Learning Objectives
1. Explain the role of the practical/vocational nurse in assessment and data collection.
2. Identify common risk factors for disease and illness.
3. Define and differentiate between acute and chronic, and between primary and secondary illnesses.
4. Describe the effects of inflammation and infection on the body.
5. State the rationale for obtaining a metabolic panel (profile), UA, CBC, UTox, or UPT.
6. List four types of tests and procedures that primary healthcare providers use to establish a medical diagnosis. Describe the information each test contributes to the medical diagnosis.
7. Discuss the purpose of the physical examination done by the primary healthcare provider and the supporting data collected about the client by the registered or practical/vocational nurse.
8. Describe common examination techniques: observation, inspection, palpation, percussion, and auscultation. In the skills laboratory, demonstrate each technique.
9. Describe common formats used to organize the physical examination.
10. In the skills laboratory, perform a daily client data collection on a sample client, distinguishing between normal and abnormal findings.
11. Recognize and describe common deviations from normal body structure and function, as described and illustrated in this top and throughout this topic.
12. Discuss the importance of client and family teaching during the entire healthcare process.
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IMPORTANT TERMINOLOGY |
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abscess |
exudate |
nodule |
sign |
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accommodation |
fistula |
observation |
slough |
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acuity |
granulation tissue |
pain |
spirometry |
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acute disease |
guaiac |
pallor |
strabismus |
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anasarca |
Hemoccult |
palpation |
striae |
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auscultation |
hemorrhage |
papule |
stridor |
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biopsy |
herniation |
percussion |
suppuration |
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chronic disease |
Homans’ sign |
primary disease |
symptom |
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cognitive function |
induration |
purulent |
thrombophlebitis |
|
complication |
infection |
pustule |
tumor |
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conjunctivitis |
inflammation |
rhonchi |
turgor |
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crackle |
inspection |
risk factor |
ulcer |
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diplopia |
keloid |
scoliosis |
vesicle |
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dysphasia |
kyphosis |
secondary disease |
wheal |
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ecchymosis |
lordosis |
sequela |
wheeze |
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emaciation |
macule |
serosanguineous |
wound sinus |
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endoscope |
malaise |
serous |
|
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erythema |
necrosis |
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Acronyms |
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ABG |
LP |
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CAM |
MRI |
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CBC |
MUGA |
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CMG |
O&P |
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C&S |
PERRLA+C |
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CT/CAT |
PET |
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DEXA |
PFT |
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E-CAT |
PSA |
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ECG |
SDB |
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EEG |
SPECT |
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EKG |
T&X |
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EMG |
UA |
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ENG |
UPP |
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ERCP |
UPT |
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IVP |
US |
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KUB |
UTox |
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LOC |
|
The process of collecting data about the client’s condition, combined with the physical examination, identifies and clarifies a client’s health status. It identifies health problems the client may be experiencing. When collecting health data about the client, it is important to consider the client’s general state of health, specific risk factors, deviations from normal body structure and/or function, and changes since the last examination. (The client and family are the primary resources for much of this information.) In addition, it is important to consider the client’s understanding of the healthcare system and previous experience, ability to cooperate with testing and examinations, and the client’s ethnic and cultural background, as well as the client’s age and developmental status. The nurse must also understand specific procedures and tests used to establish medical and nursing diagnoses. All healthcare providers must be able to distinguish between abnormal and normal physical findings.
The mnemonic COLDSPA can help the nurse remember important data that need to be collected (Box 47-1).
An organized format of data collection ensures thoroughness. It is also important to use correct language to describe findings so all members of the team will understand.
MEDICAL AND NURSING DIAGNOSIS
It is important to understand the roles of all healthcare providers in data collection and diagnosis. Remember the distinction between medical diagnosis and nursing diagnosis.
Medical Diagnosis
The medical diagnosis is determined by a primary healthcare provider—a person such as a physician, osteopathic physician, or advance practice nurse. The medical diagnosis emphasizes the disease process and includes identification of the specific disease or disorder, as well as an estimation of the course and outcome of the disease (prognosis). A diagnosis of pneumonia is a medical diagnosis.
The medical diagnosis is based on both objective observations and subjective data. In the procedures in this topic, the role of the nurse is to assist in this process by gathering as much information as possible about the client and his or her problems and by assisting the primary healthcare provider to collect additional data. Data gathered by nurses, in combination with the physical examination and specific diagnostic tests, assist the primary healthcare provider to formulate the medical diagnosis. The nurse needs a basic understanding of data collection and examination procedures to collaborate effectively in this process.
