GASTROINTESTINAL SYSTEM DIAGNOSTIC

PROCEDURES
UPPER GI (Barium Swallow)
 An examination of the upper GI tract under fluoroscopy after the client drinks barium
sulfate

PRE-PROCDURE:
 Instruct the client to fast from foods and fluids overnight prior to the study
POST-PROCEDURE:
1. A laxative may be prescribed
2. Instruct client to drink 6-8 glasses of water each day for 2 days to help pass the barium
3. Monitor stools for the passage of barium (stools will appear chalky white)

LOWER GI (Barium Enema)

 A fluoroscopic and radiographic examination of the large intestine after rectal instillation of
barium sulfate
 Maybe done without air.

PRE-PROCEDURE:
1. Laxatives on the day prior to and the morning of the test
2. Liquid diet 1 day prior to and on the morning of the test

POST-PROCEDURE:
1. Increase fluid intake for 24 to 48 hours
2. Administer mild laxatives to facilitate emptying of the barium
3. Monitor stool for passage of barium
4. Notify physician if a bowel movement does not occur within 2 days

GASTROSCOPY:
 Insertion of an endoscopic instrument through the esophagus into the stomach and upper
portion of the small intestine to visualize the mucosal lining.

PRE-PROCEDURE:1
1. Obtain informed consent
2. Remove dentures
3. Obtain baseline vital signs
4. NPO status for 12 hours

POST-PROCEDURE:
1. Assess vital signs and respiratory, cardiac and neurologic status
2. Monitor for return of gag reflex
3. Do not administer food or fluid until gag reflex returns
4. Monitor for signs of bleeding, as evidenced by hypotension pallor, and tachycardia
5. Monitor for perforation as evidenced by pain, tachypnea, and rales

1
 SIGMOIDOSCOPY

 Endoscopic visualization of the sigmoid colon using a sigmoidoscope

PRE-PROCEDURE:
1. Obtain informed consent
2. A full liquid diet the evening before the test
3. Laxatives the evening before the test and an enema or suppository 1 hour prior to the
test

POST-PROCEDURE:
1. Assess for side effects related to sedative if administered
2. Normal activities and diet may be resumed
3. Notify physician if temperature is higher than 101oF, if breathing is difficult, or if
stomach pain or bright red rectal bleeding occurs.

COLONOSCOPY
 A fiber optic endoscopic study in which the lining of the large intestine is visually examined

PRE-PROCEDURE:
1. Obtain informed consent
2. Clear liquid diet for 48 hours prior to the test
3. Bowel prep with laxatives on the evening prior to the test and an enema on the day of
the test

POST-PROCEDURE:
1. Monitor vital signs
2. Monitor for s/e if sedation was administered
3. A normal diet may be resumed
4. Monitor for signs of colon perforation as evidenced by abdominal pain or distention,
malaise,
fever, purulent rectal drainage or lower GI bleeding
GASTRIC ANALYSIS
 The passage of a nasogastric (NG) tube into the stomach aspirate gastric contents for
analysis of acidity, appearance and volume

PRE-PROCEDURE:
1. Fast for 12 hours prior to the test
2. Avoiding tobacco and chewing gum for 6 hours prior to the test
POST-PROCEDURE:
1. May resume normal activities
2. Refrigerate gastric samples if not tested within 4 hours

GALLBLADDER SERIES
 Oral cholecystography to study the dye-filled gallbladder by radiographic film

PRE-PROCEDURE:
1. A low-fat meal on the evening prior to the test and then fasting from midnight the day
before the test
2. Administer six 0.5-g iopamic acid (Telepaque) tablets 12 hours prior to the test
3. Tablets should be taken with a large amount of water at 5-minute intervals
4. Instruct client to go to the emergency department if a rash, itching or hives, or
difficulty in breathing occurs after taking the tablets

POST-PROCEDURE:
1. Inform the client that dysuria is common because the dye is excreted in the urine
2. A normal diet may be resumed; however, a fatty meal may enhance dye excretion.

LIVER BIOPSY
 A needle is inserted through the abdominal wall to the liver to detain a tissue sample for
biopsy and microscopic examination.

PRE-PROCEDURE:
1. Obtained informed consent
2. Assess hematological laboratory results
3. Administer sedative as prescribed
4. NPO after midnight on the day prior to the test
5. Note that the client is placed in the supine or left lateral position during the procedure

POST-PROCEDURE:
1. Assess vital signs frequently
2. Assess biopsy site for bleeding
3. Monitor for peritonitis
4. Maintain bed rest for 24 hours
5. Place client on the side for 1 to 2 hours to decrease the risk of hemorrhage
PARACENTESIS
 Trans abdominal removal of fluid from the peritoneal cavity for the analysis of electrolytes,
red blood cells, white blood cells, bacterial and viral cultures, cytology studies

PRE-RPOCEDURE:
1. Obtain informed consent
2. Have the client void prior to the start of the procedure to empty the bladder and move
the bladder out of the way of the paracentesis needle
3. Measure abdominal girth, weight, and baseline vital signs edge of the bed with the back
supported and the feet resting on a stool, or lying prone during the procedure

