EMERGENCY NURSING:

A. General information

1. Emergency nursing deals with human responses to any trauma or sudden illness that
requires immediate intervention to prevent imminent severe damage or death
2. Care is provided in any setting to persons of all ages with actual or perceived alterations in
physical or emotional health.
3. Initially, patients may not have a medical diagnosis.
4. Care is episodic when patients return frequently, primary when it is the initial option for
health or preventive care, or acute when patients need immediate and additional
interventions.
5. Emergency nursing is a specialty area of the nursing profession like no other.
6. Emergency nurses must be ready to treat a wide variety of illnesses or injury situations,
ranging from a sore throat to a heart attack.

B. Historical Development of Emergency Nursing

1. Florence Nightingale was the first emergency nurse, providing care to the wounded in the
Crimean War in 1854
2. The Emergency Department Nurses Association (EDNA) was organized in 1970
3. A competency-based examination, first administered in 1980, provides Certification in
Emergency Nursing; certification is valid for 4 years
4. EDNA developed Standards of Emergency Nursing Practice, published in 1983, to be used
as a guideline for excellence and outcome criteria against which performance is measured
and evaluated
5. In 1985, the Association name was changed to Emergency Nurses Association (ENA),
recognizing the practice of emergency nursing as role-specific rather than site-specific.
6. Originally ENA aimed at teaching and networking, the organization has evolved into an
authority, advocate, lobbyist, and voice for emergency nursing. It has 30,000+ members
and continues to grow, with members representing over 32 countries around the world.

C. Emergency Care Environment

1. Prehospital care by emergency medical services (EMS), emergency medical technicians,

and paramedics provides initial stabilizations and transport of patients; personnel
communicate with the emergency department during patient transport
2. The national emergency telephone number 911 is the result of an effort to improve access
to EMS
3. The concept of the emergency room has expanded to that of the emergency department,
which provides various levels of care
4. Specialized electronic technology and techniques are used to monitor patient status
continuously; these may pose safety hazards to patients, such as possible exposure to
electric shock

D. Triage
 1. Triage classifies emergency patients for assessment and treatment priorities
2. Triage decisions require gathering objective and subjective data rapidly and effectively to
determine the type of priority situation present
3. Emergent situations are potentially life-threatening; they include such conditions as
respiratory distress or arrest, cardiac arrest, severe chest pain, seizures, hemorrhage, severe
trauma resulting in open chest or abdominal wounds, shock, poisonings, drug overdoses,
temperatures over 105°F (40.5°C), emergency childbirth, or delivery complications
4. Urgent situations are serious but not life-threatening if treatment is delayed briefly; they
include such conditions as chest pain without respiratory distress, major fractures, burns,
decreased level of consciousness, back injuries, nausea or vomiting, severe abdominal pain,
temperature between 102 and 105°F (38.9 and 40.5° C), bleeding from any orifice, acute
panic, or anxiety
5. Nonemergency situations are not acute and are considered minor to moderately severe;
they include such conditions as chronic backache or other symptoms, moderate headache,
minor burns, fractures, sprains, upper respiratory or urinary infections, or instances in
which a patient is dead on arrival

E. Roles of the Emergency Nurse

1. Care provider: provides comprehensive direct care to the patient and family.
2. Educator: provides patient and family with education based on their learning needs and
the severity of the situation and allows the patient to assume more responsibility for
meeting health care needs
3. Manager: coordinates activities of others in the multidisciplinary team to achieve the
specific goal of providing emergency care
4. Advocate: ensures protection of the patient’s rights

F. Functions of the Emergency Nurse

1. Uses triage to determine priorities based on assessment and anticipation of the patient’s
needs
2. Provides direct measures to resuscitate, if necessary
3. Provides preliminary care before the patient is transferred to the primary care area
4. Provides health education to the patient and family
5. Supervises patient care and ancillary personnel
6. Provides support and protection for the patient and family

G. Legal issues affecting the provision of emergency nursing

1. Negligence
2. Malpractice
3. Good Samaritan Laws (these statutes may protect private citizens but usually do not apply
to emergency personnel on duty or in normal emergency situations)
4. Informed consent
5. Implied consent
6. Duty to report suspected crimes to the police
7. Duty to gather evidence in criminal investigations; be aware of hospital policy and state
laws for evidence collection
 8. Advanced directives, including durable power of attorney and living wills