BOX 47-1.
The COLDSPA Mnemonic
COLDSPA
CHARACTER: Describe the sign or symptom. How does it feel, look, sound, smell, and so on?
ONSET: When did it begin?
LOCATION: Where is it? Can you identify a specific location? Does it radiate?
DURATION: How long does it last? Does it recur?
SEVERITY: How bad is it? Can you rate it on a scale of 1 to 10?
PATTERN: What makes it better? What makes it worse?
ASSOCIATED FACTORS: What other symptoms occur with it?
The Nursing History and Nursing Diagnosis
This helps the nurse to obtain the client’s understanding and perspective on his or her state of health and illness and is combined with what the nurse observes. The licensed practical nurse or licensed vocational nurse (LPN/LVN) assists in much of the data collection. The collection of specific physical findings about the client is another component required to formulate a nursing diagnosis. The interview and examination of the client assists all members of the healthcare team to make both medical and nursing diagnoses and to develop and implement an effective total plan of care.
Once the nursing history and accompanying data collection have been completed, the nursing diagnosis can be formulated by the nursing team, under the direction of the registered nurse. The LPN/LVN is an integral member of this team. The nursing diagnosis focuses on the person and his or her needs in response to the disease, rather than on the disease itself. A nursing diagnosis is the concise problem-centered description of actual or potential health problems, based on the nursing process and stated in terms of NANDA diagnoses. (The list of NANDA diagnoses is presented at the end of this topic.)
Therefore, nursing diagnoses for the person with pneumonia might be “Airway Clearance, Ineffective’’ and/or “Breathing Pattern, Ineffective” because the person is coughing and needs assistance in breathing.
The Nursing Care Plan and Data Collection
Unit 6 describes how the nursing care plan is formulated, based on the nursing diagnosis. All members of the healthcare team participate in carrying out this plan. Data collection is ongoing throughout the client’s contact with the healthcare system. Each time a healthcare worker contacts a client, data are collected. For example, as the nurse assists a woman to move from bed to chair, the nurse evaluates how the client is breathing, whether she is moving more or less stiffly than the day before, how much she is able to do for herself, and whether or not she appears to be in pain. This information is documented in clear language that will be easily understood. Learning to assess breathing, movement, and pain and knowing accurate terms with which to describe these observations can be more readily done if the nurse understands the format and techniques of a systematic physical examination.
Key Concept Remember to determine if clients use complementary and alternative medicine (CAM) treatments, such as vitamins, herbs, acupuncture, or homeopathic remedies. Some forms of CAM have been proven to be helpful and safe; others pose serious health risks to the individual when used after self-diagnosis. In addition, some herbal supplements have negative interactions with prescribed medications.Some alternative treatments may cause harm or may mask symptoms, so timely medical treatment is not obtained. Remember to be accurate, but not judgmental when discussing CAM therapies.
FACTORS THAT INFLUENCE DATA COLLECTION
Many factors influence disease and the body’s response to that disease. Different people react in different ways to physical and emotional disorders. In addition, cultural and ethnic factors influence how an individual person might respond to a disease process or its treatment.
Risk Factors for Disease and Illness
Some individuals are more susceptible to illness than are others. They may have predisposing physical and emotional conditions, genetic predisposition, or lifestyle practices that increase the likelihood of developing a certain disease or disorder. These are called risk factors. Table 47-1 lists common risk factors with examples of diseases that may occur as a result of these risk factors. As part of the nursing history, the nurse asks the client if any of these risk factors are present.
Course of the Disease
An acute disease develops suddenly and runs its course in days or weeks. A chronic disease may continue for months, years, or life. Acuity refers to a disorder’s level of severity. A complication is an unexpected event in the disease’s course that often delays the client’s recovery. Complications may occur at early, continuing, late, or terminal stages of a disease.
A disease or injury may also be described as independent (primary) or dependent (secondary). A primary disease occurs independently (by itself), such as a streptococcal sore throat. A secondary disease directly results from, or depends on, another disorder. This is also known as a sequela (plural: sequelae). An example is rheumatic heart disease, which is secondary to rheumatic fever. Both of these conditions are secondary (sequelae) to a streptococcal infection in the throat and/or tonsils.
