NP235 Unit 2 Diagnostic tests 2023 with verified questions and answers

Bone Scan a nuclear imaging test . used if a patient has unexplained skeletal pain, a bone infection, or a bone injury that can't be seen on a standard X-ray. A bone scan can diagnose Fractures Arthritis Paget's disease of bone Cancer originating in bone Cancer that has metastasized to bone from a different site Infection of the joints, joint replacements or bones (osteomyelitis) Impaired blood supply to bones or death of bone tissue (avascular necrosis How does a bone scan work? It detects changes in the metabolic activity of bone -tag patients blood with radiopharmaceutical Tracers will be injected into a vein in the patient's arm. The amount of time between the injection and scan varies, depending on the reason the doctor has ordered the scan. Some images may be taken immediately after the injection. But the main images are taken two to four hours later to allow the tracer to circulate and be absorbed by the bones. Bone Scan Nursing Implications Check for allergies and pregnancy. The patient will be asked to lie quietly for 30-60 min during the scanning. All metal must be removed from the area to be scanned. Ensure patient that she will not be "radioactive." The isotope is eliminated from the body in 6-24 hr. Brain Scan (radionuclide Imaging) used to detect an intracranial mass such as a tumor, abscess, hematoma, or aneurysm. A radioisotope is administered IV. Abnormal tissue usually absorbs more of the isotope than normal tissue. After a 1- to 3-hr waiting period for absorption, a scintillation scanner is used to image the brain. The test takes 30 min-1 hr. Magnetic Resonance Imaging (MRI) magnetic fields and radio waves to produce high quality two- or three-dimensional images of brain structures without the use of ionizing radiation (X-rays) or radioactive tracers. What is a CAT Scan? A machine that lets X-Ray beams focus on an object at different levels. Nursing Implications: MRI The patient will sit or lie on a table; The scanner makes clicking noises; The amount of radioactivity is very low and is not dangerous to the patient or others. The patient will need to lie or sit still during the scanning. A drug may be given the night before to block uptake of the radioactive element by the thyroid and salivary glands. There is no food or fluid restriction; no special aftercare. How does a PET Scan Work To assess for cell death, damage in brain tissue. Radioactive material is given and provides differing color in areas of cellular activity. PET scan Nursing implications The procedure requires a signed consent form. Explain that two IV lines will be inserted. The patient is to avoid sedatives or tranquilizers before the test. Ask the patient to empty their bladder before the test. The patient may be asked to perform various activities during the test. A ventilation scan looks at how air moves in and out of the lungs. Radioactive gas is inhaled and, when scanned, presents a pattern of ventilation in the lungs, In particular, it looks at how air moves through the bronchi and bronchioles within the lungs. A tracer will fill the lungs unless the patient has an area where the air cannot move. A perfusion scan looks at how blood is flowing within the lungs. An IV injection of radionuclide-tagged, macroaggregated albumin is given and is absorbed evenly where blood flow is normal. Areas that are not getting blood do not absorb the tracer. Mammography used to screen the breasts for abnormal growths, particularly cancer. Breast discomfort from compression of the tissue during the test; occasional mild bruising. Instruct the patient to wear no deodorant or lotion on the upper body and to wear clothing that allows the top to be easily removed. Breast MRI used for women with dense breast tissue for whom a mammogram is not reliable. Carotid Ultrasound used to determine whether blood flow in carotid arteries is decreased or blocked. Doctor will recommend if the pt. has had a TIA or stroke or risk factors like: High blood pressure Diabetes High cholesterol The family history of stroke or heart disease Recent transient ischemic attack (TIA) or stroke An abnormal sound in carotid arteries (bruit), detected by the doctor using a stethoscope Coronary artery disease Ankle-brachial index test. measures and compares the blood pressure between the right ankle and the arm. The test shows reduced or blocked blood flow to the legs. Cardiac stress test. shows how well the heart performs when under stress, such as during exercise. Results can indicate poor blood flow to the heart. Other uses of carotid ultrasound Evaluate blood flow through the artery after surgery to remove plaques (carotid endarterectomy) Evaluate the placement and effectiveness of a stent; a mesh tube used to improve blood flow through an artery Locate a collection of clotted blood (hematoma) that may prevent blood flow Detect other carotid artery abnormalities that may disrupt blood flow Electrocardiogram (EKG or ECG) Records electrical impulses of the heart to determine the rate, the rhythm of the heart, the site of a pacemaker, and the presence of injury at rest. EKG Stress Test (treadmill) records the electrical activity of the heart during