H. Qualifications of an Emergency Nurse

1. An emergency nurse is a registered nurse with specialized education and experience in

caring for emergency patients.
2. Emergency nurses continually update their education to stay informed of the latest trends,
issues, and procedures in medicine today.
3. Many take a special examination that proves their level of knowledge. After successful
completion of this exam they are certified in emergency nursing.
4. Some emergency nurses also acquire additional certifications in the areas of trauma
nursing, pediatric nursing, nurse practitioner, and various areas of injury prevention
5. Many emergency nurses acquire additional certifications in the areas of trauma nursing,
pediatric nursing, nurse practitioner, and various areas of injury prevention
 Commonly Asked Emergency Drugs

Emergency Drug Initial Dose Indications

Adenosine 6 mg
Atropine sulfate 0.5 – 1 mg.q 3-5 min Bradycardia
Epinephrine 1 mg.q 3-5 min Cardiac arrest
Lasix 0.5-1 mg/kg Pulmonary edema
Lidocaine 1-1.5 mg/kg Ventricular fibrillation, Ventricular tachycardia
Magnesium sulfate 1-2 g Ventricular tachycardia r/t hypomagnesemia
Morphine Sulfate 1-3 mg Chest pain, pulmonary edema
Narcan 0.02-2mg Narcotic – respiratory depression
Nitroglycerine 0.4 mg SL Chest pain, pulmonary edema
Vasopressin 40 units Cardiac arrest

Antidotes
Agents Antidotes
Acetaminophen Acetylcysteine (Mucomyst)
Anticholinesterase Atropine So4
Anticholinergics Physostigmine
Benzodiazepines Flumazenil
Coumadine Vitamin K
Cyanide Sodium nitrate
Digoxin Digoxin immune fab (Digibind)
Dopamine Phentolamine
Heparin Protamine sulfate
Iron Deferoxamine
Lead Dimercaprol, edetate disodium and succimer
Magnesium Sulfate Calcium gluconate
Narcotics Naloxone

Drug Name Endings: What they can suggest you!!!

