ELECTROCARDIOGRAPHY

ELECTROCARDIOGRAPHY Record of electrical activities of the heart First diagnostic test ( cardio problem)

ECG Waves, Complexes, Intervals

ECG portion
P wave
PR interval

Activity
Atrial depolarization
Time of impulse transmission SA node AV node Ventricular depolarization plateau phase of the action potential Ventricular repolarization

Duration
0.04 to 0.11 secs.
0.12 0.20 secs.

QRS complex ST segment

0.05 0.10 secs.

T wave

should not exceed 5 mm amplitude

ECG CHANGES
HYPOKALEMIA Depressed ST segment
Short T wave Pathological U wave

HYPERKALEMIA Prolonged QRS complex

Elevated ST segment Peaked T wave

MYOCARDIAL INFARCTION Elevated ST segment

Inverted T wave Pathologic Q wave

CARDIAC CATHERIZATION
ASSESS O2 levels
Pulmonary blood flow Cardiac output Heart structures

RIGHT - SIDED HEART CATHETERIZATION Insert catheter via a cutdown into a large vein (medial cubital or brachial vein)
LEFT SIDED HEART CATHETERIZATION Insert catheter passing aorta via the brachial or femoral artery

NURSING INTERVENTIONS
PRETEST Assess allergy (iodine or seafoods)
No meals (to prevent N/V) Sedative as ordered Mark distal pulse Cardiac Monitoring (dysrrhythmias) Expect warm or flushing sensation (flutter sensation)

POSTTEST Bed Rest

Monitor V/S esp. peripheral pulses ECG monitoring Apply pressure Immobilize the affected extremity HOB < 30 degrees Monitor extremities : color, temp, pulse and sensation

CARDIAC STRESS TESING

ECG is monitored : Treadmill or bicycle like device PURPOSES: Identify ischemic heart disease Evaluate patients with chest pain Evaluate the effectiveness of therapy

ARTERIOGRAPHY
Contrast medium is used May be done during Cardiac Catheterization Observe hypotension ( profound diuretic effect

SWAN GANZ CATHETER

Inserted via antecubital vein into the R side of the heart and is floated into the pulmonary artery

USED TO MONITOR: PAP and PCWP

Is a flow-directed, balloontipped, 4-lumen catheter:
CVP PAP and PCWP Fluid Infusion and Blood Samples Inflation and Deflation

NURSING INTERVENTIONS
Inflated ONLY for PCWP readings; deflate between readings Observe catheter insertion site: culture site q 48h as prescribed

ASSESS EXTREMITY Color Temperature Capillary filling and sensation

CARDIAC MUSCLE ENZYMES

ASPARTATE AMINOTRANSFERASE (AST)
Most specific cardiac enzymes Elevation indicates tissue necrosis

LACTIC DEHYDROGENASE (LDH)

LDH 1- most sensitive indicator of myocardial damage

TROPONIN
most specific lab. Test to detect MI COMPONENTS Troponin I modulates the contraction Troponin C binds calcium Troponin T binds I and C

BRONCHOSCOPY
Direct inspection of and observation of the larynx, trachea and bronchi

BRONCHOSCOPY
THERAPEUTIC USES Remove aspirated foreign objects Excise small lesion

DIAGNOSTIC USES Collect secretions Determine location of pathologic process Collect specimen for biopsy

BRONCHOSCOPY
PRETEST: Informed consent Atropine sulfate and Valium as prescribed. NPO 6-8h Remove: Dentures Prostheses

POST TEST: Position: side-lying Check gag reflex return Observe: cyanosis, hypotension, tachycardia, arrhythmias, hemoptysis and dyspnea

CHEST X-RAY
Hold a deep breath for few seconds (?) Remove metals from the chest Contraindication: Pregnant client

