NCM 118 EMERGENCY NURSING
ER Assessment
» Test requires less complex equipment for recording
» Securing consent is not required
General Nursing Tasks:
» Decrease patients anxiety and offer support
» Use procedure that prevents specimen
contamination
Information Station:
 Danger Details:
» How did the accident occur?
» What type of accident was it?
» If it was a moto vehicle collision, did the
vehicle sustain exterior or interior damage?
 Patient Particulars:
» Was the patient restrained?
» Did the patient have to be extricated from the
vehicle?
» Was the patient ambulatory at the scene?
 Injuries Sustained
» What injuries have the prehospital providers
identified or suspected?
» What are the patient’s chief complaints?
 Vital Details
» What V/S have care providers obtained before
arriving in the ED?
» What treatment has the patient received and
how did they respond?
 Systematic Systems
» All patients with traumatic injuries should be
assessed rapidly with a systematic method
used consistently for all patients.
Graphic Studies of the Heart & Brain
Electrocardiogram (ECG/EKG)
 Diagnose abnormal cardiac rhythms and coronary
heart disease
Graphic record of hearts electrical activity
Shows depolarization and repolarization
Echocardiography (UTZ Cardiography)
 Diagnose valvular and other structural deformities
graphic record of motions produced by cardiac
structures
high frequency sound vibrations are echoed through
the chest wall
Electroencephalogram (EEG)
 diagnose surface lesions or tumors of the brain and
presence of epilepsy
graphic record of brains electrical potential
generates physiological activity of the brain
Types of Assessment
 Primary Survey/ Primary Assessment
 Secondary Survey/ Secondary Assessment
 Ongoing Assessment/ Focus Assessment
Echoencephalogram
 diagnose subdural hematomas, intracerebral
hemorrhage, tumors
beam UTZ is passed through the head
returning echoes are generally recorded
Primary Survey
» Focuses on stabilizing life-threatening conditions
Roentgenological Studies (X-rays)
ABCDE (Airway, Breathing, Circulation, Disability,
Exposure)
 Establish a patent airway.
 Provide adequate ventilation
 Evaluate and restore cardiac output by controlling
hemorrhage, preventing and treating shock, and
maintaining or restoring effective circulation.
 Determine neurologic disability
 Undress the patient quickly but gently so that any
wounds or areas of injury are identified
Secondary Survey
 Complete health history, including the history of the
current event Head-to-toe assessment (includes a
reassessment of airway and breathing parameters
and vital signs)
 Diagnostic and laboratory testing
 Insertion or application of monitoring devices such
as ECG electrodes, arterial lines, or urinary catheters
 Splinting of suspected fractures
 Cleansing, closure, and dressing of wounds
 Performance of other necessary interventions based
on the patient’s condition
Chest
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determine size, contour of the heart size
size, location, and nature of the pulmonary lesions
pulmonary vasculature
use lead shield to protect pregnant women
Kidney, Ureter, Bladder (KUB)
determine size, shape, and position of the kidneys
Breast (Mammography)
examination of the breast with or without injection of
dye
radio-opaque substance into the duct of mammary
gland
determine presence of tumor
no deodorant, perfume
slight discomfort due to pressure
Roentgenological Studies (Fluoroscopy)
Barium Swallow (Upper GI)
 determine patency of esophagus for varices, mobility
of gastric wall, presence of ulcer, patency of pyloric
valve
ingestion of barium sulfate
followed by fluoroscopic and x-ray examination
ER Diagnostics
Common Non-Invasive Diagnostics
Characteristics:
» Test provides indirect assessment or organ size,
shape, and function
» Easily reproducible
» Safe and effective
Barium Enema (Lower GI)
 determine contour and mobility of colon and
presence of any space occupying tumor done before
barium swallow
rectal instillation of barium sulfate
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NCM 118 EMERGENCY NURSING
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followed by fluoroscopic and x-ray examination
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patient lies still for 5-20 minutes
Nursing Tasks: Preparations
» take food and medications unless for lower studies
» restricted to those with metals