exercise. Insufficient blood flow and oxygen show up as abnormal waveforms. Small electrodes are placed on the chest, and a tracing is made while the patient exercises on a treadmill, bicycle, or stairs. Vital signs are continuously recorded. May be combined with radionuclide imaging or echocardiograph. The provider is present. EKG Stress Test: nursing implications Requires a signed consent form. Instruct the patient to wear comfortable clothes and walking shoes. Light meal 2-3 hr prior, then NPO. Regular medications are given. The chest is shaved as needed for electrode placement. Inform the patient that the test will be stopped if chest pain, severe fatigue, or dyspnea develops. Chemical Stress Test Test is conducted with Dipyridamole, Adenosine, or Dobutamine. Purpose: Used for those who cannot exercise for an ECG stress test. Procedure: Continuous 12-lead ECG monitoring is performed, and the drug is administered. Blood pressure and pulse are taken and recorded q15min. The drug effect increases cardiac workload to identify whether cardiac ischemia results. The patient is NPO during the test. Mild nausea or a headache may occur. Echocardiography evaluating size, shape, and position of structures and movement within the heart. This is the test of choice for valve problems patient is supine or turned on the left side. The test takes 30-60 min. Vascular Ultrasound rder a vascular ultrasound for: Evaluation of blood flow in the arteries and veins of the body to detect the presence, severity and specific location of disease. Diagnose narrowing of arteries and determine the severity of narrowing. Diagnose blood clots in the veins of the arms and legs, a condition known as deep vein thrombosis or DVT. Clostridium Difficile (C. Diff) a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Illness from C. difficile most commonly affects older adults in hospitals or in long-term care facilities and typically occurs after use of antibiotic medications Symptoms of C. Diff Signs and symptoms usually develop within five to 10 days after starting a course of antibiotics but may occur as soon as the first day or up to two months later. Watery diarrhea three or more times a day for two or more days Mild abdominal cramping and tenderness Severe infection Signs and symptoms of severe infection include: Watery diarrhea 10 to 15 times a day Abdominal cramping and pain, which may be severe Rapid heart rate Fever Blood or pus in the stool Nausea Dehydration Loss of appetite Weight loss Swollen abdomen Kidney failure Increased white blood cell count Treatment of C. Diff stop taking the antibiotic that triggered the infection, metronidazole (Flagyl), taken by mouth. For more severe and recurrent cases, vancomycin (Vancocin), also taken by mouth, may be prescribed. Surgery - for people with severe pain, organ failure, toxic megacolon or inflammation of the lining of the abdominal wall, surgery to remove the diseased portion of the colon may be the only option (Mayo clinic, 2018). Nursing Implications C. Diff Contact Precautions Preferred - cohorting of patients with same type of infection is acceptable Masks - Situation dependent Gowns - Always; if patients are cohorted, staff must perform hand hygiene and change PPE between patients Gloves - Always; if patients are cohorted, staff must perform hand hygiene and change PPE between patients Common disease for this isolation - Open or draining wounds; history of MRSA, VRE, ESBL positive; diarrhea; MDRO infections Occult Blood in Stool blood in the feces that is not visibly apparent (unlike other types of blood in stool such as melena or hematochezia). A fecal occult blood test (FOBT) checks for hidden (occult) blood in the stool (feces). .Bronchoscopy to remove foreign objects or mucous plugs; to biopsy lesions. When tumor is suspected, a lung biopsy may be obtained by bronchoscopy or during open thoracotomy. Nursing Implications for Bronchoscopy Keep patient NPO for 6 hr before test. IV access is initiated. monitor vital signs pulse oximetry readings level of consciousness Observe for: bleeding dyspnea wheezing discomfort swelling of face and neck Position patient on side until gag reflex has returned. .Virtual Colonoscopy An oral contrast agent may be given 1 day before the scan. combines images from a high-tech spiral CT scan to create a computer-generated three-dimensional picture of the colon. Noninvasive method of determining whether there are polyps or abnormalities in the colon. Optical Colonoscopy Patient is moderately sedated for this procedure, which takes about 30 min to 1 hr. Polyps can be removed or biopsies taken. To directly view the lining of the colon with a flexible endoscope Give clear liquid diet 1-3 days before test. Patient is kept NPO for 8 hr before test. Give bowel prep as ordered. Explain procedure and what she will experience. Verify presence of signed informed consent form for procedure. After procedure, observe for rectal bleeding and signs of perforation:abdominal distentionpainElevated temperature. Arthroscopy To inspect the interior aspect of a joint, usually a knee, with a fiberoptic endoscope to diagnose problems of the patella, meniscus, and synovium; also used to evaluate the progress of