Endings class
*cain Local anesthetics
*cillin Antibiotics
*dine Antiulcer agent
*done Opiod analgesics
*ide Oral hypoglycemics
*lam/ Antianxiety
*pam
*micin/ Antibiotics
*mycin
*mine/ Diuretics
*zide
*olol Beta blockers
*pril ACE inhibitors
*sone Steroids
 FREQUENTLY ASKED MEDICATIONS
Drugs Trade /(generics) Classification Desired Effects Best Time to be Other Considerations
Taken
1 Aminophylline Bronchodilator To case breathing AM / empty stomach  No smoking
(theophylline)  No caffeine
 Check heart rate
2 Amphogel Antacid phosphate level Between meals and HS  Give with glass of water
(aluminum hydroxide)  Report melena
3 Antabuse Antialcoholic agent Avoidance of alcohol After 12 hrs. stoppage  No alcohol in any means
(disulfiram) from alcohol
4 Aspirin (ASA) Anti-inflammatory  temperature Full stomach  Check for bleeding tendencies
Anti-pyretic  pain and  Syrup of inpecae in case of
Analgesic inflammation overdose
5 Atropine SO4 Anticholinergic and  heart rate and 30 PC  Observe facial flushing
Vagolytic decrease secretion s  Avoid hot environment
6 Bacterium Antibiotic (-) infection PC  Reddish urine
(cotrimoxazole)  Rashes
 Assess for signs of
nephrotoxicity
7 Benadryl Antihistamine (-) allergy Best taken with food  Avoid alcohol
(diphenhydramine hcl) Anti – EPS (-) movement
syndrome
8 Celestone Steroids respiratory distress Best taken with food  Monitor weight
(betamethazone) in newborn
9 Cytoxan Antineoplastic size of tumor AM  Increase fluids
(cyclophosphamide)  Monitor CBC
10 Diabinase Antidiabetic agent Normal glucose range AM  Monitor for hypoglycemia
(chlorpropaminde)
11 Diamox Antiglaucoma  urine output AM with meals  Photosensitivity
(acetazolamide) antidiuretics  vertigo
12 Digoxin (lanoxin) Cardiac glycoside Normal heart rate AM  Assess pulse rate
 Monitor serum K
13 Dilantin (phenytoin) Anti-convulsant (-) seizure Best taken with food  Taper dosage
14 Diuril (chlorothiazide) Diuretics  urine output Best taken with food  Report weakness in the
extremities
 Increase K in the diet
15 Epinephrine Bronchodilator  heart rate AM  Don’t operate machineries and
drive automobile
 Assess for increase pulse
16 Flagyl (metronidazole) Antihelmintic (-) helminth Best taken with food  Avoid alcohol
 Not to give with antabuse
 Tetratogenic
17 Haldol (haloperidol) Antipsychotic  (+) symptoms of AC  Assess BP
psychosis  Photosensitivity
18 Kayexalate Promote excretions  serum K  May cause constipation
of K  Monitor serum potassium
19 Lasix (furosemide) Diuretic  urine output AM  Increase intake of food rich in
K
20 Lithane (LiCO3) Antimanic  hyperactivity PC  Monitor lithium toxicity
 Decrease activity
21 Lovenox (mevacor) Antithrombotic (-) thrombosis  Soft bristle toothbrush
 No razor
 Keep protamine SO4
22 Magnesium SO4 Anticonvulsant (-) convulsion  Assess DTR and PR
 Antidote is Calcium gluconate
23 Mastinon Cholinesterase  muscle strength PC  Monitor for muscle weakness
(pyridostigmine) inhibitor  Antidote is atropine SO4
24 Mathergine Oxytocic for post Firmly contracted  Monitor BP
(methylergonovine partum atony uterus  Report dyspnea
maleate)
25 Monoamine oxidase Antidepressant Improved sleeping PC  No tyramine rich food
inhibitor pattern  Assess for hypertensive crisis
 Monitor BP
26 Nitroglycerin Antiangina (-) chest pain Best taken before any  Taken SL; don’t chew
 strenuous activity  Keep tablets in dark container
27 Pancrease (pancreatin) Pancreatic enzyme (-) fat in the stool Between meal and  Preparation is enteric coated,
snacks don’t show
 Observe for diarrhea
28 Phenergan Antihistamine (-) allergy Empty stomach  Antidote is epinephrine
(promethazine
hyrochloride)
29 Reserpine (serpasil) Antihypertensive  BP Best taken with meals  No sudden change of position
 Monitor BP and PR
30 Ritalin Stimulant  hyperactivity AM / PC  Monitor growth and
(methylphenidate) development
31 Robaxin Skeletal muscle (-) muscle spasm AM  No alcohol
(methocarbamol) relaxant  Antidote : Epinephrine
32 Synthroid Thyroid hormone Normal T4 level AM  Monitor BP and PR
(levothyroxine sodium) supplement
33 Tagamet (cimetidine) Antiacidity (-) heartburn Best taken with food  Avoid smoking
34 Thorazine Antipsychotic (-) positive signs of PC  Photosensitivity
(chlorpromazine hcl) psychosis  Monitor BP
35 Valium (diazepam) Antianxiety (-) anxiety AC  No alcohol, caffeine
36 Xylocaine (lidocaine) Antiarrythmic Normal heart rate  Monitor for toxicity –
convulsion
 S / E : tinnitus
37 Zyloprim (allopurinol) Antigout  uric acid Best taken with food  Increase fluid intake, restrict
vit. C
 Common Tubes

Table or Apparatus Purpose Examples of Use Key points

Miller-Abbott tube Longer than Levin 1. Small-bowel 1. Care similar to that
tube; has mercury of obstructions Levin NG tube
air in bags so tube can 2. Intussusception irrigated.
be used to decompress 3. Volvulus 2. connected to
the lower intestinal suction, not sterile
tract technique
3. orders will be
written on how to
advance the tube
gently pushing
tube a few inches
each hour, patient
position may affect
advancement of
tube
4. X-rays determine
the desired
location of tube
Cantor Tube To drain bile from the Cholecystectomy 1. Bile drainage is
common bile duct when a common duct influenced by
until edema has exploration (CDE) or position of the
subscribed choledochostomy was drainage bag.
also done 2. Clamp tubes as
ordered to see if
bile will flow into
duodenum,
normally.
T-tube A type of closed- 1. Mastectomy 1. May compress
wound drainage 2. Total hip unit, and have
connected to suction- procedure portable vacuum
used to drain, a large 3. Total knee or connect to wall
amount of procedure suction.
serosanguineous 2. Small drainage
drainage from under tube may get
an incision clogged physician
may irrigate these
at times
Hemovac A method of closed 1. Neurosurgery Empty reservoir when
wound suction 2. Neck surgery full, to prevent loss of
drainage indicate 3. Mastectomy wound drainage and
when tissue 4. Total knee and hip back contamination
displacement and replacement
tissue trauma may 5. Abdominal surgery
 occur with rigid drain 6. Urological
tubes (e.g Hemovac) procedure
Jackson-Pratt See Hemovac See Hemovac See Hemovac
Three-way Foley To provide avenues 1. Transurethral Watch for blocking by
for constant irrigation resection (TUR) clots causes bladder
and constant drainage 2. Bladder infection spasms
of urinary bladder Irrigant solution often
has antibiotic added to
normal salin or sterile
water
Sterile water rather
than normal saline
may be used for lysis
of clots
Suprapubic catheter To drain bladder via Suprapubic May have orders to
an opening through prostatectomy irrigate prn or
the abdominal wall continuously
above the pubic bone
Ureteral catheter To drain urine feom 1. Cystoscopy for Never clamp the tube-
the pelvis of one diagnostic pelvis of kidney only
kidney, or for splinting workups holds 4-8 mL
ureter 2. Ureteral surgery Use only 5 mL sterile
3. Pyelotomy normal saline if
ordered to irrigate

