Fecal occult blood test is also known as stool occult blood test, hemoccult test, guiaic smear test, gFOBT, or occult blood test. Fecal occult blood is detected by microscopic analysis or by chemical tests for hemoglobin, such as the guiaic test. Normally, stools contain small amounts of blood (2-2.5 mL/day); therefore, test for occult blood detect quantities larger than this. Testing is indicated when clinical symptoms and preliminary blood studies suggest GI bleeding. Additional tests are required to pinpoint the origin of the bleeding.

Purpose

• To detect gastro intestinal bleeding.
• To aid in the early diagnosis of colorectal cancer.

Procedure

Preparation

1. Explain the patient that this test detects abnormal GI bleeding.
2. Instruct the patient to maintain a high-fiber diet and to refrain from eating red meats, turnips, and horseradish for 48 to 72 hours before the test as well as throughout the collection period.
3. Tell the patient that the test usually requires three fecal specimens but that sometimes only one sample is needed.
4. Instruct the patient to avoid contaminating the fecal specimen with toilet tissue or urine.
5. Notify the laboratory and physician of drugs the patient is taking that may affect test results; it may be necessary to restrict them. If the patient must continue using this drugs, note this on the laboratory request.

Implementation

1. Collect three fecal specimens or a random fecal specimen.
2. Obtain specimens from two different areas of each fecal specimen.

Hematest

1. Use a wooden applicator to smear a bit of the fecal specimen on the filter paper supplied with the kit. Or, after performing a digital rectal examination, wipe the finger you used for the examination on a square of the filter paper. Place the filter paper with the fecal smear on a glass plate.
2. Remove a reagent tablet from the bottle and immediately replace the cap tightly. Place the tablet in the center of the fecal smear on the filter paper. Add 1 drop of water to the tablet, and allow it to soak in for 5 to 10 seconds. Add a second drop, letting it run from the tablet onto the specimen and filter paper.
3. After 2 minutes, the filter paper will turn blue if the test result is positive. Don’t read the color that appears on the tablet itself or develops on the filter paper after the 2-minute period. Note the results and discard the filter paper. Remove and discard your gloves and wash your hands thoroughly.

Hematocrit test

1. Open the flap on the side pack and use a wooden applicator to apply a thin smear of the fecal specimen to the guiaic-impregnated filter paper exposed in a box. Apply a second smear from another part of the specimen to the filter paper exposed in box B.
2. Let the specimen dry for 3 to 5 minutes. Open the flap at the near of the slide package and place 2 drops of hematocrit developing solution on the paper over each smear. A positive result yields a blue reaction in 30 to 60 seconds. Record the results and discard the slide package. Remove and discard your gloves and wash your hands thoroughly.

Instant-View Fecal Occult Blood Test

1. Add a fecal sample to the collection tube. Shake it to mix the sample with the extraction buffer, and then dispose 4 drops into the sample well of the cassette.
2. Results will appear on the test region and the control region of the cassette in 5 to 10 minutes, indicating whether the hemoglobin level is > 0.05 pg/ml of feces.

Nursing Interventions

1. Send the specimen to the laboratory or perform the test immediately, depending on which test is used.
2. Inform the patient that he may resume his usual diet and medications as ordered.
3. Single digital office-based test may not be as accurate as serial home collected test.

Interpretations

Normal Results

• Less than 2.5 ml of blood in feces, resulting in a green reaction.

Abnormal Results

• GI bleeding, this may result from many disorders, such as varices, a peptic ulcer, carcinoma, ulcerative colitis, dysentery, hemorrhagic disease.

Interfering Factors

• Failure to observe pretest reactions.
• Failure to test the specimen immediately or to send it to the laboratory immediately after collection.
• Bromides, colchicines, indomethacin, iron preparation, phenylbutazone, rauwolfia derivatives, and steroids (possible increase from GI blood loss).
• Ascorbic acid (false-negative, even with significant bleeding).
• Ingestion of 2 to 5 ml of blood (for example, from bleeding gums).
• Active bleeding from hemorrhoids (possible false-positive results).

Related posts:

1. Alpha-fetoprotein Blood Test
2. Blood Urea Nitrogen (BUN)
3. Arterial Blood Gas Analysis

Electromyography (EMG) is the recording of electrical activity of selected skeletal muscle groups at rest and during voluntary contraction. In this test, a needle electrode is inserted percutaneously into a muscle. The muscle’s electrical discharge (or motor unit potential) is then measured and displayed on an oscilloscope screen.

