Abdominal CT/ Abdominal and Transvaginal Ultrasound

A Case Study Presented to

Adventist University of the Philippines

College of Nursing

In Partial Fulfillment

For the Requirements in

Competency Appraisal II

Submitted by Gian Christopher T. Eugenio

1/24/2018
 ABDOMINAL CT/ ABDOMINAL AND TRANSVAGINAL ULTRASOUND

Introduction

Computed Tomography scan uses a series of X-ray images from different angles. This combined with computer
processing, produces cross sectional images or Slices of bones, blood vessels and soft body tissues (Mayo Clinic Staff, 2015).
This diagnostic procedure can be done with or without oral or IV contrast medium (Van Leeuwen & Bladh, 2015) .

Ultrasound is a safe and painless diagnostic procedure that uses a transducer that produces high frequency sound
waves to create live images by bouncing off the structures and received by the transducer. This diagnostic procedure does not
require any radiation exposure (Radiological Society of North America, 2016). An ultrasound is characterized by which part of
the body is being assessed such as an abdominal ultrasound which produces a picture of the upper abdomen and a transvaginal
ultrasound produces a picture of the endometrium (Radiological Society of North America, 2016).

Vaginal ultrasonography utilizes a transducer placed inside the vagina to pinpoint ovulation, diagnose tubal
pregnancies, or evaluate other gynecologic problems, such as endometriosis. Transvaginal ultrasonography may be particularly
useful in differentiating acute appendicitis from pelvic inflammatory disease (Corbett, 2013).

Indications

An abdominal CT is indicated for patients whose abdominal structures require visualizing and assessing whether it is
for diagnosing tumors, bleeding, and abscesses or for evaluation of surgical, radiation, and medical therapeutic interventions
(Van Leeuwen & Bladh, 2015). It is useful in examining trauma patients, patients with abdominal pain, difficulty in breathing,
detecting pulmonary embolisms and aortic aneurysms. It is also invaluable in diagnosing spinal problems and other skeletal
problems as well as diagnosing many different kinds of cancer (Radiological Society of North America, 2016).

An abdominal ultrasound is indicated for the determination of patency and function of abdominal vessels such as the
abdominal aorta, vena cava, and the portal, splenic, renal and the superior & inferior mesenteric veins. This can also detect
aneurysms, monitor abdominal aortic aneurysm that is expanding, evaluate ascites, and evaluate size shape, and pathology of
intra- abdominal organs (Van Leeuwen & Bladh, 2015).

A transvaginal ultrasound is used to detect and monitor pelvic inflammatory disease, bleeding, masses, abscesses or
peritonitis, ovarian cysts and malignancy, effectiveness of therapy, and evaluate the thickness of the uterine wall.

Contraindications

This procedure is contraindicated to those who are pregnant or those who may be pregnant. This contraindication is
waived if the benefits outweigh the risk of radiation exposure. Claustrophobia is also a contraindication. One contraindication is
intolerance to the contrast dye as well as those with renal impairment due to the contrast dye’s nephrotoxic nature of the dye
(Van Leeuwen & Bladh, 2015).
Normal Findings
Normal findings would be normal size, shape and position of abdominal organs and vascular system (Van Leeuwen &
Bladh, 2015).

For an abdominal UTZ, absence of ascites, aortic aneurysm, cysts, obstruction, or tumors is normal as well as the
visualization of normally sized, positioned, shaped intra-abdominal organs (Van Leeuwen & Bladh, 2015).

For a transvaginal UTZ, normal size, position, location, and structure of pelvic organs, IUD properly positioned within
the uterine cavity (Van Leeuwen & Bladh, 2015).

Procedure and Nursing Responsibilities

For Abdominal CT:

Before:
1. The nurse identifies the patient using at least two identifiers before providing the diagnosing service.
2. The patient is informed about the importance of the procedure in assessing the abdominal organs
3. History and information is obtained from the client to identify if the patient can tolerate the radioactive dye. The patient
is asked about allergies, medical history, and medication that is currently being taken.
4. For women, the date of the last menstrual period is recorded. Pregnancy should also be determined
5. The patient is then informed that the test may last between 5 to 30 minutes.
6. The patient is told that nausea, a feeling of warmth, a salty or metallic taste, or a transient headache may be
experienced after injection of contrast medium, if given.
7. The patient will be asked if he or she complied with the 8 hour NPO
8. Jewelry and other metallic objects are then instructed to be removed.
9. If allergic reactions are noted in patient history, prophylactic medications such as: steroids or antihistamines are given
10. The patient is then instructed to void.
11. The patient changes into gown
12. The patient is placed in supine position on the examination table

During:
1. The examination table will move through the scanner quickly to calibrate
2. The machine will slow down to start actual scanning.
3. The patient is carefully monitored for any complications such as allergic reactions, anxiety, or bronchospasm.
4. Instructions to hold their breath is given when x-ray images are given.

After:
1. The needle used in administering the dye is removed and dressing is applied.
2. Vital signs and neuro-vital signs are monitored q15 for 1 hour then q2 for four hours.
3. The patient is still being monitored for delayed allergic reactions, such as rash, tachycardia, and tachypnea.
4. The patient is instructed to report elevated heart rate, difficulty in breathing, skin rash, and chest pain
Complications
1. Cardiac Arrhythmias
2. Hematoma
3. Infection
4. Panic Attacks

Significant Findings and Interpretation

Abdominal CT scan can uncover an abscess, acute GI bleed, aortic aneurysm, appendicitis, aortic dissection, bowel
perforation, bowel obstruction, mesenteric torsion and a tumor with significant mass effect. These are only the critical findings.
The test can also uncover dilation of the common hepatic duct, common, bile duct, or gall bladder (Herrine, 2018). Some other
findings are: hematomas, diverticulitis, hemoperitoneum, hepatic cysts, and renal calculi (Van Leeuwen & Bladh, 2015).