POST-PROCEDURE:
1. Monitor vital signs
2. Maintain bed rest
3. Apply a dry sterile dressing to the insertion site
4. Monitor insertion site for bleeding
5. Measure abdominal girth and weight
 6. Monitor for hematuria due to bladder trauma
7. Instruct client to notify physician if the urine becomes bloody, pink or bed

RESPIRATORY SYSTEM DIAGNOSTIC

PROCEDURES

CHEST X-RAY (CXR) film (radiograph)

 Provides information regarding the anatomic location and appearance of the lungs

PRE-PROCEDURE:
1. Remove all jewelry and other metal objects from chest area
2. Assess ability to inhale and hold breath
3. Question women regarding pregnancy of the possibility of pregnancy

SPUTUM SPECIMEN
 A specimen obtained by expectoration or tracheal suctioning to assist in identification or
organisms for abnormal cells

PRE-PROCDURE:
1. Determine specific purpose of collection and check with institutional policy for
appropriate collection of specimen
2. Obtain an early morning sterile specimen from suctioning or expectoration after
respiratory treatment if a treatment is prescribed
3. Obtain 15 ml of sputum
4. Instruct client to rinse month with water prior to collection, instruct client to take
several deep breaths and then cough deeply to obtain sputum
5. Always collect specimen before starting antibiotics

POST-PROCEDURE:
1. If culture of sputum is prescribed transport specimen to laboratory immediately
2. Assist client with month care

BRONCHOSCOPY
 Direct visualization of the larynx, trachea, and bronchi with a fiberoptic bronchoscope

PRE-PROCEDURE:
1. Obtain informed consent
2. NPO from midnight prior to the procedure
3. Obtain vital signs
4. Monitor coagulations studies
5. Remove dentures or eyeglasses
6. Prepare suction equipment
7. Administer medication for sedation as prescribed
8. Have resuscitation equipment readily available

POST-PROCEDURE:
 1. Monitor vital signs
2. Maintain semi-fowler’s position
3. Assess gag reflex
4. Maintain NPO status until gag reflex returns
5. Have an emesis basin readily available for client to expectorate saliva
6. Monitor for bloody sputum
7. Monitor respiratory status, particularly if sedation was administered
8. Monitor for complications, such as bronchospasm bacteremia, brachial perforation
indicated by facial and neck crepitus, dysrythtmias, fever hemorrhage, hypoxemia and
pneumothorax
9. Notify physician if fever or difficulty in breathing occurs following the procedure

PULMONARY ANGIOGRAPHY
 An invasive fluoroscopic procedure following injection of iodine or radiopaque or contrast
material through the antecubital or femoral vein into the pulmonary artery or one of its
branches

PRE-PROCEDURE:
1. Obtain informed consent
2. Assess for allergies to iodine, seafood other radiopaque dyes
3. Maintain NPO status for 8 hours prior to the procedure to the procedure
4. Monitor v/s
5. Monitor coagulation studies
6. Establish an IV access
7. Administer sedation as prescribed
8. Instruct clients that they must lie still during the procedure
9. Instruct clients they may feel an urge to cough or experience flushing, nausea, or a
salty taste following injection of the dye
10.Have emergency resuscitation equipment available

POST-PROCEDURE:
1. Monitor vital signs
2. Avoid taking blood pressures in the extremity used for injection for 24 hours
3. Monitor peripheral neurovascular status
4. Assess insertion site for bleeding
5. Monitor for delayed reaction to the dye

THORACENTESIS
 Removal of fluid or air from the pleural space via a transthoracic aspiration

PRE-PROCEDURE:
1. Obtain consent
2. Obtain baseline vital signs
3. Prepare client for ultrasound or chest radiograph if prescribed prior to procedure
4. Assess coagulation studies
5. Note that client is positioned sitting upright, with arms and head supported by a table
at the bedside during the procedure
6. If the client cannot sit up, the client is placed lying in bed on the unaffected side with
the head of the bed elevated to 45o
 7. Inform client not to cough, breath deeply, or move during the procedure

POST-PROCEDURE:
1. Monitor vital signs
2. Monitor respiratory status
3. Apply a pressure dressing and assess puncture site for bleeding and crepitus
4. Monitor for signs of pneumothorax, air embolism and pulmonary edema
LUNG BIOPSY
 A percutaneous lung biopsy is perforation to obtain tissue for analysis by culture or
cytologic examination
 A needle biopsy is done to identify pulmonary lesions, changes in lung tissue and the cause
of pleural effusion

PRE-PROCEDURE:
1. Obtain informed consent
2. Maintain NPO status prior to the procedure
3. Inform the client that a local anesthetic will be used but that a sensation of pressure
during needle insertion and aspiration may be felt
4. Administer analgesics and sedatives as prescribed

POST-PROCEDURE:
1. Monitor vital signs
2. Apply a dressing to the biopsy site and monitor for drainage or bleeding
3. Monitor for signs of respiratory distress, and notify physician if they occur
4. Monitor for signs of pneumothorax and air emboli, an notify physician if they occur
5. Prepare client for chest x-ray film if prescribed
BRONCHOGRAPHY
 A liquid contrast medium is instilled into the trachea, followed by chest x-ray films of the
bronchial tree
 It is performed to diagnose abnormalities of the bronchi, such as narrowing, dilation, and
obstruction

