ENDOSCOPY AND RADIO

IODINE ASSAY
DECHY LYN PALMA
 ENDOSCOPY

A procedure in which your doctor uses specialized instruments to view

and operate on the internal organs and vessels of your body.
It allows surgeons to view problems within your body without making
large incisions.
A surgeon inserts an endoscope through a small cut, or an opening in the
body such as the mouth.
An endoscope is a flexible tube with an attached camera that allows your
doctor to see.
 PURPOSE
To screen for and prevent cancer.
To diagnose a disease or find out the cause of symptoms.
To give treatment. These treatments include:
Surgery through small incisions in the skin, called laparoscopic surgery
Laser therapy, using a powerful beam of light to destroy cancer cells
Microwave ablation, using heat to destroy cancerous tissue
Surgery using an endoscope inserted into the gastrointestinal tract, called
endoscopic mucosal resection or endoscopic submucosal dissection
Photodynamic therapy, destroying the tumor with a laser after injecting it with a
light-sensitive substance
Medicines
 TYPES OF ENDOSCOPY
Name of procedure Name of tool Area or organ viewed How endoscope reaches target
area

Arthroscopy Arthroscope Joints Inserted through a small incision

over the area to be viewed

Bronchoscopy Bronchoscope Trachea (windpipe) and Inserted through the mouth

bronchi of the lungs

Colonoscopy Colonoscope Entire length of the colon and Inserted through the anus
large intestine

Colposcopy Colposcope Vagina and cervix A speculum is inserted into the

vagina. The colposcope is placed
at the opening of the vagina but
does not enter it.

Cystoscopy Cystoscope Inside of the bladder Inserted through the urethra

Esophagoscopy Esophagoscope Esophagus Inserted through the mouth

 Name of procedure Name of tool Area or organ viewed How endoscope reaches target
area

Gastroscopy Gastroscope Stomach and duodenum Inserted through the mouth

(beginning of the small intestine)

Laparoscopy Laparoscope Stomach, liver, or other abdominal Inserted through a small, surgical
organ, including female opening in the abdomen
reproductive organs (uterus,
ovaries, fallopian tubes)

Laryngoscopy Laryngoscope Larynx (voice box) Inserted through the mouth

Neuroendoscopy Neuroendoscope Areas of the brain Inserted through a small incision in

the skull near the area to be
viewed

Proctoscopy Proctoscope Rectum and sigmoid colon Inserted through the anus

Sigmoidoscopy Sigmoidoscope Sigmoid colon (bottom part of the Inserted through the anus
colon)

Thoracoscopy Thoracoscope Pleura covering the lungs and Inserted through a small surgical
structures covering the heart opening in chest
 COMPLICATIONS OF ENDOSCOPY

chest pain
damage to your organs, including possible perforation
fever
persistent pain in the area of endoscopy
redness and swelling at the incision site
 BEFORE THE PROCEDURE
Pre-Procedural Nursing Implications.
(1) Endoscopic procedures are invasive, and therefore require a formal, signed
consent form.
(2) The patient must be educated about the procedure, the significance of any
preparation, and any post-procedural sequelae.
(3) Upper GI endoscopy (esophagoscopy, gastroscopy) requires that the patient be
fasting. Sedatives are administered prior to the procedure to relax the patient and
facilitate passage of the scope.
(4) If the patient wears dentures, have a denture cup available. The physician may
require the removal of the dentures prior to oral insertion of the scope.
(5) Colon endoscopy (proctoscopy, sigmoidoscopy, and colonoscopy) requires that
the bowel be free of stool to enhance visualization. This is normally accomplished
with laxatives and cleansing enemas.
 During the Procedure

Throughout the procedure, will monitor the temperature, blood pressure,

and heart rate.
Assist the Physician to record the images from the endoscope.
Post-Procedural Nursing Implications.
(1) Accidental perforation of the esophagus or colon may occur during endoscopy.
If pain or bleeding occur following the procedure, notify the Physician. Note the
following:
(a) Mouth or throat pain.
(b) Rectal pain.
(c) Abdominal pain.
(d) Bleeding from rectum.
(e) Bleeding from mouth or throat.
(2) Withhold foods, fluids, and p.o. medications until the patient is fully alert and
gag reflex has returned.
(3) Take vital signs per ward SOP.
 RADIO IODINE ASSAY
Uses a radioactive tracer and a special probe to measure how much
tracer the thyroid gland camera.gif absorbs from the blood.
The test can show how much tracer is absorbed by the thyroid gland.
The RAIU test often is done along with a thyroid scan, which shows if the
tracer is evenly spread in the gland.