arthritis or effectiveness of treatment Cystoscopy Under short-acting or local anesthesia, a cystoscope is passed up the urethra into the bladder. The scope can be guided into a ureter to extract a stone or to biopsy lesions in the bladder. Post-procedure: burning, frequency, and pink-tinged urine may occur. Frank bleeding should be reported. Warm sitz baths and mild analgesics are given for voiding discomfort. Hysteroscopy llows the doctor to look inside the uterus in order to diagnose and treat causes of abnormal bleeding. Nursing Implications: occasional injury to cervix or uterine wall. If endometrial ablation is done, the woman will have difficulty becoming pregnant, because the lining destruction is permanent. Bone Marrow Cells are withdrawn by needle from the sternum or iliac crest may perform a bone marrow exam to: Diagnose a disease or condition involving the bone marrow or blood cells Determine the stage or progression of a disease Check iron levels and metabolism Monitor treatment of a disease Investigate a fever of unknown origin Holter Monitor (Ambulatory EKG) Patient wears a small ECG recorder for 6, 12, or 24 hr while doing usual tasks. A diary is kept to show at what time the various activities were performed and any symptoms experienced. The record is analyzed to correlate any dysrhythmia with the activity at that time. Bone Density Scan (DSXA) To measure bone density of spine, hip, femur, or forearm To monitor changes in bone density and to diagnose metabolic bone disease Lumbar puncture To determine whether Cerebral Spinal Fluid (CSF) pressure is elevated; To determine whether there is a blockage to the flow of CSF; To inject medications; To obtain fluid for chemical analysis and culture Nursing Implications for Lumbar Puncture Obtain sterile lumbar puncture tray, local anesthetic, sterile gloves, and tape. Assist patient into position with back bowed, head flexed on chest, and knees drawn up to the abdomen. Patient may be lying or sitting. Assist patient to maintain position and to hold still during procedure. Reassure patient and provide emotional support. Personnel must wear a mask during procedure. Keep patient flat in bed to reduce headache for 1 hr or longer after procedure and encourage fluid intake unless contraindicated. Observe the site for signs of drainage and inflammation. Paracentesis procedures for removing fluid buildup in the body. Thoracentesis refers to the removal of fluid from the space between the lungs and the chest wall, called the pleural cavity. Paracentesis refers to removing fluid from the abdominal cavity. Thoracentesis Medical Animation with local anesthetic, and ultrasound guidance, a large-bore needle is inserted through the chest wall into the pleural space, and fluid is withdrawn with a syringe or into vacuum bottles by a physician at the patient's bedside. Aseptic technique must be used. Specimens are obtained for culture, microscopic examination, and stains. Medication may be instilled. Nursing Implications with Thoracentesis Explain procedure to patient. Take baseline vital signs. Position patient sitting, facing side of bed, and leaning over the over-bed table with arms crossed on it; pillows or the back of a chair can also be used. Monitor respirations and skin color during procedure. Assist patient to remain still. Chest radiograph may be ordered after procedure. Monitor vital signs q15min for 1 hr or until stable, then routinely. Auscultate breath sounds frequently. Rapid breathing, cyanosis, hemoptysis, changes in breath sounds, and tachycardia should be reported immediately. Chart amount and appearance of fluid and condition of patient. Send specimens to the laboratory as ordered. Blood Cultures how Sepsis is diagnosed use aseptic technique, where indicated and with sterile equipment; (2) only collect fresh material from the suspected site, avoiding contamination by microbes from nearby tissues and fluids; and (3) use the appropriate container for the sample, making sure the container is correctly labeled and tightly covered to avoid spilling and contamination during transport to the laboratory. Maintaining Asepsis - Sterile Technique Standard precautions are used during procedures where blood or body fluids are extracted. Assume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting and apply the following infection control practices during the delivery of healthcare. Venous Puncture Use Standard Precautions and aseptic technique for the venipuncture and the correct tubes for each sample. Skin testing Schick test to determine susceptibility to diphtheria and the TST (Mantoux test) to identify those who might need treatment for TB. Pulmonary Function Tests To determine integrity of mechanical function and gas exchange function of the lungs: volume of air lung can hold; rate of flow of air in and out of the lung; and elasticity, or compliance, of lung Chest X-ray To determine pathologic conditions in the lungs, such as pneumonia, lung abscess, tuberculosis, atelectasis, pneumothorax, and tumor; also gives indication of heart size and any abnormalities of bony structures Pulse Oximetry To noninvasively monitor arterial oxygen saturation (SaO2) To allow comparison of oxygenated hemoglobin to total