Common Diagnostics Procedures

Noninvasive Diagnostic Procedures

Characteristics:
1. it provides an indirect assessment of organ size, shape, and / or function
2. it is safe
3. it is easily reproducible
4. it requires less complex equipment for recording
5. it does not require the written consent of patient or guardian

General Nursing Tasks:

1. Decrease patients anxieties and offer support by
a. Explain purpose and procedure of test
b. Acknowledge questions regarding safety of the procedure
c. Remain with the patient while the procedure is going on
2. Use procedure in the collection of specimens that avoids contamination

A. Graphic studies of Heart and brain

1. Electrocardiogram (ECG) – graphic record of electrical activity generated by the heart
during depolarization and repolarazation.
- diagnose abnormal cardiac rhythms and coronary heart disease
 2. Echocardiography (ultrasound cadiography) – graphic record of motions produced by
cardiac structure as high-frequency sound vibrations are echoed though chest wall into the
heart.
- used to demonstrate valvular or other structural deformities, detect pericardial
effudion, diagnose tumors and cardiomegaly, evaluate prosthetic valve function.

3. Electroencephalogram (ECG) – graphic record of the electrical potentials generated by the

physiological activity of the brain
- used to detect surface lesions or tumors of the brain and presence of epilepsy.

4. Echoencephalogram – beam of ultrasound is passed though the head, and returning echoes
are graphically recorded.
- used to detect subdural hematomas, intracerebral hemorrhage, or tumors.

B. Roentgenological studies (X-ray)

1. Chest – used to determine size, contour of the heart; size, location, and nature of pulmonary
lesions: pleural thickening and effusions: pulmonary vasculature: disorder of thoracic ones
and soft tissues.
- used lead shield to protect pregnant woman

2. Kidney, Ureter, and Bladder (KUB) – used to determine size, shape, and position of
kidney, ureter and bladder
- No special consideration
3. Breast (Mammography) – examination of the breast with or without the injection of the
radiopaque substance into the duct of mammary gland.
- used to determined the presence of tumor or cyst (best done a week after
menstruation)
- no deodorant, perfume, powder, or ointment in underarm area on the day of X-ray
(contains Calcium oxalate)
- May be uncomfortable due to the pressure on the breast. (uses two x-ray plates)

C. Roentgenological studies (FLUOROSCOPY) – requires the ingestion or injection of a

contrast medium to visualize the target organ.

Additional Nursing Task:

a. Administration of enemies or cathartics before the procedure and laxative after.
b. Keeping the patient NPO 6-12 hours before examination
c. Ascertain patient’s allergy and allergic reactions
d. Observing for allergic reactions to contrast medium
e. Providing fluid and food after procedure to prevent dehydration
f. Observe stool for color and consistency until barium passes

1. Upper GI (Barium swallow) – ingestion of barium sulfate or meglumine diatrizoate

(Gastrografin [white and chalky substance], followed by fluoroscopic and x-ray
examination)
 - used to determine patency and caliber of the esophagus and to detect esophageal
varices, mobility of gastric wall, presence of ulcer, filling defects due to tumor,
patency of pyloric valve and presence of structural abnormalities
2. Lower GI (Barium Enema) – rectal instillation of barium sulfate followed by
glouroscopic and x-ray examination
- used to determine contour and mobility of colon and presence of any space-
occupying tumors. Perform before upper GI

Patients preparations:
- no food after evening meal the evening before the test
- stool softener laxatives and enema suppositories to cleanse the bowel before the test
- NPO after midnight before the test