PRE-PROCEDURE:
1. Obtain informed consent
2. Assess for allergies to iodine, seafood, and contrast media (dye)
3. Maintain NPO status
4. For several hours prior to the test to prevent post procedure aspiration
5. Administer sedation as prescribed

POST-PROCEDURE:
1. Assess vital signs
2. Asses for dyspnea and deep bleeding
3. Maintain NPO status until gag reflex returns
4. Encourage fluid intake when gag reflex returns

ARTERIAL BLOOD GASES (ABGS)

 Measures the dissolved oxygen and carbon dioxide in the arterial blood and reveals the
acid base state and how well the oxygen is being carried to the body
PRE-RPOCEDURE:
1. Perform Allen’s test on both wrists prior to drawing radical artery specimens
2. Have client rest for 30 minutes prior to specimen collection
3. Avoid suctioning prior to drawing blood gases
4. Do not turn off oxygen unless blood gases are ordered to be drawn at room air

POST-PROCEDURE:
1. Place specimen on ice
2. Note client’s temperature on laboratory form
3. Note oxygen and type of ventilation client is receiving on the laboratory form
4. Apply pressure to puncture site for 5-10 minutes and longer if the client is on
anticoagulant therapy or has a bleeding disorder
5. Transport the specimen to the laboratory within 15 minutes

PULSE OXIMETRY

 A noninvasive test that registers the oxygen saturation of the client’s hemoglobin
 This normal oxygen saturation (SAO2) is recorded as percentage
 The normal value is 95% to 100%
 After a hypoxic client uses up the readily available oxygen (measured as the arterial
oxygen pressure, PaO2, an arterial blood gas testing, the reserve oxygen, that oxygen
attached to the hemoglobin (SaO2) is drawn onto provide oxygen to the tissues
 A pulse oximeter reading can alert the nurse to hypoxemia before clinical sign occur

POST-PROCEDURE:
1. A sensor is placed on the client’s finger, toe, nose, earlobe, or forehead to measure
oxygen saturation, which is then displayed on a monitor
2. Maintain transducer at heart level
3. Do not select an extremity with an impediment to blood flow
4. Results lower than 91% necessitate immediate treatment
5. If the SaO2 id below 855, the body’s tissue have a difficult tissue becoming oxygenated,
an SaO2 of less than 70% is life threatening

DIAGNOSTIC TEST FOR THE EYE

FLUORESLEIN ANGIOGRAPHY
Description:
 Detailed imaging and recording of ocular circulation by a series of photographs after the
administered of a dye
 PRE-PROCEDURE
a. Assess client for allowing and previous reactions to dyes
b. Obtain informed consent
c. A mydriatic is instilled in the eye 1 hour before the test
d. The dye is injected into a vein of the clients arm
 e. Inform the client that the dye may cause the skin to appear yellow for several hours
after the test
f. The client may experience nausea, vomiting, sneezing, parenthesis of the tongue, or
pain at the injection site
g. If hives appear, or at or IM antihistamines as diphenhydramine (Benadryl) is
administered as prescribed

POST-PROCEDURE
a. Encourage rest
b. Encourage fluids to remove the dye from the clients system
c. Remind the client that the yellow skin appearance will disappear
d. Instruct the client that the urine will appear bright green until the dye is excreted
e. Instruct the client that the photophobia will continue until pupil dilation returns to
normal

SLIT LAMP
Description
a. Allows examination of the anterior ocular structure under microscope magnification
b. The client leans on a chin rest to stabilize the head while a narrowed bean of light is
armed so it illuminates only a narrow segment of the eye

Implementation
a. Explain the procedure to the client
b. Advise the client about the brightness of the light and the need to look forward at a
point over the examiner’s ear

CORNEAL STAINING
Description
a. Instillation of a topical dye into the conjunction see to outline irregularities of the
corneal surface that are not easily visible
b. The eye is viewed through a blue filler, and a bright green color indicates areas of non-
intact corneal epithelium

Implementation
a. If the client wears contact lenses, they must be removed
b. The client is instructed to blink after the dye has been applied to distribute the dye
evenly across the corneal

TONOMETRY
Description
a. The test is primarily used to assess for an increase of intraocular pressure and potential
glaucoma
b. Normal ocular pressure is 10 to 21 mmHg

Implementation
a. Each eye may be anesthetized
b. The client is asked to stare forward at a point above the examiner’s ear
 c. A flattened come is brought in contact with the cornea
d. The amount of pressure needed to flatten the cornea is measured
e. The client must be institute to avoid rubbing the eye following the examination if the
eye has been anesthetized and the potential for scratching the cornea exists

EAR (Assessment)

TUNING FORK TESTS

WEBER TEST
a. Place the vibrating tuning fork in the middle of the client’s head at the midline of the
forehead or above the upper lip over the teeth
b. Hold the fork by the stem only
c. The client is ask whether the sound is louder in one ear
d. A normal test result is hearing the sound equally in both ears
e. If the client heard the sound louder in one ear, the term lateralization is applied to the side
hearing the loudest
f. Such a finding may indicate that the client has a CONDUCTIVE HEARING LOSS in the ear to
which the sound is lateralized, or that there is a SENSORINEURAL HEARING LOSS in the
opposite