TABLE 47-1. Risk Factors for Disease
|
RISK FACTOR |
EXAMPLE/EXPLANATION |
EXAMPLES OF POSSIBLE DISEASE OR DISORDER |
|
Diet |
Excess intake of fatty foods Excess intake of sodium (salt) Lack of vitamin C Low intake of protein Low intake of calcium |
Cholecystitis (inflammation of the gallbladder); weight gain, increased cholesterol and triglycerides Increased incidence of hypertension; edema and/or water retention Scurvy, slow wound healing Poor wound healing, breakdown of muscle tissue Demineralization of bones, increased incidence of osteoporosis and/or fractures |
|
Immobility, lack of exercise |
Leg/arm immobilized in a cast secondary to fracture Individual confined to bed rest |
Atrophy (tissue wasting) of muscles, decreased functionality Increased incidence of pneumonia, constipation, thrombophlebitis, weight gain; pressure ulcers on bony prominences |
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Age |
Toddler Older adult Young adult |
Accidental poisoning, swallowing of foreign objects, other accidents Chronic constipation; risk of falling, increased risk of fractures; increased incidence of chemical dependency, accidental overdose; enlarged prostate; cataracts; osteoporosis; overweight and underweight; hearing and vision difficulties; depression and suicide; loss of satisfying relationships; financial difficulties Auto accidents, drug abuse, unsafe sex, eating disorders, depression and suicide |
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Obesity |
Decreased ability to perform usual physical activities |
Shortness of breath, muscle atrophy (wasting); increased incidence of hypertension, diabetes mellitus, accidental injuries, coronary artery disease, certain cancers, gallbladder disease, sexual dysfunction |
|
Smoking and use of smokeless tobacco |
Constant irritation of lung tissue from smoke; systemic effects of nicotine; irritation of throat and mouth |
Cancer of the mouth, larynx, bronchi, or lung; peripheral vascular disease; coronary artery disease, hypertension, chronic obstructive pulmonary disease (COPD; emphysema) |
|
Excessive use of alcohol and other drugs |
Predisposition to family and personal difficulties |
Liver disorders, dysfunctional family and employment relationships, auto and other accidents, poor nutritional status, depression, coexisting drug abuse, risk of suicide |
|
Heredity |
Genetically transmitted disorders or predisposition |
Coronary artery disease, diabetes mellitus, hypertension, hemophilia, sickle cell disease, Huntington’s disease |
|
Race |
Disorders specific to certain racial groups |
Sickle cell disease, Tay-Sachs |
The Body’s Response to Disease
When gathering data about a client, the examiner looks for evidence of health or illness. Signs are objective evidence (data) of disease that can be seen or measured, such as a rash, swelling, or change in vital signs. Symptoms are subjective evidence (data) of disease, sensations that only the client knows and can report, such as pain, itching, nausea, fear, or light-headedness. While collecting data on the client, the examiner looks for evidence of change or abnormalities and asks the client to describe previous signs and symptoms. To gather health data accurately, it is important to understand normal characteristics and to use correct examination techniques. While determining objective physical findings in the client, the examiner also needs to ask pertinent questions to gather subjective information from the client. Together, objective and subjective information help to clarify the client’s health problems. Table 47-2 lists common signs and symptoms of illness and disease, with some possible causes.
Inflammation and Infection
One of the most common health problems is inflammation (heat, redness, often accompanied by swelling). Inflammation is the body’s response to an injury, irritant, or foreign substance. Inflammation can affect nearly every body tissue, organ, or system. It results when white blood cells rush into an area in an attempt to fight off a foreign body, heal an injury, or prevent an infection from developing or spreading. The suffix -itis is used to designate inflammation in a body part.
Infection is the invasion of cells, tissues, or organs by pathogens. Infection is harmful to the body and may result in inflammation, tissue destruction, tissue or organ dysfunction, or even cellular, tissue, or organ death. Diagnosis of infection is made when microorganisms are identified as present through microscopic examination and culture of tissues or drainage from the site of inflammation.
An inflammation or infection may be local or generalized. A local inflammation or infection is confined to one body part, such as an organ or a limb. A generalized infection affects the entire body. The most common signs of local inflammation are redness, swelling or edema, heat, pain, and loss of function of an area. Inflammation or infection may also be described as acute, subacute, or chronic. If an infection becomes generalized, the person may also experience some feelings of general discomfort, such as headache, fever, loss of appetite, and general malaise (an overall feeling of illness). A generalized infection is more likely to be life-threatening than is a localized infection. Generalized septicemia is an example of a life-threatening generalized infection.
