Special Examinations & Tests

Examinations & Test

• A Diagnostic Examination is a procedure that
involves physical inspection of the body
structures and evidence of their functions , it
may or may not collecting specimens , it is
facilitated by the use of technical equipments
and techniques such as :
• 1-Radiography (X-rays)
• 2-Endoscopies
• 3-Radionuclide imaging ( Radioactive
Chemicals)
• 4-Ultrasonography , Ultra sound , high-
frequency waves
• 5-Electrical Graphic recordings
• A Laboratory Test : is a procedure that
involves the examination of body fluids or
specimens comparing with the normal
findings
 General Nursing Responsibilities: Before ,
During & After Procedures
• 1-Preprocedural care : the client should
understand the procedure then we obtained the
consent ,the steps of procedural are
• A-Clarifying Explanations ; after explanation in
some case consent form is required , usually the
physician gives explanation about the procedure
but there are some patient too anxious , insecure
ask questions in these case the nurse repeat the
explanations or clarify procedure in a simple way
• B-Preparing the clients ; like keep patient NPO
or modify the diet , in some hospital there is
written protocols for certain procedures , if
the preparing is not accurate the nurse should
inform because the test or the examinations
will not be accurate , also the nurse should
help the client to wear gown , identification
bands , vital signs some needs to empty
bladder
• C-obtaining equipments & supplies ; should be
prepared ahead of time , if the nurse needs
package she/he should be sure of the sterility
and if they need additional equipments such
as clean gloves ,goggles , masks , sterile
gloves…
• D-Arranging the examination area ; at the
procedure is performed at the bedside the
nurse removes unnecessary articles from the
area and provide privacy , if it is an examination
room the table should be clean and cover with
sheet or paper , the nurse arrange equipment
and supplies for easy access by the examiner ,
the nurse takes care about the sterility , and
the light of the equipments
• 2-Procedural responsibilities : During the
examination or test nurse first attention are
positions and drapes the client , there are five
positions are commonly used depending on
the type of examination , condition of the
client and preference of the examiner such as
dorsal recumbent position , lithotomy position
Sims’ position , knee-chest , standing used to
examine prostate gland in men
• Second assisting the examiner ; the nurse
should be aware about the procedure , the
nurse should place the equipments or
instruments on the side of the examiner’s
dominant hands , the nurse should be aware
about the drugs that will be used , if the nurse
perform the test , the nurse should not leave
the patient and if the nurse needs assistance
she/he call for assistance
• Third the nurse provide physical and
emotional support , physically if the patient in
pain to give pain killer , hold the patient hands
offering support and encouragement
• 3-Post Procedural Care : after completion of
examinations and tests the nurse attends to
the client’s comfort and safety , cares for the
specimens and reporting
• A-Vital signs take till stable , offer clean gown
or help the patient to wear his/her cloth ,
discharge process by giving instructions for
referral or follow-up care
• B-Caring for the specimens , specimen’s tissues ,
blood samples or body fluids in order to ensure
the accurate analysis the nurse does the
following : Collect the specimen in an
appropriate container , right labeling the
specimens container appropriate request form ,
send specimens to the lab as soon as possible
• C-Accurate recording and reporting the data
specimen collection
Common Diagnostic Examinations
• 1-Pelvic Examination : is the physical
inspection of the vagina and cervix with
palpation of the uterus and ovaries , the
physician or nurse practitioner collect a
specimen of cervical secretion for Pap test
called Pap smear for abdominal cervical cells
• 2-Radiography or Roentgenography or X-rays
procedures : images of body structures usually
x-ray are avoided during pregnancy procedures
: Forms of Radiography are ;
• Magnetic Resonance Imaging MRI : is a
technique for producing an image by using
atoms subjected to a strong electromagnetic
field , for head , chest MRI no need to keep pt
NPO , abdomen needs to empty colon
• Contrast Medium : is a substance that adds
density to a body organ or cavity such as
barium sulfate or iodine , some people are
sensitive or allergic to the substance , contrast
media are administered orally or rectally or
injected IV
• Fluoroscopy : is a form of radiography used to
observe the movement of contrast media
• Computed Tomography CT : scanning is a
form of roentgenography that shows planes of
tissue , we use contrast media in order to
identify differences in tissue density , as MRI
no need to keep pt NPO for head and chest
but we need to keep pt NPO for abdomen and
empty the colon , nowadays we use Maroken
solution
 The Nursing Responsibilities for
Radiography
• Vital signs , before during and after the
procedures
• Remove metal such as bra and collar
• If there is administration of contrast media ask
the client about any allergies such as sea food
or iodine
• Know the location of the emergency trolley in
case of unexpected allergic reaction from media
• After the examination encourage the client to
drink large amount of fluid to promote
excretion of waste and check bowel
elimination and stool characteristics for at
least 2 days after administration or oral
barium , because barium can lead to
constipation and bowel obstruction in this
case administer laxative
• 3-Endoscopies examinations : Endoscopies is
a direct visual examination of the internal
structures , sometimes specimens or biopsy
obtained for the purpose of analysis , short-
acting anesthesia is administered
 Nursing Responsibilities for Endoscopies