This helps your doctor know if the thyroid gland is working properly.
The radioactive tracer commonly used in this test is iodine.
A radioactive iodine uptake test is done to find problems with how the
thyroid gland works, such as hyperthyroidism
 PURPOSE:

A radioactive iodine uptake (RAIU) test is done to:

Find the cause of an overactive thyroid gland (hyperthyroidism).
Plan treatment for hyperthyroidism.
Plan treatment for patients who have had thyroid cancer surgery.
 RISKS

There is a slight chance of damage to cells or tissue from radiation,

including the low levels of radiation used for this test. But the chance of
damage from the radiation is usually very low compared with the
benefits of the test.
This test is not done for pregnant women because of the chance of
exposing the baby (fetus) to radiation. This test is also not recommended
for breastfeeding women or young children.
 PRE- TEST
Positively identify the patient using at least two person-specific identifiers before services, treatments, or procedures
are performed.
Inform the patient this test can assist in assessing thyroid function.
Obtain a history of the patients health concerns, symptoms, surgical procedures, and results of previously performed
laboratory and diagnostic studies. Include a list of known allergens, especially allergies or sensitivities to latex,
anesthetics, sedatives, or radionuclides.
Obtain a history of the patients endocrine system, symptoms, and results of previously performed laboratory tests
and diagnostic and surgical procedures.
Note any recent procedures that can interfere with test results, including examinations using iodine-based contrast
medium.
Ensure that this procedure is performed before all radiographic procedures using iodinated contrast medium.
Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
Obtain a list of the patients current medications, including over-the-counter medications and dietary supplements.
Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some
pain may be experienced during the test, and there may be moments of discomfort. Inform the patient that the
procedure is performed in a nuclear medicine department by a health-care provider (HCP) who specializes in this
procedure, with support staff, and takes approximately 15 to 30 min. Delayed images or data collection is needed 24
hr later.
Instruct the patient to remove jewelry and other metallic objects from the area to be examined.
Instruct the patient to fast and restrict fluids for 8 to 12 hr before the procedure. The patient may eat 4 hr after the
injection unless otherwise indicated. Protocols may vary among facilities.
 INTRA TEST
Observe standard precautions, and follow the general guidelines in Patient
Preparation and Specimen Collection . Positively identify the patient.
Ensure the patient has complied with dietary, fluid, and medication restrictions
prior to the procedure, as instructed.
Ensure that the patient has removed all external metallic objects from the area
to be examined prior to the procedure.
Avoid the use of equipment containing latex if the patient has a history of
allergic reaction to latex.
Instruct the patient to cooperate fully and to follow directions. Instruct the
patient to remain still throughout the procedure because movement produces
unreliable results.
Administer the I-123 orally (pill form).
Place the patient in a sitting or supine position in front of a radionuclide
detector at 2, 6, and 24 hr after ingestion for uptake images.
 POST - TEST
Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the
results with the patient.
Instruct the patient to resume usual diet, as directed by the HCP.
Advise patient to drink increased amounts of fluids for 24 hr to eliminate the radionuclide from the body, unless
contraindicated. Tell the patient that radionuclide is eliminated from the body within 24 to 48 hr.
If a woman who is breastfeeding must have a nuclear scan, she should not breastfeed the infant until the radionuclide
has been eliminated. This could take as long as 3 days. She should be instructed to express the milk and discard it
during the 3-day period to prevent cessation of milk production.
Instruct the patient to immediately flush the toilet and to meticulously wash hands with soap and water after each
voiding for 24 hr after the procedure.
Instruct all caregivers to wear gloves when discarding urine for 24 hr after the procedure. Wash gloved hands with
soap and water before removing gloves; then wash ungloved hands.
Recognize anxiety related to test results, and be supportive of perceived loss of independent function. Discuss the
implications of abnormal test results on the patients lifestyle. Provide teaching and information regarding the clinical
implications of the test results, as appropriate.
Reinforce information given by the patients HCP regarding further testing, treatment, or referral to another HCP.
Answer any questions or address any concerns voiced by the patient or family.
Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of
the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patients
symptoms and other tests performed.
 RESULTS
Radioactive thyroid scan and radioactive iodine uptake test (RAIU)

The amount of radioactive tracer in the thyroid gland is normal. An RAIU test measures the amount of tracer taken up by the thyroid
gland at certain times after the tracer is given. The measured amount of radioactive tracer in the thyroid gland at each one of these times
is at normal levels.
These are normal results at 6 and 24 hours after swallowing the radioactive iodine:
Normal: At 6 hours: 3% to 16%
At 24 hours: 8% to 25%

The test shows either more or less uptake of tracer than normal in the thyroid gland. If hyperthyroidism is present, abnormal test results
may mean certain conditions are present.

A low uptake of tracer by the thyroid gland may mean that hyperthyroidism is caused by inflammation of the

thyroid gland (thyroiditis), taking too much thyroid medicine, or another rare condition.
Abnormal:
A high uptake of tracer spread evenly in the thyroid gland may mean that hyperthyroidism is caused by conditions

such as Graves' disease.

 Higher-than-normal uptake may be due to an overactive thyroid gland. The most common
cause is Graves disease.

Other conditions can cause some areas of higher-than-normal uptake in the thyroid gland. These
include:
An enlarged thyroid gland that contains nodules producing too much thyroid hormone (toxic
nodular goiter)
An single thyroid nodule that is producing too much thyroid hormone (toxic adenoma)

Lower-than-normal uptake may be due to:

Factitious hyperthyroidism (taking too much thyroid hormone medicine or
supplements)
Iodine overload
Subacute thyroiditis (swelling or inflammation of the thyroid gland)
Silent (or painless) thyroiditis
Amiodarone (medicine to treat some kinds of heart disease)