TABLE 47-2. Common Signs and Symptoms of Disease and Illness
|
SIGN |
DEFINITION |
SELECTED CAUSES |
|
Anorexia |
Loss of appetite; refusal to eat |
Infection, gastrointestinal (GI) disorders, mental illness, poor dentition, mouth or throat cancer |
|
Cough |
Forceful expiratory effort |
Abnormal substances in respiratory tract, noxious irritation to the respiratory mucous membranes, cancer; tuberculosis, allergies |
|
Cyanosis |
Bluish discoloration of skin and mucous membranes |
Low oxygen levels in the blood, anemia, lung disorders, heart and circulatory disorders |
|
Diarrhea |
Frequent, watery stools |
GI inflammation or obstruction, medication side effect, fecal impaction, bulimia |
|
Dyspnea |
Shortness of breath; difficult or painful breathing |
Low blood oxygen levels due to respiratory disease or obstruction, chemical imbalances, pneumonia, lung cancer |
|
Edema |
Swelling of tissues; fluid retention |
Circulatory disease, local inflammation or infection, malnutrition, electrolyte imbalance, kidney disorders, fluid retention; obesity |
|
Emesis |
Vomiting |
GI inflammation, infection, or obstruction; irritation of GI lining; electrolyte imbalance; bulimia; medication side effect |
|
Fatigue |
Loss of energy |
Sleep loss, poor nutrition, inflammation, infection, depression, circulatory disorders |
|
Hemorrhage |
Abnormal or unexpected bleeding |
Trauma or injury to tissues, nutritional losses, blood clotting disorders, high blood pressure, cancers |
|
Jaundice |
Yellowish discoloration of skin and mucous membranes |
Obstruction of bile pathways due to gallstones, inflammation, tumors; liver disorders |
|
Malaise |
Generalized discomfort |
Infection, biochemical imbalances, various diseases, emotional difficulties |
|
Pallor |
Paleness; loss of normal skin color/tone |
Acute or chronic blood loss, nutritional deficiencies (e.g., iron), hypothermia, panic, trauma, anemia |
|
Pyrexia (fever) |
Fever; elevated body temperature |
Inflammation, infection, brain dysfunction, drug toxicity |
In acute inflammation, an excess of fluid and cells (exudate) is usually present in, or oozing from, tissues. A serous exudate involves clear drainage from a wound (serum). An exudate may be mucoid, such as the discharge from a nasal cold (coryza) or fibrinous, which causes adhesions (abnormal joining of tissues) to form, as tissues are repaired. Bloody (sanguineous) exudate is the result of small hemorrhages (bleeding) in the area. Serosanguineous exudate contains a combination of serum and blood. An exudate described as purulent contains pus, caused by the presence of bacteria. (The formation of pus is called suppuration.) A collection of pus in a localized area is called an abscess.
When bacteria grow within an inflammation site, the disorder has become an infection, in which pathogens release toxins (poisons) that destroy white blood cells and tissues. Tissue death is called necrosis. Destroyed tissue may be cast off (sloughed, pronounced “sluffed”), leaving behind an area that fills with new tissue (granulation tissue). Sometimes, a local unhealed area of epithelial tissue is left, called an ulcer. (A healed injury often leaves a scar— keloid.) A canal or passage leading to an abscess is called a wound sinus. An abnormal tubelike passage that connects two internal organs, or connects an internal organ to the surface of the body, is called a fistula. A fistula is often difficult to heal, the most common being an anal fistula in the rectal area.
Key Concept Evaluation and treatment of wounds, particularly those caused by pressure, is described.
Chronic inflammation persists over a long period of time, often for the remainder of the individual’s life, and does not follow the usual healing process. A subacute inflammation is midway in severity between acute and chronic. The person may appear to be clinically well. However, laboratory tests, radiologic (x-ray) examinations, or computed tomography/computed axial tomography (CT/CAT) scans (also called emission-computed axial tomography—E-CAT scans) may diagnose the condition. For example, a person may be a carrier of a disease, such as hepatitis, but may not show any outward symptoms of the disease. An acute infection is one that heals and leaves no aftermath or other related disorders (sequelae).
Pain
Physical pain is a subjective symptom reported by the client. It is a feeling of distress, discomfort, or suffering caused by stimulation of specific nerve endings. Pain is usually protective, warning the person that tissues are being damaged. A number of pain rating scales are available to assist in quantifying reported pain.