Purpose

• To aid in differentiating between primary muscle disorders, such as the muscular dystrophies, and secondary disorders.
• To help assess diseases characterized by central neuronal degeneration such as ALS.
• To help diagnose neuromascular disorders such as myasthenia gravis.
• To help diagnose radiculopathies.

Procedure

Preparation

1. Make sure the patient has signed an appropriate consent form.
2. Note and report all allergies.
3. Check for and note drugs that may interfere with test results such as cholinergics, anticholinergics, anticoagulants, and skeletal muscle relaxants.
4. Tell the patient he need not restrict food and fluids before the test but that it may be necessary to restrict cigarettes, coffee, tea, and cola for 2 to 3 hours beforehand.
5. Warn the patient that he might experience some discomfort as a needle is inserted into selected muscles.
6. Explain that the test takes at least 1 hour.

Implementation

1. The patient is positioned in a way that relaxes the muscle to be rested.
2. Needle electrodes are quickly inserted into the selected muscle.
3. A metal plate lies under the patient to serve as a reference electrode.
4. The resulting electrical signal is recorded during rest and contraction, amplified 1 million times, and displayed on an oscilloscope or computer screen.
5. Lead wires are usually attached to an audio-amplifier so that voltage fluctuations within the muscle are audible.

Nursing Interventions

1. Assess the patient’s pain level. If the patient experiences residual pain, apply warm compresses and administer prescribed analgesics.
2. Tell the patient that he may resume his usual medications as ordered.
3. Monitor the patient for signs and symptoms of infection at the needle electrode sites.

Interpretation

Normal Results

1. At rest, muscle exhibits minimal electrical activity.
2. During voluntary contraction, electrical activity increased markedly.
3. A sustained contraction, or one of increasing strength, produces a rapid “train” of motor unit potentials.

Abnormal Results

1. Short (low-amplitute) motor unit potentials, with frequent, irregular discharges suggest possible primary muscle disease such as muscular dystrophies.
2. Isolated and irregular motor unit potentials with increased amplitude and duration suggest possible disorders such as ALS and peripheral nerve disorders.
3. Initially normal motor unit potentials that progressively diminish in amplitude with continuing contractions suggest possible myasthenia gravis.

Interfering Factors

• The patient’s inability to comply with instructions.
• Drugs affecting myoneural junctions, such as anticholinergics, cholinergics, and skeletal muscle relaxants.

Precaution

• EMG is contraindicated in the patient with a blessing disorder.

Complications

• Infection at the insertion site.

Related posts:

1. Bone Marrow Aspiration and Biopsy
2. Arthrography
3. ADMINISTERING AN INTRADERMAL INJECTION

The fasting plasma glucose (or fasting blood sugar) test is used to measure plasma glucose levels after a fast of at least 8 hours. This test is commonly used to screen for diabetes mellitus and prediabetes, in which absence of deficiency of insulin allows persistently high glucose levels.

Purpose

• To screen for diabetes mellitus and prediabetes.
• To monitor drug or diet therapy in the patient with diabetes mellitus.
• To monitor for hyperglycemia and hypoglycemia.

Fasting Plasma Glucose Procedure

Preparation

1. Explain to the patient that this test detects disorders of glucose metabolism and aids in the diagnosis of diabetes.
2. Tell the patient that the test requires a blood sample. Explain who will perform the venipuncture and when.
3. Explain to the patient that he may experience slight discomfort from the tourniquet and needle puncture.
4. Instruct the patient to fast for 12 to 14 hours before the test.
5. Notify the laboratory and physician of medications the patient is taking that may affect test results; it may be necessary to restrict them.
6. Alert the patient to the symptoms of hypoglycemia such as weakness, restlessness, nervousness, hunger, and sweating and tell him to report such symptoms immediately.

Implementation

1. Perform a venipucture and collect the sample in a 5-ml clot-activator tube.
2. Send the sample to the laboratory immediately.
3. Note on the laboratory results when the patient last ate, when the sample was collected, and when the patient received the last pretest dose of insulin or oral antidiabetic drug (if applicable).