RINNE TEST
a. Compares the client’s hearing by air conduction and bone conduction
b. Air conduction is two to three times greater than bone conduction
c. Place the vibrating tuning fork stem on the client’s mastoid process and ask the client to
when he or she no longer hears the sound
d. The examiner quickly brings the tuning fork in front of the pinna without touching the client
and ask the client to indicate if he or she still hears the sound
e. The client normally continues to hear the sound two times louder in front of the pinna;
such results are a positive Rinne Test
f. The examiner records the duration of both phases, bone conduction followed by air
conduction and compares the times
g. If the client is unable to hear the sound through the ear in front of the pinna, the client
may have a CONDCUTIVE HEARING LOSS on the side tested, because in this situation, the
bone conduction is greater than the air conduction; such results are a negative Rinne test
because air conduction is normally greater than bone conduction
h. The Rinne test is of no value in determining SENSORINEURAL HEARING LOSS

TOMOGRAPHY
Description
a. May be performed with or without contrast enhancement
b. Assesses the mastoid, middle ear, and inner ear structures
c. Multiple x-rays of the heard are done
d. Especially helpful in the diagnosis of acoustic tumors
Implementation
 a. All jewelry is removed
b. Lead eye shield are used to cover the corner to diminish the radiation dose to the eyes
c. The client must remain still in a supine position
d. No follow-up care is required
AUDIOMETRY
Description
a. Measures hearing acuity
b. Uses two types, pure tone audiometry and speech audiometry
c. Pure tone audiometry is used to identify problems with hearing speech, music, and
other sounds in the environment
d. In speech audiometry, the clients ability to hear spoken words is measured
e. After testing, audiogram patterns are depicted on a graph to determine the type and
level of the hearing loss

Implementation
a. Inform the client regarding the procedure
b. Instruct the client to identify the sounds as they are heard

ELECTRONSTAGMOGRAPHY
Description
a. A vestibular test that evaluates spontaneous and induced eye movements known as
nystagmus
b. Used to distinguish between normal nystagmus and either medication – induced
nystagmus or nystagmus caused by a lesion in the central or peripheral vestibular
pathway
c. Records changing electrical fields with the movement of the eye, as monitored by
electrodes placed on the skin around the eye

Implementation
a. The client is instructed to remain NPO for 3 hours before testing
b. Unnecessary medications are omitted for 24 hours before testing
c. Instruct the client that is a long and tiring procedure
d. The client should bring prescription eyeglasses to the exam
e. The clients sits and is instructed to gaze at lights focus on a moving pattern, focus on a
moving point, and then sit with the eyes closed
f. While sitting in a chair, the client may be rotated to provide information about
vestibular function
g. In addition the client’s ears are irrigated with both cool and warm water, which may
cause nausea and vomiting
h. Following the procedure, the client begins taking clear fluids slowly and cautiously
because nausea and vomiting may occur
i. Assistance with ambulation may also be necessary following the procedure

CALORIC TEST (Bithernal Test)

Description
a. Performed to evaluate the client experiencing dizziness
 b. Nystagmus, nausea, vomiting or ataxia may indicate a pathological condition of the
labyrinth system, whereas a decrease response may indicate that the vestibular system
is affected

Implementation
a. Warm water causes a greater response than add water
b. Warm water testing (irrigation) precedes cool water caloric testing (irrigation)
c. The character and duration of the eye movements are measured
d. The client must assume a supine position with the eyes closed and the head elevated to
30 degrees
e. Following the procedure, the client begins taking clear fluids slowly and cautiously
because nausea and vomiting may occur
f. Assistance with ambulation may also be necessary following the procedure

DIAGNOSTIC TEST OF NEUROLOGICAL SYSTEM

SKULL AND SPINAL X-RAY

Description
a. X-rays of the skull reveal the size and shape of the skull bones, suture separation in
infants, fractures on bony defects, erosion, or calcification
b. Spinal x-rays identify fractures, dislocation, compression curative, erosion, narrowed
spinal cord, and degeneration processes

PRE-PROCEDURE
a. Provide nursing support for the confused; combative or ventilator – dependent client
b. Maintain immobilization of the neck if a spinal fractured is suspected
c. Remove metal items from body parts
d. If the client has thirst heavy hair, this should be documented, because it may affect
interpretation of the x-ray film

POST-PROCEDURE
a. Maintain immobilization until results are known

COMPUTED TOMOGRAHPY (CT) CSAN

Description
a. A type of brain scanning that may or may not require an injection of a dye
b. Used to detect intracranial bleeding, space – occupying lesions, cerebral edema,
infarctions, hydrocephalus, cerebral atrophy, and shifts of brain structures

Implementation
a. Obtain a consent if a dye is used
b. Assess for allergies to iodine, contrast dyes, or shellfish if a dye is used
c. Instruct the client in need to lie still and flat during the test
d. Instruct the client to hold hi or her breath when requested
e. Initiate an IV if prescribed
 f. Remove objects from the head, such as wigs, barrettes, earring, and hairpins
g. Assess for claustrophobia
h. Inform the client of possible mechanical noises as the scanning occurs
i. Inform the client that there may be a hot flushed sensation and a metallic taste in the
mouth when the dye is injected
j. Note that some clients may be given the dye even if they report an allergy, and are
treated with an antihistamine and cortecosteroids prior to injection to reduce the
severity of a reaction