Laboratory Tests
Laboratory tests are often done as part of the physical exam ination. Results of these tests are used in planning th client’s care. Some laboratory tests are a routine part o screening; others are specific for certain disorders. Many o these tests are discussed in relationship to disorders of spe cific body systems throughout the remainder of this topic Commonly accepted normal values for some of the mor frequently performed laboratory tests are presented in th Student Resources in Point,’-..
Examples of common laboratory tests include urinalysi (UA), complete blood count (CBC), stool examinations fo blood (guaiac or Hemoccult) or for ova and parasites (O&P) and blood tests for specific antibodies, electrolytes, chemi cals, or abnormal blood components. The prostate-specifi antigen (PSA) test is done to determine the likelihood o prostate cancer in the male. Various metabolic panels or pro files are often done. These may include a wide variety o tests, as many as 40+, all done at the same time. Various lab oratories have different lists of tests to be included in thei basic panel. Other tests may be added, as needed. The pane may include blood and urine samples. Reasons for perform ing a metabolic panel include the following: to provide baseline set of values for the client before surgery, to differ entiate mental illness from other disorders, to evaluat clients with total-body situations (e.g., alcoholism or drug toxicity), and to assess a number of organs at once Specimens of body fluids may be cultured to isolat pathogens and to determine the appropriate medication fo treatment: culture and sensitivity (C&S). Arterial blood ga analysis (ABG) or analysis of a sputum specimen can helj determine a client’s respiratory status or diagnose a disorde such as tuberculosis. Specific blood tests can help determin damage to heart (cardiac) muscle and other conditions. Th client’s blood may be typed and crossmatched (T&X) fo: later blood transfusions. Blood or urine may be tested fo levels of various drugs (e.g., urine toxicology; UTox) to evaluate situations, such as driving under the influence o alcohol, the amount and identification of a drug used in suicide attempt, or presence of drugs of abuse. It may b necessary to determine the blood level of a therapeutic drug in order to adjust dosages.
Key Concept If a culture and sensitivity (C&S) study is ordered along with antibiotic therapy the C&S must be done before the antibiotic therapy is started or it will not be valid.
Special Types of Diagnostic Procedures
Many diagnostic procedures are done to determine abnormalities or disorders of various body systems. Preparation of the client and results obtained through many of these examinations are discussed throughout this text. Table 47-3 lists common diagnostic tests for several body systems. Some of these are discussed in more detail below.
TABLE 47-3. Selected Diagnostic Tests
|
TYPE OF TEST |
PURPOSE |
PROCEDURE |
|
Skin Tests Biopsy |
Identifies tissue abnormalities (often to determine presence of cancer) |
Provider surgically removes a portion of tissue, which is examined microscopically |
|
Intradermal test |
Identifies client’s previous exposure to an allergen; controls may be used to determine if client is anergic (unable to formulate antibodies) |
Provider or nurse injects an amount of the allergen intra-dermally and later examines the area to identify changes in color (e.g., erythema—redness) or temperature or the presence and size of induration (hardened tissue, lump). Frequently used to test for tuberculosis or allergies |
|
Patch or scratch test |
Identifies allergies |
Patch: Filter paper or gauze impregnated with allergen is applied to skin. Scratch: Minute amount of allergen is applied to tiny scratch. These tests are read in a manner similar to that used for the intradermal test. |
|
Transdermal testing (transdermal iontophoresis) |
Used most commonly to diagnose cystic fibrosis; also to monitor drug therapy (e.g., lithium levels), or to detect abnormal concentrations of electrolytes (e.g., sodium), or glucose |
Collects substances such as sweat, using a patch on intact skin. |
|
Musculoskeletal Tests Electromyogram (EMG) |
Diagnoses conditions such as amyotrophic lateral sclerosis (ALS), poliomyelitis, and other muscle disorders |
Measures electrical activity of skeletal muscles. Recordings are obtained while muscles are relaxed, when contracted voluntarily, and when contraction is electrically stimulated. |
|
(Rectal EMG) |
Identifies abnormal voiding patterns, dysuria, enuresis, caused by sensory deficits in bladder muscles or sphincters |
Identifies bladder sensations (e.g., fullness, bladder capacity). |
|
Radiography (x-ray) |
Identifies disorders such as bone fractures. Also used in combination with dyes, radioactive materials, and other equipment to evaluate condition of most internal structures of the body |
