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COMMON EMERGENCY DRUGS Emergency Drug Adenosine Atropine sulfate Epinephrine Lasix Lidocaine Magnesium sulfate Morphine Sulfate

Narcan Nitroglycerine Vasopressin Initial Dose 6 mg 0.5 1 mg.q 3-5 min 1 mg.q 3-5 min 0.5-1 mg/kg 1-1.5 mg/kg 1-2 g 1-3 mg 0.02-2mg 0.4 mg SL 40 units Indications Bradycardia Cardiac arrest Pulmonary edema Ventricular fibrillation, Ventricular tachycardia Ventricular tachycardia r/t hypomagnesemia Chest pain, pulmonary edema Narcotic respiratory depression Chest pain, pulmonary edema Cardiac arrest

ANTIDOTES Agents Acetaminophen Anticholinesterase Anticholinergics Benzodiazepines Coumadine Cyanide Digoxin Dopamine Heparin Iron Lead Magnesium Sulfate Narcotics Endings *cain *cillin *dine *done *ide *lam/ *pam *micin/ *mycin *mine/ *zide *olol *pril sone Antidotes Acetylcysteine (Mucomyst) Atropine So4 Physostigmine Flumazenil Vitamin K Sodium nitrate Digoxin immune fab (Digibind) Phentolamine Protamine sulfate Deferoxamine Dimercaprol, edetate disodium and succimer Calcium gluconate Naloxone DRUG SUFFIXES class Local anesthetics Antibiotics Antiulcer agent Opiod analgesics Oral hypoglycemics Antianxiety Antibiotics Diuretics Beta blockers ACE inhibitors Steroids

Drugs Trade /(generics) (Aminophylline) theophylline

Classification Bronchodilator

FREQUENTLY ASKED MEDICATIONS Desired Effects Best Time to be Taken To case breathing AM / empty stomach

2 3 4

(Amphogel) Antacid aluminum hydroxide Antabuse (disulfiram) Antialcoholic agent Aspirin (ASA) Anti-inflammatory Anti-pyretic Analgesic Anticholinergic and Vagolytic Antibiotic

phosphate level Avoidance of alcohol temperature pain and inflammation heart rate and decrease secretion s (-) infection

Between meals and HS After 12 hrs. stoppage from alcohol Full stomach

Other No s No c Che Give w Report No alc Check

5 6

Atropine SO4 (Bacterium) cotrimoxazole (Benadryl) diphenhydramine hcl

30 PC PC

7 8

Antihistamine Anti EPS Steroids Antineoplastic Antidiabetic agent Antiglaucoma antidiuretics Cardiac glycoside Classification Anti-convulsant Diuretics

Celestone (betamethazone) 9 Cytoxan (cyclophosphamide) 10 Diabinase (chlorpropaminde) 11 Diamox (acetazolamide) 12 Digoxin (lanoxin) Drugs Trade /(generics) 13 (Dilantin) phenytoin 14 (Diuril) chlorothiazide

(-) allergy (-) movement syndrome respiratory distress in newborn size of tumor Normal glucose range urine output vertigo Normal heart rate Desired Effects (-) seizure urine output

Best taken with food Best taken with food AM AM AM with meals AM Best Time to be Taken Best taken with food Best taken with food

Observ Avoid Reddis Rashes Asse Avoid


Increas Monito Monito


15 Epinephrine


heart rate (-) helminth


16 (Flagyl) metronidazole


Best taken with food

17 (Haldol) haloperidol 18 Kayexalate

Antipsychotic Promote excretions of K

(+) symptoms of psychosis serum K


Assess Monito Other Taper d Rep extr Incr Don driv Asse Avoid Not to Tetrato Assess Photos May ca Monito

19 (Lasix) furosemide 20 (Lithane) LiCO3 21 (Lovenox) mevacor

Diuretic Antimanic Antithrombotic

urine output hyperactivity (-) thrombosis


22 Magnesium SO4 23 Mastinon (pyridostigmine) 24 (Methergine) methylergonovine maleate 25 Monoamine oxidase inhibitor Drugs Trade /(generics) 26 Nitroglycerin 27 Pancrease (pancreatin)

Anticonvulsant Cholinesterase inhibitor Oxytocic for post partum atony Antidepressant

(-) convulsion muscle strength Firmly contracted uterus Improved sleeping pattern Desired Effects (-) chest pain (-) fat in the stool PC PC

Incr Monito Decrea Soft br No raz Keep p Assess Antido Monito Antido Monito Report

Classification Antiangina Pancreatic enzyme

Best Time to be Taken Best taken before any strenuous activity Between meal and snacks Empty stomach Best taken with meals AM / PC AM AM Best taken with food PC AC

28 (Phenergan) promethazine hyrochloride 29 Reserpine (serpasil) 30 (Ritalin) methylphenidate 31 (Robaxin) methocarbamol 32 (Synthroid) levothyroxine sodium 33 (Tagamet) cimetidine 34 (Thorazine) chlorpromazine hcl 35 (Valium) diazepam 36 (Xylocaine) lidocaine 37 (Zyloprim) allopurinol

Antihistamine Antihypertensive Stimulant Skeletal muscle relaxant Thyroid hormone supplement Antiacidity Antipsychotic Antianxiety Antiarrythmic Anesthetic Antigout

(-) allergy BP hyperactivity (-) muscle spasm Normal T4 level (-) heartburn (-) positive signs of psychosis (-) anxiety Normal heart rate uric acid

