Ateneo de Zamboanga University

College of Nursing

NURSING SKILLS OUTPUT (NSO)

Week: 9

ARTERIOGRAPHY

I. DESCRIPTION:

An arteriogram is a procedure that produces an image of your arteries. During

the procedure, your doctor will use contrast material, or dye, and X-rays to
observe the flow of blood through your arteries and note any blockages.

This procedure, also known as an angiogram, can be done on many different

parts of your body. The terms “arteriogram” and “angiogram” (and the related
“arteriography” and “angiography”) aren’t specific to a particular part of the
body. These terms simply refer to a particular method of observing your arteries.

II. MATERIALS / EQUIPMENT NEEDED:

 A consent form
 Hospital gown
 Bed
 IV fluid
 Injection/catheter
 A dye (contrast) that is being injected into an artery.
 X-ray machine so the doctor can see if there are
blockages.
 III. PROCEDURE

 The patient will be positioned on the X-ray table.

 An intravenous line will be inserted, generally into a vein in the patient's arm or
hand.

 The patient will be connected to an electrocardiogram (ECG) monitor that records

the electrical activity of the heart and monitors the heart during the procedure using
small, adhesive, electrode patches. Vital signs (heart rate, blood pressure, and
breathing rate) will be monitored during the procedure.

 A small incision will be made in the arm or groin, into which a small catheter will be
inserted.

 The catheter will be threaded into the desired artery.

 Once the catheter is in place, an injection of contrast dye will be given into the
catheter.

 A series of X-rays will be taken.

 Once the desired X-ray images have been obtained, the catheter will be removed
and pressure will be applied over the area to keep the artery from bleeding.

 In order to prevent bleeding from the catheter insertion site, the patient will remain
flat in bed in a recovery room for several hours after the procedure.

 Once at home, the patient should monitor the incision for bleeding, unusual pain,
swelling, and abnormal discoloration or temperature change in the arm or leg on the
side of the puncture site. A small bruise is normal. The patient may be advised not to
do any strenuous activities for at least 72 hours, nor take a hot bath or shower until
the next day.
IV. DIAGRAM / ILLUSTRATIONS:

I. NURSING RESPONSIBILITIES:

 Secure written informed consent. Make sure to let the patient sign the
consent before sedative medication is given.
 Prepare all the needed forms (depending on the hospital protocol)
 Routine vital signs must be obtained before the procedure.
 Allergies should be assessed, especially seafood, iodine, radiopaque dyes, or
any drug allergy. Coronary angiogram and angioplasty are procedures that
use contrast media like dye. Make sure to inform the physician if patient have
allergies. The client are usually pre-medicated with antihistamines and
corticosteroids to avoid allergic reactions.
 NPO post-midnight or hours prior to procedure, usually 6-8 hours (depends
upon the physician’s order or the protocol of the catheterization laboratory)
 Start IV fluid of Plain NSS or D5 containing as ordered
 If patient is taking metformin, the medication is usually withheld 48 hours
prior to the procedure because of the risk of lactic acidosis associated with
the iodine dye.
 Make sure that ordered diagnostic and laboratory tests were taken before the
procedure like creatinine, CBC with platelet, aPTT, Prothrombin Time,
Potassium.
 Shave and prepare both groins with antiseptic solution, if the site for insertion
will be the femoral vein.
 Have patient void before wheeling in to cardiac catheterization laboratory.
SOURCES:

 https://www.hopkinsmedicine.org/healthlibrary/conditions/radiology/arteriogram
_85,p01274
 https://www.healthline.com/health/arteriogram#types

Belamide,Mitzi Caress E.
Clinical Instructor
 Ateneo de Zamboanga University

College of Nursing

NURSING SKILLS OUTPUT (NSO)

Week: 10

HEMOGLUCO TEST

I. DESCRIPTION:

A blood sugar test is a procedure that measures the amount of sugar, or

glucose, in your blood. Your doctor may order this test to help diagnose diabetes.
People with diabetes can also use this test to manage their condition.

Blood sugar tests provide instant results and let you know the following:

 your diet or exercise routine needs to change

 how your diabetes medications or treatment is working

 if your blood sugar levels are high or low

 your overall treatment goals for diabetes are manageable

II. MATERIALS / EQUIPMENT NEEDED:

 Blood glucose meter

 Vial of test strips
 Lancing device
 Lancets
III. PROCEDURE

Step 1: Get a blood sample

Use your lancing device and a new lancet to get a drop of blood from your fingertip.
Some people find that getting a blood sample from the side of their fingertip, rather
then the top,
makes it easier to apply the blood to the test strip.
Step 2: Apply blood to strip
Apply the blood droplet to the test strip when the blood droplet symbol appears
in your meter window.
Touch and hold the drop of blood to the narrow channel at the top edge of the
test strip.
Make sure that the channel in the strip is completely full. This ensures that your
meter has a large enough blood sample to give you an accurate reading.
If your sample doesn’t fill the channel, add more blood to that strip within 5
seconds. If you get an
error reading, discard the strip and start again.
Step 3: Read the result
Your meter will count down and display the result of your blood glucose level.

