CHAPTER 13

SPECIAL EXAMINATIONS AND TESTS

LEARNING OBJECTIVES
• DIFFERENTIATE BETWEEN AN EXAM AND A TEST
• LIST 10 NURSING RESPONSIBILITIES THAT RELATE TO ASSISTING WITH SPECIAL EXAMS AND TESTS
• NAME 5 POSITIONS COMMONLY USED FOR EXAMS
• LIST 6 COMMON CATEGORIES OF EXAMS OR TESTS
• IDENTIFY 4 WORD ENDINGS AND THEIR MEANINGS TO PROVIDE CLUES TO HOW SPECIFIC EXAMS
OR TESTS ARE DONE
• EXPLAIN THE FOLLOWING PROCEDURES:
SIGMOIDOSCOPY
PARACENTESIS
LUMBAR PUNCTURE
THROAT CULTURE
PAP SMEAR
CAPILLARY BLOOD GLUCOSE
• DISCUSS AT LEAST 3 FACTORS THAT ARE CONSIDERED WHEN EXAMS AND TESTS ARE
PERFORMED ON OLDER ADULTS
DEFINITIONS –USING WORD BEGINNINGS (PREFIXES) AND ENDINGS (SUFFIXES) AS CLUES TO
PROCEDURES
-GRAPHY : TO RECORD AN IMAGE
-SCOPY : TO LOOK THROUGH A LENSED INSTRUMENT
-CENTESIS : TO PUNCTURE
-METRY : TO MEASURE WITH AN INSTRUMENT
SONO- : TO ASSESS USING SOUND
ELECTRO- : TO ASSESS USING ELECTRICAL IMPULSES
GLUCO- : SUGAR
ENDO- : INSIDE
• DIAGNOSTIC EXAMINATION: PROCEDURE THAT INVOLVES PHYSICAL INSPECTION OF BODY
STRUCTURES AND EVIDENCE OF THEIR FUNCTION—may or may not include the collection of specimens.
• LABORATORY TEST: PROCEDURE THAT INVOLVES THE EXAMINATION OF BODY FLUIDS OR BODY
SPECIMENS AND THE COMPARISON OF THOSE SPECIMENS WITH NORMAL FINDINGS.
• ENDOSCOPY: VISUAL EXAMINATION OF INTERNAL STRUCTURES USING OPTICAL SCOPES.
• PARACENTESIS: PUNCTURING THE SKIN AND WITHDRAWING FLUID FROM THE ABDOMINAL CAVITY
• LUMBAR PUNCTURE: INSERTING A NEEDLE BETWEEN LUMBAR VERTEBRAE IN THE SPINE BUT
BELOW THE SPINAL CORD.
• RADIONUCLIDE IMAGING: USING ELEMENTS WHOSE STRUCTURES ARE ALTERED TO PRODUCE
RADIATION FOR THE ASSESSMENT OF SPECIFIC TISSUES AND ORGANS
EXAMPLES:
RADIOACTIVE IODINE 131
RADIOACTIVE TECHNITIUM 99
RADIOACTIVE CARBON 14
HOT SPOT: INTENSE CONCENTRATION OF RADIATION
COLD SPOT: LITTLE IF ANY RADIATION
• POSITRON EMISSION TOMOGRAPHY (PET): COMBINES TECHNOLOGY OF RADIONUCLIDE SCANNING
WITH THE LAYERED ANALYSIS OF TOMOGRAPHY.
• ULTRASONOGRAPHY (ECHOGRAPHY): EXAMINATION OF SOFT TISSUE USING SOUND WAVES
BEYOND HUMAN HEARING
• SONOGRAM OR ECHOGRAM: RESULTING VISUAL IMAGE PRODUCED BY THE REFLECTION OF THE
SOUND WAVES BACK FROM THE TISSUES BEING ASSESSED AND INTO THE MACHINE. SUCH AS:
BREAST TISSUE, ABDOMINAL AND PELVIC ORGANS, MALE REPRODUCTIVE ORGANS, HEAD AND
NECK STRUCTURES, HEART AND VALVES, STRUCTURES WITHIN THE EYES, OBSTETRICS FOR
ASSESSMENT OF FETUS AND PLACENTA.
NOT GOOD FOR AIR-FILLED TISSUES SUCH AS LUNGS NOR DENSE TISSUES SUCH AS BONES
• ELECTRICAL GRAPHIC RECORDINGS
 ELECTRO - CARDIO - GRAPHY (EKG, ECG):
EXAM OF THE ELECTRICAL ACTIVITY IN THE HEART.
