Manuel V. Gallego Foundation Colleges Inc.
Cabanatuan City, Nueva Ecija, Philippines 3100
Institute of Nursing and Allied Health Education
DIAGNOSTIC PROCEDURE
Fecal occult blood test
INDICATIONS OF DIAGNOSTIC
PROCEDURE
 Aid in diagnosing disorders related to
gastrointestinal (GI) bleeding or
medication therapy that results in
bleeding
 Assist in the diagnosis of
pseudomembranous enterocolitis
following the use of broad-spectrum
antibiotic therapy
 Help diagnose suspected inflammatory
bowel syndrome (IBS)
 Identify the cause of diarrhea of
unknown origin
 Investigate disorders of protein
digestion
 Screen for colorectal cancer
 Screen for cystic fibrosis
 Determine intestinal parasitic
infestation, as indicated by diarrhea of
unknown cause
 Evaluate the effectiveness of
therapeutic regimen for intestinal
malabsorption or pancreatic
insufficiency
NURSING PREPARATION
Nursing Responsibility for Stool
Analysis
 The following are the nursing
interventions and nursing care
considerations for the patient
 Before the procedure
 The following are the nursing
interventions prior to a stool
analysis.
 Assess the patient’s level of
comfort. Collecting stool specimen
may produce a feeling of
embarrassment and discomfort to the
patient.
 Encourage the patient to
urinate. Allow the patient to urinate
before collecting to avoid
contaminating the stool with urine.
 Avoid laxatives. Advise patient that
laxatives, enemas, or suppositories
are avoided three days prior to
collection.
 Instruct a red-meat free and high
residue diet. The patient is indicated
for an occult blood test, must follow
a special diet that includes generous
amounts of chicken, turkey, and
tuna, raw and uncooked vegetables
and fruits such as spinach, celery,
prunes and bran containing cereal for
two (2) days before the test.
 After the procedure
 The nurse should note of the
following nursing interventions after
fecal analysis:
 Instruct patient to
do handwashing. Allow the patient to
thoroughly clean his or her hands
and perianal area. 
 Resume activities. The patient may
resume his or her normal diet and
medication therapy unless otherwise
specified.
 Recommend regular screening. The
American Cancer Society
recommends yearly occult blood test
as part of the screening for colorectal
cancer starting at the age of 45 years
 old for people with average risk.

Stool culture  Specific indications for stool cultures

include bloody stools, stools that test
positive for occult blood or leukocytes,
prolonged course of diarrhea that has
not been treated with antibiotics,
immunocompromised host, or for
epidemiologic purposes, such as cases
involving food handlers.
Colorectal transit study  This test shows how well food moves ASK THE CLIENT TO:
through the colon
 DO NOT take laxatives,
enemas, or suppositories during
the week this test is in progress.
 Eat and drink as usual.
 Tell the patient that they will
need to come in for an abdominal
x-ray a specific number of days
after you swallow the radiopaque
markers depending on your
location, per the following
instructions.
 Tell the patient that they will
need will need an x-ray in
exactly 5 full days after they
swallow the radiopaque markers.
Do not swallow the Sitz Markers
on Tuesday or Wednesday
because most x-ray centers are
closed on the weekend when you
would need your x-ray done. If
you swallow the capsule on:
o Monday, you need an
x-ray on Friday
o Thursday, you need
an x-ray on Monday
o Friday, you need an x-
ray on Tuesday
o Saturday, you need an
x-ray on Wednesday
o Sunday, you need an
x-ray on Thursday