After care:
- increased fluid intake, food and rest
- laxatives for at least two days or until stools are normal in color and consistency

3. Cholecystogram – ingestion of organic iodine contrast medium (Telepaque) followed in

12 hour by x-ray visualization
- gallbladder disease is indicated with poor or no visualization of the bladder
- accurate only if GI and liver function is intact
- perform before barium swallow and barium enema

Patients preparations:
- administer large amount of water with contrast capsule
- low-fat meal before evening before x-ray
- oral laxative of stool softener after meal
- no food allowed after contrast capsule

After care:
- increased fluid intake, food and rest
- observe for any untoward reactions

4. Intravenous Pyelography (IVP) – injection of a radiopaque contrast medium in the vein

of the client to visualize ureter, bladder and kidney

Patients preparations:
- Laxative in the evening before the examination
- NPO for 12 hours
- Cleaning enema morning of the procedure

After care:
- increased fluid intake, food and rest;
- observe for any untoward reactions
D. Computed Tomography (CT) – an x-ray beam sweeps around the body, allowing measuring
of various tissue densities. Provides clear radiographic deficition of structures that are not
visible by other techniques.
- initial scan may be followed by “contrast enhancement” using an injection of
contrast agent iodine via vein, followed by a repeat scan.

Patients preparations:
- instructions for eating before test vary
- clear liquids up to 2 hours before the procedure are permitted

E. Magnetic resonance imaging (MRI) – noninvasive technique that produces cross sectional
images by exposure to magnetic energy sources. It uses no contrast medium; takes 30-0
minutes to complete. Patient may still for periods of 5-20 minutes at a time.

Patients preparations:
- patient can take food and medications except for low abdominal and pelvic studies
(food and fluid withheld) 4-6 hr to decrease peristalsis)
- Restrictions
a. those who have metal implants
b. those with permanent pacemakers
c. those who are pregnant

F. Ultrasound (sonogram) – uses sound waves to diagnose disorders of the thyroid, kidney,
liver, uterus, gallbladder, fetus and intracranial structures of the neonate.

Patients preparations:
- advise client not to chew gum or smoke before the procedure
- no x-ray
- for gallbladder studies; NPO for 8 hours
- for lower abdomen and uterus ; 32 ounces of water PO 30 minutes before the
procedure

G. Pulmonary function studies

 Ventilatory studies – use of incentive spirometer to determine how well the lung is
ventilating.

1. Vital capacity (VC) – largest amount of air that can be expelled after maximal
inspiration

Normal = 4000 – 5000 mL.

Decrease = indicate lung disease
Increase or decrease = indicate chronic obstructive lung disease

2. Forced expiratory volume (FEV) – percentage of vital capacity that can be forcibly
expired in 1, 2, or 3 seconds.

Normal = 80 – 83% in 1 sec

90 – 94% in 2 sec
 95 – 97% in 3 sec

decrease = indicate expiratory airway obstruction

H. Sputum Studies

1. Gross sputum evaluations – collection of sputum samples to ascertain quantity,

consistency, color and odor
2. Sputum smear – sputum is smeared thinly on a slide so that it can be studied
microscopically.
- used to determine cytological changes or presence of pathogenic microorganism
3. Sputum culture – sputum samples are implanted or inoculated into special media.
- used to diagnosed pulmonary infection

I. Examination of the gastric contents

1. Gastric analysis – aspiration of the contents of the fasting stomach analysis of free and total
acid

Gastric acidity increase : duodenal ulcer

Gastric acidity decrease : pernicious anemia an cancer of the stomach

J. Doppler ultrasound – measures blood flow in the major veins and arteries. The
transducer of the test instrument is placed on the skin, sending ultra-high-frequency
sound.
- sound varies with respiration and valsalva maneuver
- no discomfort to the patient.

K. Glucose Testing – to detect disorder of glucose metabolism, such as diabetes.

1. Fasting blood sugar (FBS) – blood sample is drawn after a 12 fast (usually midnight).
Water is allowed.

Normal blood glucose ; 60 – 120 mg/dL

Diabetic patient = 126 mg/dL

2. 2 hr postprandial (PPBS) – blood is taken after meal

Patients preparations:
- offer a high-carbohydrate diet for 2-4 days before testing
- patient fast overnight
- eats a high-carbohydrate breakfast
- blood sample is drawn 2 hr interval
- no cigarette smoking and caffeine for these may increase glucose level
 Common Diagnostics Procedures

Invasive Diagnostics Procedures

Characteristics:
1. it directly records the size, shape and function of an organ;
2. it requires the written consent of the patient or guardian;
3. it may result in morbidity and occasionally death.