Nursing Interventions

1. Apply direct pressure to the venipucture site until bleeding stops.
2. Provide a balanced meal or a snack.
3. Instruct the patient that he may resume his usual medications that were stopped before the test.

Interpretation

Normal Results

• Results vary according to the laboratory procedure.
• After at least an 8-hour fast, 70 to 100 mg of true glucose per deciliter of blood (SI, 3.9 to 5.6 mmol/L).

Abnormal Results

Elevated Levels

• Diabetes mellitus (fasting plasma glucose levels of 126 mg/dL {SI, 7 mmol/L} or more obtained on two or more occasions).
• Impaired fasting glucose or impaired glucose tolerance (levels ranging from 110-125 mg/dL).
• Pancreatitis, recent acute illness (such as myocardial infarction), Cushing’s syndrome, acromegaly, and pheochromocytoma.
• Acute stress
• Hyperthyroidism
• Pancreatic cancer
• Hyperlipoproteinemia

Interfering Factors

1. Recent illness, infection,, or pregnancy (possible increase).
2. Glycolisis resulting from failure to refrigerate the sample or to send it to the laboratory immediately (possible false negative).
3. Acetaminophen, if using the glucose oxidase or hexokinase method (possible false positive).
4. Arginine, benzodiazepines, chlorthalidone, corticosteroids, and dextrothyroxine may cause an increase.
5. Ethacrynic acid may cause hyperglycemia; large doses in patients with uremia can cause hypoglycemia.
6. Alcohol, beta-adrenergic blockers, insulin, monoamine oxidase inhibitors, and oral antidiabetic agents (possible decrease).
7. Stenous exercise (decrease)
8. Drug interactions: numerous medications may alter blood glucose levels.

Complications

• Hematoma at the venipuncture site.

Related posts:

1. Serum Creatinine
2. Nursing Care Plan – Diabetes Mellitus Type 2
3. Nursing Care Plan – Diabetes Mellitus Type 1

Doppler ultrasonography evaluates blood flow in the major blood vessels of the arms and legs and in the extracranial cerebrovascular system. A handheld transducer directs high- frequency sound waves to the artery or vein being tested. The sound wave strike moving red blood cells and are reflected back to the transducer at frequencies that corresponds to blood flow velocity through the vessel. The transducer then amplifies the sound waves to permit direct listening and graphic recording of blood flow. Measurement of systolic pressure helps detect the presence, location, and extent of peripheral arterial occlusive disease.

Pulse volume recorder testing may be performed along with Doppler ultrasonography to yield a quantitative recording of changes in blood volume or flow in extremity or organ.

Purpose of Doppler Ultrasonography

• To help diagnose venous insufficiency and superficial and deep vein thrombosis (popliteal, femoral, and iliac).
• To help diagnose peripheral artery disease and arterial occlusion.
• To monitor the patient who has had arterial reconstruction and bypass grafts.
• To detect abnormalities of carotid artery blood flow associated with such conditions as aortic stenosis.
• To evaluate possible arterial trauma.

Doppler Ultrasonography Procedure

Patient Preparation

1. Explain to the patient that Doppler ultrasonography is used to evaluate blood flow in the arms and legs or neck. Tell him who will perform the test and when.
2. Reassure the patient that the test doesn’t involve risk or discomfort.
3. Inform the patient that he’ll be asked to move his arms to different positions and to perform breathing exercises as measurements are taken.
4. Advise him that a small ultrasonic probe resembling a microphone is placed at various sites along veins or arteries, and blood pressure is checked at several sites.
5. Check with the vascular laboratory about special equipment or instructions.

Implementation

1. Doppler ultrasonography is performed bilaterally.
2. The patient is assisted into the supine position on the examination table with his arms at his sides.

Peripheral arterial evaluation

1. For peripheral arterial evaluation in the leg, the usual test sites are the common and superficial femoral, popliteal, posterior tibial, and dorsalis pedis arteries.
2. For peripheral arterial evaluation in the arm, the usual test sites are the subclavian, brachial, radial, and ulnar arteries.
3. Brachial blood pressure is measured, and the transducer is placed at various points along the test arteries.
4. The signals are monitored, and the waveforms are recorded for later analysis.
5. The blood flow velocity is monitored and recorded over the test artery.
6. Segmental limb blood pressures are obtained to localize arterial occlusive disease.