Computed tomography scan Computed tomography is a useful and Before the procedure
(CT or CAT scan). accurate cross-sectional imaging test ideally
suited for investigating possible pathology
in body cavities where the organs of interest
may not be accessible to superficial imaging
techniques (e.g. ultrasound). These cavities
include the skull, thorax, abdomen and
pelvis.
CT is a good examination in a variety of
conditions including:
 acute head injury;
 suspected subarachnoid
haemorrhage;
 ureteric calculus;
 acute cervical spine trauma where
there is a higher than average
likelihood of fracture or dislocation;
 suspected acute appendicitis in a
non-pregnant patient.
The following are the nursing
interventions before computed
tomography:
 Informed Consent. Obtain an
informed consent properly
signed.
 Look for allergies. Assess for
any history of allergies to
iodinated dye or shellfish if
contrast media is to be used.
 Get health history. Ask the
patient about any recent illnesses
or other medical conditions and
current medications being taken.
The specific type of CT scan
determines the need for an oral or
I.V. contrast medium
 Check for NPO status. Instruct
the patient to not to eat or drink
for a period amount of time
especially if a contrast material
will be used.
 Get dressed up. Instruct the
patient to wear comfortable,
loose-fitting clothing during the
exam.
 Provide information about the
contrast medium. Tell the
patient that a mild transient pain
from the needle puncture and a
flushed sensation from an I.V.
contrast medium will be
experienced.
 Instruct the patient to remain
still. During the examination, tell
the patient to remain still and to
immediately report symptoms of
itching, difficulty breathing or
swallowing, nausea, vomiting,
dizziness, and headache.
 Inform about the duration of
the procedure. Inform the patient
that the procedure takes from five
(5) minutes to one (1) hour
depending on the type of CT scan
and his ability to relax and remain
still.
 After the procedure

The nurse should be aware of

these post-procedure nursing
interventions after computed
tomography (CT) scan:

 Diet as usual. Instruct the

patient to resume the usual diet
and activities unless otherwise
ordered.
 Encourage the patient to
increase fluid intake (if
a contrast is given). This is so to
promote excretion of the dye.

Defecography  incomplete or obstructed defecation  PREPARATION FOR THE

/ constipation PROCEDURE
 Give the patient a Fleet® enema
 pelvic floor disorder 2 hours prior to your study.
 rectal prolapse Repeat the enema after 15
minutes.
 fecal incontinence
 The patient should not eat
anything during the two hours
prior to the procedure. If the
patient is diabetic, this may
involve adjusting their diabetic
medications.
 The patient should take their
regular medications with small
sips of water at least 2 hours
prior to the procedure.
barium enema  Abdominal pain  Instruct the patient to eat a low-
residue diet for several days
 Rectal bleeding before the procedure and
consume only clear liquids
 Changes in bowel habits
during the 24 hr before the
 Unexplained weight loss procedure, including the
evening before the test. There
 Chronic diarrhea are no activity restrictions
unless by medical direction.
 Persistent constipation  Instruct the patient to fast and
restrict fluids for 8 hr, or as
ordered, prior to the procedure.
Fasting may be ordered as a
precaution against aspiration
related to possible nausea and
vomiting.
 Regarding the patient’s risk for

Magnetic resonance imaging Indications for when to get an MRI scan
(MRI). include:
 After 4 to 6 weeks of leg pain, if the
pain is severe enough to warrant
surgery
 After 3 to 6 months of low back pain,
if the pain is severe enough to warrant
surgery
 If the back pain is accompanied by
constitutional symptoms (such as loss
of appetite, weight loss, fever, chills,
shakes, or severe pain when at rest)
that may indicate that the pain is due
to a tumor or an infection
 For patients who may have lumbar
spinal stenosis and are considering an
epidural injection to alleviate painful
symptoms
 For patients who have not done well
after having back surgery, specifically
if their pain symptoms do not get
better after 4 to 6 weeks.
bleeding, the patient should be
instructed to avoid taking
natural products and
medications with known
anticoagulant, antiplatelet, or
thrombolytic properties or to
reduce dosage, as ordered, prior
to the procedure. Number of
days to withhold medication is
dependent on the type of
anticoagulant. Note the last time
and dose of medication taken.
Protocols may vary among
facilities.
 Inform the patient that a laxative
and cleansing enema may be
needed the day before the
procedure, with cleansing
enemas on the morning of the
procedure, depending on the
institution’s policy. Patients
with a colostomy will be
ordered special preparations and
colostomy irrigation depending
on the area of the colon to be
studied.
 Take the patient's history and
perform a thorough head-to-toe
assessment. If she has any metal
object in her body, such as an
aneurysm clip, orthopedic
hardware, an implanted
pacemaker or implantable
cardioverter defibrillator, certain
types of prosthetic heart valves,
or an intrauterine device, she
can't undergo MRI. Device
electrodes and wires may
overheat and burn tissues, and
electromagnetic fields may
cause implants to malfunction.
Implanted device movement
may also occur.
 Remove drug patches with
metal backings, which can cause
burns. Tattoos containing metal
particles can also cause
problems.
  Pregnancy is a relative
contraindication for MRI. Tell
the radiologist if the patient
might be pregnant or if she's
breast-feeding.