 ELECTRO - ENCEPHALO - GRAPHY (EEG):
EXAM OF THE ENERGY EMITTED BY THE BRAIN

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  ELECTRO - MYO - GRAPHY (EMG):
EXAM OF THE ENERGY PRODUCED BY STIMULATED MUSCLES
• CULTURE: TO COLLECT FROM THE BODY A SAMPLE SUSPECTED OF CONTAINING INFECTIOUS
MICROORGANISMS, GROWING THE MICROBES IN A NUTRIENT SUBSTANCE, AND EXAMINING THE
RESULTING GROWTH UNDER A MICROSCOPE.
• SENSITIVITY: ADDING ANTIBIOTICS TO THE CULTURED ORGANISMS TO DETERMINE WHAT WILL KILL
THAT PARTICULAR ORGANISM.
• GRAM STAIN: PROCESS OF ADDING A DYE TO A MICROSCOPIC SLIDE "SMEARED" WITH A SAMPLE
GRAM + (gram positive) organisms, such as streptococci (strep throat ) absorb "take up" the violet stain
and appear violet (purple)
GRAM – (gram negative) organisms repel the violet turn red instead—like the counterstain
• PELVIC EXAMINATION: PHYSICAL INSPECTION OF THE VAGINA AND CERVIX AND PALPATION OF
UTERUS AND OVARIES
• PAPANICOLAOU (PAP SMEAR OR TEST): SCREENING OF CELLS REMOVED FROM THE CERVIX AND
CANAL TO DETECT ABNORMAL CELLS, HORMONAL STATUS, AND PRESENCE OF ABNORMAL
MICROORGANISMS.
NURSING RESPONSIBILITIES
FOR EXAMINATIONS AND TESTS
• WHAT DOES THE PATIENT UNDERSTAND ABOUT THE PROCEDURE?
• WITNESS THE PATIENT'S SIGNATURE ON THE CONSENT FORM
• TEACH OR FOLLOW THE TEST PREPARATION REQUIREMENTS
• OBTAIN EQUIPMENT AND SUPPLIES
• ARRANGE THE EXAMINATION AREA
• POSITION AND DRAPE THE PATIENT
• ASSIST THE EXAMINER
• PROVIDE THE PATIENT WITH PHYSICAL AND EMOTIONAL SUPPORT
• CARE FOR SPECIMENS
• RECORD AND REPORT APPROPRIATE INFORMATION (CHART)
NURSING RESPONSIBILITIES CONTINUED
• ELEMENTS OF INFORMED CONSENT
DOES THE PATIENT HAVE THE CAPACITY TO UNDERSTAND AND MAKE A RATIONAL
DECISION? this may temporarily be affected by medications.
COMPREHENSION: HAS THE PATIENT UNDERSTOOD THE MD's EXPLANATION OF THE
PROCEDURE, ITS RISKS, BENEFITS AND ALTERNATIVES THAT MIGHT BE AVAILABLE.
(this may also be temporarily affected by meds.)
IS THIS A VOLUNTARY ACTION?
CLARIFYING EXPLANATION: WHAT EXACTLY HAS THE MD TOLD THE PATIENT?
• TEST PREPARATIONS
INSTRUCTIONS VARY FROM ONE CATEGORY OF PROCEDURE TO ANOTHER. LOOK AT THE
PROCEDURE MANUAL. DON'T GUESS.
PROVIDE WRITTEN, AS WELL AS VERBAL, DIRECTIONS TO THE PATIENT
EVERYONE WHO IS INVOLVED NEEDS TO COORDINATE THEIR CARE.
INSTRUCTIONS MUST BE PROVIDED TO THEM ALL. (if instructions are not followed exactly as needed,
the exam might have to be postponed or canceled!) (this is NOT fun)
• OBTAINING EQUIPMENT AND SUPPLIES
OBTAIN ALL SUPPLIES AHEAD OF TIME
IF PREPACKAGED KITS ARE USED, CHECK THE CONTENTS AND OBTAIN ANY ADDITIONAL ITEMS
NEEDED. THESE COME FROM CLEAN UTILITY OR A CENTRAL SUPPLY DEPT.