Peripheral venous evaluation

1. For peripheral venous evaluation in the leg, the usual test sites are the popliteal, superficial and common femoral veins, and posterior tibial vein.
2. For extracranial cerebrovascular evaluation, usual test sites are the supraorbital artery; the common, external, and internal carotid a arteries; the vertebral arteries; and the brachial, axillary, subclavian, and jugular veins.
3. The transducer is placed over the appropriate vessel, waveforms are recorded, and respiratory modulations are noted.
4. Proximal limb compression maneuvers are performed.
5. Augmentation after release of compression is noted to evaluate venous valve competency.
6. For test involving the legs and feet, the patient is asked to perform Valsalva’s maneuver, and venous blood flow is recorded.

Nursing Interventions

1. Remove the conductive gel from the patient’s skin.
2. Assist the patient to a comfortable position.

Interfering Factors

• Unknown

Precautions

• Bradyarrhythmias may occur if the probe is placed near the carotid sinus.
• Make sure that the Doppler probe isn’t placed over an open or draining lesion.

Related posts:

1. Arterial Blood Gas Analysis
2. Cardiac Catheterization
3. Techniques to Stop Severe Bleeding

A quantitative analysis of serum creatinine levels, the serum creatinine test provides a more sensitive measure of renal damage than do blood urea nitrogen levels because renal impairment is virtually the only cause of creatinine elevation.

Creatinine is a non-protein end product of creatinine metabolism that appears in serum in amount proportional to the body’s muscle mass.

Purpose of Serum Creatinine Test

• To assess glomerular filtration.
• To screen for renal damage.

Serum Creatinine Test Procedure

Patient Preparation

1. Confirm the patient’s identity using two patient identifiers according to facility policy.
2. Explain to the patient that the serum creatinine test is used to evaluate kidney function.
3. Tell the patient that the test requires a blood sample.
4. Explain to the patient that he may experience slight discomfort from the tourniquet and the needle puncture.
5. Instruct the patient that he doesn’t need to restrict food and fluids.
6. Notify the laboratory and the practitioner of medications the patient is taking that may affect test results; they may need to be restricted.

Implementation

1. Perform a venipuncture and collect the sample in a 3 or 4 ml clot activator tube.
2. Handle the sample gently to prevent hemolysis.
3. Send the sample to the laboratory immediately.

Nursing Interventions

1. Send the sample to the laboratory immediately.
2. Apply direct pressure to the venipuncture site until bleeding stops.
3. Assess the venipuncture site for hematoma formation; if one develops, apply pressure.
4. Inform the patient that he may resume his usual medications that were discontinued before the test, as ordered.

Interpretation

Normal Results

• In men, 0.8 to 1.2 mg/dl (SI, 62 to 115 pmol/L)
• In women, 0.6 to 0.9 mg/dl (SI, 53 to 97 pmil/L)

Abnormal Results

• Elevated levels generally indicate renal disease that has seriously damaged 50% or more of the nephrons.
• Elevated levels may also indicate gigantism and acromegaly.

Interfering Factors

• Ascorbic acid, barbiturates, and diuretics that may possibly increase.
• Exceptionally large muscle mass, such as found in athletes that may possibly increase despite normal renal function.
• Phenolsulfonphthalein given within the previous 24 hours (possible increase, if the test is based on Jaffe’s reaction.

Complications

• Hematoma to the puncture site.

Related posts:

1. Blood Urea Nitrogen (BUN)
2. Fasting Plasma Glucose
3. Alpha-fetoprotein Blood Test

Electrocardiography is the most commonly used test for evaluating cardiac status, graphically records the electrical current (electrical potential) generated by the heart. This current radiates from the heart in all directions and, on reaching the skin, is measured by electrodes connected to an amplier and strip chart recorder. The standard resting ECG uses five electrodes to measure the electrical potential from 12 different leads; the standard limb leads (I,II,III), the augmented limb leads (aVf, aVL, and aVr), and the precordial, or chest, leads (V1 through V6).

ECG tracings normally consist of three identifiable waveforms: the P wave, the QRS complex, and the T wave. The P wave depicts atrial depolarization; the QRS complex, ventricular depolarization; and the T wave, ventricular repolarization.