 Inform the radiologist if the

patient has chronic kidney
disease or requires dialysis.
Gadolinium-containing contrast
agents may cause nephrogenic
systemic fibrosis or nephrogenic
fibrosing dermopathy.

 Make sure that only MRI-

compatible equipment is taken
into the MRI room.
Ferromagnetic objects can fly
toward the center of the MRI
system like projectiles,
endangering everyone.

 In general, your patient won't

have food or drink restrictions
and can continue to take her
medications unless her health
care provider directs otherwise.

Explain to the patient what she can

expect during the MRI, especially the
importance of lying still. Warn her that
the MRI scanner will make loud
banging and clicking noises but that
earplugs or headphones will be
available. Encourage her to use
relaxation techniques such as listening
to music or meditating.

 Reassure the patient that she

shouldn't experience any
discomfort during the MRI. She
should inform the technologist
immediately if she feels
anything unusual.

 About 1 in 20 patients require

sedation because of
claustrophobia, but open MRI

Magnetic resonance MRCP can be used to evaluate various
cholangiopancreatography conditions of the pancreaticobiliary ductal
(MRCP). system, some of which are:
 identification of congenital
anomalies of the cystic and hepatic
ducts
 post-surgical biliary anatomy and
complications
 pancreas divisum
 anomalous pancreaticobiliary
junction
 choledocholithiasis
 biliary strictures
 chronic pancreatitis
 pancreatic cystic lesions
 trauma to biliary system
units may prevent
claustrophobia.
 If she's an outpatient and
received sedation, give her
discharge instructions and make
sure that someone drives her
home, according to facility
policy; if she's an inpatient,
initiate safety precautions as
indicated.
 Ask the patient if they have any
kind of allergies, including
allergies to food or drugs, hay
fever, hives or allergic asthma.
However, the contrast material
used for an MRI exam is based
on gadolinium and does not
contain iodine.
 Instruct the patient not to eat or
drink anything for several hours
before the procedure.
 Ask the patient if they have any
serious health problems and
what surgeries you have
undergone. Some conditions,
such as kidney disease, may
prevent you from having an
MRI with contrast material.
 Know if the patient has
claustrophobia (fear of enclosed
spaces) or anxiety, because the
patient may want to ask their
doctor to prescribe a mild
sedative prior to their exam.
 Tell the patient to leave all
jewelry and other accessories at
home or remove them prior to
the MRI scan. Metal and
electronic items can interfere
with the magnetic field of the
MRI unit, and they are not
allowed in the exam room. 
 As a nurse, take note also if the
patient has a metal implants
because there are few implants
that might interfere with the