SPUTUM EXAMINATION
Assess gross appearance of the sputum

Examples: Pneumococcal pneumonia Rusty sputum Pseudomonas infection Greenish sputum PTB Blood tinges sputum
CULTURE AND SENSITIVITY TEST (?) Detects actual microorganism causing infection ACID FAST BACILLI STAINING Detects PTB

COLLECTION OF SPUTUM
PRE TEST: Early morning sputum specimen Rinse mouth Use sterile container AFB collect sputum for three consecutive mornings

THORACENTESIS
Aspiration of fluid or air from the pleural space. PRETEST: Secure written consent Take V/S Positions: ____________________

INTRATEST: Remain still Avoid coughing Pressure sensation is felt

THORACENTESIS
POST TEST: Position : Unaffected side (?) Bed rest Check: Expectoration of blood MONITOR: Tachycardia Tachypnea Hypotension

PULMONARY FXN TEST

VITAL CAPACITY
Maximum volume of air that can be exhaled after maximum inhalation Reduced in COPD

TIDAL VOLUME
The volume of air inhaled and exhaled with normal quiet breathing

INSPIRATORY RESERVE VOLUME

The maximum volume that can be inhaled following a normal quiet inhalation

PULMONARY FXN TEST

EXPIRATORY RESERVE VOLUME The maximum volume that can be exhaled following a normal exhalation FUNCTIONAL RESIDUAL CAPACITY The volume of air that remains in the lungs after normal quiet exhalation

RESIDUAL VOLUME The volume of air that remains in the lungs after forceful exhalation

LUNG SCAN
Measure integrity of the pulmonary blood vessels
Confirmatory: PULMONARY EMBOLISM/ pulmonary blood flow abnormalities

After injection of a radioisotope Measures blood perfusion through the lungs Remain still during the procedure

MANTOUX TEST
Signifies exposure to Mycobacterium tubercle bacilli

PROCEDURE: PPD (Purified Protein Derivative ) is used Read after 48-78h (ID)
INDURATION: Interpretations??? REMEMBER: Positive (+) may mean __________ is given!

LUNG BIOPSY
Excision of small amount of Lung tissue Determine malignancy OPEN LUNG BIOPSY Done during surgery PERCUTANEOUS NEEDLE BIOPSY Done with the use of aspiration needle TRANSBRONCHOSCOPIC BIOPSY Done during bronchoscopy

The EYES

TONOMETRY
Indirect measure of Intraocular Pressure (IOP)

Normal: 12 - 21 mmHg
PRINCIPLE of APPLANATION Painless; no SE Topical Anesthetics given (where?)

GONIOSCOPY
Biomicroscopic examination: visualizes the anterior chamber angle DIAGNOSE: Chronic open vs. Acute Closed Glaucoma

SNELLENS CHART
Test for visual acuity Normal : 20/20
Can see the letters on the line designated as 20/20 from a distance of 20 feet

Legal blindness???
can see an object from 20 feet away that a person whose vision is 20/20 can see from 200

ISHIHARA PLATE
Test color vision

COVER-UNCOVER TEST
Differentiates various types of strabismus

OCULOVESTIBULAR TEST
Ice water caloric test Irrigate ear with cold water C-O-W-S

Gastrointestinal system

BARIUM SWALLOW
Visualizes : Esophagus Stomach Duodenum Jejunum POSTTEST Laxative administration Increase fluid intake White CLAY stool Observe Barium impaction

PROCEDURE: NPO 6-8h BaSO4 PO X-ray: standing, lying position

BARIUM ENEMA
Visualizes: Colon Low Residue (LO RES) or clear liquid diet for 3 days prior to BE Laxative for cleansing the bowel Suppository/cleansing enema in AM BaSO4 per rectum Inc. OFI post procedure

GUAIAC STOOL EXAM

Stool for Occult blood Detects GI bleeding High fiber diet for 48-72h No dark colored foods