General Nursing Task:

1. Before procedure:
a. have patient sing permit to procedure
b. ascertain and repot any patient history of allergy or allergic reaction
c. explain procedure briefly and accurately
d. explain that contrast medium might cause flushing or warm feeling
e. keep patient NPO 6-12 hour before procedure if anesthesia is to be used
f. allow patient to verbalize concerns
g. administer preprocedure sedatives, as ordered
h. if procedure done at bed side:
- remain with patient and offer reassurance
- assist with optimal positioning of patient
- observe for indication of complications – shock, pain and dyspnea

2. After procedure:
a. observe and record vital signs
b. check injection or biopsy sites for bleeding, infection, tenderness, or thrombosis
 report untoward reaction to the physician
 apply warm compress to ease discomfort, as ordered
c. if tropical anesthesia is used during procedure, do not give food or fluid until gag
reflex returns
d. encourage relaxation by allowing patient to discuss experience and verbalize
feelings.

A. Procedures to evaluate the cardiovascular system

1. Angiography – intravenous injection of radiopaque solution or contrast for the purpose
of studying its circulation through the patient’s heart, lungs and great vessels.
- Used to check the competency of the heart valves, diagnose congenital septal
defects, study heart function and structure before cardiac surgery, detect occlusions
of coronary arteries.
2. Cardiac catheterization – insertion of a radiopaque catheter into a vein to study the
heart great vessels.
- Used to confirm diagnosis of heart disease and determine extent of disease,
measure pressures in the heart chamber and great vessels, obtain estimate of cardiac
output, and obtain blood samples to measure oxygen content.
a. Right heart catheterization – catheter is inserted through a cut-down in the
antecubital vein into the superior vena cava, through the right atrium and
ventricle and into the pulmonary activity.
 b. Left-heart catheterization- catheter maybe passed retrograde to the left
ventricle through the brachial and femoral artery, it can be passed through
the left atrium after right-heart catherization by means of a special needle
that punctures the septa; or it may be passed directly into the left ventricle
by means of a posterior puncture.

Specific nursing considerations:

1. Preprocedure patient teaching:

a. Fatigue is a common complaint due to lying still for 3 hr
b. Feeling of fluttery sensation while the catheter is passed back into the left
ventricle
c. Flushed, warm feeling may occur when contrast medium is injected.

2. Postprocedure observations:
a. monitor ECG pattern for arrhythmias
b. check extremities for color and temperature, peripheral pulses for quality.

3. Angiography (Arteriography) – injection of a contrast medium in to the arteries to

study the vascular tree.
- Used to determine obstructions or narrowing of peripheral arteries.

B. Procedure to evaluate the respiratory system

1. Lung scan – injection of radioactive isotope into the body, followed by lung scintiscan,
which produces a graphic record of gamma rays emitted by the isotopes in the tissues.
- used to determine lung perfusion when pulmonary emboli and infarctions are
suspected.

2. Pulmonary angioghraphy – x – ray visualization of the pulmonary vasculature after the

injection of a radiopaque contrast medium.
- used to evaluate pulmonary disorders such as pulmonary embolism, lung tumor and
aneurysms, and changes in the pulmonary vasculature due to such conditions as
emphysema.

3. Bronchoscopy – introduction of a fiberoptic scope into the trachea and bronchi

- used to inspect tracheobronchial tree for pathological changes, remove foreign
bodies or mucous plugs causing airway obstruction, and apply chemotherapeutic
agents.
a. Prebronchoscopy interventions:
 oral hygiene
 postural drainage as indicated
b. Postbronchoscopy interventions:
 Instruct patient not to swallow oral secretions
 Save expectorated sputum for laboratory analysis
 NPO till gag reflex returns
 Observe for subcutaneous emphysema and dyspnea
 Apply ice collar to reduce throat discomfort
 4. Thoracentesis – needle puncture through the chest wall and into the pleura
- used to remove fluid and occasionally air from the pleural space
- nursing considerations
a. position : high fowler’s position or sitting upon edge of the bed, with feet
supported on the chair.
b. If the patient is unable to sit up – turn unto unaffected side

a. Position: high fowler’s position or sitting upon edge of the bed, with feet supported on
the chair.
b. If the patient’ is unable to sit up-turn unto unaffected side

C. Procedures to evaluate the renal system

1. Renal angiogram – small catheter is inserted into the femoral artery and passed into
the aorta or renal artery, radiopaque fluid is in stilled, and serial films are taken.
- Used to diagnose renal hypertension and pheochromocytoma and differentiate renal
cyst from tumors.

