 to 14 days </li></ul>
    67. 67. CARDIAC MARKERS <ul><li>TROPONIN </li></ul><ul><li>Nursing Considerations: </li></ul><ul><li>Testing is repeated in 12 hours, followed by daily testing for 3 to 5 days. </li></ul><ul><li>Rotate venipuncture sites. </li></ul>
    68. 68. CARDIAC MARKERS <ul><li>MYOGLOBIN </li></ul><ul><li>Oxygen-binding protein found in striated muscle that releases oxygen at very low tensions </li></ul><ul><li>Injury to skeletal muscle will cause a release of myoglobin into the blood </li></ul>
    69. 69. CARDIAC MARKERS <ul><li>MYOGLOBIN </li></ul><ul><li>>90 mcg/L… MI </li></ul><ul><li>R: 1 to 2 hours </li></ul><ul><li>P: 4 to 6 hours </li></ul><ul><li>N: 24 to 36 hours </li></ul>
    70. 70. SERUM LIPIDS <ul><li>Total Cholesterol--- </li></ul><ul><li>140 to 199 mg/dl </li></ul><ul><li>Low Density Lipoprotein (LDL)--- <130 mg/dl </li></ul><ul><li>High Density Lipoprotein (HDL)--- 30 to 70 mg/dl </li></ul><ul><li>Triglycerides--- </li></ul><ul><li>< 200 mg/dl </li></ul>
    71. 71. SERUM LIPIDS <ul><li>Nursing Considerations: </li></ul><ul><li>o oral contraceptives </li></ul><ul><li>PO except water for 12 to 14 hours </li></ul><ul><li>o alcohol for 24 hours </li></ul><ul><li>o high cholesterol foods the evening meal before the test </li></ul>N N N N
    72. 72. ECG <ul><li>-valuates heart rate and the regularity of heartbeats. </li></ul><ul><li>-ardiac dysrhythmias, MI, and cardiac hypertrophy </li></ul><ul><li>- raph of the electrical impulses moving through the heart. </li></ul>E C G
    73. 73. ECG <ul><li>Nursing Consideration: </li></ul><ul><li>-lectrical shock will not occur </li></ul><ul><li>-ardiac medications of the patient should be documented </li></ul><ul><li>-ive instructions to lie still, breathe normally, and refrain from talking during the test </li></ul>E C G
    74. 74. BASIC ECG INTERPRETATION Normal Sinus Rhythym Sinus Tachycardia Sinus Bradycardia Atrial Tachycardia Atrial Fibrillation Atrial Flutter Ventricular Tachycardia Ventricular Fibrillation Asystole
    75. 75. STANDARD LEAD PLACEMENT <ul><li>PRECORDIAL LEADS </li></ul>White: Right Arm Black: Left Arm Green: Right Leg Red: Left Leg
    76. 76. STANDARD LEAD PLACEMENT <ul><li>LIMBS LEADS </li></ul>
    77. 77. BASIC ECG INTERPRETATION
    78. 78. BASIC ECG INTERPRETATION <ul><li>P WAVE: Atrial depolarization </li></ul><ul><li>PR INTERVAL: AV conduction time </li></ul><ul><li>QRS COMPLEX: Ventricular depolarization </li></ul><ul><li>ST SEGMENT: Time interval between complete depolarization of ventricles and repolarization of ventricles </li></ul><ul><li>T WAVE: Ventricular repolarization </li></ul>
    79. 79. NORMAL CARDIAC RHYTHM PARAMETERS <ul><li>NORMAL SINUS RHYTHM: 60 TO 100 bpm </li></ul><ul><li>SINUS BRADYCARDIA: <60 bpm </li></ul><ul><li>SINUS TACHYCARDIA: >100 bpm </li></ul><ul><li>QRS WIDTH: 0.08 to 0.12 sec </li></ul><ul><li>PR INTERVAL: 0.12 to 0.20 sec </li></ul><ul><li>QT INTERVAL: 0.30 to 0.40 sec </li></ul>
    80. 80. FIGURING HEART RATE <ul><li>1500 method </li></ul><ul><li>RR method </li></ul><ul><li>6-second method </li></ul>
    81. 81. FIGURING HEART RATE <ul><li>1500 method </li></ul>
    82. 82. FIGURING HEART RATE <ul><li>2. RR method </li></ul>
    83. 83. FIGURING HEART RATE <ul><li>3. 6-second method </li></ul>
    84. 84. NORMAL SINUS RHYTHM Rate Rhythm P Waves P-R QRS 60 to 100 Regular Present 0.12 to 0.20 secs 0.08 tp 0.12 secs
    85. 85. SINUS TACHYCARDIA Rate Rhythm P Waves P-R QRS >100 BPM Regular Present 0.12 to 0.20 secs 0.08 to 0.12 secs
    86. 86. SINUS BRADYCARDIA Rate Rhythm P Waves P-R QRS <60 BPM Regular Present 0.12 to 0.20 secs 0.08 to 0.12 secs