Computerized ECG machines use small electrode tabs that peel off a sheet and adhere to the patient’s skin. The entire ECG tracing is displayed on a screen so abnormalities can be corrected before printing; then it’s printed on one sheet of paper. Electrode tabs can remain on the patient’s chest, arms, and legs to provide continuous lead placement for serial ECG studies.

Purpose of Electrocardiography (ECG)

• To help identify primary conduction abnormalities, cardiac arrhythmias, cardiac hypertrophy, pericarditis, electrolyte imbalances, myocardial ischemia, and the site and extent of myocardial infarction.
• To monitor recovery from an MI.
• To evaluate the effectiveness of cardiac medication.
• To assess pacemaker performance
• To determine effectiveness of thrombolytic therapy and the resolution of ST-segment depression or elevation and T-wave changes.

Electrocardiography (ECG) Procedure

Patient Preparation for Electrocardiography (ECG)

1. Explain to the patient the need to lie still, relax, and breathe normally during the procedure.
2. Note current cardiac drug therapy on the test request form as well as any other pertinent clinical information, such as chest pain or pacemaker.
3. Explain that the test is painless and takes 5 to 10 minutes.

Implementation

1. Place the patient in a supine or semi-Fowler’s position.
2. Expose the chest, ankles, and wrists.
3. Place electrodes on the inner aspect of the wrists, on the medical aspect of the lower legs, and on the chest.
4. After all electrodes are in place, connect the lead wires.
5. Press the START button and input any required information.
6. Make sure that all leads are represented in the tracing. If not, determine which electrode has come loose, reattach it, and restart the tracing.
7. All recording and other nearby electrical equipment should be properly grounded.
8. Make sure that the electrodes are firmly attached.

Nursing Interventions

1. Disconnect the equipment, remove the electrodes, and remove the gel with a moist cloth towel.
2. If the patient is having recurrent chest pain or if serial ECG’s are ordered, leave the electrode patches in place.

Interpretations

Normal Results

1. P wave that doesn’t exceed 2.5 mm (0.25 mV) in height or last longer than 0.12 second.
2. PR interval (includes the P wave plus the PR segment) persisting for 0.12 to 0.2 second for heart rates above 60 beats/min.
3. QT interval that varies with the heart rate and lasts 0.4 to 0.52 second for heart rates above 60 beats/min.
4. Voltage of the R wave leads V1 through V6 that doesn’t exceed 27 mm.
5. Total QRS complex lasting 0.06 to 0.1 second.

Abnormal Results

1. Myocardial infarction (MI), right or left ventricular hypertrophy, arrhythmias, right or left bundle-branch block, ischemia, conduction defects or pericarditis, and electrolyte abnormalities.
2. Abnormal wave forms during angina episodes or during exercise.

Precautions

• The recording equipment and other nearby electrical equipment should be properly grounded to prevent electrical interference.
• Double-check color codes and lead markings to be sure connectors march.
• Make sure that the electrodes are firmly attached, and reattached them if loose skin contact is suspended. Don’t use cables that are broken, frayed, or bare.

Interfering Factors

• Improper lead placement.

Complications

• Skin sensitivity to the electrodes.

Related posts:

1. Cardiac Catheterization
2. Myocardial Infarction
3. Pathophysiology of Myocardial Infarction

Successful examinees of the July 2010 Nursing Board Exam should personally register and sign in the Roster of Registered Professionals at the PRC Central or Regional Office where he/she filed his/her application.

Those who will register are required to bring the following:

1. Duly accomplished Oath Form or Panunumpa ng Propesyonal
2. Current Community Tax Certificate (cedula)
3. 2 pieces passport size picture (colored with white background and complete name tag)
4. 1 piece 1” x 1” picture (colored with white background and complete name tag)
5. 2 sets of metered documentary stamps, and 1 short brown envelope with name and profession
6. Initial Registration Fee of P600 and Annual Registration Fee of P450 for 2010-2013.

Manila and Pampanga Passers ONLY

Related posts:

1. PRC Initial Registration Schedule for Cebu Passers
2. Registration Schedule for November 2008 Nursing Board Exam Passers (Manila Only)
3. Registration Schedule for November 2008 Nursing Board Exam Passers (Cebu Only)

Cerebrospinal fluid is a clear substance that circulates in the subarachnoid space, protects the brain and spinal cord from injury and transports products of neurosecretion, cellular biosynthesis, and cellular metabolism through the Central Nervous System.

