The nurse must remember at all times that the client and family are important members of the healthcare team.
Key Concept It is important for you as a nurse to realize that medical procedures and terminology are all foreign to the client. An endoscope is a long, slender, flexible tube with a fiberoptic scope (similar to a TV camera) on the end.
Endoscopy is also used for surgery and tests of internal areas of the body, via a tiny incision. If a growth or body tissue appears questionable, a biopsy is performed to determine the presence of cancer or other disorders. Many tests that do not require surgery can yield valuable diagnostic information about the status of the body’s internal organs and structures. A lumbar puncture (LP), also called a spinal tap, may be done to determine the status of the client’s nervous system.
An arteriogram is a procedure in which a catheter is inserted into a blood vessel in order to visualize a particular area via fiberoptics. In any procedure in which a dye or contrast medium is used, a skin test may be done first, to determine if the client is sensitive to that dye.
During, and for about one-half hour after the test, be alert for signs of anaphylaxis (an exaggerated and life-threatening allergic reaction).
Usually an anaphylactic reaction involves either respiratory or cardiovascular symptoms but not both. Ultrasound (very high frequency sound) is used to examine nearly every structure in the body.
When assisting with all tests and examinations, follow Standard Precautions to protect yourself, clients, and other healthcare staff.
Key Concept Remember that before and after any interaction with a client, including data collection, it is important to wash or sanitize your hands.
The nurse has a number of responsibilities before and during special diagnostic examinations.
The physical examination is a tool that healthcare providers use to distinguish between normal and abnormal body structure and function.
If a client complains of physical symptoms, the affected body area is examined for signs that might explain the symptoms. Key Concept Palpation is done only after inspection and auscultation, to prevent pockets of gas from moving in the intestines and being mistaken for normal bowel sounds. Because nurses collaborate with other healthcare professionals to provide care, each healthcare worker must report and record continuing assessments promptly so other providers may act as needed. As does the primary healthcare provider, nurses examine the client’s entire body regularly to determine changes or may focus on a particular body part when the client has a complaint.
Effective oral and written communication skills are essential to successfully interview the client and accurately document findings. Some reflexes can be observed because they occur spontaneously, such as automatic constriction of the pupil when a light is shined into the eye. A variation of this format is the focused physical examination, in which one body system is thoroughly examined because the client has a particular complaint or problem in that area. FIGURE 47-2 • Basic equipment and supplies used for physical examination and data gathering. Each examiner develops an examination method that is thorough but brief, accurate, and easy to use.
Guidelines for performing the head-to-toe data collection of an adult and special considerations for the child follow. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only.
Upload medical pictures, schematic representations or medical findings and share it with your colleagues. These topics are individualized and include areas such as nutritional or dietary concerns, observation of wounds after discharge, or demonstration of self-injection of insulin. The provider obtains a piece of tissue or a small amount of fluid and sends it to a laboratory, where it is examined microscopically. Tests such as the electrocardiogram (ECG or EKG) and the stress test help evaluate a client’s cardiovascular status. Lumbar puncture can determine intracranial pressure (within the head and spinal cord) and the presence of abnormal components, such as blood, pathogens, or pus in the cerebrospinal fluid, or it can be done to inject drugs or spinal anesthesia.
Ultrasonic waves are produced by a transducer, which creates “echoes.” These echoes are directed at body tissues and some are relayed back to the transducer, depending on their density. The primary purpose is to determine the client’s physical condition, and to identify potential or actual problems that can be prevented or treated.
For example, if the client complains of constipation and gas pains, the nurse will inspect and then auscultate (listen to) the abdomen in all four quadrants with a stethoscope.
Carefully documented data about physical findings portrays a picture of the client’s condition over time.


For example, the nurse may examine only the abdomen when the client complains of constipation.