• NPO
• Monitor vital signs
• Breathing O2 saturation
• Endoscopies for lower intestine we should
empty the colon
• Report and record anything unusual after
endoscopies
• 4-Radionuclide Imaging : procedure radiation
identified by a number followed by chemical
symbol such as Radioactive iodine and
Radioactive Technetium administer IV
• Types :
• Position Emission Tomography PET
 Nursing Responsibilities
• Because it is nuclear so the menses women ,
pregnant women , breast feeding should be
identified
• Ask about allergy , assist in wearing gown
• Obtain accurate weight because radiation is
calculated according to the weight
• Drink to flush radioactive in urine ,stool or
sometime we get rid through vomiting
• 5-Ultrasoung : soft tissue examination that
uses sound waves in ranges beyond hearing ,
the sound waves cause vibration within body
tissues produce images the reflected sound
waves are converted into visual image called
an Ultra sonogram or echogram which viewed
in real time on a monitor and recorded for
future analysis
 Nursing Responsibilities

• For best vision ultra sound should be done

before barium , for abdominal ultra sound we
keep patient NPO but let the patient to drink 5
to 6 full glasses of fluid 1 to 2 hours before the
test full bladder
• 6-Electrical Graphic Recording : machine can
record electrical impulses from structures of the
heart Electrocardiography EKG or ECG
examination of the electrical activity in the
heart
• Electroencephalography EEG ; examination of
the energy emitted by the brain
• Electromyography EMG : examination of the
energy produced by stimulated muscles
 Nursing Responsibilities
• For ECG we need to do shaving for male after
obtaining the consent
• For EEG tell the patient to wash the head with
shampoo , stop drink coffee , tea and cola
before procedure 8 hours
• For EMG painless unless the needle touch a
terminal nerve area
 Diagnostic Laboratory

• Such as collection specimens of blood , blood

culture , stool , urine , intestinal secretion ,
spinal fluids, wound drainage
• 1-Assisting with a Paracentesis ; is a procedure
for withdrawal fluid from abdominal cavity
• 2-Assisting with Lumbar Puncture ; this
procedure involves inserting a needle
between lumbar vertebrae in the spine below
the spinal cord purpose to withdraw a small
amount of fluid this aspiration used in case of
brain or spinal cord tumors that raise the
pressure or in case of infections such as
meningitis
• 3-Collecting a specimens for Throat Culture ;
culture means incubation of microorganisms is
performed by collecting infectious
microorganisms growing the living
microorganisms in a nutritive substance and
examine their characteristics with microscope
• Culture may be blood , urine , stool , wound
drainage and throat secretion
• To identify and treat the cause of throat
infection commonly streptococcal bacteria the
nurse obtain specimen from the throat
• 4-Measuring Capillary Blood Sugar ;
glucometer test instrument to measure the
amount of glucose in capillary blood in case of
diabetic patient