For qualitative analysis, CSF is obtained most commonly by lumbar puncture (usually between the third and fourth lumbar vertebrae) and, rarely by cisternal or ventricular puncture. A CSF specimen may also be obtained during other neurologic tests such as myelography.

Purpose of Cerebrospinal Fluid Analysis

• To measure cerebrospinal fluid (CSF) pressure as an aid in detecting an obstruction of CSF circulation.
• To aid in the diagnosis of viral or bacterial meningitis, subarachnoid or intracranial hemorrhage, tumors, and brain abscesses.
• To aid in the diagnosis of neurosyphilis and chronic central nervous system infections.
• To check for alzheimer’s disease.

Cerebrospinal Fluid Analysis Procedure

Patient Preparation

1. Tell the patient that this test usually takes at least 15 minutes.
2. Inform him that a headache is the most common adverse effect of lumbar puncture, but reassure him that his cooperation during the test helps minimize the reaction.
3. Make sure that the patient or a responsible family member has signed an informed consent form.
4. If the patient is unusually anxious, assess and report his vital signs.

Implementation

1. If the patient is positioned on his side, provide pillows to support the spine on a horizontal plane. This position allows full flexion of the spine and easy access to the lumbar subarachnoid space.
2. Help him maintain his position by placing one arm around his knees and the other arm around his neck.
3. If the sitting position is used, help the patient maintain this position throughout the procedure.
4. After the skin is prepared for injection, the area is draped.
5. The anesthetic is injected, and the spinal needle is inserted in the midline between the spinous vertebral process, usually between the third and fourth lumbar vertebrae.
6. When the stylet is removed from the needle, CSF drips from it if the needle is properly positioned.
7. A stopcock and manometer are attached to the needle to measure initial (opening) CSF pressure.
8. After the specimen is collected, label the containers in the order in which they were filled and record the doctor’s specific instruction for the laboratory.
9. A final pressure reading is taken, and the needle is removed.
10. Clean the puncture site with local antiseptic, such as providone-iodine solution, and apply a small adhesive bandage.
11. Send the form and labeled specimens to the laboratory immediately.

Nursing Interventions

1. Check whether the patient must lie flat or if the head of his bed may be slightly elevated.
2. Encourage the patient to drink fluids. Provide a flexible straw.
3. Check for the puncture site for redness, swelling, and drainage every hour for the first 4 hours, and then every 4 hours for the first 24 hours.
4. If CSF pressure is elevated, assess the patient’s neurologic status every 15 minutes for 4 hours. If he’s stable, assess him every hour for 2 hours and then every 4 hours or according to the present schedule.

Interpretation

Normal Results

• Clear, colorless fluid.
• Cell count: No red blood cells (RBCs); 0 to 5 white blood cells (WBCs).
• Gram stain: No organism
• Pressure: 50 to 180 mm H2O

Abnormal Results

• Cloudy, bloody, brown, orange, or yellow fluid.
• Cell count: RBCs present; increased WBCs
• Gram stain: Gram positive or gram-negative organisms.
• Pressure: Increased or decreased.

Precautions

• Infection at the puncture site contraindicates CSF removal.
• In the patient with increased intracranial pressure, CSF should be removed with extreme caution because fluid withdrawal can cause a rapid reduction in pressure and cerebellar tonsillar herniation and medullary compression.

Interfering Factors

• Patient position and activity may possibly increase or decrease in CSF pressure.
• Crying, coughing, or straining.
• Delay between collection time and laboratory testing that may possibly invalidation of test results, especially cell counts.

Complications

• Reaction to anesthetic, meningitis, bleeding into the spinal canal, cerebellar tonsillar herniation, and medullary compression.
• Signs of meningitis.
• Signs of herniation.

Related posts:

1. Arterial Blood Gas Analysis
2. Serum Creatinine
3. Bone Marrow Aspiration and Biopsy

Breast biopsy is necessary to confirm or rule out cancer. Needle biopsy or fine-needle biopsy can provide a core of tissue or a fluid aspirate, but needle biopsy should be restricted to fluid-filled cysts and advanced malignant lesions. Both methods have limited diagnostic value because of the small and perhaps unrepresentative specimens they provide. Open biopsy provides a complete tissue specimen, which can be sectioned to allow more accurate evaluation.