DIET INSTRUCTION: AVOID! Red meats Poultry Fish Horseradish Cauliflower

ERCP
Direct visualization with radiographic examination Liver ,Gallbladder and Pancreas Contrast medium: X-ray and GI endoscopy PRETEST: Written consent NPO 10-12h Allergy to iodine/ seafoods Take V/S AtSO4, Valium as ordered Local anesthesia; Throat Position: Left side

ERCP
POST TEST: NPO Position: Side lying Monitor V/S : sepsis, perforation and pancreatitis

LIVER BIOPSY
PRETEST Consent NPO 2-4h Vit. K injection Monitor PT; initial V/S Position: Left side Instruct: Exhale deeply and hold breath (5-10 secs) POSTTEST Position: Right side- 4h (Pressure dressings) Bed rest 24h

LIVER BIOPSY

COLONOSCOPY
PRETEST: Clear liquid diet 24h Administer cathartic/ laxative as ordered Cleansing enema Sedation is done Position: left side or knees flexed POSTTEST: Monitor V/S (vasovagal response) Assess s/s of perforation

COLONOSCOPY

ELECTROMYOGRAPHY
Measures and records activity of contracting muscles in response to electrical stimulation PREPARATION:

Explain the procedure Pain is expected

ARTHROCENTESIS
Removal of synovial fluid, blood or pus from a joint NURSING CARE Apply dressing over the area x 24h Limit activity for several days

ARTHROSCOPY
Insertion of fiberoptic scope into a joint Purposes: Visualization Perform biopsies
FOCUS: OR (sterile technique) NURSING CARE: Apply dressing x 24h Limit activity

BONE SCAN
Measures radioactivity in bone ( 2h after injection of a radioisotope) PURPOSES: Detects bone tumors NURSING CARE : FOCUS Remain still during scan

BONE SCAN

TENSILON TEST
Edrophonium Test A short-acting cholinergic PROCEDURE: Tensilon (IV) (+) improvement of muscular strength within 30 seconds Muscle weakness (3-5 mins) returns Antidote: AtSO4

ELECTROENCEPHALOGRAPHY
Graphical recording of electrical impulses of the brain (scalp electrodes) Hair shampoo to remove oil AVOID: at least 24h Caffeine and other stimulants Anticonvulsants Wash hair after the procedure

CT SCAN
Computerized reconstruction of body parts (seen in SUCCESSIVE LAYERS) Nursing Considerations: Remove metallic objects Remain during the entire procedure Assess for claustrophobia Sedation is done NPO 4-6h (contrast medium) Observe allergic reaction

CT SCAN

MRI
Strong magnet + radiofrequency waves + computer
NURSING CONSIDERATIONS:

No metal implants/ items Procedure: Lasts 30-90 mins Painless Assess for claustrophobia Drum-like or knocking sound is expected

CEREBRAL ANGIOGRAPHY
Visualizes intracranial and extracranial vessels Intra-arterial injection of contrast medium (radiographs) NURSING CONSIDERATIONS Warm sensation as dye injected Contrast medium: femoral. Brachial or carotid Remove metallic clips Check allergy to iodine/ seafoods NPO 4-6 hours IVF (hydration status)

LUMBAR PUNCTURE
Introduction of needle into spinal subarachnoid space to assess CSF
NURSING CONSIDERATIONS:

Encourage to void Position: fetal position Label specimen

POST TEST: Flat in bed 6-8h Encourage fluids

PET SCAN
Provides metabolic profile by revealing the rate at which tissues metabolize glucose

KUB
X- ray visualization of Kidney, Ureters and Bladder Painless procedure No special preparation

INTRAVENOUS PYELOGRAPHY
EXCRETORY UROGRAM X-ray visualization of Kidney, ureters and bladder IV contrast medium (Hypaque) PRETEST: Consent NPO 6-8 h Laxative as ordered Assess allergy to iodine or seafoods Epinephrine at bed side

INTRAVENOUS PYELOGRAPHY
POST TEST: Monitor VS Increase fluid intake Burning sensation or voiding may experienced Observe for delayed allergic reaction