Film pictures of internal structures—procedure depends on x-ray being done. Often combined with computer analysis. |
|
Bone marrow biopsy (aspiration) |
Identifies hemolytic blood disorders and certain malignancies; helps to evaluate the effectiveness of chemotherapy |
Specimen of bone marrow is obtained via needle or aspiration. |
|
Bone mineral density (BMD), bone densitometry. DEXA/DXA—dual-energy absorptiometry; pDXA— peripheral DXA; SXA— single-energy x-ray absorptiometry; RA—radiographic absorptiometry |
Measures density of bone minerals to diagnose osteoporosis. DEXA/DXA measures spine, hip, and forearm density; pDXA—forearm; SXA—heel and forearm; RA—phalanges. |
Special radiographic procedures used to evaluate bone strength. Early treatment can be provided to help prevent fractures in osteoporosis. |
|
Bone scan |
Most often used to detect primary or metastatic cancers in bony tissue |
Dye is injected and the total skeleton is visualized, using x-ray and computerization. |
|
Neurologic Tests Cerebrospinal fluid analysis— Lumbar puncture (LP) (spinal tap) |
Measures pressure of cerebrospinal fluid; collects specimen to determine organisms causing disorders, such as encephalitis, and to measure drug levels and levels of substances, such as chloride, glucose, protein, and to locate tumor markers. Also to inject contrast media, drugs, or spinal anesthetics for spinal block. |
Client positioned on left side. Hollow needle is introduced into subarachnoid space (lumbar sac) between L4 and L5 (because using this area is least likely to cause injury). |
|
Electroencephalogram (EEG) |
Diagnoses disorders such as seizure disorders (epilepsy), brain tumors, or other brain disorders; sleep studies. Also, one of the criteria for establishing brain death (cerebral death). Can measure evoked potentials (induced responses) or brain activity at rest. |
Recording of electrical potentials in different areas of the brain. Electrodes applied to head with gel or needles. May be done with client awake or asleep, depending on purpose. |
|
Electroneurography (ENG) |
Detection of neuromuscular abnormalities; to differentiate between nerve and muscle disorders |
Electrodes placed and testing done when at rest and when exercising, to determine disorders such as spinal cord lesions or ALS |
|
Neuropsychiatric testing |
Determines level of functioning, ability to care for oneself, presence of intellectual impairment; measures intelligence and ability to learn, presence of some psychiatric disorders; determines ability to think and to reason |
Battery of various tests, including intelligence tests, motor tests; tests of reasoning, verbal ability and thought processes; spatial abilities, and personality tests (e.g., Minnesota Multiphasic Personality Inventory [MMPI]) (see Chapter 94). |
TABLE 47-3. Selected Diagnostic Tests Continued
|
TYPE OF TEST |
PURPOSE |
PROCEDURE |
|
Sleep studies—sleep disordered breathing study (SDB) |
To determine the presence of sleep apnea (temporary cessation of breathing during sleep) or sleep disordered breathing. To evaluate heart rate and rhythm during sleep. Done preoperatively in bariatric surgery. |
The client is studied during normal sleeping time. Simultaneous ECG, pulse oximetry, chest wall movement, and oral/nasal airflow are measured. EEG may also be done. |
|
Cardiovascular Tests Electrocardiogram (ECG) (Formerly known as EKG) |
Graphically records electrical impulses of cardiac musculature, to identify dysrhythmias or tissue damage |
Electrodes attached to client’s chest wall and limbs to record electrical impulses within cardiac muscles. |
|
Stress testing (Exercise test, graded exercise tolerance test, submaximal effort test) |
Identifies changes during cardiovascular stress |
Client walks on a treadmill or rides stationary bike (ergonometer) with ECG, blood pressure (BP), oxygen saturation, and pulse recordings. Recovery stages also recorded. (May also be done by injection of a specific drug, without exercise.) |
|
Echocardiogram |
Measures heart size and thickness; identifies valve function; measures cardiac output; identifies structural deformities, cardiac lesions, and aneurysms |
External probe (Doppler transducer) sends high-frequency sound waves through the chest wall, creating "echoes” that can determine depth and size of tissue. External ECG often done simultaneously. |
|
Angiography |
Outlines blood flow through cardiac vasculature to identify blockages, deformities, or aneurysms |
Small catheter is threaded through a vein or artery into the heart vessels; dye is injected and radiographs are taken. |
|
Cardiac catheterization (usually combined with angiography) |
Measures pressures within heart chambers to determine muscular strength, valve function, cardiac output, and fluid volume |
Catheters are threaded through veins or arteries into heart chambers; catheters have devices to measure pressure. Interior of heart and vessels can be visualized via fiberoptics. Client will be placed in various positions. |