No tyra Assess Monito Other Taken Keep t Prep don Obs Antido

No sud Monito Mon No alc Antido Monito

Best taken with food

Avoid Photos Monito No alc Mon S/E Incr Rest

Test Antigen skin Benedicts test Bentonite Flacculation Test Beutlers test Blanching test Bronsulpthalein test Caloric test CD4 determination Cerebral perfusion test Coombs test CPK BB CPK MB CPK MM Dark field illumination test and kalm test Dick test Dulls eye test ELISA test Gram staining and Culture of cervical and urethral smear Gross hearing test Guthrie test Heat and Acetic acid test Immunochromatographic test Jones Criteria Lepronin test Liver enzyme test Liver profile test Lumbar puncture Malaria smear Mantoux test Menieres test Methylene blue test Moloney test Oxytocin challege test Pandys test Phenosulpthalein test Queckkenstedts test Rectal swab

Indication Test to rule-out cancer of the lungs For glucose monitoring Test for filariasis Test for galactosemia Determines the impairment in circulation Liver angiography Test done by placing water in the ear canal causes nystagmus. A test for inner ear Checking the immune status to AIDS patient Test used to check the cerebral function Determines the production of the antibodies. RhoGAM is given (1st 72 hours) Test for brain muscles Test for cardiac muscles: for MI Test for muscle injury Determination for the presence of syphilis Detect scarlet fever Determines the presence of blindness. Done in 1st ten days (+) normal (-) abnormal Determines presence of HIV Determination for the presence of gonorrhea Test used by whispering words or spoken voice test Test for PKU For protein or albumin detection A rapid assessment method done for filariasis. The antigen test that can be done at daytime One way of diagnosing Rheumatic heart fever A screening test for leprosy For SGOT and SGPT Determines Hepa-b surface antigen Determines for the presence of meningitis and encephalitis. Position the patient in side lying position Test to confirm malaria; specimen is taken at the height or peak of fever Determination for TB exposure Test for vestibular function For ketone detection Hypersensitivity test for Diphtheria Determines if the fetus can tolerate uterine contraction; (+) CS is necessary Determines the presence of protein in the CSF Kidney angiogram Test that involve the compression of jugular veins Done in patient with cholera, pinworm detection

Rinne Test Rombergs test Schick test Schillers test Schilling test Schwabach test Shake test Skin test Slit skin smear Specific gravity test Sperm count test Sputum exam Sulkowitch test Sweat chloride test Tensilon (Endophonium) test Tonometer Torniquet test TZANK test Weber test Wedals Test Western blot test

Shifted between mastoid bone and two inches from the ear canal opening Assess gait and station such as ataxia Susceptibility test for diphtheria (+) no immunity (-) with immunity Staining the cervix with an iodine solution. Healthy tissues will turn brown, while cancerous tissue resist the stain Used to patient with severe chilling sensation; for confirmation of pernicious anemia Differentiate between conductive and sensorineural deafness, mastoid of patient and examiner Determines the amount of surfactant in the lungs. Purpose it to produce antigen reaction A confirmatory test for leprosy For diabetes mellitus and insipidus as well as for dehydration For male infertility (low sperm count-oversex) For defection and sensitivity of causative microorganism, for pneumonia and TB Urine test detection for calcium deficiency and calcium in the urine Used to diagnosed cystic fibrosis For rapid detection of myasthenia gravis Test used to measure ocular tension and helping in detecting early glaucoma N=12-20 mmHg Done to determine presence of petechiae in Dengue Hemorrhagic fever Determination for the presence of herpes simplex Evaluation of bone conduction. Tuning fork is placed on patients forehead or teeth For typhoid fever determination A confirmatory for AIDS

Arterial Blood Gases

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

: Respiratory Opposite; Metabolic Equal : pH = 7.35 7.45 PCO2 = 34 45 HCO3=22-26

Common Tubes

Table or Apparatus Miller-Abbott tube

Purpose Longer than Levin tube; has mercury of air in bags so tube can be used to decompress the lower intestinal tract

Cantor Tube



Key points 1. Care similar to that Levin NG tube irrigated. 2. connected to suction, not sterile 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 To drain bile from the Cholecystectomy when 1. Bile drainage is common bile duct until a common duct influenced by edema has subscribed exploration (CDE) or position of the choledochostomy was drainage bag. also done 2. Clamp tubes as ordered to see if bile will flow into duodenum, normally. A type of closed1. Mastectomy 1. May compress unit, wound drainage 2. Total hip procedure and have portable connected to suction3. Total knee vacuum or connect used to drain, a large procedure to wall suction. amount of 2. Small drainage serosanguineous tube may get drainage from under an clogged physician incision may irrigate these at times A method of closed 1. Neurosurgery Empty reservoir when wound suction 2. Neck surgery full, to prevent loss of drainage indicate when 3. Mastectomy wound drainage and tissue displacement 4. Total knee and hip back contamination and tissue trauma may replacement occur with rigid drain 5. Abdominal surgery tubes (e.g Hemovac) 6. Urological

Examples of Use 1. Small-bowel obstructions 2. Intussusception 3. Volvulus

Jackson-Pratt Three-way Foley

See Hemovac To provide avenues for constant irrigation and constant drainage of urinary bladder

procedure See Hemovac 1. Transurethral resection (TUR) 2. Bladder infection

Suprapubic catheter

Ureteral catheter

To drain bladder via an opening through the abdominal wall above the pubic bone To drain urine feom the pelvis of one kidney, or for splinting ureter

Suprapubic prostatectomy 1. Cystoscopy for diagnostic workups 2. Ureteral surgery 3. Pyelotomy

See Hemovac Watch for blocking by clots causes bladder spasms 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 May have orders to irrigate prn or continuously Never clamp the tubepelvis of kidney only holds 4-8 mL Use only 5 mL sterile 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 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. 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) 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 patients 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 spaceoccupying 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

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 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 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 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 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 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 : Gastric acidity decrease : duodenal ulcer pernicious anemia an cancer of the stomach

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. 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 patients 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 fowlers 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 fowlers 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 (Rubins 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