Oropharyngeal motility
(swallowing) study.
Radioisotope gastric-emptying
scan.
 To detect the following:
- strictures, ulcers, tumors,
polyps, motility disorders and
hiatal hernia, diverticula, and
varices
 Gastric emptying scans are often used
to diagnose gastroparesis, a condition in
which the stomach’s muscles don’t
work properly. This delays food from
being sent to the small intestine.
exam or might cause danger to
the patient
 Make sure that the consent form
is signed by the patient or legal
guardians/significant others.
 Explain that the test evaluates
the function of the pharynx and
esophagus.
 Maintain the patient on a
nothing-by-mouth status beginning
at midnight before the test. (For an
infant, delay feeding to ensure
complete digestion of the barium.)
 The patient may be given a
restricted diet for 2 to 3 days before
the test.
 Describe the test, who will
perform it, and where it will take
place.
 Describe the milk shake
consistency and chalky taste of the
barium preparation. Although
flavored, it may be unpleasant to
swallow.
 Explain to the patient that
they’ll first receive a thick mixture,
then a thin one; he must drink 12 to
14 oz (355 to 414 ml) during the
examination.
 Inform the patient that they’ll be
placed in various positions on a
tilting X-ray table and that X-rays
will be taken.
 Emphasize the importance of
remaining still during the X-rays.
 Reassure the patient about
safety precautions.
 Withhold antacids, histamine-2
receptor antagonists, and proton
pump inhibitors, if gastric reflux is
suspected.
 The patient should not eat or drink
anything after midnight the day before
the test. At a minimum, the patient
should not eat or drink within the 4 to
6 hours prior to the study. The study
should be performed in the morning
when the rate of gastric emptying is
increased.

Ultrasound  Pleural and peritoneal effusions
 Prostatic disease
 Pregnancy examination and evaluation
of the female genital tract
 Urinary tract disease and cystocentesis
 Mass lesions Cardiac diseases
 Ultrasound-guided aspiration and
biopsy
barium swallow
Indications
However, there remain many indications for
a barium swallow including:
 Premenopausal women should be
studied within the first 10 days of their
menstrual cycle to prevent
radiopharmaceutical administration to
a potentially pregnant woman and to
avoid hormonal effects on
gastrointestinal motility. Research
demonstrates that gastric emptying of
solids varies with the phases of the
menstrual cycle. Emptying is slower
during the luteal phase (post-
ovulation), which correlates with
elevated serum levels of
progesterone. 
 Blood glucose levels should be
reasonably controlled, as
hyperglycemia delays gastric
emptying.
 Patients should not smoke the morning
of the test or until after the test is
complete. Smoking is known to slow
gastric emptying of solids.
 A focused history of diseases such as a
hiatal hernia, gastroesophageal reflux,
and esophageal motility disorders
should be obtained. In addition,
previous stomach or abdominal
surgery that can alter the shape or
route of emptying should be noted.
 the patient must be instructed about
the logistical demands of the test, such
as the content of the meal, requirement
to consume the meal in less than 10
minutes, length of the procedure,
number of images acquired, activity
restrictions, and position between
images.
 Tell the patient to fast for eight
to 12 hours before your
ultrasound
 For an examination of the
gallbladder, liver, pancreas, or
spleen. Tell the patient to eat a
fat-free meal the evening before
your test and then to fast until
the procedure. 
Patient Preparation
1. Explain to the patient that
this test evaluates the
  high or low dysphagia function of the pharynx
and esophagus.
 gastro-esophageal reflux disease 2. Instruct the patient to fast
(GERD/GERD) after midnight before the
 assessment of a hiatus hernia test.
 generalized epigastric pain 3. If the patient is infant,
delay the feeding to ensure
 globus pharyngeus complete digestion of the
 persistent vomiting barium.
 assessment of fistula 4. Explain that the test takes
approximately 30 minutes.
 inability to pass the endoscope 5. Describe the milkshake
during UGIE consistency and chalky
 taste of the barium
preparation the patient will
ingest; although it’s
flavored, it may be
unpleasant to swallow.
6. Tell him he’ll first receive
a thick mixture and then a
thin one and that he must
drink 12 to 14 oz (355 to
414 ml) during the
examination.
7. Inform him that he’ll be
placed in various positions
on a tilting radiograph
table and that radiographs
will be taken.
8. If gastric reflux is
suspected, withhold
antacids, histamine-2 (H2)
blockers, and proton pump
inhibitors, as ordered.
9. Just before the procedure,
instruct the patient to put a
hospital gown without snap
closures and to remove
jewelry, dentures, hairpins,
and other radiopaque
objects from the
radiograph field.
10. Check the patient history
for contraindications to the
barium swallow, such as
intestinal obstruction and
pregnancy. Radiation may
have teratogenic effects.