|
MUGA (Multigated acquisition) scan |
Evaluates ventricular function of the heart at rest and during stress. Contraction and relaxation of the heart can be visualized. |
A sample of the client’s blood is tagged with special material and reinjected. An ECG is run simultaneously with the scanning equipment. All results are combined and computerized, to obtain results. |
|
Myocardial perfusion (nuclear medicine scan, cardiac imaging) |
To diagnose ischemia of the heart and to differentiate myocardial infarction from other causes of ischemia.To assess effectiveness of coronary artery bypass and angioplasty |
Testing is done at rest and under stress. Radioactive material is injected and SPECT (single-photon emission computed tomography) imaging done. |
|
Cardiac flow studies (nuclear medicine scan, cardiac imaging) |
To evaluate blood flow through the great vessels and after vessel surgery |
Dye is injected and a computerized camera documents blood flow. |
|
Respiratory Tests Chest radiograph (x-ray) |
Provides images of structures of the chest cavity, particularly lungs and heart; identifies tissue changes, fluid collection, narrowed airways, collapsed alveolar tissue, enlarged heart, tuberculosis; also used to determine deformities of mediastinum, diaphragm, and thyroid gland. |
A flat-plate radiograph is taken. Dye may be used. |
|
Pulmonary function tests (PFT) |
Measures lung size and airway patency; identifies lung volumes and airflow, and pulmonary disease |
Using a spirometer, client takes in maximal inhalation and then exhales forcefully and as rapidly as possible. Room air, helium, or 100% oxygen may be used. |
|
Pulse oximetry |
Estimates percentage of oxygenated blood flow through a body part (see Nursing Procedure 46-6 in Chapter 46) |
Sensor is attached to the client’s finger or earlobe and light is used to determine the amount of oxygen attached to circulating hemoglobin in the blood. |
|
Bronchoscopy |
Allows direct visualization of the airways to diagnose disorders; foreign bodies may be removed and airway stents placed. |
Flexible fiberoptic scope with a tiny camera is inserted into airways; an image is projected on a viewing screen. Specimens may be collected for biopsy or culture. |
|
Arterial blood gases (ABG) |
Identifies blood levels of oxygen, carbon dioxide, and alkalinity (provides fast evaluation of lung function). |
A sample of arterial blood is withdrawn through arterial puncture. |
|
Gastrointestinal Tests Oral endoscopy |
Allows direct visualization of the esophagus, stomach, duodenum; samples taken of gastric fluids and other contents; assesses gastric bleeding. |
Flexible fiberoptic scope with a tiny camera is inserted into upper GI system through the mouth and projects an image on a screen. Samples may be taken for microscopic analysis or culture. |
|
Gastric analysis/tube gastric analysis |
Stomach contents are examined for abnormal substances and to determine gastric acidity |
Specimens are collected via nasogastric tube |
TABLE 47-3. Selected Diagnostic Tests Continued
|
TYPE OF TEST |
PURPOSE |
PROCEDURE |
|
Magnetic resonance imaging (MRI, MR—spatial imaging) |
Allows visualization of body tissues through a series of images recorded in layers (can be used in any body area); differentiates between normal and abnormal tissue. Yields detailed sectional images. |
Client is positioned in scanner; images obtained by superconducting magnet and radio frequencies; contrast media is frequently used. |
|
Computed (axial) tomography (CT, CAT) scan or emission-computed axial tomography (E-CAT) scan |
Used for head, body, or abdomen to assess abnormalities, tumors, aneurysms, and many other disorders. Entire body scan may be done. |
Client lies on motorized table which moves through the CT gantry (open CT is also available). Contrast media used. Thin beam of x-ray reveals images in layers (not obscured by other structures). |
|
Endoscopic retrograde cholangiopancreatography (ERCP) and manometry |
Provides radiologic visualization of the gallbladder and common bile duct; obtains pressure readings. Evaluates disorders of the entire hepatobiliary system.. |
Combines endoscopy with x-ray imaging, using contrast media. |
|
Proctoscopy or colonoscopy |
Allows direct visualization of the colon or rectum to identify abnormalities and obtain biopsies; small polyps can be removed. |
Flexible fiberoptic scope with a tiny camera is inserted into lower GI system through the rectum and projects an image on a viewing screen. |
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Barium enema |
Allows x-ray visualization of large intestine |
Client is given a retention enema containing barium, a radio-opaque substance. A postevacuation x-ray is often taken. |