• ARRANGING THE EXAMINATION AREA
• PROCEDURAL RESPONSIBILITIES
• POSITIONING AND DRAPING
DORSAL RECUMBENT POSITION
LITHOTOMY
SIMS' POSITION
KNEE-CHEST POSITION (GENUPECTORAL)
MODIFIED STANDING POSITION
• ASSIST THE EXAMINER
BE FAMILIAR WITH:
THE EXAMINATION
THE EQUIPMENT

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 THE MEDICATIONS TO BE USED
THE NEEDS OF THE EXAMINER
ATTENDING TO THE PATIENT
• DURING THE PROCEDURE: GIVE PHYSICAL AND EMOTIONAL SUPPORT BY PROVIDING WARM
BLANKETS, A HAND TO HOLD, AN ENCOURAGING WORD SO THAT POTENTIALLY UNCOMFORTABLE
PROCEDURES CAN BE ENDURED, COMMUNICATION TO THE EXAMINER WHEN APPROPRIATE IF THE
PATIENT'S CONDITION CHANGES. THE EXAMINER MAY BE ABLE TO SHORTEN OR CHANGE THE
EXAM IN SOME MANNER.
CONSIDERATIONS FOR OLDER ADULTS
• FATIGUE — DUE TO: GI PREPS, LONG PROCEDURES, FASTING
• MENTAL STATE—DUE TO: FASTING, DX,
• DRUG THERAPY—MAY NEED TO ALLOW ADMINISTRATION OF USUAL MEDS PRIOR TO TESTS USING
SMALL SIPS OF WATER—CHECK WITH MD
• INTERPRETATION OF LABORATORY RESULTS—DUE TO: MEDICATIONS, AGE, DEHYDRATION
• OTHER—PROVIDE FOOD, FLUID AND REST BEFORE SENDING THEM TO OTHER ACTIVITIES
• INCLUDE A CG OR FAMILY MEMBER IN PROCEDURE WHEN PT IS COGNITIVELY IMPAIRED,
PROVIDE EXTRA WARMTH IN WAITING ROOMS AND EXAM AREAS, BE PREPARED TO PROVIDE
HANDS-ON ASSISTANCE BEFORE, DURING, AND AFTER EXAMS
POST-PROCEDURE:
• ASSIST PT. TO COMFORTABLE POSITION
• VERIFY STABLE CONDITION BY RECHECKING V.S.
• ASSIST WITH PT'S HYGIENE IF NEEDED
• ASSIST WITH APPROPRIATE CLOTHING
• PROVIDE WITH WRITTEN POST-PROCEDURAL INSTRUCTIONS FOR FOLLOW-UP CARE
• ASSIST WITH DISMISSAL
SPECIMEN CARE
• COLLECT IN APPROPRIATE CONTAINER
• LABEL CONTAINER WITH ACCURATE INFORMATION
• ATTACH THE PROPER LABORATORY REQUEST FORM COMPLETELY AND ACCURATELY FILLED IN
• CARE FOR THE SPECIMEN APPROPRIATELY UNTIL DELIVERY TO THE LABORATORY
• DELIVER THE SPECIMEN TO THE LAB IN A TIMELY MANNER
FACTORS THAT INVALIDATE TEST RESULTS
• INCORRECT DIET PREPARATION
• FAILURE TO REMAIN FASTING
• INSUFFICIENT BOWEL CLEANSING
• DRUG INTERACTIONS
• INADEQUATE SPECIMEN VOLUME
• FAILURE TO DELIVER SPECIMEN TO LAB IN TIMELY MANNER
• INCORRECT OR MISSING REQUEST FORM
COMMON DIAGNOSTIC PROCEDURES
(EXAMINATIONS)
• RADIOGRAPHY OR ROENTGENOGRAPHY—X-RAYS (ROENTGEN RAYS):
PRODUCE ELECTROMAGNETIC ENERGY THAT PASSES THROUGH BODY STRUCTURES LEAVING
AN IMAGE OF DENSE TISSUE ON SPECIAL FILM. CONTRAST MEDIUM ADDED TO BODY
ORGANS OR CAVITIES, MAKES HOLLOW BODY AREAS APPEAR MORE DISTINCT UNDER X-
RAY.
• FLUOROSCOPY:
IMAGE IS BEING DISPLAYED IN REAL TIME—AS FOLLOWING THE MOVEMENT OF CONTRAST
MEDIUM DURING A SWALLOWING TEST.
• COMPUTERIZED TOMOGRAPHY – CT SCAN:
SHOWS PLANES OF TISSUE, AND WHEN CONTRAST MEDIUM IS USED, IT IS POSSIBLE TO
DIFFERENTIATE TISSUE DENSITY WHEN LOOKED AT FROM VARIOUS ANGLES AND LEVELS IN
THE BODY.
• MAGNETIC RESONANCE IMAGING (MRI) (NOT THE SAME TYPE OF RADIATION):
TECHNIQUE TO PRODUCE AN IMAGE BY USING ATOMS SUBJECTED TO A MAGNETIC FIELD.