    87. 87. ATRIAL TACHYCARDIA Rate Rhythm P Waves P-R QRS 150 to 250 bpm Regular Present Short <0.12 0.08 to 0.12 secs
    88. 88. ATRIAL FIBRILLATION Rate Rhythm P Waves P-R QRS Variable Irregularly- Irregular Absent Non- discernible Narrow
    89. 89. ATRIAL FLUTTER Rate Rhythm P Waves P-R QRS 250 to 350 bpm Usually regular Sawtooth pattern Non- discernible Usually narrow
    90. 90. VENTRICULAR TACHYCARDIA Rate Rhythm P Waves P-R QRS 100 TO 220 BPM Usually regular Absent NA Wide >0.12 sec
    91. 91. VENTRICULAR FIBRILLATION Rate Rhythm P Waves P-R QRS 350 TO 450BPM Completely chaotic and disorganized Absent NA Absent
    92. 92. ASYSTOLE Rate Rhythm P Waves P-R QRS No Rate No Rhythm Absent NA Absent
    93. 93. CVP <ul><li>-atheter is attached to an IV infusion and H2O manometer by a three way stopcock </li></ul><ul><li>-eins external jugular, antecubital, or femoral </li></ul><ul><li>- ressure within the superior vena cava </li></ul>C V P
    94. 94. CVP <ul><li>Normal Value: 3 to 8 mmHg </li></ul><ul><li>Position: </li></ul><ul><li>Cardiac Disease: Semi Fowler’s </li></ul><ul><li>Dressing or Tubing Change: Flat or Trendelenburg </li></ul><ul><li>CVP Reading and Monitoring: Flat, Supine, or Dorsal Recumbent </li></ul><ul><li>Air Embolism: Left Side Lying </li></ul>
    95. 95. CVP
    96. 96. 1. Maintain zero point of manometer always at level of right atrium (intersection between midaxillary line and 4 th ICS, also referred to as the phlebostatic axis) 2. Determine patency of catheter by opening IV infusion line
    97. 97. 3. Turn stopcock to allow IV solution to run into manometer to a level of 10-20cm above expected pressure reading 4. Turn stopcock to allow IV solution to flow from manometer into catheter; fluid level in manometer fluctuates with respiration
    98. 98. 5. Stop ventilatory assistance during measurement of CVP 6. After CVP reading, return stopcock to IV infusion position 7. Record CVP reading and position of client (angle of recline)
    99. 99. PERICARDIOCENTESIS <ul><li>ericardial effusion </li></ul><ul><li>uncture </li></ul><ul><li>ericardial sac </li></ul><ul><li>ericardial fluid </li></ul>P P P P
    100. 100. PERICARDIOCENTESIS <ul><li>PREPROCEDURE </li></ul><ul><li>erform blood analysis </li></ul><ul><li>CG </li></ul><ul><li>estriction of food and water is recommended for six hours before the test. </li></ul><ul><li>V line for sedation </li></ul>P E R I
    101. 101. PERICARDIOCENTESIS <ul><li>INTRAPROCEDURE </li></ul><ul><li>vail emergency resuscitative equipment at bedside </li></ul><ul><li>ed is elevated to 45 to 60 degrees </li></ul><ul><li>ardiac activity monitoring </li></ul><ul><li>one in emergency room, ICU, or at the bedside </li></ul>A B C D
    102. 102. PERICARDIOCENTESIS <ul><li>POSTPROCEDURE </li></ul><ul><li>pical pulse monitoring </li></ul><ul><li>lood pressure </li></ul><ul><li>VP </li></ul><ul><li>etect complications: Ventricular or coronary artery puncture, dysrhythmias, pleural laceration, gastric puncture, myocardial trauma </li></ul>A B C D
    103. 103. RESPIRATORY SYSTEM Chest X-ray Sputum Specimen Bronchoscopy Thoracentesis Lung Biopsy ABG Analysis Incentive Spirometer Peak Flow Meter
    104. 104. CHEST X-RAY <ul><li>A-natomy </li></ul><ul><li>A-ppearance </li></ul>
    105. 105. CHEST X-RAY <ul><li>PREPROCEDURE: </li></ul><ul><li>emove all jewelry and other metal objects from the chest area </li></ul><ul><li>ssess the client’s ability to inhale and hold his or her breath </li></ul><ul><li>ou question women regarding pregnancy or possibility of pregnancy </li></ul>R A Y