Postangiogram nursing actions:

1. Check pedal pulse for signs of decreased circulation.

2. Cystoscopy – Visualization of bladder, urethra, and prostatic urethra by insertion of a

tubular, lighted, telescopic lens (cystoscope) through the urinary meatus.
- Used to directly inspect the bladder; collect urine from the renal pelvis; obtain biopsy
specimens from bladder and urethra; remove calculi; and treat lesions in the bladder,
urethra, and prostate.

Nursing actions following procedure:

 Observe for urinary retention
 Warm sitz baths to relieve discomfort
3. Renal biopsy – needle aspiration of tissue from the kidney for the purpose of
microscopic examination.

Procedures to evaluate the digestive system:

1. Esophagoscopy and gastroscopy – visualization of the esophagus, the stomach,
and sometimes the duodenum by means of a lighted tube inserted through the
mouth.

2. Proctoscopy – visualization of rectum and colon by means of a lighted tube

inserted through the anus.
 3. Peritoneoscopy – direct visualization of the liver and peritoneum by means of a
peritoneoscope inserted through an abdominal stab wound.

4. Liver biospsy – needle aspiration of tissue for the purpose of microscopic

examination; used to determine tissue changes, facilitate diagnosis, and provide
information regarding a disease course.

Nursing action:
1. Place patient on right side and position pillow for pressure, to prevent bleeding.

5. Paracentesis – needle aspiration of fluid from the peritoneal cavity used to relieve
excess fluid accumulation or for diagnostic studies.
a. Specific nursing actions before paracentesis:
a. Have patient void - to prevent possible injury to bladder during
procedure
b. Position – sitting up on side of bed, with feet supported by
chair.
c. Check vital signs and peripheral circulation frequently
throughout procedure
d. Observe for signs of hypovolemic shock – may occur due to
fluid shift from vascular compartment following removal of
protein – rich ascitic fluid.

b. Specific nursing actions following paracentesis:

a. Apply pressure to injection site and cover with sterile dressing.
b. Measure and record amount and color of ascitic fluid; send
specimens to lab for diagnostic studies.

D. Procedures to evaluate the reproductive system in women

1. Culdoscopy – surgical procedure in which a culdoscope is inserted into the
posterior vaginal cul-de-sac
- Used to visualize uterus, fallopian tube, and peritoneal contents.

2. Breast biopsy – needle aspiration or incisional removal of breast tissue for

microscopic examination.
- used to differentiate among benign tumors, cysts, and malignant tumor in the
breast.

3. Uterotubal insufflation (Rubin’s Test) – injection of carbon dioxide into the

cervical canal.
- Used to determin fallopian tube patency

E. Procedure to evaluate the neuroendocrine system

1. Cerebral angiography – fluoroscopic visualization of the brain vasculature

after injection of a contrast medium into the carotid or vertebral arteries
- used to localize lesions (tumors, abscesses, and occlusions) that are large enough
to distort cerebrovascular blood flow.
 2. Myelogram – through a lumbar-puncture needle, a contrast medium is injected into
the subarachnoid space of the spinal column to visualize the spinal cord.
- Used to detect herniated or ruptured intervertebral disks, tumors and cysts that
compress or distort spinal cord.

Nursing consideration:
 Elevate head of bed = with water soluble contrast
 Flat position – with oil contrast
 V/s every 4 hr for 24 hr.

3. Lumbar puncture – puncture of the lumbar subarachnoid space of the spinal

cordwith a needle to withdraw samples of cerebrospinal fluid.
- Used to evaluate CSF for infections and determine presence of hemorrhage.

