FUNDAMENTALS OF NURSING (DAY 2) COMPETENCY APPRAISAL 2

Lecturer: Prof. Melody Bautista January 08, 2023 (1:00-7:00 PM)

Magnetic resonance imaging (MRI) Upper GI series (UGIS/ UGI Xray)

- a noninvasive medical imaging test that produces - Barium swallow
detailed images of almost every internal structure - Barium – non iodine based contrast
in the human body, including the organs, bones, - To aid in the diagnosis of strictures, blockage,
muscles and blood vessels. ulcers, tumor, regional enteritis, hiatal hernia.
1) Secure consent - Crohn’s disease = terminal ileum
2) The procedure will last 45-60 mins - Hiatal hernia – pyrosis (heart burn)
3) Assess client for claustrophobia (fear of being in a - NPO after midnight (swallow large volume barium
closed space) in AM, xray after 1hour
o Open MRI - Force fluid after the test to prevent constipation/
o Sedatives – pwede ibigay sa pedia barium impaction
- Increase anxiety - Tell client that the stool will turn white 24-48 hours
4) Remove all metal items after the test
5) Client should remain still - Contraindicated for patient with intestinal
6) Tell client that he will feel nothing but may hear
noises (drumlike, humming, vibrating) - Complication of barium:
7) Client with pacemaker, prosthetic valves, • Barium impaction = constipation, abdominal
implanted clips, wires are not eligible for MRI distention
- Alternative dx: CT scan o Management: oil retention enema
o Retain enema atleast 30 mins para
- Tattoo pigments (body parts), eyeliner, eyebrow or lumambot
lip liner may contain metals which create an - Prevention:
electrical current that can cause redness and 1) Force fluid – 3-4 liters per day
swelling to a first degree burn at the site of the 2) Eat high fiber diet – fruits and vegetables
tattoo. Bran diet – oat meal, wheat, for constipation
• MRI = radio frequency and electromagnetic BRAT – for diarrhea
wave 3) Take laxative tablet – Dulcolax with MDs order
• CT/ CAN scan and X-ray = radiation 4) Repeat enema with MDs order
• Metal can cause electric current
- Client with cardiac and respiratory complication Lower GI series (LGIS/ LGI Xray)
may be excluded. - Bowel prep = LGIS, Colonoscopy, bowel surgery,
• CHF-LSHF – pulmonary congestion (orthopneic) IVP KUB
• COPD, Asthma, pneumonia (mahihirapan 1) Instruct client on low residue diet 1-3 days
huminga) before the procedure. (to decrease bulk of stool
in the lower GI)
2) Administer laxative evening before the
procedure
3) NPO after midnight
4) Administer suppository in AM
5) Enema until clear
6) Force fluid after the test to prevent constipation/
barium impaction
7) Tell client that the stool will turn white 24-48
Close type
hours after the test.
- High frequency
8) No bowel movement after 48 hours – notify MD
- Si patient lng magisa sa loob dapat
Open type =
Colonoscopy
- Low frequency
Position: left lateral – to follow the natural curve of
- Pwede magbigay ng isang bantay ng pasyente
sigmoid. Para hindi sya against the curve
while undergoing MRI
• Iodine based contrast is nephrotoxic if poor BUN
and creatinine.
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FUNDAMENTALS OF NURSING (DAY 2) COMPETENCY APPRAISAL 2
Lecturer: Prof. Melody Bautista January 08, 2023 (1:00-7:00 PM)