Colonoscopy.  Screen for colon and rectal cancer Explain the following to the patient:
  Detect and evaluate inflammatory 1. Refer to Standard Considerations.
and ulcerative bowel disease 2. Explain specific positioning which
 Locate the source of lower GI will be required during the procedure:
bleeding and perform hemostasis by prone or left lateral position.
coagulation 3. Explain symptoms of pancreatitis and
 Determine the cause of lower GI sepsis (i.e. chills, low grade fever, pain,
disorders, especially when barium vomiting and tachycardia).
and proctosigmoidoscopy results 4. Explain that if pancreatitis occurs it
are inconclusive usually occurs within 2-4 hours after the
 Assist diagnose colonic strictures procedure.
and benign or malignant lesions
 Evaluate the colon postoperatively
for recurrence of polyps and
malignant lesions
 Investigate iron-
deficiency anemia of unknown
origin
 Remove colon polyps
 Remove foreign objects and
sclerosing strictures by laser

Endoscopic retrograde  Jaundice of undetermined etiology.
cholangiopancreatography  Biliary obstruction, extrinsic or
(ERCP) intrinsic (e.g., stones, tumor,
stricture, sclerosing cholangitis,
papillary stenosis).
 Suspected or known pancreatic
disease, including pancreas
divisum.
 Pancreatitis - acute, recurrent or
chronic.
 Suspected or known pseudocyst.
 Pancreatic neoplasm.
 Unexplained abdominal pain of
suspected biliary or pancreatic
origin.
 Suspicion of disease in a non-
jaundiced patient.
 Preoperative evaluation.
 Manometric evaluation of common
biliary and pancreatic ducts.
 Abnormal abdominal radiologic
study (ultrasound, CT Scan, MRCP,
endoscopic ultrasound,
percutaneous transhepatic
cholangiogram, biliary
scintigraphy).
 Persistent elevation in liver
enzymes in patient predisposed to

Esophagogastroduodenoscopy
Sigmoidoscopy
Anorectal manometry  Anorectal manometry is also useful for
biliary disease.
 Pancreatic duct obstruction.
 Post operative complications (i.e.
after liver transplantation).
 Treatment of ampullary adenomas.
 Persistent upper abdominal pain or
pain associated with alarming
symptoms such as weight loss or
anorexia
 Dysphagia, odynophagia or feeding
problems
 Intractable or chronic symptoms of
GERD
 Unexplained irritability in a child
 Persistent vomiting of unknown
etiology or hematemesis
 Iron deficiency anemia with
presumed chronic blood loss when
clinically an upper gastrointestinal
(GI) source is suspected or when
colonoscopy is normal
 Chronic diarrhea or malabsorption
 Assessment of acute injury after
caustic ingestion
 Surveillance for malignancy in
patients with premalignant
conditions such as polyposis
syndromes, previous caustic
ingestion, or Barrett esophagus  

