indications,preparation and post interventions of some diagnostic prossuders

1. Presented by:
Amal Alharbi & Sarah Alzahrani
Diagnostic procedures
Under supervision of:
D/ Dalia Salah
College of Nursing- Qassim university

2. 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
iodinated contrast medium such as diatrizoate sodium
or diatrizoate meglumine is injected, and then serial
filming is performed.

4. 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 .

5. • 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 he
matoma or lacerations.
• Diagnosis of congenital abnormalities such as absence of one kidney, ab
normal 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 hydronephrosis
or polycystic kidney disease.

6. 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.

7. 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.

8. Dual x ray (DEXA)
• A dual energy X-ray absorptiometry (DEXA) scan, is a common
technique used to measure bone density. This completely painless
procedure is easily performed and exposes the patient to minimal
radiation.

9. Preparation:
• No prior radionuclide studies for 2 weeks
• No barium contrast studies for 2 weeks
• No metal in clothing (i.e. zippers)

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

11. NURSING CARE AFTER THE PROCEDURE
• Perform neurological checks and vital signs and
compare with baselines.
• Complications and precautions: Note and report
suspected fracture or injury to the cervical spine
or neck pain.

12. MAMMOGRAPHY:
• Mammography is the process of using low-energy X-rays to exami
ne the human breast, which is used as a diagnostic and screening
tool.

13. Indications :
• Early detection of malignant tumors of the breast.
• Previous surgery for breast cancer, history of cancer involving 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.

14. 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.

15. 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.

16. Bone marrow aspiration
• A bone marrow aspiration removes only the marrow. These tests
are often done to find the reason for many blood disorders and
may be used to find out if cancer or infection has spread to the b
one marrow.

17. Indications:
• To diagnose thrombocytopenia, leukemia, granulomas,
anemias, and primary and metastatic tumors.
• To determine the causes of infection.
• To help stage disease.
• To evaluate chemotherapy.
• To monitor myelosuppression.

18. 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 anesthetic.

19. 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. Apply 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.

20. duplex ultrasound
• A duplex ultrasound is a test to see how blood moves through yo
ur arteries and veins.

21. Indications:
A duplex ultrasound can help diagnose the following conditio
ns:
• Abdominal aneurysm
• Arterial occlusion
• Blood clot
• Carotid occlusive disease (See: Carotid duplex)
• Renal vascular disease
• Varicose veins
• Venous insufficiency

22. 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.

23. NURSING CARE AFTER THE PROCEDURE
• Note and report neurological symptoms
such as dizziness, syncope, or blurred vision.
Protect from injury if symptoms occur.
• Administer or resume ordered medication regi
men.

24. MRI Scans

25. Indications for MRI Scans
 Brain
 Indications include stroke, temporal lobe epilepsy, infection, inflamm
ation, tumour, multiple sclerosis (MS), dementia, post-trauma, metab
olic 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.

26. Musculoskeletal (MSK)
 Indications include all MSK system: joints for derangement, in
fection, inflammation, post-trauma, tumour and vascular patho
logies.
 Abdomen and pelvis
 tumours, vascular pathologies, infection, inflammation, conge
nital abnormalities and metabolic disorders. Used for detectio
n of local invasion of rectal, prostatic and cervical carcinomas
 Cardiac
• Indications include ischemia, tumour, infiltrative diseases, con
genital malformation and cardiomyopathy

27. How you prepare
• Patient may be asked not to eat or drink anything for 4 - 6 hour
s before the scan.
• Asked patient if they are afraid of close spaces or claustrophobi
a and inform the doctor. Patient may be given a medicine to he
lp 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

28.  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

29. 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.

30. CT scan

31. 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.

32. • 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 fallopia
n 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.

33. How To Prepare
• Before the test, asked the patient if they ha
ve 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.

34. 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.

35. Endoscopy
• Endoscopic procedures are named for the organ or
body area to be examined or treated, including the:
• larynx, trachea, bronchi, pleurae, mediastinum, pericardi
um, esophagus, stomach, duodenum, pancreas, bile duct
s, liver, colon, rectum/sigmoid colon, bladder, urethra, ur
eters, prostate, vagina, cervix, uterus, fetus, fallopian tub
es, ovaries, and joints.

36. 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 i
ndirect)
• 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.

37. 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 uppe
r endoscopy.
• Bloating and cramping are sometimes reported after a lower endos
copy.
•
• The physician will inform the patient about when it will be safe to e
at and drink again, as well as provide a time frame for resuming nor
mal activity.
• In most cases, patients are urged to rest and eat lightly for the rem
ainder of the day following the endoscopy.

38. Stress test

39. Indications
• Suspected CAD in the presence of chest pain and other symptoms
• Diagnosis of heart abnormalities such as tachycardia, bradycardia, an
d
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 .

40. 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 exercises
• Inform the client that a total time of 45 to 90 minutes is needed to comple
te 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.

41. NURSING CARE AFTER THE PROCEDURE
• Provide a period of rest and monitor vital
signs and ECG in 3-, 10-, and 30-minute i
ntervals.
• Remove the electrodes and paste and
cleanse the skin sites.

42. paracentesis

43. 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

44. Preparation:
• Prior to a paracentesis the doctor must b
e informed regarding the intake of any
medication, allergies to any medication, i
ncluding anesthetics, bleeding problems
or intake of medications for blood thinni
ng and pregnancy . The bladder must be
emptied prior to the procedure.

45. 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 ba
ndage.
• You may shower tomorrow.
• Resume your regular diet today,

46. Sources:
• http://www.nlm.nih.gov/
• Nurse’s manual of laboratory and diagno
stic tests.
• http://www.uphs.upenn.edu/
• http://www.cc.nih.gov
• http://www.medicalhealthtests.com