Knowledge of the body’s normal structure and function (see Unit 4) is crucial, in order to understand the relevance of findings. Although the examiner’s own eyes, ears, hands, and nose may be the most important tools, the examiner also uses items such as the thermometer, stethoscope, sphygmomanometer, and tongue blade. A vaginal speculum and a nasal speculum are other instruments used for specialized examinations. It begins with a general appearance examination, then moves to the head, and proceeds to the neck, chest, breasts, abdomen, arms, legs, back, and perineum. For example, the client admitted to the Emergency Department complaining of chest pain and severe shortness of breath will have a focused cardiovascular and respiratory examination.
Endotracheal intubation may be accomplished through the mouth using an orotracheal tube, or through the nose using a nasotracheal tube.
Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content. The nurse has the responsibility to teach the client about every procedure and to answer questions before any procedure is done. Try to remember how you felt when you first heard medical language or observed medical and laboratory procedures. Part of these lessons will include putting medical terminology into phrases, examples, or language that is understood by the client.
The use of endoscopes can help determine a client’s digestive or respiratory structure and function.
A biopsy specimen may be obtained with an endoscope or needle or by making an incision through the skin. The positron emission tomography (PET) scan combines intravenous (IV) administration of radioactive isotopes and the E-CAT scan to image tissues and their functioning.
Many areas of the body are examined and treated using arteriography, particularly the heart and large blood vessels. Death can result very quickly (within 1-2 minutes) if the allergy is severe and it is not treated at once. The computer converts these echoes to a “picture,’ which is used to visualize structures in the body and to determine abnormalities. This means that the client has had a full explanation of the test, the reasons for the test, what to expect during the procedure, and possible adverse effects of the test before signing the permission form for the test. The nurse often transports the client to a designated area of the facility for special tests. A physician will look for abnormalities to establish a medical diagnosis, monitor a disease’s progression, or evaluate changes in the client’s condition. Because nurses assess physical, emotional, psychological, developmental, and spiritual aspects, their examination can help determine how a client’s physical condition affects overall health and functioning. The nurse will also lightly palpate the abdomen to determine physical clues about the source of the pain. Objectivity ensures that all examiners approach the physical examination without previously set expectations.
For example, the client is asked to perform a number of activities to test the function of the cranial nerves (see In Practice: Data Gathering in Nursing 47-1).
Primary care providers may also use some type of device to test the tactile senses of sharp, soft, hot, or cold and use substances to test smell and taste. As the examiner moves to each area, the focus is not only on the structures, but also on the functions of these body areas. The primary healthcare provider is expected to interpret the findings, based on data collected by all members of the team. You may be asked to choose the best response that addresses the client’s needs for instruction. Specially trained providers examine areas such as the esophagus (esophagoscopy), stomach (gastroscopy), large intestine (colonoscopy), or rectum (sigmoidoscopy). However, some of these procedures require a very small incision (called a “stab wound”) or the injection of dye (contrast media). This procedure is often used to place a stent (a device that expands and keeps a vessel open), to perform angioplasty (a procedure to enlarge the lumen of a blood vessel), place tubes or filters, embolize tumors (introduction of a substance to occlude a vessel or obstruct a tumor), or drain an abscess.
Ultrasonography is particularly useful in obstetrics, to visualize the fetus, and to determine size and a multiple pregnancy. Clients who know what to expect are likely to be less apprehensive and more relaxed during the examination. It is the nurse’s responsibility to make sure that the client’s record is up to date before the test; sometimes, a special checklist is used. The physician’s examination may be extensive and thorough, or it may focus on a particular body area. This information lays the groundwork for nursing diagnosis and then for developing a nursing care plan to meet client needs.


The head-to-toe method flows smoothly and provides the examiner with a mental road map of directions to follow while conducting the examination. As the nurse’s expertise and knowledge grow, an understanding of the meaning of these findings will also develop.
This will help the client to be more comfortable and will improve the accuracy of the test or procedure. It is used to diagnose tumors in many areas of the body, including heart and blood vessels, abdominopelvic organs, and eyes.