PATIENTS WITH ANY IMPLANTED METAL DEVICES (i.e. STAPLES, PACEMAKERS, PLATES)
CANNOT USE THIS TYPE OF DIAGNOSTIC IMAGING.
NURSING RESPONSIBILITIES FOR RADIOGRAPHY
• BASELINE V.S.
• REMOVE ANY AND ALL METAL ITEMS FROM BODY. (IF AN MRI IS PLANNED, DOUBLE CHECK FOR
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 ANY IMPLANTED METAL DEVICES. BE CREATIVE IN ASKING)
• LEAD APRON OR THYROID COLLAR
• CHECK ALLERGIES TO CONTRAST MEDIUM—BE MINDFUL OF IODINE AND ALLERGIES TO SEAFOOD
• KNOW WHERE EMERGENCY EQUIPMENT IS—ALLERGIC REACTIONS CAN BE MILD, MODERATE, OR
LIFE THREATENING
• SCHEDULE IODINE TESTS BEFORE BARIUM TESTS
• AFTER IODINE PROMOTE URINARY EXCRETION BY ENCOURAGING PT TO DRINK A LARGE AMOUNT
OF WATER
• BARIUM CAN CAUSE CONSTIPATION AND BOWEL OBSTRUCTION—PROMOTE BOWEL ELIMINATION.
REPORT IF NO BM IN 2 DAYS. LAXATIVE THERAPY MAY BE NECESSARY.
ENDOSCOPIC EXAMINATIONS
• ENDOSCOPIC EXAMS—NAMED FOR STRUCTURE THAT IS BEING EXAMINED.
• HAVE A LIGHTED MIRROR-LENS ATTACHED TO A FLEXIBLE TUBE
• HAVE ATTACHMENTS THAT ALLOW TX OR THE COLLECTION OF SPECIMENS
• PERFORMED UNDER SHORT-ACTING ANESTHESIA—CALLED CONSCIOUS SEDATION.
EXAMPLES OF ENDOSCOPIC EXAMS
• BRONCHOSCOPY: INSPECTION OF BRONCHI
• GASTROSCOPY: INSPECTION OF STOMACH
• COLONOSCOPY: INSPECTION OF COLON
• ESOPHAGOGASTRODUODENOSCOPY: INSPECTION OF ESOPHAGUS, STOMACH, DUODENUM
• LAPAROSCOPY: INSPECTION OF THE ABD. CAVITY
• CYSTOSCOPY—INSPECTION OF URINARY BLADDER
NURSING RESPONSIBILITIES
• TO PREVENT ASPIRATION: NPO AT LEAST 6 HRS. BEFORE ANY PROCEDURE WHERE AN
ENDOSCOPE IS INSERTED INTO THE UPPER AIRWAY OR UPPER GASTRO-INTESTINAL TRACT.
• IF CONSCIOUS SEDATION IS USED: VS, BREATHING, O2 SAT. AND CARDIAC RHYTHM. HAVE
RESUSCITATION EQUIPMENT READILY AVAILABLE.
• IF TOPICAL ANESTHESIA IS USED TO FACILITATE THE PASSAGE OF THE ENDOSCOPE INTO THE
AIRWAY OR UPPER GI TRACT: NPO FOR 2 HOURS AFTER THE PROCEDURE AND UNTIL SWALLOW,
COUGH AND GAG REFLEXES ARE PRESENT
• SORE THROAT : RELIEVE WITH ICE CHIPS, GARGLES, OR FLUIDS AS APPROPRIATE AFTER THE
EXAM
• COMPLETE BOWEL PREPARATION DONE: CONFIRM PRIOR TO LOWER GI EXAMS
• REPORT ANY OF THE FOLLOWING SHOULD THEY OCCUR:
DIFFICULTY AROUSING THE PATIENT
SHARP PAIN
FEVER
UNUSUAL BLEEDING
NAUSEA
VOMITING
DIFFICULTY VOIDING
NURSING RESPONSIBILITIES FOR COLLECTING A THROAT CULTURE
• NOTIFY MD IF PT IS ON ABS
• DELAY COLLECTION IF ANTISEPTIC GARGLE HAS RECENTLY BEEN USED
• SUPPLIES NEEDED: STERILE CULTURE SWAB, GLASS SLIDE, TONGUE BLADE, GLOVES, MASK, IF PT
IS COUGHING, PAPER TISSUES, AND AN EMESIS BASIS IF THE PT GAGS
• PLACE PT IN OPTIMUM LIGHT
• DON GLOVES, AND MASK IF NEEDED
• LOOSEN THE CAP ON THE TUBE IN WHICH THE SWAB IS LOCATED
• TELL PT TO OPEN THE MOUTH WIDE, TILT HEAD BACK, AND STICK OUT THE TONGUE