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Urologic Tests (Urodynamic Studies) and Tests of Male Genitourinary System Uroflowmetry (flow study, urine Provides graphic representation of urinary flow (urody-flow study) namic studies) to evaluate sphincter competence, voiding problems, or incontinence |
Bladder is quite full at start of test. Client voids during test. |
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Cystoscopy/cystourethroscopy |
Allows visualization of the lower urinary tract, including the urinary bladder, urethra, ureters, and male prostate gland, via endoscope. Can diagnose malignancies, infections, and bladder/voiding disorders. |
Scope is inserted through the urethra. Usually, fluid is instilled to distend the bladderThe area is directly visualized through the scope and minor procedures can be performed. |
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Cystometrography cystometro-gram (CMG) |
Provides graphic recording of pressures in the bladder during filling and emptying; also measures residual after voiding |
Amount of fluid instilled into bladder and client’s sensations of fullness and urge to void are recorded and compared with measured pressures. |
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Urinalysis (UA) |
Detects presence of bladder/urinary infections, pregnancy drug use, generalized physical disorders, presence of abnormal components of urine; aids in diagnosis of many disorders, bleeding, fluid retention, or dehydration, and so forth. |
Urine sample is obtained and tested in various ways. Culture and sensitivity may be done. |
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Testicular and rectal examination |
Aids in diagnosis of male genitourinary (GU) system, such as prostatic hypertrophy, testicular or prostate cancer |
Examiner inserts gloved finger into rectum and palpates prostate; external examination of testes; combined with prostate-specific antigen (PSA) blood test and biopsy, to diagnose prostate cancer. |
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Urethral pressure profile (UPP) |
Records urethral pressures, to evaluate incontinence and other abnormal voiding patterns. |
Specially designed catheter, coupled with a transducer, records urethral pressures as it is withdrawn. |
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Cystourethrogram |
Diagnosis of voiding abnormalities, including incontinence; visualization of urethra |
X-ray contrast medium is instilled into the bladder and various x-rays are taken. Studies also done after the catheter is removed, as the contrast medium is voided. |
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Intravenous pyelogram (IVP) and KUB (kidney, ureter, bladder) x-rays |
To evaluate the anatomy of urinary system structures. Can rule out ascites, organ enlargement, rupture, stone formation, and foreign bodies. |
KUB is a simple x-ray For IVP a contrast medium is injected. |
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Gynecologic Tests Pelvic examination |
Provides opportunity to assess general condition of vagina, cervix, vaginal secretions; obtain cultures, Pap test for cervical cancer; determines state and stage of pregnancy and progress of labor. |
Female client placed in lithotomy position; vaginal speculum inserted. Examiner visualizes structures, obtains samples of secretions for laboratory tests or biopsy, or performs procedures, such as conization or cervical biopsy |
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Mammography, xerography (xeroradiography) |
Allows radiographic examination of the breast to determine presence of cystitis/mastitis, breast tumors, or breast malignancy |
Client’s breasts are x-rayed or otherwise visualized from various angles. Breasts are compressed. Powder and deodorant should not be worn. |
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Miscellaneous Ultrasonography (US) |
Allows visualization of many deep body structures by recording the echoes of ultrasonic waves. Used to diagnose disorders of the thyroid, prostate, testicles, breast, gallbladder, kidney, and many other structures. Used to visualize fetus in pregnancy and to place or locate an IUD (intrauterine device) for fertility control. |
Bladder often full for abdominal and pregnancy examinations. Preparation depends on area of body to be studied. Uses a transducer-gel/cream applied to skin first—transducer moved about on the skin. |
Key Concept It is important to remember that the preparation for many diagnostic tests is done by the client at home. Be sure the client and family understand both the goals of the specific test and exactly what preparation is needed. It is vital to obtain the client’s cooperation or testing will not be accurate and diagnostic. Factors that may influence the client’s ability to perform an adequate preparation include stress and fear, improper specimen collection, physical and mental disabilities, and communication deficits.