The nurse assists the client to dress properly (usually in a hospital gown) and assures that the client either voids or does not void before the test, as ordered. A physical therapist will examine the client’s functional abilities and ability to move, to develop a therapy plan and monitor the client’s progress. Some healthcare agencies require all nurses to use the same method of data collection and provide documentation data sheets or electronic pages for recording these findings.
Once the cuff is inflated there is no flow of air through the trachea other than that going through the endotracheal tube. In some cases, frequent vital sign monitoring and other special nursing care is required after the test. Care should be taken not to overinflate the cuff.Passage of an endotracheal tube during surgery is a well-established and long-used technique. In recent years the procedure has become a part of medical management of ventilatory failure as an alternative to tracheotomy. Tube placement is verified by watching the tube pass through the vocal cords, listening to the lungs and stomach, and checking it radiographically within one hour of placement. Adjunct techniques such as capnometry and pulse oximetry can also be used to verify placement. Endotracheal intubation has the advantages of not requiring a surgical procedure as does tracheotomy, of removal of the tube (extubation) being less involved, and of the procedure being able to be repeated as necessary.The endotracheal tube cannot be used for long-term relief of ventilatory failure. Pulmonary infections may result from interference with the normal protective mechanisms of the glottis and from the introduction of pathogenic organisms into the respiratory tract and difficulty in their removal by coughing. Secure anchoring of the tube and apparatus is necessary to prevent tension on or misplacement of the tube. The patient will require mouth care and frequent observation for signs of pressure against the lips and nose. Since a patient with an endotracheal tube in place cannot talk, means must be arranged to assist with communication. During an emergency, medications that can be administered through the endotracheal tube include epinephrine, atropine, and lidocaine.Suctioning an endotracheal tube. At the other end are two tails, one used to collect gastric specimens and the other to collect specimens from the duodenum. It can be used as the only source of nutrition or as a supplement to oral feeding or parenteral nutrition.Patients who may require tube feeding include those unable to take in an adequate supply of nutrients by mouth because of the side effects of chemotherapy or radiation therapy, those with depression or some other psychiatric disorder, and those suffering from severe hypermetabolic states such as burns or sepsis, or malabsorption syndromes.
Other conditions that may require tube feeding include surgery or trauma to the oropharynx, esophageal fistula, and impaired swallowing such as that which occurs following stroke or that related to neuromuscular paralysis.There are commercially prepared formulas for tube feeding.
Some contain all six necessary nutrients (carbohydrates, fats, proteins, vitamins, minerals, and trace elements) and need no supplement as long as they are given in sufficient volume to meet nutritional and caloric needs.
Other types of tube feeding formulas are incomplete and therefore will require some supplementation. Choice of formula is based on the patient's particular needs, presence of organ failure or metabolic aberration, lactose tolerance, gastrointestinal function, and how and where the feeding is to be given, that is, via nasogastric, gastrostomy, or enterostomy tube.Patient Care.
In addition to frequent and periodic checking for tube placement and monitoring of gastric residuals to prevent aspiration, other maintenance activities include monitoring effectiveness of the feeding and assessing the patient's tolerance to the tube and the feeding.
See also biliary drainage test.Salem sump tube a double-lumen nasogastric tube used for suction and irrigation of the stomach. One lumen is attached to suction for the drainage of gastric contents and the second lumen is an air vent. A T-tube cholangiogram is usually performed prior to removal of the tube in order to determine that the common duct is patent and free of stones. Polyethylene tubes are inserted surgically into the eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent middle ear infections.
Synonym(s): intratracheal tube, tracheal tubeendotracheal tube a large-bore catheter inserted through the mouth or nose and into the trachea to a point above the bifurcation of the trachea. It is used for delivering oxygen under pressure when ventilation must be totally controlled and in general anesthetic procedures.



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