» restricted to those with permanent pacemakers
» restricted to pregnant patients
Nursing Tasks: Pre-procedure
» no food after evening meal the night prior to the test
» stool softener laxative and enema
» NPO after midnight
» Defecate/ cleanse the bowel
Ultrasound (Sonogram)
 diagnose thyroid, kidney, liver, uterus, gallbladder,
fetus, intracranial structures of the neonate
uses sound waves
Nursing Tasks: Post-procedure
» Increased fluids and offer food
» Encourage rest periods
» Laxatives for 2 days or more
» Evaluate stool color and consistency
Nursing Tasks: Preparations
» advise not to chew gum or smoke
» no x-ray
» NPO ?? hours for gallbladder UTZ
» For lower abdomen and uterus, 32 oz of H2O
Cholecystogram
 Gallbladder disease with poor visualization, accurate
if GI and liver function is intact, done before upper
and lower GI
Ingestion of organic iodine contrast medium
X-ray visualization for 12 hours
Pulmonary Function Studies
Vital Capacity (VC)
 Normal: 4000-5000 mL
 Decreased: lung disease
 Increased/ Decreased: COPD
Largest amount of air that can be expelled after
maximal inspiration
Forced Expiratory Volume (FEV)
 Normal: 80-83% in 1 sec; 90-94% in 2 secs; 95-97%
in 3 secs
 Decreased: airway obstruction
Percentage of vital capacity that can be forcibly
expired in 1-3 seconds
Nursing Tasks: Pre-procedure
» Administer large amounts of water with contrast
capsule
» Low-fat meal before evening of x-ray
» Oral laxative or stool softener after meal
» No food allowed after contrast capsule
Nursing Tasks: Post-procedure
» Increased fluids and offer food
» Encourage rest periods
» Observe for any untoward reactions
» Evaluate stool color and consistency
Sputum Studies
Intravenous Pyelography
 Visualize the ureter, bladder, and kidney
Injection of radio-opaque contrast medium in the
vein
Gross Sputum Evaluations
Collection of sputum samples
to ascertain quantity, consistency, color, and odor
Nursing Tasks: Pre-procedure
» Laxative in the evening prior to the test
» NPO for 12 hours
» Cleansing enema in the morning
Sputum Smear
smeared thinly in a slide for microscopic studies
to determine cytological changes or presence of
pathogenic microorganisms
Nursing Tasks: Post-procedure
» Increased fluids and offer food
» Encourage rest periods
» Observe for any untoward reactions
» Evaluate stool color and consistency
Sputum Culture
samples are implanted or inoculated into special
media
diagnoses pulmonary infection
Examination of Gastric Contents
Computed Tomography (CT Scan)
 Initial scan may be followed by contrast
enhancement, followed by repeat scan
x-ray bean sweeps around the body
allows measures of various tissue densities
provides clear picture of structures not visible with
other tests
Gastric Analysis
 increased acidity  duodenal ulcer
 decreased acidity  pernicious anemia, stomach
cancer
aspiration of gastric contents of the fasting stomach
analysis of free and total acid
Nursing Tasks: Pre-procedure
» instruct on having a meal before the test
» clear liquids up to 2 hours are permitted
Doppler Ultrasound
measures blood flow in the major veins and arteries
transducer is placed on the skin, sending ultra-high
frequency sound
sound varies with respiration and Valsalva maneuver,
no discomfort to the patient
Magnetic Resonance Imaging (MRI)
 provides clearer image compared to other tests
produces cross-sectional images by magnetic energy
sources
no contrast medium; takes 20 minutes to complete
Glucose Testing
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NCM 118 EMERGENCY NURSING
Fasting Blood Sugar (FBS)
 Normal: 60-110 mg/dL
 Increased  hyperglycemia
 Decreased  hypoglycemia
Blood sample is drawn after 12 hours fasting (usually
after midnight)
»
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Presence of a fluttery sensation
Flushing and warm sensation is felt
Nursing Tasts: Post-procedure
» Monitor ECG pattern
» Check for color and temperature of extremities
» Check peripheral pulses
2-hour Post-Prandial (PPBS)
Determines glucose utilization
Blood is taken after meal
Procedures to Evaluate the Respiratory System
Nursing Tasks: Pre-procedure
» Offer high carbohydrates 2-4 days before test
» Fasting overnight
» Blood sample is drawn with 2 hours interval
» No cigarette smoking, caffeine
Lung Scan
Injection of isotope into the body, followed by lung
scan
Produces graphic record of gamma rays emitted by