POST-PROCEDURE
a. Provide replacement fluids because diuresis from dye is expected
b. Monitor for a allergic reaction to dye is expected
c. Assess dye injection site for bleeding or hematoma and monitor extremity for color,
warmth, and the presence of distal pulses

MAGNETIC RESONANCE IMAGING (MRI)

Description
a. A non-invasive procedure that identifies types of tissues, tumors, and vascular
abnormalities
b. Similar to CT scan but provides more detailed pictures and has not expose the client to
ionizing radiation

PRE-PROCEDURE
a. Removed all metal objects from the client
b. Determine if the client has a pacemaker, implanted defibrillator, or metal implants such
as hip prosthesis or vascular clips because these clients cannot have this test performed
c. Remove IV fluid pumps during the test
d. Provide precautions for the client who is attached to pulse oximetry because it can
cause a burn during testing if coiled around the body or a body part
e. Provide as assessment of the client with claustrophobia
f. Administer medication as prescribed for the client with claustrophobia
g. Determine if a contrast agent is to be used, and follow the prescription related to the
administration of food fluids and medications

POST-PROCEDURE
a. Client may resume normal activities
b. Expect diuresis if a contrast agent was used

LUMBAR PUNCTURE
Description
a. Insertion of spinal needle through L3 – L4 interspace into the lumbar subaradinod space
to obtain cerebrospinal fluid (CSF), measures CSF fluid or pressure, or instill air dye or
medications
b. Contraindicated in clients with increased intracranial pressure because the procedure
will cause a rapid decrease in pressure within the CSF around the spinal cord, leading to
brain herniation
PRE-PROCEDURE
a. Obtain a consent
b. Have the client empty the bladder

DURING PROCEDURE
a. Position the client in a lateral recumbent positive and have the client draw knees up to
the abdomen and chin into the chest
b. Assist with the collection of specimens (label the specimens in sequence)
c. Maintain strict asepsis

POST-PROCEDURE
a. Monitor vital signs and neurological signs
b. Position the client flat as prescribed
c. Force fluids
d. Monitor I & O

MYELOGRAM
Description
Injection of dye or air into the subarachnoid space to detect abnormalities of the spinal
cord and vertebrae

PRE-PROCEDURE
a. Obtain a consent
b. Provide hydration for at least 12 hours before the test
c. Assess for allergies to iodine
d. If the client is taking a phenophiazine, hold the medication because this medication
lowers the seizure threshold
e. Premedicate for sedation as prescribed

POST-PROCEDURE
a. Vital signs and neurological assessment frequently as prescribed
b. If a water-based dye is used, elevate the head 15 to 30 degrees for 8 hours as
prescribed
c. If an oil-based dye is used, keep the client flat 6 to 8 hours as prescribed
d. If air is used, keep the head lower than the trunk as prescribed
e. Administer analgesics for headache or backache as prescribed
f. Force fluids
g. Monitor I & O
h. Assess for bladder distention and voiding

CEREBRAL ANGIOGRAPHY
Description
Injection of contrast through the femoral artery into the carotid arteries to visualize the
cerebral arteries and assess for lesions

PRE-PROCEDURE
a. Obtain a consent
 b. Assess the client for allergies to iodine and shellfish
c. Encourage hydration for 2 days before the test
d. NPO 4 to 6 hours prior to the test as prescribed
e. Obtain a baseline neurological assessment
f. Mark the peripheral pulses
g. Remove metal items from the hour
h. Apply sandbags and a pressure dressing to the injection site as prescribed
i. Place ice on the puncture site as prescribed
j. Force fluids

ELECTRO ENCEPHALOGRAPHY (EEG)

Description
A graphic recording of the electrical activity of the superficial layers of the cerebral
cortex.

PRE-PROCEDURE
a. Wash the clients hair
b. Inform the client that electrodes are attached to the head and the electricity does not
enter the head
c. Withhold stimulants antidepressants, tranquilizers, and anticonvulsants for 24 to 48
hours prior to the test as prescribed
d. Allow the client to have breakfast if prescribed
e. Premedicate for sedation as prescribed

POST-PROCEDURE
a. Wash the client’ s hair
b. Maintain site rails and safety precautions if the client was sedated

CALORIC TESTING COCULOVESTIBULATE TESTING

Description
Provides information about the function of the vestibular portion of the eight cranial
nerve and aids in the diagnosis of cerebellum and brainstem lesions

PROCEDURE
a. Patency of the external canal is confirmed
b. Cold or warm water is introduced into the external auditory canal
c. Stimulation of the auditory canal with warm water produces a horizontal nystagmus
toward the side of the irrigated ear when the vestibular eight cranial nerve is normal
d. Stimulation of the auditory canal with cold water produces a horizontal nystagmus away
from the side of the irrigated on if the brainstem is intact

