Special Procedures NUR1020

Aspiration Procedure

A procedure where you insert a needle into someone's body, organ, or cavity, to remove tissue and/or fluid for sampling.

Biopsy

The removal and examination of tissue to determine diagnosis

Liver Biopsy

A procedure where a sample of liver tissue is removed through needle aspiration and examined to determine the presence of liver disease.

Where is the liver sample taken from during a biopsy?

A needle is inserted in the intercostal space between two of the right lower ribs, near the bottom of the rib cage, and a sample of liver tissue is drawn.

What is a risk involved when you take a sample of the liver?

Liver disease may be associated with some blood clotting deficiencies; you should make sure that you check pt (prothrombin time) and platelet count before administering blood thinners

Does a patient need to be NPO before a liver biopsy? If so, for how long?

Yes. The patient must be NPO for 2 hours before the examination.

What position does the patient have to be in during a liver biopsy?

Supine position, with the right hand behind the head.

To avoid injury during a liver biopsy, the patient must:

be immobilized and hold their breath

movement and breathing during the procedure puts your lungs at risk as the needle can move and puncture them

What position does the patient maintain AFTER a liver biopsy?

Lying on their right side to apply pressure to prevent bleeding

How often do you check vital signs after a liver biopsy?

First, 15 minutes for the first hour

Then, 30 minutes for the next two hours

Finally, every 4 hours until your patient is stable.

What are three complications of liver biopsy?

hemorrhage: bleeding

pneumothorax: lungs are punctured, then collapse due to the collection of air in the pleural space that leaks in.

peritonitis: inflammation of the peritoneum, the thin layer of the tissues of the abdomen

why would you do a lumbar puncture, a.k.a. spinal tap?

to obtain a specimen of the cerebral vascular cerebrospinal fluid (CSF) for analysis and culture

to relieve pressure

to inject drugs into the spinal cord

to inject dyes for some extreme stuff

Where is a needle inserted for a lumbar puncture?

In the subarachnoid space, between the 3rd and the 4th lumbar vertebrae.

What are the risks of lumbar puncture?

you can have CSF leakage. this can lead to low CSF, which can cause the brain to shift, or introduce bacteria to the CSF and cause an infection.

brain herniation may also happen due to a sudden decrease in pressure in the spinal cord caused by removal of CSF.

What two positions can a patient be in during a lumbar puncture?

fetal position (also known as sims')

or,

sitting at the edge of the bed and leaning on the bedside table

the important part is that the spine is stretched for easy access

What position is the patient AFTER a lumbar puncture?

Recumbent position

Does a patient need to be NPO before a lumbar puncture? If so, for how long?

Yes; for at least 3 hours

paracentesis

withdrawal of fluid from the peritoneal area (found in the abdominal area)

What are three reasons why you would do a paracentesis procedure?

1) to diagnose/determine if there are malignant cells in the fluid

2) to diagnose trauma/determine if blood is present in the abdominal and the peritoneal cavity

3) to withdraw fluids to therapeutically relieve symptoms caused by ascites

What are ascites?

the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.

What are the risks of paracentesis? What can the patient to mitigate these risks?

you can puncture the bowel or the bladder., to mitigate the risk of this, the patient must void and defecate before the exam.

How is the patient positioned during paracentesis?

the patient is positioned so that the fluid flows into a container. the needle is covered in plastic, drains fluid, and leads to a bottle positioned lower than the patient's body.

What are three things you need to monitor the patient for after paracentesis?

electrolyte imbalance, bleeding, and peritonitis

thoracentesis

surgical puncture to remove fluid from the pleural cavity (found in the chest)

What position is the patient in during thoracentesis?

Sitting up with their arms resting on an over-bed table. This position helps to spread out the spaces between the ribs, where the needle is inserted.

Supine position may used for patient's comfort if they are unable to sit up (making sure to lie on their unaffected side).

Malignant pleural effusion

an accumulation of fluid in the pleural cavity as a result of cancer, trauma, infection, etc.

visceral pleural

attaches to the lung (inner layer)

Parietal pleural

attaches to the wall of the lungs of the chest (outer layer)

What are two reasons for doing a thoracentesis procedure?

to obtain fluid for analysis

to ease respiratory effort for the person to breathe

What is a risk of thoracentesis?

You can puncture the lungs. this is why the patient must not cough or breathe too deeply during the procedure.

What are the signs of a punctured lung?

1) respiratory distress.

2) increased pulse rate because now your sympathetic nervous system is reacting to it.

3) decreased breathing sounds

4) restlessness

5) anxiety

6) fever

What do you observe for after a thoracentesis?

observe respiratory rates

EKG (or ECG)

electrocardiogram; electrical activity in the heart

EEG

electroencephalogram; electrical activity in the brain

What are some simple things you can explain to the patient before an EKG?