hemoglobin Peak flowmeter Normal peak flow values for adults are based on age, gender, height, and underlying lung disorder. Normal values range from 300 to 700 L/min but are assessed by comparison against a patient's baseline values Schilling Test Determines ability to absorb vitamin B12; used to diagnose pernicious anemia Assess kidney function. Requires an 8- to 12-hr fast. No B vitamins for 3 days prior; no laxatives for 24 hr. Subnormal levels of B12 in the urine indicate the lack of intrinsic factor, which facilitates absorption of vitamin B12. Babinski Reflexes Normal in infants - Positive Babinski reflex displayed by infants - fanning of toes when medial side of sole is stimulated - May indicate CNS damage in adults if toes fan when sole is stimulated - Negative Babinski reflex - seen in normal adults. When - stimulated, curling of toes (plantar reflex) occurs Extraocular muscle function test To test the function of the extraocular musclesObserve for parallel eye movements and any deviation of movement. Nystagmus is a normal finding for the far lateral gaze. Record your finding Topical dye (corneal staining) To detect abrasions of the cornea or the presence of a foreign body on the corneaExplain the procedure and the rationale for the test. Warn that the drops may sting slightly for a few minutes. Give the patient a tissue to absorb the excess drops, because they may stain clothing. Barium Enema Radiographic examination of the colon using fluoroscopy to locate tumors, obstruction, and ulcerationKeep patient NPO for 8 hr before test. Give ordered laxatives and enemas. Bowel must be clear of stool.Explain what will happen during the test.Post-test care is same as for upper GI series. Upper GI Series Radiographic examination with fluoroscopy to locate obstruction, ulceration, or growths in the esophagus, stomach, and duodenum Flexible sigmoidoscopy To examine the lining of the rectum and sigmoid colon to detect polyps, tumor, obstruction, or ulceration Observe for rectal bleeding after biopsy or polyp removal. Arthrocentesis To extract synovial fluid for analysis or to reduce swelling The elastic bandage, if present, should be worn for 2-3 days.Patient should avoid overuse of the joint until pain and swelling have subsided.Administer ordered analgesics PRN. Diagnostic Tests for Urologic Disorders a complete blood count (CBC), blood urea nitrogen (BUN), serum creatinine, Creatinine clearance. Intravenous pyelogram (IVP) To visualize the kidneys, ureters, and bladderTo detect obstructions related to stones or tumors Patient may feel a hot flush or nausea when dye is injected.After procedure, encourage PO fluids for rehydration. Bladder scan Noninvasive method to measure postvoid residual volume or urinary retention Cortisol To assess cortisol production by adrenal glands Keep stress to a minimum.Note time collected on laboratory slip. Explain that a specimen may be collected two or three times in 24 hr to evaluate circadian effects on cortisol secretion. TSH To differentiate between pituitary dysfunction and primary thyroid dysfunction; assists with diagnosis of hypothyroidism Glucose tolerance test (GTT) Instruct patient to eat a balanced diet with at least 150 g of carbohydrate for 3 days before the test and maintain a normal level of physical activity.Instruct patient to fast for 10-12 hr before beginning the test.Explain that during the test the patient cannot eat, drink, or smoke, and must stay at rest for 2 hr.During the test, instruct patient to report feelings of weakness, dizziness, nervousness, and confusion. Ketone bodies To determine presence of ketones in the urine, which indicates a state of ketoacidosisInstruct diabetic patient that ketone testing should be done whenever illness has interfered with normal eating and activity for more than 24 hr and whenever signs of hyperglycemia are present Dilation and Evacuation (D&E) To detect cause of excessive bleeding; to remove hypertrophied uterine lining, retained placenta, or tissue remaining from incomplete abortion. Complications include uterine perforation, excessive bleeding, infection. Instruct patient to report heavy bleeding, clotting, sharp/severe abdominal pain, abnormal or foul discharge. Prostate-specific antigen (PSA) level sample of blood is examined for the level of glycoprotein produced only by the prostate. An elevated level is found in benign prostatic hyperplasia, and levels above 10 mg/mL may be indicative of prostate cancer. However, abnormal levels do not indicate a positive diagnosis. The USPS Task Force recommends against routine screening for prostate cancer. The National Comprehensive Cancer Network recommends risk-stratified screening. Urography Radiologically detects changes caused by ureter abnormalities and follows urine excretion pathway. Uroflowmetry Measures the volume of urine expelled from the bladder per second. Detects outflow tract obstruction. Patient voids into a urine flowmeter. Privacy is provided. Urethral smears Used for laboratory microscopy study to identify pathogens. Prostate massage increases secretions in the urethra. A sterile swab is inserted into the urethra to obtain the specimen. Often used to diagnose some sexually transmitted infections.