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HANDOUT 3

Skin test: Mantoux Test

Previous vaccination like BCG/small pox
Checking for correct bottle of antigen used
Observe correct administration of intradermal injection and its dosage
Make sure to document the right reading of results

X-ray, Fluoroscopy, Chest Roentgenograms (X-Rays)

Ensure the patient is not pregnant or suspected to be pregnant
Ensuring the comfort of the patient while at the x-ray room
Remove all metallic objects
Assess the patient’s ability to hold his or her breath
Provide appropriate clothing

Bronchogram
A signed consent form is obtained from the patient
Obtain medical history
Obtain baseline vital signs and inform the practitioner of any abnormal findings.
Maintain NPO status until gag reflex is returned and coughed
Check for possible rise of body temperature

Bronchoscopy
Secure informed consent
Check for NPO status. Withheld food and fluids for 6 to 12 hours prior to the
exam to decrease the risk of aspiration
Monitor vital signs
Provide oral hygiene. remove any dentures if appropriate
Provide assistance with the diagnostic procedure and/or treatment
Assess respiratory status after
Relieve anxiety and provide comfort measures

Lung Scan
Explain the procedure and its purpose
Alleviate the patient’s fears concerning the procedure
Make sure that the patient can follow directions for breathing and holding his
breath
Evaluate procedure outcomes, and counsel appropriately

Sputum Examination
Using aseptic technique, close the container securely and place it in a leak proof bag
before sending it to the laboratory
Reading of results from laboratory
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Lung Biopsy
Explain the procedure and offer opportunity to ask questions from SO and patient
Obtain consent form
Maintain NPO for eight hours before the procedure, generally after midnight
Ensuring the patient is not pregnant
After a transbronchial lung biopsy, instruct patient to gently cough up and spit
saliva into a basin. Monitor the secretions. Secretions may be blood tinged.
Check for redness, swelling, or bleeding or other drainage from the biopsy site

Transbroncoschopic Biopsy: During bronchoscopy

Secure informed consent
Check for NPO status. Withheld food and fluids for 6 to 12 hours prior to the
exam to decrease the risk of aspiration
Obtain medical history that may contraindicates the procedure like asthma
After procedure, provide comfort and bedside care
Assess respiratory status after

Percutaneous Needle Biopsy: Aspiration

The nurse’s functions include patient education, screening (for coagulation
problems), and informed consent. First, the nurse explains the procedure and
answers any questions the patient might have. Before the procedure, special
attention should be paid to the review of relevant medical history, medications and
laboratory data
Once the procedure starts, the nurse is responsible for monitoring the patient.
Baseline vitals should be monitored before and during the procedure
The nurse then dresses the puncture site with antibiotic ointment and an adhesive
bandage and continues to assess the site for bleeding or swelling.

Open biopsy: surgery

Make sure the patient or a responsible family member has signed an informed
consent form.
Check the patient’s history for hypersensitivity to anesthetics
Assist with the collection of specimens into the appropriate containers, if indicated.
Send the specimens to the laboratory immediately, if appropriate.
If the patient has received a general or local anesthetic, monitor the patient’s vital
signs regularly.
Administer analgesics for pain, as ordered, and provide ice bags for comfort.
Observe for and report bleeding, tenderness, and redness at the biopsy site.

Lymph node biopsy

Make sure the patient has signed an appropriate consent form.
Note and report all allergies.
Check the patient’s history for hypersensitivity to anesthetic.
Prepare the skin over the biopsy site, and drape the area for privacy.
Tell the patient to resume his usual diet and activity.
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Monitor vital signs

Watch for bleeding and infection
Observe the biopsy site

Pulse oximetry
Assess breathless patients or those who are acutely ill, including those who have
acute confusion
Determine the need for emergency oxygen therapy in acute illness
Provide a continuous oxygen saturation recording, for example, during anaesthesia or
sedation, or in the assessment of oxygenation during sleep studies;

HANDOUT 5
Complete Blood Count
Explain test procedure. Explain that slight discomfort may be felt when the skin is
punctured.
Encourage to avoid stress if possible because altered physiologic status influences and
changes normal hematologic values.
Explain that fasting is not necessary. However, fatty meals may alter some test results
as a result of lipidemia.
Apply manual pressure and dressings over puncture site on removal of dinner.
Monitor the puncture site for oozing or hematoma formation.
Instruct to resume normal activities and diet.