 Diarrhea
 Belly pain
 Constipation
 Polyps (abnormal growths)
 Bleeding

diagnosis of anismus. The most
important indications are anal
incontinence, distal constipation and
preoperative evaluation before
 There are no activity restrictions
unless by medical direction. The
patient may be given additional
instructions about following a
special diet for 1 or 2 days
before the procedure.
 Instruct the patient to fast and
restrict fluids for 6 to 8 hr prior
to the procedure to reduce the
risk of aspiration related to
nausea and vomiting.
 The patient may be required to
be NPO after midnight. 
 The patient may be instructed to
take a laxative, an enema, or a
rectal laxative suppository.
 Patients on beta blockers before
the surgical procedure should be
instructed to take their
medication as ordered during
the perioperative period.
 Ensure that barium studies were
performed more than 4 days
before the
esophagogastroduodenoscopy
(EGD)
 Before the procedure, you will
be asked to remove any jewelry
or other objects that may
interfere with the procedure.
You may be asked to remove
your clothing and change into a
hospital gown.
 sphincteroplasty or surgical rectocele
repair.
Esophageal manometry. Esophageal manometry is indicated for the
following situations:
 Evaluation of noncardiac chest pain
or esophageal symptoms not
diagnosed by endoscopy (or after
gastroesophageal reflux
disease [GERD] has been excluded)
 Evaluation for achalasia [5]  or
another type of nonobstructive
dysphagia
 Preoperative evaluation for patients
undergoing corrective surgery for
GERD, particularly if an alternative
diagnosis like scleroderma or
achalasia is being considered  
 Postoperative evaluation of
dysphagia in patients who
underwent corrective surgery for
reflux or after treatment of
achalasia
 Prior to esophageal pH monitoring
to assess the location of the LES for
proper electrode positioning
 Evaluation of esophageal motility
problems associated with systemic
diseases
Esophageal pH monitoring  
 There are no activity restrictions
unless by medical direction.
Under medical direction, the
patient should withhold
medications for 24 hr before the
study.
 Instruct the patient to fast and
restrict fluids for 6 hr prior to
the procedure to reduce the risk
of aspiration related to nausea
and vomiting.
 Patient may be required to be
NPO after midnight. 
Regarding the patient’s risk for
bleeding, the patient should be
instructed to avoid taking
natural products and
medications with known
anticoagulant, antiplatelet, or
thrombolytic properties or to
reduce dosage, as ordered, prior
to the procedure. Number of
days to withhold medication is
dependent on the type of
anticoagulant. Protocols may
vary among facilities.
 Ensure that barium studies were
performed more than 4 days
before the esophageal
manometry
Do not eat or drink anything
after midnight. This includes
candy, lozenges, or gum.
 Medications to take the day of
the procedure:
o Blood pressure and heart
medications with a small sip of
water
o Your other medications can
be held until after your
procedure.
 Bring your current insurance
card(s), deposit, and a current
picture I.D. with you.
 Bring a list of ALL of your

Capsule endoscopy   It is used as a diagnostic tool for
detecting obscure GI bleeding, it has
also aided in the diagnosis
of inflammatory bowel disease
(IBD) and celiac disease and helped in
the detection of small-bowel neoplasia. 
medications and allergies, a
copy of your most recent
medical evaluation, and a copy
of your EKG if you had one
recently.
 Wear a shirt or blouse which
opens in the front so that it is
easier to dress after the probe is
placed and leave your valuables
at home.
 There are no activity restrictions
unless by medical direction.
 Inform the patient to stop taking
medications that have a coating effect,
such as sucralfate and Pepto-Bismol, 3
days before the procedure; they may
prevent the camera from providing clear
images.
 Instruct the patient to abstain
from the use of tobacco products for 24
hr prior to the procedure and not to take
any medication for 2 hr prior to the
procedure, by medical direction.
 Instruct the patient to start a
liquid diet on the day before the
procedure, then from 2200 the evening
before the procedure, the patient should
not eat or drink except for necessary
medication with a sip of water.
 Ask the patient to wear loose,
two-piece clothing on the day of the
procedure because this assists with the
placement of the sensors on the
patient’s abdomen.
 As appropriate, provide
information for the patient to take a
standard bowel prep the night before the
procedure. Protocols may vary among
facilities.
 Ensure that this procedure is
performed before an upper GI series or
barium swallow.