the isotopes in the tissues
Determine lung perfusion when emboli and
infarctions are suspected
Common Invasive Diagnostics
Characteristics:
» Test directly records the size, shape, and function of
an organ
» Enforce consent of the patient
» Some result to morbidity
» There might be death for some
Pulmonary Angiography
Introduction of fiberoptic scope into the trachea and
bronchi
Inspect tracheobronchial tree for pathologic
changes, remove foreign bodies, mucus plugs
Thoracentesis
Need puncture through the chest wall and into the
pleura
Used to remove fluid and occasionally, air from the
pleural space
General Nursing Tasks:
» Be ready for consent signing
» Evaluate history of allergy
» Formal procedure explanation
» On NPO for 6-12 hours
» Re-asses anxiety
» Explain pre-procedure sedatives
» Assess and record vital signs
» Food is not immediately given
» The need to refer
» Encourage relaxation
» Re-enforce use of warm compress
Procedures to Evaluate the Renal System
Renal Angiogram
Small catheter is inserted in the femoral artery and
passed to the aorta or renal artery
Diagnose renal hypertension, differentiate renal cyst
from tumors
Cystoscopy
Visualization of bladder, urethra, and prostatic
urethra by insertion of tubular, telescopic lens
through urinary meatus
Used to inspect the bladder, collect urine sample for
biopsy, remove calculi, treat lesions
Procedures to Evaluate the Cardiovascular System
Angiography
Studying circulation through the heart, lungs, and
great vessels
To check competent heart valves, diagnose septal
defects, detect occlusion of coronary arteries
Renal Biopsy
needle aspiration of tissue from the kidney
for microscopic cell examination
Cardiac Catheterization
To study the hearts great vessel
Confirm diagnosis of heart disease and extent of
disease, measure pressures, measure O2 content in
blood sample
Procedures to Evaluate the Digestive System
Esophagoscopy and Gastroscopy
visualization of esophagus, the stomach, and
sometime duodenum
determine patency of the alimentary tract
Right Heart Catheterization
Cutdown in the antecubital vein to the superior vena
cava, right atrium, and ventricle, and into the
pulmonary cavity
Evaluates the patency of blood flow in the right side
of the heart
Proctoscopy
visualization of rectum and colon by means of a
lighted tube inserted through the anus
determine growth of cells from the assessed tissue
Left Heart Catheterization
Passed retrograde to the left ventricle through the
brachial and femoral artery, to the left atrium then to
the left ventricle
Evaluates the patency of blood flow in the left side of
the heart
Peritoneoscopy
direct visualization of the liver and peritoneum by
means of peritonescope inserted through an
abdominal wound
determine size, location, and shape of organs
Nursing Tasks: Pre-procedure
» Ascertain fatigue as a common complain
Liver Biopsy
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NCM 118 EMERGENCY NURSING
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needle aspiration of tissue
for microscopic examination to facilitate diagnosis
Paracentesis
needle aspiration of fluid from the peritoneal cavity
to relieve excess fluid accumulation, for diagnostic
studies
Procedures to Evaluate the Reproductive System in
Women
Culdoscopy
surgical procedure in which a culdoscope is inserted
into the posterior vaginal culdesac
to visualize uterus, fallopian tube, and peritoneal
contents
Breast Biopsy
needle aspiration or incisional removal of breast
tissue
for microscopic exam to differentiate among benign
tumors, cysts
Uterotubal Insufflation (Rubin’s Test)
injection of carbon dioxide into the cervical canal
determine the patency of the fallopian tube
Procedures to Evaluate the Neuro-Endocrine System
Cerebral Angiography
visualization of the brain vasculature after injection
of a contrast medium into the carotid or vertebral
arteries
localize lesions that are large enough to distort
cerebrovascular blood flow
Myelogram
lumbar-puncture needle, contrast medium is
injected into the subarachnoid space of the spinal
column
detect herniated or ruptured intervertebral disks,
tumors, and cysts that compress or distort spinal
cord
Lumbar Puncture
puncture of the lumbar subarachnoid space of the
spinal cord with needle to withdraw CSF
to evaluate CSF for infections and determine
presence of hemorrhage
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