Procedure and Nursing Responsibilities

For Abdominal Ultrasound:

Before:
1. The nurse identifies the patient using at least two identifiers before providing the diagnosing service.
2. The patient is informed about the importance of the procedure in assessing the abdominal organs.
3. History of results of the patient’s cardiovascular, gastrointestinal, genitourinary, and hepatobiliary systems, symptoms,
and results of previously performed laboratory tests, diagnostic and surgical procedures is obtained.
4. The client is informed of the pain and discomfort experienced during the test.

During:
1. It is ensured that food and fluids have been restricted, if required, prior to the procedure.
2. The patient is instructed to remove external metallic objects prior to the procedure.
3. The patient is told to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
4. The patient asked to cooperate fully and to follow directions.
5. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
6. The patient is placed in the supine position on an examination table. The right- or left-side-up positions may be used to
allow gravity to reposition the liver, gas, and fluid to facilitate better organ visualization.
7. The abdominal area is exposed and the patient is draped.
8. Conductive gel is applied to the skin, and a Doppler transducer is moved over the skin to obtain images of the area of
interest.
9. The transducer is placed on the abdomen and moved back and forth over the area of interest.

After:
1. The gel is removed from the abdomen
2. Instructions to resume usual diet and fluid consumption are given.
Significant Findings and Interpretation

Abdominal Ultrasound can reveal abdominal abscess which could indicate a burst appendix, intestine or ovary. It could
also indicate inflammatory bowel disease, infection of an intra abdominal organ, pelvic infection or parasite infestation. It could be
present due to trauma perforated ulcer disease, past surgery in the abdomen, or a weakened immune system (Medline Plus,
2017).Ascitic fluid could indicate liver cirrhosis (Herrine, 2018). Aortic aneurysm greater than 4 cm, congenital absence or
malplacement of organs, g allbladder or renal calculi, tumor, liver, spleen, or retroperitoneal space could also be found in an
abdominal ultrasound result (Van Leeuwen & Bladh, 2015).

Procedure and Nursing Responsibilities

For Transvaginal Ultrasound:

Before:
1. The nurse identifies the patient using at least two identifiers before providing the diagnosing service.
2. The patient that is informed that this procedure can assist in assessing pelvic organ function.
3. A history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or
sensitivities to latex is obtained
4. A history of the patient’s reproductive system, symptoms, and results of previously performed laboratory tests and
diagnostic and surgical procedures is obtained.
5. Any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). There should
be 24 hr between administration of barium and this test are noted.
6. The date of the last menstrual period is noted and the possibility of pregnancy in perimenopausal women is
determined.
7. Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some
pain may be experienced during the test, and there may be moments of discomfort. Inform the patient that the
procedure is performed in a UTZ department by an HCP who specializes in this procedure, with support staff, and
takes approximately 30 to 60 min.
8. Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support
before, during, and after the procedure.
9. The patient is instructed to remove jewelry and other metallic objects from the area to be examined.
10. The patient is asked to change into the patient’s gown

During:
1. The patient is instructed to listen to all instructions and to remain still during the test.
2. The client is then placed in supine position on the examination table.
3. The abdominal and pelvic area is exposed
4. The patient is draped.
5. The probe is covered and lubricated and inserted into the vagina. This is moved to different levels. All images are
obtained and recorded.
6. The patient is instructed to breathe normally during the examination. If necessary for better organ visualization, the
patient will be told to inhale deeply and hold her breath.

After:
1. The patient is allowed to void, as needed.
2. The lubricant is removed when the study is done.
3. The HCP will discuss the results of the test with the patient.
Complications

There are no harmful effects of ultrasound on humans (Corbett, 2013).

Significant Findings

A transvaginal ultrasound could find these anomalies: pelvic abscess, adnexal torsio, appendicitis, endometrioma,
fibroids (leiomyoma), infection, nonovarian cyst, ovarian cysts, ovarian tumor, peritonitis, PID, uterine tumor or adnexal tumor
(Van Leeuwen & Bladh, 2015).

References

Corbett, J. V. (2013). Laboratory Tests and Diagnostic Procedures with Nursing Diagnoses. New Jersey:

Pearson Education.

Herrine, S. K. (2018). MSD Manual Consumer Version. Retrieved from MSD Manual:

http://www.msdmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-

disease/ascites

Mayo Clinic Staff. (2015, March 25). Mayo Clinic. Retrieved January 22, 2018, from Mayo Clinic:

https://www.mayoclinic.org/tests-procedures/ct-scan/basics/definition/prc-20014610

Medline Plus. (2017, December 21). Medline Plus Trusted Health Information for You. Retrieved from

Medline Plus: https://medlineplus.gov/ency/article/000212.htm

Radiological Society of North America. (2016, March 16). Radiology Info. Retrieved January 23, 2018,

from Radiology Info: https://www.radiologyinfo.org/en/info.cfm?pg=bodyct

Radiological Society of North America. (2016, May 30). Radiology Info. Retrieved from Radiology Info:

https://www.radiologyinfo.org/en/info.cfm?pg=genus

Van Leeuwen, A. M., & Bladh, M. L. (2015). Davis's Comprehensive Handbook of Laboratory & Diagnostic

Test with Nursing Implications. Philadelphia: F.A. Davis Company.