• DEPRESS CENTER OF TONGUE WITH TONGUE BLADE IN NON-DOMINANT HAND
• RUB AND TWIST THE TIP OF THE SWAB ABOUT THE TONSIL AREAS AND THE BACK OF THE THROAT
WITHOUT TOUCHING THE LIPS, TEETH, OR TONGUE
• THROAT CULTURE
BE PREPARED FOR GAGGING
REMOVE SWAB AND DISCARD TONGUE BLADE
SPREAD THE SECRETIONS FROM THE SWAB ACROSS THE GLASS SLIDE
REPLACE THE SWAB SECURELY WITHIN THE TUBE, WITHOUT TOUCHING THE OUTSIDE
CRUSH THE GROWTH MEDIUM PACKET IN THE BOTTOM OF THE TUBE
NSG RESPONSIBILITIES: LUMBAR PUNCTURE
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• < ALL COMMON RESPONSIBILITIES >
• PERFORM A BASIC NEUROLOGICAL EXAM, INCLUDING PUPIL SIZE AND RESPONSE, MUSCLE
STRENGTH AND SENSATION IN ALL EXTREMITIES
• ADMINISTER SEDATIVE DRUG IF ORDERED
• OBTAIN EXTRA GLOVES, GOWN, MASK AND GOGGLES
• PLACE PT ON HIS/HER SIDE WITH KNEES AND NECK ACUTELY FLEXED, OR IN A SITTING POSITION
BENT FROM THE HIPS
• INSTRUCT THE PATIENT NOT TO MOVE
• STABILIZE THE CONTAINER OF LOCAL ANESTHETIC TO ALLOW THE MD TO WITHDRAW AN
APPROPRIATE AMOUNT WITHOUT BEING CONTAMINATED
• TELL THE PT IT IS NOT UNUSUAL TO FEEL PRESSURE OR A SHOOTING PAIN DOWN HIS/HER LEG
• LUMBAR PUNCTURE
PERFORM QUECKENSTEDT'S TEST, IF ASKED, BY COMPRESSING EACH JUGULAR VEIN FOR 10
SECS WHILE PRESSURE IS BEING MEASURED.
OBSERVE THAT THE MD FILLS THREE SEPARATE NUMBERED VIALS WITH 5-10 CC OF CSF IN
APPROPRIATE SEQUENCE
PLACE BAND-AID OR SMALL DRESSING OVER PUNCTURE WOUND
POSITION THE PT SUPINE OR PRONE AND INSTRUCT THEM TO REMAIN FLAT x 6-12 HRS.
REASSESS NEUROLOGICAL SIGNS
CHECK FOR BLEEDING OR CLEAR FLUID FROM PUNCTURE WOUND
OFFER FLUIDS FREQUENTLY
NURSING RESPONSIBILITIES FOR
PARACENTESIS
• < ALL COMMON RESPONSIBILITIES >
• OBTAIN EXTRA GLOVES, GOWN, MASK AND GOGGLES
• ENCOURAGE THE PATIENT TO EMPTY THE BLADDER PRIOR TO THE PROCEDURE
• PLACE THE PT IN A SITTING POSITION
• HOLD THE CONTAINER OF LOCAL ANESTHETIC SO THE MD CAN WITHDRAW A SUFFICIENT AMOUNT
WITHOUT BEING CONTAMINATED
• OFFER PT SUPPORT AS AN AREA OF THE ABD IS ANESTHETIZED AND THEN PIERCED WITH AN
INSTRUMENT CALLED A TROCAR AND A HOLLOW SHEATH CALLED A CANULA IS INSERTED
RECORDING AND REPORTING DATA
(CHARTING)
• PATIENT'S NAME
• DATE AND TIME
• PERTINENT PRE-EXAM ASSESSMENT AND PREPARATION
• TYPE OF TEST OR EXAM
• WHO PERFORMED THE PROCEDURE
• WHERE WAS IT PERFORMED
• RESPONSE OF PT. TO THE EXAM AND AFTERWARD
• TYPE OF SPECIMEN OBTAINED, IF ANY
• APPEARANCE, SIZE, OR VOL. OF SPECIMEN
• WHERE THE SPECIMEN WAS DELIVERED TO
NURSING DIAGNOSES ASSOCIATED WITH
PRE- AND POST- PROCEDURAL EXAMS
• ANXIETY
• FEAR
• IMPAIRED JUDGEMENT
• DECISIONAL CONFLICT
• HEALTH-SEEKING BEHAVIOR
• POWERLESSNESS
• SPIRITUAL DISTRESS

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