What is Abdominal Paracentesis?

The insertion of a needle to remove a sample of fluid to drain fluid that has accumulated.

Reasons to have an Abdominal Paracentesis? 

Bleeding, Infection,

Disease of organs such as the liver,to ease the difficulty of breathing, and to relieve pain

Possible Complications & Factors that increase complications of an Abdominal Paracentesis?

Complications: Bleeding, Infection, Accidental piercing of structures in the abdomen

Factors to Increase Risk: Smoking, Bleeding Disorder, Poor Nutrition, Pregnancy, Full Bladder, Infection in the area where the paracentesis instrument will be inserted

Prior to Abdominal Paracentesis a patient may have?

Physical exam, blood test, X Ray, CT Scan, Ultrasound, MRI Scan

Patient Teaching for an Abdominal Paracentesis?

The patient should know:

1. There will be some stinging or burning while the anesthesia(local) is injected.

2. The patient should know to empty their bladder just before procedure and not to eat or drink 12 hours before procedure.

3. They should rest the day after their procedure, and follow the doctors "at home" instructions.

The doctor should be informed and nurse should look for... after an abdominal paracentesis if?

1.Signs of infections, including fever and chills

2. Redness, swelling, increasing pain, excessive bleeding, or fluid from the paracentesis site

3. Pain that cannot be controlled by the pain medications that have been  prescribed

4.Cough, SOB, feeling faint, or chest pain

5. Swelling of the abdomen

Nursing responsiblities before and after an abdominal paracentesis?

The nurse should monitor the patients blood pressure and other vital signs such as respiration.

What is an Agiogram/Arteriogram?

An angiogram is an imaging test that uses x-rays to view your body’s blood vessels.

Reasons to have an Angiogram/Arteriogram?

1. Blockages of the arteries outside of your heart, called peripheral artery disease (PAD)

2. Enlargements of the arteries, called aneurysms

3. Kidney artery conditions, called renovascular conditions

4. Problems in the arteries that branch off the aorta, called aortic arch conditions

5. Malformed arteries, called vascular malformations

6. Problems with your veins, such as deep venous thrombosis (DVT) or blood clots in the lungs called pulmonary emboli

Patient teaching regarding Angiogram/ Arteriogram?

1. The doctor will preform blood test to determine how patients blood clots.

2. Kidney test to assess kidney function.

3. You may have to stop drugs that prevent blot clotting, or more fluids may be introduced to you.

4. Do not eat or drink anything within 6 hours of your procedure.

5. Allergies of Iodine and Shellfish should be noted.

6. You should not drive immediately after the procedure so you will need to arrange for someone to drive you home.

7. For 1 to 2 days following procedure patient should avoid stenous physical activity, such as climbing stairs, walking and driving. Patient should also conitinue to drink extra fluids.

What puts a patient at risk for complications when having an Angiogram/Arteriogram?

Blood clotting problems

Kidney problems

Obesity

Advanced age

Allergies

Patient whom heart have poor pumping abilities

Patient with congestive heart failure

What should happen after am Angiogram/ Arteriogram (Nursing Responsibilities)?

1. Keep leg or arm that the procedure was completed on straight to avoid bleeding
2. Give patient fluids to prevent dehydration and flush the dyes from patients kidneys.
3. Monitor patient vital signs.

What is an Arthroscopy?

 Direct joint visualization by means if an arhroscope, usually to remove, repair, or replace tissue, such as cartilage fragments or torn ligaments, or to anneal injured tissues.

Complications of an Arthroscopy?

Leakage of the lavage fluid used during the procedure in the procedure in the surrounding soft tissues which causes swelling of the area around the joint.

Nursing responsibilities for an Arthroscopy?

Preoperative:

    1. Prepare the client physically and emotionally.

    2. Determine patients' ROM capabilities.

    3. Take patients' girth measurments (to measure around something).

Postoperative:

   1. Make sure  patient is referred for outpatient follow-up care as necessary.

   2. Monitor patient vital signs.

   3. Monitor patient dressing. 

Client teaching for a patient having a Arthroscopy?

1. Teach patient about post-op soreness and grinding; the application of ice to relieve pain and swelling.

2. Teach patient how to take any analgesics that may be prescribed.

3. Make sure patient knows the activity and ambulation restrictions that apply after surgery.

4. Teach patient how to use crutches and other assistive devices.

5. mke sure patient knows to report any unusal drainage, redness, joint swelling, unusal softness in the joint, sever or persistent pain, or fever.

What is a Barium Enema/ Lower GI Series?

Barium Enema/ Lower GI Series is used to detect divertivulitis, polyps, colonic abscessess, abnormal colon movement, dilation of the colon, Hirschsprung's disease (disease of the large intestine that causes severe constipation) in infants, and cancer, where barium is inserted into a catheter that's inserted into the rectum until it feels the large bowel; and a X-Ray films of the colon are taken to find any abnormalities in the colon outline.