Note: not done if increased ICP is suspected

Position: Before : fetal position / knee chest position

After : flat or supine

Test Indication
Antigen skin Test to rule-out cancer of the lungs
Benedict’s test For glucose monitoring
Bentonite Flacculation Test Test for filariasis
Beutler’s test Test for galactosemia
Blanching test Determines the impairment in circulation
Bronsulpthalein test Liver angiography
Caloric test Test done by placing water in the ear canal causes nystagmus.
A test for inner ear
CD4 determination Checking the immune status to AIDS patient
Cerebral perfusion test Test used to check the cerebral function
Coomb’s test Determines the production of the antibodies. RhoGAM is
given (1st 72 hours)
CPK BB Test for brain muscles
CPK MB Test for cardiac muscles: for MI
CPK MM Test for muscle injury
Dark field illumination test and Determination for the presence of syphilis
kalm test
Dick test Detect scarlet fever
Dull’s eye test Determines the presence of blindness. Done in 1st ten days (+)
normal (-) abnormal
ELISA test Determines presence of HIV
Gram staining and Culture of Determination for the presence of gonorrhea
cervical and urethral smear
Gross hearing test Test used by whispering words or spoken voice test
Guthrie test Test for PKU
Heat and Acetic acid test For protein or albumin detection
Immunochromatographic test A rapid assessment method done for filariasis. The antigen test
that can be done at daytime
Jones Criteria One way of diagnosing Rheumatic heart fever
Lepronin test A screening test for leprosy
Liver enzyme test For SGOT and SGPT
Liver profile test Determines Hepa-b surface antigen
Lumbar puncture Determines for the presence of meningitis and encephalitis.
Position the patient in side lying position
Malaria smear Test to confirm malaria; specimen is taken at the height or
peak of fever
Mantoux test Determination for TB exposure
Meniere’s test Test for vestibular function
Methylene blue test For ketone detection
Moloney test Hypersensitivity test for Diphtheria
Oxytocin challege test Determines if the fetus can tolerate uterine contraction; (+) CS
is necessary
Pandy’s test Determines the presence of protein in the CSF
Phenosulpthalein test Kidney angiogram
Queckkenstedt’s test Test that involve the compression of jugular veins
Rectal swab Done in patient with cholera, pinworm detection
Rinne Test Shifted between mastoid bone and two inches from the ear
canal opening
Romberg’s test Assess gait and station such as ataxia
Schick test Susceptibility test for diphtheria (+) no immunity (-) with
immunity
Schiller’s test Staining the cervix with an iodine solution. Healthy tissues
will turn brown, while cancerous tissue resist the stain
Schilling test Used to patient with severe chilling sensation; for confirmation
of pernicious anemia
Schwabach test Differentiate between conductive and sensorineural deafness,
mastoid of patient and examiner
Shake test Determines the amount of surfactant in the lungs.
Skin test Purpose it to produce antigen reaction
Slit skin smear A confirmatory test for leprosy
Specific gravity test For diabetes mellitus and insipidus as well as for dehydration
Sperm count test For male infertility (low sperm count-oversex)
Sputum exam For defection and sensitivity of causative microorganism, for
pneumonia and TB
Sulkowitch test Urine test detection for calcium deficiency and calcium in the
urine
Sweat chloride test Used to diagnosed cystic fibrosis
Tensilon (Endophonium) test For rapid detection of myasthenia gravis
Tonometer Test used to measure ocular tension and helping in detecting
early glaucoma N=12-20 mmHg
Torniquet test Done to determine presence of petechiae in Dengue
 Hemorrhagic fever
TZANK test Determination for the presence of herpes simplex
Weber test Evaluation of bone conduction. Tuning fork is placed on
patient’s forehead or teeth
Wedal’s Test For typhoid fever determination
Western blot test A confirmatory for AIDS

Arterial Blood Gases

Type Causes Manifestations Management
Respiratory . COPD . Weakness . Assess VS
Acidosis . Respiratory . Tachycardia . Monitor
pH<7.35; . Overdose . Decreased LOC . ABG
PaCO2>45 . Atelectasis . Headache . CPT
. Pulmonary edema . TCDB
. Aspiration
Respiratory . Hyperventilation . Lightheadedness . Slow
Alkalosis . Anxiety . Ringing of the breathing
pH>7.45; . Pain ears . Paper bag
PaCO2<35 . Ventilators . Tingling
Metabolic . DKA . Headache . Administer sodium
Acidosis . Diarrhea . N/V bicarbonate
pH<7.35; . ASA poisoning . Kussmaul . Monitor I/O
HCO3,22 . Renal failure respiration . Use seizure
. Dysrhythmias precautions
Metabolic . Vomiting . Tingling . Monitor VS
Alkalosis . NGT . Dizziness . I/O
PH>7.45; . Diuretics and . Bradypnea . ABG
HCO3>26 Antacids

Remember : Respiratory Opposite; Metabolic Equal

Facts : pH = 7.35 – 7.45 PCO2 = 34 – 45 HCO3=22-26