DIAGNOSTIC TEST OF MUSCULOSKELETAL SYSTEM

 ARTHROCENTESIS
Description
a. Involves aspirating synovial fluid, blood on pus via a needle inserted into a joint cavity
b. Medication may be instilled into the joint if necessary to alleviate inflammation

Implementation
a. Obtain a consent form
b. Apply a compress bandage post-procedure as prescribed
c. Instruct the client to rest the joint for 8 to 24 hours post-procedure
d. Instruct the client to notify the physician if a fever or swelling of joint occurs

ARTHROGRAM
Description
a. A radiographic examination of the soft tissues of the joint structures: use to diagnose
trauma to the joint capsule or ligaments
b. A local anesthetic is used
c. A contrast medium or air is injected into the joint cavity, and the joint is moved
through range of motion as a series of x-rays are taken

Implementation
a. Instruct the client to fast from food and fluids for 8 hours prior to the procedure
b. Assess the client for allergies to iodine or seafood prior to the procedure
c. Obtain a consent form
d. Inform the client of the need to remain as still as possible, except when asked to
reposition
e. Minimized the use of the joint for 12 months after the procedure
f. Instruct the client that the joint may be edematous and tender for 1 to 2 days after the
procedure and may be treated with ice packs and analgesics as prescribed
g. Instruct the client that if edema and tenderness last longer than 2 days, to notify the
physician
h. If knee orthography was performed, n ace wrap over the knee may be prescribed for 3
to 4 days
i. If air was used for injection, crepitus may be felt in the joint for up to 2 days

ARTHROSCOPY
Description
a. Provides an endoscopic examination of various joints
b. Articular cartilage abnormalities can be assessed, loose bodies can be removed, and the
cartilage can be trimmed
c. A biopsy may be performed during the procedure
Implementation
a. Instruct the client to fast for 8 to 12 hours prior to the procedure
b. Obtain a consent form
c. Administer pain medication as prescribed post-procedure
d. An elastic wrap should be worn for 2 to 4 days as prescribed post-procedure
e. Instruct the client that walking without weight bearing is usually permitted after
sensation returns but to limit activity for 1 to 4 days as prescribed following the
procedure
f. Instruct the client to elevate the extremity as often as possible for 2 days following the
procedure, and to place ice on the site to minimize swelling
g. Reinforce instructions regarding the use of crutches, which may be used for 5 to 7 days
post-procedure when walking
h. Advice the client to notify the physician if fever or increased knee pain occurs or if
edema continues for more than 3 days post-procedure

BONE SCAN
Description
a. Radiosotope is injected IV and will collect in areas that indicate abnormal bone
metabolism and some fractures, if they exist
b. The isotope is excreted in the urine and feces within as hours and is not harmful to
others

Implementation
a. Hold fluids for 4 hours prior to the procedure
b. Obtain a consent form
c. Remove all jewelry and metal objects
d. Following the injection of the radiosotpe, the client must drink 32 ounces of water (if
not contraindicated) to promote renal filtering of the excess isotope
e. Form 1 to 3 hours after the injection, have the client void, and then the scanning
procedure is performed
f. Inform the client of the need to lie supine during the procedure and that the procedure
is not painful
g. No special precautions are required after the procedure because a minimal amount of
radioactivity exits in the radiosotope
h. Monitor the injection site for redness and swelling
i. Encourage oral fluid intake following the procedure

BONE OR MUSCLE BIOPSY

Description
May be done during surgery or through aspiration, or punch or needle biopsy

Implementation
a. Obtain a consent form
b. Monitor for bleeding, swelling, hematoma, or severe pain
c. Elevate the site for 24 hours following the procedure to reduce edema
 d. Apply ice packs as prescribed following the procedure to prevent the development of a
hematoma
e. Monitor for signs of infection following the procedure
f. Inform the client that mild to moderate discomfort is normal following the procedure

ELECTROMYOGRAPHY
Description
a. Measures electrical potential associated with skeletal muscle contractions
b. Needles are inserted into the muscle, and recordings of muscular electrical activity are
traced or recording paper through an oscilloscope

Implementation
a. Obtain a consent form
b. Instruct the client that the needle insertion is uncomfortable
c. Instruct the client not to take any stimulants or sedatives for 24 hours prior to the
procedure
d. Inform the client that slight bruising may occur at the needle insertion sites

MYELOGRAM
Description
Injection of dye or air into the subarachonoid space to detect abnormalities of the
spinal cord and vertebrae

Implementation Procedure
a. Obtain a consent form
b. Provide hydration for at least 12 hours before the test
c. Assess for allergies to iodine
d. Premedicate for sedation as prescribed

Implementation Post-Procedure
a. Perform vital signs and neurological assessment frequently as prescribed
b. If a water-base dye is used, elevate the head 15 to 30 degrees for 8 hours as
prescribed
c. If an oil-base dye is used, keep the client flat 6 to 8 hours as prescribed
d. If air is used, keep the head lower than the trunk
e. Force fluids and monitor I & O

MAMMOGRAPHY
Description
 Radiographic study using a low-dose x-ray technique to examine breast tissue. It is used in
conjunction with physical palpation
 Used to screen for pathology in women over 40, and animal mammograms are
recommended

TEST PROCEDURE
1. The client is placed in sitting or standing position with her breasts flattened in plastic
composer. Allows for correct positioning of the breasts
2. Instruct client to hold her breath when film is taken. Prevents movement during
respiration

NURSING CARE
Before Test
1. Explain procedure and purpose of the test
2. Assure client that exposure to radiation is minimal
3. Instruct the client that during the procedure it may be uncomfortable to sit on the hard
table. It is important to remain as still as possible during the test
4. It is necessary to remove dental prosthesis, jewelry, eyeglasses or other metal objects
like hair clips.