What are the risks of a barium enema/lower gi series?

1. The patient may feel uncomfortable or even feel pain

2. Possible radiation exposure

3. Possible infection

4. Peritonitis (generalized infection if the abdominal cavity)

4. Women who are pregnant or may be pregnant should inform their doctor of this, because radition exposure may cause harm to the fetus.

Client teaching for a patient having a barium enema/ lower gi series?

1. The patient should rid themselves of as much fecal material as possible before the surgery.

2. Prior to examination, a clear liquid diet and cleansing enemas are often used to empty the colon.

3. The patient should not wear excessive clothing, metallic devices, or jewerly due to interactons with the X-Ray.

Nursing repsonsibilities for the nurse with a patient having a barium enema/ lower gi series?

1. Make sure the patient's large intestine is free of stool.

2. Make sure the patient understands the procedure.

3. Some patient's may experience constipation following the procedure, make sure that patient has effective relief measures.

4. Observe patient for any signs of abdominal or rectal discomfort.

5. Make sure patient understands diet and medication restrictions and understand the imporatance of following the restriction.

What is a bone marrow biopsy?

The doctor inserts the biopsy needle into the bone. The center of the needle is removed and the hollowed needle is moved deeper into the bone. This captures a tiny sample, or core, of bone marrow within the needle. The sample and needle are removed. Pressure and a bandage are applied to the biopsy site. Normally used to diagnose leukemia, infections, some types of anemia, and other blood disorders. It may also be used to help determine if a cancer has spread or responded to treatment.

Client teaching and preparation for a bone marrow biopsy?

1. If you are allergic to any medications

2. What medications you are taking

3. If you have bleeding problems

4. If you are pregnant

5. There may be some bleeding at the puncture site. More serious risks, such as serious bleeding or infection, are very rare.

Nursing reponsibilities for a bone marrow biopsy?

1. Make sure patient is positioned according to biopsy site and instruct them to remain as still as possible.

2. After aspiration the nurse should apply firm pressure for 5 to 10 minutes to the point of entry.

3. Make sure the specimen is labeled corectly with patient information.

What is a bronchoscopy?

Bronchoscopy is the direct visualization of the larynx, trachea, and bronchial tree by means of a either a rigid or a flexible bronchoscope, it can be a diagnostic or therapeutic procedure.

What do we use bronchoscopy's to diagnosis?

1. Lung growth, lymph node, atelectasis (partial or complete of the lung), or other changes seen on an x-ray or other imaging test

2. Suspected interstitial lung disease

3. Coughing up blood (hemoptysis)

4. Possible foreign object in the airway

5. Cough that has lasted more than 3 months without any other explanation

6. Infections in the lungs and bronchi that cannot be diagnosed any other way or need a certain type of diagnosis

7. Inhaled toxic gas or chemical

8. To diagnose a lung rejection after a lung transplant

What do we use bronchoscopy's to treat?

1. Remove fluid or mucus plugs from your airways

2. Remove a foreign object from your airways

3. Widen (dilate) an airway that is blocked or narrowed

4. Drain an abscess ( a swollen area witin body tissue, containing accumulation of pus)

5. Treat cancer using a number of different techniques

6. Wash out an airway (therapeutic lavage)

Risk of having a bronchoscopy?

1. Bleeding from biopsy sites

2 Infection

3. Arrhythmias

4. Breathing difficulties

5. Fever

6. Heart attack, in people with existing heart disease

7. Low blood oxygen

8. Pneumothorax (air or gas in the cavity between the lungs and the chest)

9. Sore throat

10. Muscle pain

11. Change in blood pressure

12. Slower heart rate

13. Nausea

14. Vomiting

15. Heart attack

Client teaching for a bronchoscopy?

1. Do not eat or drink anything 6 to 12 hours before the test.

2. The doctor may request that patient avoids aspirin or other blood thinning drugs.

3. You may be sleepy after the test, so you should have someone drive you to and from the test.

4. Rest the day after the test.

5. Local numbing medication is used to relax and numb your throat muscles.

6. When the medication wears off your throat may feel scratchy for several days .

7. You cannot eat or drink anything until your cough reflex returns which normally occurs 1 to 2 hours after the test.

Nursing alerts for a patient having a bronchoscopy?

1. the smaller airway lumen in children is further compromised by a bronchoscope that causes some edema and can result in hypoxia (decreased O2 to tissues). resucitation equipment should be on hand for use if needed.

2. The use of morphine sulfate in clients with asthma or other pulmonary disease in which bronchospasms are common can further exacerbate the spasms and respiratory impairment.