    106. 106. CHEST X-RAY <ul><li>POSTPROCEDURE: </li></ul><ul><li>Help the client get dressed </li></ul>
    107. 107. SPUTUM SPECIMEN <ul><li>pecimen thru expectoration </li></ul><ul><li>uctioning of the trachea </li></ul><ul><li>putum amount: 15 ml </li></ul>S S S
    108. 108. SPUTUM SPECIMEN <ul><li>PREPROCEDURE: </li></ul><ul><li>-lways collect the specimen before antibiotic therapy </li></ul><ul><li>-e sure that the client rinse mouth with water </li></ul><ul><li>-lient to take several deep breaths and then cough deeply </li></ul>A B C
    109. 109. SPUTUM SPECIMEN <ul><li>POSTPROCEDURE: </li></ul><ul><li>If a culture of sputum is prescribed, transport the specimen to the laboratory immediately </li></ul><ul><li>Assist the client with mouth care </li></ul>
    110. 110. BRONCHOSCOPY <ul><li>To visualize: </li></ul>L B T arynx rachea ronchi
    111. 111. BRONCHOSCOPY
    112. 112. BRONCHOSCOPY <ul><li>Purposes: </li></ul><ul><li>-pply medications </li></ul><ul><li>-rush biopsy </li></ul><ul><li>-arefully remove foreign objects </li></ul><ul><li>-irect visualization </li></ul>A B C D
    113. 113. BRONCHOSCOPY <ul><li>PREPROCEDURE: </li></ul><ul><li>tain informed consent </li></ul><ul><li>emove dentures or eyeglasses </li></ul><ul><li>btain vital signs </li></ul><ul><li>PO postmidnight </li></ul><ul><li>oagulation studies result must be checked </li></ul><ul><li>ave emergency resuscitation equipment readily vailable </li></ul><ul><li>give IVF and medication for sedation </li></ul><ul><li>uction equipment at bedside </li></ul>B O N C H U S R
    114. 114. BRONCHOSCOPY <ul><li>POSTPROCEDURE: </li></ul><ul><li>ag reflex return </li></ul><ul><li>ssess for bloody sputum </li></ul><ul><li>ive instruction that sore throat is common </li></ul><ul><li>espiratory status must be monitored </li></ul><ul><li>mesis basin at bedside </li></ul><ul><li>owler’s semi position </li></ul><ul><li>ook out for complications like bronchospasm or bronchial perforation </li></ul><ul><li>levated temperature and DOB- Notify! </li></ul><ul><li>amine vital signs </li></ul>G A G R E F L E X
    115. 115. THORACENTESIS <ul><li>Insertion of a needle through the chest wall: </li></ul><ul><li>Obtain specimen </li></ul><ul><li>Remove pleural fluid accumulation </li></ul><ul><li>Instill medication </li></ul>
    116. 116. THORACENTESIS
    117. 117. THORACENTESIS <ul><li>PREPROCEDURE: </li></ul><ul><li>o obtain informed consent </li></ul><ul><li>ealth teaching: not cough, breathe deeply, or move during the test </li></ul><ul><li>n doctor's office, in the X-ray department, ER, OR or at bedside </li></ul><ul><li>idden on bed: Sidelying towards the unaffected side with HOB elevated </li></ul><ul><li>mbulatory: Sit upright with arms and shoulders supported by a table </li></ul><ul><li>-ray or ultrasound before the procedure </li></ul>T H O R A X
    118. 118. THORACENTESIS <ul><li>POSTPROCEDURE: </li></ul><ul><li>Monitor vital signs </li></ul><ul><li>Monitor respiratory status </li></ul><ul><li>Apply a pressure dressing </li></ul><ul><li>Assess the puncture site for bleeding and crepitus </li></ul><ul><li>Monitor for signs of pneumothorax, air embolism, and pulmonary edema </li></ul>
    119. 119. LUNG BIOPSY <ul><li>C -ulture </li></ul><ul><li>C -ytological exam </li></ul><ul><li>P -ulmonary lesion </li></ul><ul><li>P -leural effusion </li></ul>
    120. 120. LUNG BIOPSY <ul><li>PREPROCEDURE: </li></ul><ul><li>-et the patient signs informed consent </li></ul><ul><li>-se of local anesthesia, pressure during insertion of needle </li></ul><ul><li>-PO </li></ul><ul><li>-ive analgesics and sedatives as prescribed </li></ul>L U N G