Erythrocyte Sedimentation Rate

Patient Preparation - There are no food, fluid, activity, or medication restrictions unless
by medical direction.
Nursing Education for the patient on the process of the procedure
Explain the indicated result from laboratory

Blood Coagulation Test

Patient education on the purpose of the test
Check patient if taking some Blood-thinning medications
Assist patient in PT test (drawing blood)
Explain the result of the blood coagulation test
Educate patient on what must be done if ever the test came back below and above
normal

Blood Urea Nitrogen (BUN)

Check for medications taken by the patient (prescribed or over the counter)
Draw blood from the patient or assist patient if someone is drawing blood Some
medications, including chloramphenicol or streptomycin, may lower BUN levels. Other
drugs, such as certain antibiotics and diuretics, may increase BUN levels.

Blood Lipids
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Before the test assess for any symptoms or health problems, family history, heart health
all medications and supplements that are currently taking
Maintain 12-hour fast (no food or drink, except water)
Patient education on the information needed by the patient

Serum Tryglycerides
Explain to the patient that the triglyceride test is used to detect fat metabolism
disorders.
Notify the laboratory and physician of drugs the patient is taking that may affect the
test results; it may be necessary to restrict them.
Instruct the patient to fast at least 12 hours before the test and abstain from alcohol
for 24 hours. Tell him that he may drink water.
Explain to the patient that he may experience slight discomfort from the tourniquet and
the needle puncture.

Blood Cultures
Explain to the patient that the blood culture procedure is used to help identify the
organism causing his symptoms.
Inform the patient that he doesn’t need to restrict food and fluids.
Advise the patient that he may experience slight discomfort from the tourniquet and
needle punctures.

Serum Enzyme Studies (AST, LDH), Hydroxybutyrate Dehydrogenase HBD, Troponin

Blood drawing -- through a needle inserted into a vein in your arm
Asess all the medicines, supplements, herbs, vitamins, and anything else px is taking.
Patient education on possible side effect on the drawn area

Urinalysis
Instruct the patient to void directly into a clean, dry container. Sterile, disposable
containers are recommended. Women should always have a clean-catch specimen if a
microscopic examination is ordered. Feces, discharges, vaginal secretions and menstrual
blood will contaminate the urine specimen.
Cover all specimens tightly, label properly and send immediately to the laboratory.
If a urine sample is obtained from an indwelling catheter, it may be necessary to clamp
the catheter for about 15-30 minutes before obtaining the sample. Clean the specimen
port with antiseptic before aspirating the urine sample with a needle and a syringe.
If the specimen cannot be delivered to the laboratory or tested within an hour, it should
be refrigerated or have an appropriate preservative added.

Blood Uric Acid (BUA), Serologic Test

Explain to the patient the significance of the test
Tell the patient that the test requires a blood sample.
Instruct the patient to fast for 8 hours before the test.
Explain to the patient that he may experience slight discomfort from the tourniquet and
the needle puncture.
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Electrocardiography (ECG,EKG)
Explain the procedure to the patient
Ensure to empty the bladder (for px comfort)
Assess the patient by noting his pulse rate, breathing difficulties if any, the chest pain if
any, and many other factors and determine whether the heart rhythm is stable or
unstable.
Nurses watch for the readings for every component your heart rhythm and interpret
which areas of the heart are normal and which areas suffer damage. They use a
systematic approach to determine whether your heart’s rhythm is regular or irregular and
fast or slow.

Holter Monitoring
Advise the patient to wear loose-fitting clothing. This will allow the Holter monitor to
stay in place and to avoid lead dislodgment.
Apply electro paste or conductive paste to the skin sites. This will provide conduction
between the skin and electrodes.
Explain how to check the recorder to make sure it’s working properly. A light signal on
the monitor will signify that an equipment malfunction or that an electrode has
accidentally come off.