A breast biopsy can usually be done on an outpatient basis under local anesthesia; however, an excisional open biopsy may require general anesthesia. In sufficient tissue is obtained and the mass is found to be a malignant tumor, specimens are sent for estrogen and progesterone receptor assays to assist in determining future therapy and the prognosis.

Purpose Breast Biopsy

• To differentiate between benign and malignant breast tumors.

Breast Biopsy Procedure

Patient Preparation

1. Make sure the patient has signed a consent form.
2. Note and report all allergies.
3. If the patient is to receive a local anesthesia, tell her she need not restrict food or fluids.
4. If the patient is to have a general anesthesia, tell her she is to have nothing by mouth after midnight or before the procedure.
5. Obtain and report abnormal results of prebiopsy studies, such as blood tests, urine tests, and radiographs of the chest.
6. Explain that the test takes 15 to 30 minutes.

Implementation

Needle Biopsy

1. Instruct your patient to undress to the waist.
2. After guiding her to a sitting or recumbent position with her hands at her sides, tell her to remain still.
3. The doctor then prepares the biopsy site, administers a local anesthetic, and introduces the syringe (luer-lock syringe for aspiration, Vim-Silverman needle for tissue specimen) into the lesion.
4. Fluid aspirated from the breast is expelled into a properly labeled, heparinized tube; the tissue specimen is placed in a labeled specimen bottle containing normal saline solution or formalin.
5. Send both specimens to the laboratory immediately. (With fine needle aspiration, a slide is made and viewed immediately under a microscope).
6. Because breast fluid aspiration isn’t diagnostically accurate, some doctors aspirate fluid only from cysts. If such fluid is clear yellow and the mass disappears, the aspiration is both diagnostic and therapeutic, and the aspirate is discarded. If aspiration yields no fluid or if the lesion recurs two or three times, an open biopsy is then considered appropriate.
7. After the procedure, pressure is exerted on the biopsy site and, after bleeding has stopped, an adhesive bandage is applied.

 Open Biopsy

1. The site is prepared and draped, and the patient is given a local or general anesthetic.
2. An incision is made in the breast to expose the mass. A portion of tissue or the entire mass is extracted.
3. Benign-appearing masses smaller than ¾” (2cm) in diameter are usually excised.
4. The specimens are placed in properly labeled specimen bottles containing 10% formalin solution.
5. The malignant-appearing tissue is sent for frozen suction and receptor assays.

Nursing Interventions

1. If the patient has received a general or local anesthetic, monitor the patient’s vital signs regularly. If she has received a general anesthetic, check her vital signs every 15 minutes for 1 hour, every 30 minutes for 2 hours, every hour for the next 4 hours, and then every 4 hours.
2. Administer analgesics for pain, as ordered, and provide ice bags for comfort.
3. Instruct the patient to wear a support bra at all times until healing is complete.
4. Observe for and report bleeding, tenderness, and redness at the biopsy site.
5. Provide emotional support to the patient awaiting diagnosis.

Interpretation

Normal Results

1. Breast tissue consists of cellular and noncellular connective tissue, fat lobules, and various lactiferous ducts.
2. Breast tissue is pink, more fatty than fibrous, and shows no abnormal development of cells or tissue elements.

Abnormal Results

1. Benign tumors may suggest fibrocystic disease, adenofibroma, intraductal papilloma, mammary fat necrosis, or plasma cell mastitis.
2. Malignant tumors may suggest adenocarcinoma, cystosarcoma, intraductal and infiltrating carcinoma, inflammatory carcinoma, medullary or circumscribed carcinoma, colloid carcinoma, lobular carcinoma, sarcoma, or Paget’s disease.

Precaution

• Breast biopsy is contraindicated in the patient with a condition that precludes surgery.

Interfering Factors

• Failure to obtain an adequate tissue specimen or to place the specimen in the proper solution container interfering with test results.

Related posts:

1. Bone Marrow Aspiration and Biopsy
2. Colonoscopy Procedure
3. Cerebrospinal Fluid (CSF) Analysis

Cardiac catheterization involves passing a catheter into the right or left side of the heart. Catheterization can determine blood pressure and blood flow in the chambers of the heart, permits blood sample collection, and record films of the heart’s ventricles (contrast ventriculography) or arteries (coronary arteriography or angiography).