IV. DIAGRAM / ILLUSTRATIONS:

V. NURSING RESPONSIBILITIES:
 . It is usually the responsibility of the nurse to perform blood glucose
readings. As with any clinical procedure:
  ensure that you understand the patient’s condition, the reason for the test,
and the possible outcomes of the procedure. Prior to performing a blood
glucose test,
 ensure that you have read and understood the manufacturer’s instructions
and your agency’s policy for the blood glucose monitoring machines .
 It is also important that you determine the patient’s understanding of the
procedure and the purpose for monitoring blood glucose level. Before you
begin, you should also determine if there are any conditions present that
could affect the reading.
SOURCES:

 https://provider.ghc.org/open/caringForOurMembers/patientHealthEd
ucation/conditionsDiseases/diabetes/bloodGlucoseMeter.pdf
 https://www.healthline.com/health/blood-sugar-tests#results

Belamide,Mitzi Caress

Clinical Instructor
 Ateneo de Zamboanga University

College of Nursing

NURSING SKILLS OUTPUT (NSO)

GASTROINTESTINAL ENDOSCOPY

I. DESCRIPTION:
An endoscopy is 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. Your doctor can use forceps (tongs) and scissors on the
endoscope to operate or remove tissue for biopsy.

II. MATERIALS/EQUIPMENTS
 CO2 and Irrigation Pumps
 Irrgitation Tubing
 Polyp Traps
 Procedure Kits
 Procedure Room Accessories
 Rinse and Insufflation Tubing
 Single – Use Valves

III. PROCEDURE
 During an endoscopy
1. During an upper endoscopy procedure, you'll be asked to lie down on a
table on your back or on your side. As the procedure gets underway:
2. Monitors often will be attached to your body. This will allow your health
care team to monitor your breathing, blood pressure and heart rate.
3. You may receive a sedative medication. This medication, given through a
vein in your forearm, helps you relax during the endoscopy.
4. Your doctor may spray an anesthetic in your mouth. This medication will
numb your throat in preparation for insertion of the long, flexible tube
 (endoscope). You may be asked to wear a plastic mouth guard to hold
your mouth open.
5. Then the endoscope is inserted in your mouth. Your doctor may ask you
to swallow as the scope passes down your throat. You may feel some
pressure in your throat, but you shouldn't feel pain.
6. You can't talk after the endoscope passes down your throat, though you
can make noises. The endoscope doesn't interfere with your breathing.
 As your doctor passes the endoscope down your esophagus:
1. A tiny camera at the tip transmits images to a video monitor in the exam
room. Your doctor watches this monitor to look for abnormalities in your
upper digestive tract. If abnormalities are found in your digestive tract,
your doctor may record images for later examination.
2. Gentle air pressure may be fed into your esophagus to inflate your
digestive tract. This allows the endoscope to move freely. And it allows
your doctor to more easily examine the folds of your digestive tract. You
may feel pressure or fullness from the added air.
3. Your doctor will pass special surgical tools through the endoscope to
collect a tissue sample or remove a polyp.Your doctor watches the video
monitor to guide the tools.
4. When your doctor has finished the exam, the endoscope is slowly
retracted through your mouth. An endoscopy typically takes 15 to 30
minutes, depending on your situation.
 After the endoscopy
1. You'll be taken to a recovery area to sit or lie quietly after your
endoscopy. You may stay for an hour or so. This allows your health care
team to monitor you as the sedative begins to wear off.
2. Once you're at home, you may experience some mildly uncomfortable
signs and symptoms after endoscopy, such as:
 Bloating and gas
 Cramping
 Sore throat
3. These signs and symptoms will improve with time. If you're concerned or
quite
4. uncomfortable, call your doctor
5. Take it easy for the rest of the day after your endoscopy. After receiving a
sedative, you may feel alert, but your reaction times are affected and
judgment is delayed.
 IV. DIAGRAM/ILLUSTRATIONS

V. NURSING RESPONSIBILITIES
BEFORE PROCEDURE

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.
AFTER PROCEDURE

1. Accidental perforation of the esophagus or colon may occur during endoscopy. If

pain or bleeding occur following the procedure, notify the professional nurse.
Note the following:
 Mouth or throat pain.
 Rectal pain.
 Abdominal pain.
 Bleeding from rectum.
 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.

Sources:

http://www.healthline.com/health/endoscopy#followup6

http://www.mayoclinic.org/tests-procedures/endoscopy/basics/what-you-can-
expect/prc-20020363

http://brooksidepress.org/giu/lessons/lesson-1-nursing-care-related-to-the-
gastrointestinal-system/section-iii-diagnostic-procedures/1-23-endoscopy/

Belamide,Mitzi Caress E. Lourdes Grace Antolihao RN, MN

Clinical Instructor
 Ateneo de Zamboanga University

College of Nursing

IRRIGATING AND CLEANING A STOMA

I. DESCRIPTION.
Colostomy irrigation is a way to regulate bowel movements by flushing and
emptying the colon at a scheduled time. The process involves instilling water into
the colon through the colostomy, or stoma, which stimulates the colon to empty.
By repeating this process regularly – once a day or once every second day – the
colon can be trained to empty with minimal spillage of stool in between
irrigations. Colostomy irrigation also can help avoid constipation.