-explain the procedure itself: electrodes will be attached to them

-they shouldn't move around too much

-there will be no hurt or discomfort

-electricity will not be transferred to the body

Endoscopic procedures

Medical assessment of body cavities and organs using a fiber optic instrument (endoscope) to gain a direct visualization

Bronchoscopy

examination of the bronchi and trachea using a bronchoscope

Gastroscopy

examination of the stomach, esophagus, and duodenum with an endoscope

Protosigmoidoscopy

visual examination of the rectum, the rectosigmoid junction, and the sigmoid colon

Colonoscopy

visual examination of the colon

Cystoscopy, a.k.a Cystourethroscopy

examination of the urethra, bladder, and ureters

cystoscope is inserted through the urethra

pt will undergo general anesthesia or local anesthesia with sedation

what are your nursing responsibilities during endoscopic procedures?

explain to your patient, use laymen's terms

make sure that the consent has been obtained and signed

prepare your patient, which can include dietary restriction as in making them NPO or bowel prep like laxatives or enemas

what are some things you may monitor after an endoscopic procedure?

monitor vital signs and compare to baseline

Observe for signs of hemorrhage and peritonitis

observe for perforation

what are some things you may assess for after a bronchoscopy procedure?

observe your patient for hypoxemia

assess them for pneumothorax and laryngospasms.

Bronchospasms, bleeding from wherever, aspiration, and infection

radiologic procedures (simple things it does)

done to determine the size, the shape, the functions of some organs, the characteristics of bones, the density of masses

can be done with or without contrast

radiologic procedures (more complex definition)

•Xray imaging using a radiopaque substance such as barium either swallowed or given rectally

•Abnormal findings include tumors, diverticula, obstructions

What kind of bowel prep must be done for a radiologic procedure?

bowel should be completely emptied through the use of laxatives and/or enemas

What are two different types of contrast that may be used for a radiological procedure?

barium and iodine

methods of inserting contrast can be instilled or infused.

instilled would be like doing a barium enema. infused would be IV infusion. (tbh, i'm not solid on that, but i'm like Pretty Sure)

What allergies do you need to check for before using iodine on a patient?

iodine or shellfish

Why should a patient eliminate barium after a radiologic procedure?

to avoid hardening and potential for impaction

What does black stool indicate?

upper GI bleed

the stool is black because it will be digested by the enzymes by the time you get it out

What does red stool indicate?

lower GI bleed or hemorrhoids

What does white, speckled stool indicate?

recent barium enema. stool stays this color for a few days after the procedure

cholectystogram

visualization of the gallbladder

Does a patient need to be NPO before a cholecystogram? If so, for how long?

Yes, usually the night before.

How is the gallbladder made visual during a cholecystogram?

iodine contrast that they drink orally, and that will concentrate in the gallbladder and allow doctor to be able to see it

IVP (intravenous pyelogram)

visualization of the kidneys' ability to excrete urine, the visualization of collection ducts, ureters, bladder, urethra, just the entire urinary system

Does a patient need to be NPO before an IVP? If so, for how long?

Yes, the night before (after midnight)

What prep is needed to do an IVP?

Bowel prep (free of feces)

IV PUSH bolus of iodine

ERCP (endoscopic retrograde cholangiopancreatography)

visualization of the pancreatic ducts, the liver, and the biliary tree by means of endoscopy into the duodenum

Does a patient need to be NPO before an ECRP? Do they need to be sedated?

Yes and yes

If you are doing multiple different tests, when would you schedule one that uses contrast medium?

procedures using contrast medium should be scheduled LAST

ultrasound

noninvasive; uses sound waves to image an organ and bounces back according to density of an organ

What are some different places that ultrasound imaging can be done?

Done outside the skin or transvaginally, transrectally, or transesophageal

CT scan (computed tomography)

using computer-controlled X-rays that scan different part of the body from different angles. Through the CT, you can calculate densities of tissues.

The CT can be done plain or...

with contrast

What position must the patient be in during a CT scan?

Lying flat with no movement

MRI (magnetic resonance imaging)

a technique that uses magnetic fields and radio waves to produce computer-generated images of soft tissue

What is a closed MRI?

MRI where patient is enclosed in a circular magnetic tunnel

What is an open MRI?

Instead of an enclosed capsule, the open MRI uses a magnet top and bottom and is open on all four sides

What are some contraindications for MRI?

pacemakers

metal pieces in eye

aneurysm clips

ear implants

metal prosthetics

basically NOTHING METAL OR YOU DIE

note: tattoos are not ALWAYS a contraindication, but they can become irritated during an MRI and some tattoo inks contain trace amounts of metal

MRIs specifically measure what kind of atoms?

hydrogen atoms

nuclear medicine studies

Nuclear medicine detect differences in the concentration of radioactive materials in normal and abnormal tissue.

Uses radioisotopes to visualize anatomy and function. (e.g. PET scan, thyroid scan, bone scan)