Central Venous Pressure

Assemble equipment according to manufacturer’s directions.
Explain that the procedure is similar to an IV and that the patient may move in bed as
desired after passage of the CVP catheter.
Place the patient in a position of comfort. This is the baseline used for subsequent
readings.
Pulmonary Artery pressure (PAP) and Pulmonary Capillary Wedge Pressure
Assess patient’s clinical condition. Frequent changes in measurements (interpreted within
the context of the clinical situation) will serve as a guide to detect whether the heart
can handle its fluid load and whether hypovolemia or hypervolemia is present.

Sonic Studies
Echocardiography
Explain the procedure to the patient.
Encourage the patient to cooperate
Inform that a conductive gel is applied to the chest area
Position the patient on his left side
Remove the conductive gel from the patient’s skin after procedure

Transesophageal Echocardiography (TEE)

Explanation of the procedure to the patient
Monitoring during transesophageal and stress examinations
establishing intravenous access for sonicated saline
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Encourage the patient to cooperate. Advise the patient to remain still during the test
because movement may distort results. He may also be asked to breathe in or out or to
briefly hold his breath during the exam.

Phonocardiography
Place patient in a suggested position
No special preparation is needed. Advise the patient that he doesn’t need to restrict
food and fluids for the test.
Instruct patient to resume regular diet and activities. There is no special type of care
given following the test.

Stress Testing or Exercise Testing

Check patient not to eat, drink or smoke for a period of time before a stress test. May
need to avoid caffeine the day before and the day of the test.
Assess medication history
Check for medical history like diabetes or asthma

Cardiac Fluoroscopy
Explaining the procedure to the px
Make sure that patient isn’t pregnant
Assess for any allergy
Assist patient in wearing px gown

Cardiac Catheterization
To prepare the patient, teach him about the procedure and answer his questions.
Assess for allergies, especially significant allergies such as a previous anaphylactic reaction
to one or more allergens, including contrast media. Ask if he has a history of asthma,
which is associated with an increased likelihood of a contrast reaction. Also note if he's
allergic to medications—including lidocaine, the local anesthetic commonly used for vascular
access.
The patient may be instructed to fast for 3 to 8 hours before the procedure and
withhold or decrease the dosages of scheduled medications (including insulin,
antihypertensive drugs, and diuretics).

Angiography/Arteriography
Check for an indication of the procedure
Educate patient for possible risks and complication during the procedure
Check that px Don't eat or drink anything after midnight before the procedure
If px have diabetes, ask the physician if you px take insulin or other oral medications
before your angiogram.
Assist px on supine position
When the angiogram is over, the catheter is removed from your arm or groin and the
incision is closed with manual pressure, a clamp or a small plug.

MRI (Magnetic Resonance Imaging)

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Make sure the scanner can accommodate the patient’s weight and abdominal girth.
Explain to the patient that skeletal MRI assesses bone and soft tissue. Tell him who will
perform the test and where it will take place.
Explain that the test takes 30 to 90 minutes.
Explain to the patient that although MRI is painless and involves no exposure to
radiation from the scanner, a contrast medium may be used, depending on the type of
tissue being studied.
If the patient is claustrophobic or if extensive time is required for scanning, explain to
him that a mild sedative may be administered to reduce anxiety. Open scanners have
been developed for use on the patient with extreme claustrophobia or morbid obesity,
but tests using such machine take longer.
Reassure the patient that he’ll be able to communicate with the technician at all times.
Instruct the patient to remove all metallic objects, including jewelry, hairpins, or watches.
Stop I.V. infusion pumps, feeding tubes with metal tips, pulmonary artery catheters, and
similar devices before the test.
Ask whether the patient has any surgically implanted joints, pins, clips, valves, pumps, or
pacemakers containing metal that could be attracted to strong MRI magnet. If he does,
he won’t be able to have the test.
Note and report all allergies.
Make sure that the patient or a responsible family member has signed an informed
consent form, if req uired.