Lower GI endoscopy lower quadrant with palpation pressure in

- Direct visualization of the bowel the left lower quadrant—is a sign of acute
- Invasive = informed consent – perforation bleeding appendicitis
- Pre op meds: demorol, valium - Liver biopsy is sterile technique
1) Proctosigmoidoscopy (rectosigmoidscopy) is - Skin preparation
the visualization of the anal canal, rectum and - Lidocaine 2%
sigmoid colon through a fiver optic - Check for sign of bleeding
sigmoidoscope. • Check for eccymos
2) Colonoscopy (with biopsy) is the visualization • VS – decrease BP LOC, increase HR RR
of the entire large intestine, sigmoid colon,
rectum and anal canal. Confirmatory test for Paracentesis (peritoneal tap)
colorectal cancer. (wala syang pain) - Indication:
3) Sigmoidoscopy or colonoscopy can be used to • To relieve diff of breathing in client with ascites.
diagnose malignancy, polyps, inflammation or • To analyze peritoneal fluid in client with
strictures. peritonitis.
May Bowel preparation sa lower GI endoscopy 1) Secure consent
2) Check VS especially BP and HR. (problem:
Liver biopsy hypovolemic shock)
- Indication: 3) Weigh the client before and after the procedure if
- To diagnose liver cancer ascites
- To assess liver tissue (liver cirrhosis) 4) Measure abdominal girth before the procedure if
1) Aspiration of core of liver tissue for histologic ascites (find the umbilicus, doon ilalagay ung tape
analysis using Menghini needle (gauge 14-16) measure)
(cystologic test g 25,26,27,28) 5) Let the patient void (empty bladder) before the
2) Secure consent procedure to prevent puncture of the bladder
3) NPO 2-4 hrs before the test (hematuria)
4) Monitor PT vit K at bedside. (coagulant – to stop 6) Use gauge to torcher or cannula (1-2 inches below
bleeding) the umbilicus
5) Practice strict asepsis (sterile technique) 7) Check for serum protein. Excessive loss of plasma
6) Place the client in supine at the right side of the protein may lead to hypobolemic shochk
bed. (edge ng bed) - Normal total serum protein = 6-8 grams/ dl
- Alternative: left lateral position - Serum albumin = 3.5-5.5 gm/ dl
- Best position pa rin ang supine
7) Instruct the client to inhale and exhale deeply Excessive plasma protein loss > decreases oncotic
for several times and then exhale and hold pressure > shifting of fluids between fluid
breath while the MD insert the needle. (to compartments > hypovolemic shock
prevent injure of diaphragm)
- Inhale and hold – kidney biopsy Para magkaroon ng shifting of fluid:
- Exhale and hold – liver biopsy (between 6th • Increase hydrostatic pressure
and 7th ribs) • Decrease oncotic pressure
8) Right lateral post procedure for 4 hours to apply
pressure and prevent bleeding. (splinting) Signs of hypovolemic shock:
9) Bed rest 24 hours Cardiac output: 100% = 20% kay brain, 20% kay heart,
10) Observe for sign and symptoms of peritonitis. 20% kay kidneys, 20% kay GI, 20% kay extremities
- s/s – fever, abdominal pain, WBC more than • Pallor (cool to touch)
22k, board like rigid abdomen (guarding)
• Tachycardia
- Paralytic ileus – hindi gumagalaw ang bituka
• Decreased blood pressure
(light palpation to assess)
• Oliguria (<500 ml of urine a day)
- Blumberg sign – for appendicitis
• Dyspnea (increase RR, poor LOC, restlessness,
- Rovsing sign – press left lower, pag bitaw sa
cyanosis)
kanan masakit. Pain elicited in the right

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FUNDAMENTALS OF NURSING (DAY 2) COMPETENCY APPRAISAL 2
Lecturer: Prof. Melody Bautista January 08, 2023 (1:00-7:00 PM)

8) Position: sitting on a chair with feet supported with - Kernig's sign, Brudzinski's sign, and nuchal rigidity
footstool or place in high fowlers position. are bedside diagnostic signs used to evaluate
(Contraindicated if poor LOC balance) suspected cases of meningitis.
9) Strict aseptic technique to prevent peritonitis. • Resistance or pain and the inability to extend
(sterile technique) the patient's knee beyond 135 degrees, because
10) Local anesthetic is injected. of pain, bilaterally indicates a positive Kernig's
11) The procedure takes about 45 mins sign
12) Normal urine output = 30-60 ml/ hr • Reflex flexion of the patient's hips and knees
13) Monitor urine output for 24 hrs as watch out for after passive flexion of the neck constitutes a
hematuria which may indicate bladder trauma. positive Brudzinski sign
• Nuchal rigidity has tightness and inability to
Bowel perforation = Color of drainage: brownish move the neck muscles — or feels pain while
trying to do so. (hallmark sign of meningitis)
Lumbar puncture (spinal tap)
- CSF analysis diagnostic test = meningitis and
encephalitis
1) Obtain consent. (invasive = cord trauma,
bleeding, edema, compression, ischemia,
necrosis, paralysis)
2) Instruct client to empty the bladder and bowel.
3) Position the client in lateral recumbent with
back at the edge of the examining table
4) Spinal needle in inserted in the midline between
the spinous process between the 3rd and 4th
lumbar vertebrae. (mas mababa mas manipis)
5) Using 18G(pink) or 20G(yellow) in adults,
22G(black) in children. (23G blue).
6) Instruct the client to remain still during needle
insertion to prevent trauma on the spinal cord
7) Instruct the client to remain in flat position for 8
hrs to prevent spinal headache.
8) Obtain specimen per MDs order. (2-3 bottles –
3-5ml per bottle)
9) Headache is the most common adverse effects
of a lumbar puncture.
- Management for spinal headache:
• Bedrest in flat position
• Place patient in dark and quiet room
(limited visitors)
• Administer analgesic (contraindicated
to narcotics, side effects: sedation.
Complication of lumbar puncture:
meningitis infection.) DOC: Ibuprofen –
most prescribed analgesic
• Fluids
- Note: if the headache continues, epidural
patch maybe required. Blood is withdrawn
from the client vein and injected into the
epidural space, usually at the LP site.

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