Pre-Op:

Nursing responsibilities pre-op a bronchoscopy?

1. Obtain a history of allergies to medications.

2. Ensure that dietary and fluid restrictions have been followed.

3. Ensure that hematologic status and blood clotting ability have been assessed.

4.Note and record results of ECG, chest x-ray, and pulmonary function studies.

5. Remove full and partial dentures, and inform person perserving test if the patient has any crowns on teeth(caps).

6. Remove glasses, contact lenses, or eye prosthesis.

7. Provide mouth care.

8. Record vital signs.

9. Administer pre-medications.

Nursing responsibilties for post-op care for a bronchoscopy?

1. If local anesthesia is used, maintain the client in a Semi-Fowler's position for about 2 hours.

2. Monitor vital signs.

3. Administer oxygen and monitor hypoxemia.

4. Supply tissue and emesis basin.

5. Advise patient to refrain from smoking for several hours.

6. Advise patient to withhold food and fluids for 4  to 6 hours after procedure.

7. Advise client that normal activity can resume after medication and anesthesia have worn off.

8. Remind client that some horseness and soreness after procedure.

9. Provide warm saline gargles, throat lozenges, and a cool compress to neck to alleviate throat pain or horseness.

10. Provide pencil and paper for those who find it hard to speak.

11. Report any adverse reactions to the doctor.

What is cardiac catherization?

An invasive study that provides diagnostic information about the heart chambers and valves, coronary arteries, and the great vessels which involves a cardiac catheterization passing a thin flexible tube (catheter) into the right or left side of the heart, usually from the groin or the arm.

Risk when having an cardiac cathetization?

Cardiac tamponade ( mechanical compression of the heart resulting from large amounts of fluid collecting in the pericardial space)

Heart attack

Injury to a coronary artery

Irregular heartbeat

Low blood pressure

Reaction to the contrast dye

Stroke

Bleeding, infection, and pain at the IV or sheath insertion site

Damage to the blood vessels

Blood clots

Kidney damage due to the contrast dye (more common in patients with diabetes or kidney problems)

Client teaching before having a cardiac catheterization?

1. You should not eat or drink 6 to 8 hours before the test.

2. Tell your doctor if you:

     - are allergic to seafood or any medications

     - have had a bad reaction to contrast dye or iodine in the past

     - take any medications, including Viagra for erectile dysfuction

     - might be pregnant

3. Tel the patient that the operation site is shaved, cleansed, and anesthetized with local anesthetic.

4. Explain to the patient that they may feel pressure after the catheter is inserted.

5. Inform patient that ECG activity, pulse, and blood pressure are monitored during the procedure.

6. Inform the client that they may be asked to cough or deep breathe during the procedure to enhance the blood flow through the heart.

Nursing responsibilities pre-op of a patient having a cardiac catherization?

1. Obtain the client's height and weight, which is used to determine dye administration.

2. Ensure that dietary and fluid restrictions have been followed.

3. Ensure that routine medications are restricted or allowed per physician orders, and that anticoagulants have been discontinued.

4. Provide a hospital gown with no metallic closures.

5. Ensure that medications to reduce allergic response to contrast medium are administered.

6. Obtain baseline vital signs.

7. Have the client void before the procedure.

8. Obtain a history of suspected or known cardiac conditions.

What is a cholangiography?

Contraindications of having a cholangiography?

Pregnancy

Allergy to iodine

Severe renal or hepatic insufficiency

Jaundice

Post-op wound sepsis

Client unable to cooperate

Sever ascites, cholangitis

Uncontrolled coagulopathy

Indications for having a cholangiography?

Evaluation of bile ducts

Detection of stones in bile ducts

Detection of fistula

Detection of strictures (restreiction) and neoplasms( new or abnormal growth) of the biliary tract

To determine cause of jaundice

Performing liver biopsy

To visualize the gallbladder

Persistence of symptoms after cholecystectomy

Client teaching for a patient having  a cholangiography?

1. GI tract should be as empty as possible of feces.

2. Patient should not et 8 to 12 hours before the procedure.

3. There should be no metal objects within the x-ray field.

Nursing responsibilties before patient has a cholangiography?

1. Bowel preparation

2. Obtain client's CBC, PT or PTT counts.

3. Make sure patient has any prescribed Vit K and antibiotics before procedure.

Nursing responsibilities after an a cholangiography?

1. Assess the venipuncture site for inflammation and bruising.

2. Inform client that some discomfort may occur during urination as the dye it excreted.

3. Monitor delayed reaction to dye.

4. Note any phelbitis at the injection site.

5. Note inflammation of bile ducts.

6. Have client rest for a couple of hours.

What is a cholecystogram?

Indications for having a cholecystogram?

To determine the presence of gallstones.