Catheterization of the heart’s left side assesses the patency of the coronary arteries, mitral and aortic valve function, and left ventricular function. Catheterization of the heart’s right side assesses tricuspid and pulmonic valve function and pulmonary artery pressures.

Purpose of Cardiac Catheterization

• To evaluate valvular insufficiency or stenosis, septal defects, congenital anomalies, myocardial function, myocardial blood supply, and cardiac wall motion.
• To aid in diagnosing left ventricular enlargement, aortic root enlargement, ventricular aneurysms, and intracardiac shunts.

Cardiac Catheterization Procedure

Patient Preparation

1. Explain the procedure to the patient.
2. Tell him to restrict fluids for at least 6 hours before the test.
3. Inform him that the test takes 1 to 2 hours.
4. Tell him that he may receive a mild sedative but will remain conscious during the procedure.
5. Have the patient to void just before the procedure.
6. Check the patient history for hypersensitivity to shellfish, iodine, or contrast media used in other diagnostic tests. Discontinue any anticoagulant therapy as ordered.

Implementation

1. The patient is placed supine on padded table and his heart rate and rhythm, respiratory status, and blood pressure are monitored throughout the procedure.
2. An I.V. line is started, if not already in place, and a local anesthetic is injected at the insertion site.
3. A small incision is made into the artery or vein, depending on whether the test is for the left or right.
4. The catheter is passed through the sheath into the vessel and guided using fluoroscopy.
5. In the right-sided catheterization, the catheter is inserted into the antecubital or femoral vein and advanced through the vena cava into the right side of the heart and into the pulmonary artery.
6. If left-sided heart catheterization, the catheter is inserted into the brachial or femoral artery and advanced retrograde through the aorta into the coronary artery ostium and left ventricle.
7. When the catheter is in place, contrast medium is injected to make visible the cardiac vessels and structures.
8. Nitroglycerin is given to eliminate catheter-induced spasm or watch its effect on the coronary arteries.
9. After the catheter is removed, direct pressure is applied to the incision site until bleeding stops, and a sterile dressing is applied.

Nursing Interventions

1. Monitor the patient’s heart rate and rhythm, respiratory and pulse rates, and blood pressure frequently.
2. Monitor the patient’s vital signs every 15 minutes for 2 hours after the procedure, every 30 minutes for the next 2 hours, and then every hour for 2 hours.
3. If no hematoma or other problems arise, begin monitoring every 4 hours. If vital signs are unstable, check every 5 minutes and notify the practitioner.
4. Observe the insertion site for a hematoma or blood loss. Additional compression may be necessary to control bleeding.
5. Check the patient’s color, skin temperature, and peripheral pulse below the puncture site.
6. Enforce bed rest for 8 hours. If the femoral route was used for catheter insertion, keep the patient’s leg extended for 6 to 8 hours.
7. If medications were withheld before the test, check with the practiotner about resuming their administration.
8. Administer prescribed analgesics.
9. Make sure a posttest ECG is scheduled to check for possible myocardial damage.

Interpretation

Normal Results

• No abnormalities of heart valves, chamber size, pressures, configuration, wall motion, or thickness, and blood flow.
• Coronary arteries have a smooth and regular outline.

Abnormal Results

• Coronary artery narrowing greater than 70% suggests significant coronary artery disease.
• Narrowing of the left main coronary artery and occlusion or narrowing high in the left anterior descending artery suggests the need for revascularization surgery.
• Impaired wall motion suggests myocardial incompetence.
• A pressure gradient indicates valvular heart disease.
• Retrograde flow of the contrast medium across a valve during systole indicates valvular incompetence.

Precautions

• Coagulopathy, impaired renal function, and debilitation usually contraindicate catheterization of both sides of the heart. Unless a temporary pacemaker is inserted to counteract induced ventricular asystole, left bundle-branch block contraindicates catheterization of the right side of the heart.
• If the patient has valvular heart disease, prophylactic antimicrobial therapy may be indicated to guard against subacute bacterial endocarditis.

Complications

• Ineffective endocarditis in a patient with vulvular heart disease.
• Myocardial infarction, arrhythmias, cardiac tamponade, pulmonary edema, hematoma, blood loss, adverse reaction to contrast media, and vasovagal response.

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