Colostomy irrigation is a personal decision. If you are a candidate, your doctor or

a nurse trained to help people with colostomies will discuss this option with you.

II. MATERIALS

(1) Irrigation kit (irrigation bag with clamp and tubing, cone-tip irrigation
catheter, irrigation drain pouch).

(2) Water soluble lubricant.

(3) IV pole (or other suspending hook).

(4) Soap and water.

(5) Washcloth and towel.

(6) Ostomy appliance.

(7) Waste receptacle.

(8) Prescribed irrigating solution, usually 500-1000cc warm (100º–105ºF) tap

water.
III. ILLUSTRATION

IV. PROCEDURE

1. Gather your supplies:

o Irrigation bag, tubing, and cone tip
o Irrigation sleeve
o Water-based lubricant
o Colostomy pouch or stoma covering
o Paper towel or washcloth
o Water
2. Irrigate your colostomy in a bathroom. Set up your supplies on a countertop or small
table near the toilet.
3. Fill the irrigation bag with warm water (never hot or cold). On the first day, use 250
milliliters (mL) of water. On the second day, use 500 mL. The third day, use 750 mL.
From the fourth day onward, use 1,000 mL.
o Once you’re emptying your bowel on a regular schedule, you can use the
smallest amount of water necessary to make you regular. This amount is
different for every person, and finding it is a trial-and-error process. Your WOC
nurse will help you.
4. Let some of the water drain through the tubing of the irrigation bag. This will push out
any air. Once the air is pushed out, clamp the tubing.
5. Sit on the toilet or in a chair next to the toilet for the irrigation. Hold the irrigation bag
so that the bottom of the bag is at your shoulder level. This means the bag should be
about 18 inches above your stoma. A hanging device can be put in the bathroom to hold
the irrigation bag.
6. Unsnap and remove the colostomy bag from your stoma. Snap on the irrigation sleeve.
Place the end of the irrigation sleeve in the toilet.
7. Cover the cone tip with the water-based lubricant.
8. Insert the lubricated cone tip through the top open end of the irrigation sleeve and
gently put it into your stoma. Angle the cone tip so that it follows the natural direction of
your colon. Never force it. Never insert it beyond its widest point.
9. Hold the cone tip in place for 1 to 2 minutes before starting the irrigation. Take a slow,
deep breath. This will relax your abdominal muscles.
10. Release the clamp on the irrigation bag tubing little by little. This will allow the water to
flow slowly into your colostomy. Once the water flows into you colostomy, you may feel
bloated.
o If water back flows around the cone tip or doesn’t flow into your stoma, gently
change the angle or position of the cone tip. Keep adjusting until water flows
 and there is no backflow of water. If this doesn’t help, remove the cone tip from
the stoma to allow stool to flow from your colostomy.
o If you have cramping:
1. Stop the flow of the water, take some slow deep breaths, and gently rub
your abdomen. This will help relax the muscles.
2. Check the height of the irrigation bag. If the bag is too high, the
increased pressure can cause cramping.
3. Check and reset the clamp. If water flows too rapidly, it can cause
cramping.
11. When the irrigation bag is empty, close the clamp on the tubing, remove the cone tip
from your stoma, and set the irrigation bag, tubing, and cone tip aside. Close the top of
the irrigation sleeve.
12. Returns (water and stool) from the irrigation will start within 5 to 10 minutes. After 15
minutes, you may close the bottom of the irrigation sleeve. Use the clamp provided. You
may wish to use the next 30 to 45 minutes to shave or wash. At this point, it’s safe to
leave the bathroom. However, you should stay close by in case you have more returns
from the irrigation.
13. After the second return, empty the contents into the toilet. Remove the irrigation sleeve.
Then, snap on your colostomy pouch. Flush the toilet and clean your hands.
14. To clean your equipment, use the paper towel or washcloth to wash it with mild soap
and lukewarm water. Hot water will damage the plastic.

V. NURSING RESPONSIBILITIES

 Try to irrigate at the same time each day.

 Don’t irrigate if you have diarrhea.
 Don’t irrigate if you notice a bulge (hernia) around your stoma. If you notice a bulge or
hernia, call your doctor.
 Check with your doctor before irrigating while you are getting chemotherapy or radiation
therapy. Irrigation is not recommended during these treatments.
 The amount of returns will vary from irrigation to irrigation.

References:

https://www.mskcc.org/cancer-care/patient-education/colostomy-irrigation-instructions-
sigmoid-descending-colostomy

https://www.ostomy.org/colostomy-irrigation/

Belamide, Mitzi Caress Lourdes Grace Antolihao , RN, MN

Clinical Instructor