DURING TEST
1. Adhere to standard precautions
2. Provide reassurance and calm atmosphere
3. Instruct client to take a deep breath and hold it or to exhale and not to breath as the
x-ray is taken

AFTER TEST
1. Recommend that client have a routine mammogram after 50.
2. Also inform client that women should have a mammogram annually after as 40

MANTOUX SKIN TEST

Description
 Evaluates whether there is active or dormat tuberculosis infection. Tuberculin is a protein
fraction of the tubercle bacilli and is injected intradermally. The injection of tuberculin skin
test solution will produce an erythema at the injection site in a position client.

TEST PROCEDURE
1. Draw up 0.1 ml of tuberculin skin test into TB syringe
2. Swab area on dorsal side of arm with alcohol swab
3. When dry, pull the skin tant and inject intradermally
4. A 6 to 10 mm pale wheal should be evident
5. Evaluate injection site in 72 hr.

AFTER TEST
1. Ensure client understands the importance of returning for reading of the skin test after
72 hours
2. Evaluate the reaction in a well-lit area
3. Have client flex forearm
4. Look for hardening or thickening
 5. Circle the induration and measure the diameter (in mm)

MULTIGATED ACQUISITION (MUGA scan)

Description
 The client receives a radionuclide agent (technetium) intravenously that radiolabels red
blood cells. With the use of as eletrocardiogram synchronized to computer and gamma scin
tillator camera, pictures are taken that represent as single cardiac cycle
 The result show left ventricular function, determine ejection fraction and look for heart wall
abnormalities

TEST PROCEDURE
1. Insert IV line and attach the client to an ECG
2. Place client in supine position so that the camera is over the preordain. (Allows for
accurate test result)
3. Trained personnel administer the IV radionuclide. (Helps to minimize the risk of
exposure to radioactive material
4. The scan can begin 1-5 min after the injection and is done with the client at rest, if
desired, repeated during a stress test

BEFORE TEST
1. Explain procedure and purpose of the test
2. Educate client on need to remain still during scan
3. Reassure client no pain will be experienced during the test
4. Instruct client to void before procedure
5. Have client remove all jewelry or metal objects
6. Administer sedatives as ordered

DURING TEST
1. Instruct client that he must be in supine position during test (which could last up to 1
hr)

AFTER TEST
1. Instruct client and caregivers to wash hands after voiding or bowel movements
because the radionuclide is excreted in urine and feces
2. Instruct client to drink fluids to assist in flushing isotopes from the body

Acid - Fast Bacterial Stain and culture, Nocardia Species

Description
 Acid-fast bacteria are those species of bacteria that retain staining after an acid-alcohol
wash. Nocardia species are acid – fast although less positively washes may be used to
obtain a specimen. The AFP stain is done to quickly identify possible Nocardia. Positive
diagnosis is only possible after culture, which takes approximately 6 weeks

TEST PROCEDURE
1. Collect specimen in the early morning
 2. Instruct client not to touch the insider lip of the sputum cup. (Prevents introduction of
unrespiratory organisms into the sample)
3. Have client rinse mouth. (Remove organisms from the mouth)
4. Have client sit, breathe deeply, and cough into the sputum container
5. If the client cannot raise sputum, the following may be helpful; increase hydration by
having client drink 1-2 glasses of water; increase hydration by using nebulizer; induce
coughing by deep breathing; perform postural drainage after hydration has increased
and administer expectant
6. Send specimen cup immediately to the laboratory or refrigerate. (Sitting at room
temperature will allow overgrowth of contaminating organisms and make identification
of Nocardia more difficult)

LIVER BIOPSY
Description
 Invasive procedure performed in surgical setting. An excision on needle punch sample of a
small of liver tissue is taken under sterile techniques and examined microscopically for cell
morphology and tissue anomalies

TEST PROCEDURE
1. Place client in supine or left lateral position with right arm over head
2. Skin is cleansed and local anesthetic is injected into skin over the biopsy site
3. During the insertion and biopsy, client must hold their breath for approximately 10 sec
to avoid pneumothorax
4. Send specimen to the laboratory

NURSING CARE
Before Test
1. Provide pre-procedure sedation and analgesic as ordered
2. Instruct client to be NPO 12 hr prior to test
3. Instruct client to hold breath for 10-15 seconds
4. Assess prothrombin and hemoglobin level

AFTER TEST
1. Clean site of biopsy
2. Provide Analgesics as necessary
3. Apply pressure dressing and assess site for potential bleeding

PARACENTESIS
Description
 Remove accumulated exudative or transudative fluid from the abdominal cavity for
diagnostic or therapeutic purpose