    121. 121. LUNG BIOPSY <ul><li>POSTPROCEDURE: </li></ul><ul><li>-ital signs must be monitored </li></ul><ul><li>-nspect biopsy site for drainage or bleeding </li></ul><ul><li>-n biopsy site dressing must be applied </li></ul><ul><li>-neumothorax and air embolism </li></ul><ul><li>-igns of respiratory distress must be monitored </li></ul><ul><li>-ou prepare the patient for chest x-ray </li></ul>B I O P S Y
    122. 122. ABG ANALYSIS <ul><li>Measurement </li></ul><ul><li>Oxygen </li></ul><ul><li>Carbon dioxide </li></ul><ul><li>Arterial blood </li></ul><ul><li>Acid base state </li></ul>
    123. 123. ABG ANALYSIS <ul><li>PREPROCEDURE: </li></ul><ul><li>- llen’s test before drawing radial artery specimens </li></ul><ul><li>-efore specimen collection, client to rest for 30 minutes </li></ul><ul><li>-iving suction before drawing ABG sample is avoided </li></ul>A B G
    124. 124. ABG ANALYSIS <ul><li>POSTPROCEDURE: </li></ul><ul><li>Place the specimen on ice </li></ul><ul><li>Note the client’s temperature on the laboratory form </li></ul><ul><li>Note the oxygen and type of ventilation that the client is receiving on the laboratory form </li></ul>
    125. 125. ABG ANALYSIS <ul><li>POSTPROCEDURE: </li></ul><ul><li>Apply pressure to the puncture site for 5 to 10 minutes or longer if the client is taking anticoagulant therapy or has a bleeding disorder </li></ul><ul><li>Transport the specimen to the laboratory within 15 minutes </li></ul>
    126. 126. ABG ANALYSIS <ul><li>Normal Arterial Blood Gas Values: </li></ul>pH 7.35 to 7.45 PCO2 35 to 45 mmHg HCO3 22 to 26 mmHg PO2 80 to 100 mmHg O2 sat 96% to 100 %
    127. 127. ABG ANALYSIS <ul><li>R - espiratory </li></ul><ul><li>O - pposite </li></ul><ul><li>M - etabolic </li></ul><ul><li>E - qual </li></ul>
    128. 128. INCENTIVE SPIROMETER <ul><li>Sustained </li></ul><ul><li>Maximal </li></ul><ul><li>Inspiration </li></ul>
    129. 129. INCENTIVE SPIROMETER
    130. 130. INCENTIVE SPIROMETER <ul><li>INDICATIONS: </li></ul><ul><li>Upper-abdominal surgery </li></ul><ul><li>Thoracic surgery </li></ul><ul><li>Surgery in patients with chronic obstructive pulmonary disease </li></ul><ul><li>Pulmonary atelectasis </li></ul><ul><li>Presence of a restrictive lung defect associated with quadraplegia and/or dysfunctional diaphragm. </li></ul>
    131. 131. INCENTIVE SPIROMETER <ul><li>Nursing Considerations </li></ul><ul><li>PREPROCEDURE </li></ul><ul><li>-void smoking or eating heavy meal for 4 to 6 hours before the test </li></ul><ul><li>-e sure to remove dentures </li></ul><ul><li>-onsult with the physician regarding holding bronchodilators before testing </li></ul><ul><li>-etermine whether analgesic that may depress the respiratory function is being administered </li></ul><ul><li>-ncourage to void and wear loose clothing </li></ul>A B C D E
    132. 132. INCENTIVE SPIROMETER <ul><li>Nursing Considerations </li></ul><ul><li>POSTPROCEDURE </li></ul><ul><li>Resume: </li></ul><ul><li>Diet </li></ul><ul><li>Bronchodilators </li></ul><ul><li>Respiratory treatments </li></ul>
    133. 133. PEAK FLOW METER <ul><li>determines the effectivity of bronchodilator for asthmatic patients </li></ul>
    134. 134. PEAK FLOW METER <ul><li>Management: </li></ul><ul><li>Diary </li></ul><ul><li>Weeks period that the child is well </li></ul><ul><li>Blows </li></ul><ul><li>Results: </li></ul><ul><li>GREEN: 80 to 100%... Very Good </li></ul><ul><li>YELLOW: 50 to 80%... Beginning Attack </li></ul><ul><li>RED: <50%... Bring to ER </li></ul>

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