NURSING CARE
Before Test
1. Instruct client to void or a Foley catheter will need to be inserted
2. Take clients baseline vital signs, height, and abdominal girth
 3. Inform client that there will be a stinging sensation when local anesthetic is given an a
feeling
or pressure/pain when the aspirating needle is inserted into the peritoneum

After Test
1. Apply adhesive bandage to the site after maintaining pressure for several minutes
2. Take client vital signs every 15 minute for 1 hr
3. Monitor temperature 24-25 hr
4. Assess urinary output and presence of blood in urine
5. Place client on the unaffected side for 1-2 hr and can move to whatever position is most
comfortable
6. Document color and character of the fluid removed and ongoing leakage, vital signs and
clients description of pain, feeling of dizziness or changes in metal status

POSITRON EMISSION TOMOGRAPHY (pet)

Description
 Uses a radionuclide to provide information on the blood flow, O 2 uptake, glucose transport
and metabolic functioning of an organ
 It can also identify regional lymph node metastasis and evaluate response to therapy

NURSING CARE
Before Test
1. Educate client on used to remain still during scan
2. Reassurance client no pain will be experienced during the test
3. Instruct client to void before procedure
4. Assess if client is pregnant or nursing
5. Have client remove all jewelry or metal objects
6. Administer sedatives as ordered
7. Client must obtain from caffeine, smoking, and alcohol for at least 24 hr before the test
8. Instruct client not to drink large amounts of fluids within 2 hr of the test
9. Assess for potential allergies to contrast medium
10.Inform client that during injection of contrast medium a burning sensation may be felt
for a few seconds behind the eyes or in the jaw, teeth, tongue, or lips

DURING TEST
1. Assess for allergies reactions to contrast medium
2. Instruct client to remain still

After Test
1. Instruct client and caregivers to wash hands after voiding or bowel movements because
radionuclide is excreted in urine and feces
2. Encourage client to drink fluids to assist in flushing isotopes from the body
3. Assess for allergies reaction to contrast medium

RENAL SCAN
Description
 An IV injection of a radioisotope for visual imaging of renal blood flow

PRE-PROCEDURE
a. Obtain informed consent
b. Assess for allergies
c. Assist with administering radioisotope as necessary
d. Instruct clients that they will be required to remain motion less
e. Instruct clients that imaging may be repeated at various intervals before test is
complete

POST-PROCEDURE
1. Encourage fluids unless contraindicated
2. Assess the client for signs of delayed allergic reaction, such as itching and hives
3. Note that the radioactivity is eliminated in 24 hours
4. Follows standards precautions when caring for incontinent clients and double-bag client
linens per agency policy

CYSTOMETROGRAM (CMG)
Description
 A graphic recording of the pressure exerted at varying filling phases of the bladder

PRE-PROCEDURE
a. Inform the clients of the voiding requirements during the procedure

POST-PROCEDURE
1. Monitor client voiding after the procedure

CYSTOSCOPY
Description
 The bladder mucosa is examined for inflammation, calculi, or tumors by means of a
cystoscope

PRE-PROCEDURE
a. Obtain informed consent
b. Withhold food and fluids after midnight on the night before the test
c. Administer enemas and medications as prescribed

POST-PROCEDURE
a. Monitor VS
b. Monitor for postural hypotension
c. Force fluids as prescribed
d. Monitor intake and output
e. Encourage deep-breathing exercises to relieve bladder spasms
 f. Administer analgesics as prescribed
g. Administer site baths for back and abdominal pain
h. Note that leg cramps are common due to the lithotomy position maintained during the
procedure
i. Assess urine for color and consistency
j. Note that pink-tinged or tea-colored urine is common
k. Monitor for bright red urine or clots and notify physician if this occurs

RENAL BIOPSY
Description
 Insertion of a needle into the kidney to obtain a sample of tissue for examination

PRE-PROCEDURE
a. Assess vital signs
b. Assess baseline clotting studies
c. Obtain informed consent
d. Withhold food and fluids after midnight on the night before the test

DURING PROCEDURE
a. Position client prone with a pillow under the abdomen and shoulders

POST-PROCEDURE
a. Monitor vital signs
b. Monitor hemoglobin and hematocrit
c. Place client in the supine position on bed rest for 8 hours as prescribed
d. Provide pressure to be biopsy site for 30 minutes
e. Check the biopsy site for bleeding
f. Force fluids from 1500 to 2000 ml as prescribed
g. Instruct client to heavy lifting and strenuous activity for 2 weeks

TENSILON TEST
Description
 Tensilon, an anticholonstenase drug, is injected intravenously to test for myasthemia
gravis. Upon injection of the Tensilon, the person with myasthemia gravis will have marked
improvement in muscle strength for about 5 min. if there is no change in muscle strength,
the person does not have MG. This test evaluates the ability of impulses to get to muscle
fibers for contraction

TEST PROCEDURE
1. Initiate an IV saline lock if there is not one in place (Tensilon is given so IV is needed)
2. Inject Tensilon
3. Observe client for up to 5 mins

NURSING TEST
Before Test
1. Instruct the client not to take any medication 4hr before the test

After Test
1. Encourage client to realize fears if test results are positive for myasthene gravis.