| Mammography Posted: 09 Sep 2010 06:44 PM PDT 
 Mammography is a radiographic technique used to detect breast cysts or tumors, especially those not palpable on physical examination. In xeromammography, a specially charged plate records the radiographic images and transfers them to a special paper. Biopsy of suspicious areas may be required to confirm malignancy. Although 90% to 95% of malignant breast tumors can be detected by mammography, this test produces many false positive results. Mammography may follow such screening procedures as ultrasonography or thermography.
Purpose of Mammography - To screen for malignant breast tumors.
- To investigate breast masses, breast pain, or nipple discharge.
- To differentiate between benign breast disease and malignant tumors.
- To monitor patients with breast cancer who are treated with breast-conserving surgery and radiation.
Mammography Procedure Patient Preparation - Instruct the patient to avoid using underarm deodorant or powder the day of the exam.
- Explain that the test takes about 15 minutes.
- Explain to the patient that she may be asked to wait while the films are checked.
- When scheduling the test, inform the staff if patient has breast implants.
- Make sure the patient has signed an appropriate consent form.
- Note and report all allergies.
Implementation - The patient rests one breast on a table above the X-ray cassette.
- The compressor is placed on the breast.
- The patient holds her breath until the X-ray is taken and she's told to breathe again.
- An X-ray of the cranicaudal view is taken.
- The machine is rotated, and the breast is compressed again.
- An X-ray of the lateral view is taken.
- The procedure is repeated for the other breast.
- The film is developed and checked for quality.
Nursing Intervention - Answer the patient's questions about the test.
- Encourage the patient to deep breathe to alleviate fear and anxiety.
- Make the patient feel comfortable after the procedure.
- Prepare to educate the patient about her diagnosis.
- Prepare the patient for further testing or surgery, as indicated.
Interpretation Normal Results - The test reveals normal ducts, glandular tissue, and fat architecture.
- No abnormal masses or calcifications are present.
Abnormal Results - Irregular, poorly outlined, opaque areas suggest malignant tumors, especially if solitary and unilateral.
- Well-outlined, regular, clear spots may be benign, especially if bilateral.
Interfering Factors
- Powders, deodorants, or salves on the breast and axilla that may cause false positive results.
- Failure to remove jewelry and clothing (possible false-positive results or poor imaging).
- Glandualr breasts that are common in patients younger than age 30, active lactation and previous breast surgery (possible poor imaging).
- Breast implants (possible hindrance in detecting masses).
Comlications - Vasovagal reaction during compression.
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| Human Chorionic Gonadotropin (hCG) Pregnancy Test Posted: 09 Sep 2010 06:27 PM PDT 
 As a qualitative analysis of urine levels of human chorionic gonadotropin (hCG), this test can detect pregnancy as early as 14 days after ovulation. A glycoprotein that is produced after conception, hCG prevents degeneration of the corpus luteum at the end of a normal menstrual cycle.
During the first trimester, hCG levels rise steadily and rapidly, peaking around 10 weeks' gestation, and subsequently taper off to less than 10% of peak levels. The most common and inexpensive method of evaluating qualitative and quantitative hCG levels is through hemagglutination inhibition of a urine sample. The serum hCG test (beta-subunit assay) is a more expensive alternative. Purpose - To detect and confirm pregnancy.
- To help diagnose hydatiform mole of hCG-secreting tumors, threatened abortion, or dead fetus.
Procedure Patient Preparation - If appropriate, explain to the patient that the urine hCG test determines whether she's pregnant or determines the status of her pregnancy.
- Alternatively, explain how the test functions as a screen for some types of cancer.
- Tell the patient that she need not to restrict food but should restrict fluids for 8 hours before the test.
- Inform the patient that the test requires a first-voided morning specimen or urine collection over a 24-hour period, depending on whether the test is qualitative or quantitative.
- Notify the laboratory and physician of drugs the patient is taking that may affect test results; it may be necessary to restrict them.
Implementation - For verification of pregnancy (qualitative analysis), collect a first-voided morning specimen. If this isn't possible, collect a random specimen.
- For quantitative analysis of hCG, collect the patient's urine over a 24-hour period in the appropriate container, discarding the first specimen and retaining the last.
- Specify the date of the patient's last menstrual period on the laboratory request.
- Refrigerate the 24 hour specimen or keep it on ice during the collection period.
- Be sure the test occurs at least 5 days after a missed period to avoid a false-negative result.
Nursing Interventions - Instruct the patient to resume her usual diet and medications.
Interpretation Normal Results - In a qualitative immunoassay analysis, results are negative (nonpregnant) or positive (pregnant) for hCG.
- In a qualitative analysis, urine hCG levels in the first trimester of a normal pregnancy may be as high as 500,000 IU/24 hours; in the second trimester, from 10,000 to 25,000 IU/24 hours.
- Measurable hCG levels don't normally appear in the urine of men or nonpregnant women.
Abnormal Results - During pregnancy, elevated urine hCG levels may indicate multiple pregnancy or erythoblastosis fetalis; depressed urine hCG levels may indicate threatened abortion or ectopic pregnancy.
- Measurable levels of hCG in men and nonpregnant women may indicate choriocarcinoma, ovarian or testicular tumors, melanoma, multiple myeloma, or gastric, hepatic, pancreatic or breast cancer.
Interfering Factors - Gross proteinuria (greater than 1g/24 hours), hematuria, or an elevated erythrocyte sedimentation rate (possible false-positive; depending on the laboratory method).
- Early pregnancy, ectopic pregnancy, or threatened abortion (possible false-positive).
- Phenothiazine (possible false negative or false positive)
Complication Related posts: - Fecal Occult Blood Test
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| Direct Laryngoscopy Posted: 09 Sep 2010 06:01 PM PDT 
Direct laryngoscopy allows visualization of the larynx by the use of a fiberoptic endoscope or laryngoscope passed through the mouth or nose and pharynx and larynx. It's indicated for any condition requiring direct visualization or specimen samples for diagnosis, such as in patients with strong gag reflexes resulting from anatomic abnormalities and in those who have had no response to short-term therapy for symptoms of pharyngeal or laryngeal disease, such as chronic hoarseness, stridor, and hemoptysis. Secretions or tissue may be removed during this procedure for further study. The test is usually contraindicated in patients with epiglottitis, but it may be performed on them in an operating room with resuscitative equipment. Purpose of Direct Laryngoscopy - To detect lesions, strictures, or foreign bodies.
- To remove benign lesions or foreign bodies from the larynx.
- To help diagnose laryngeal or upper airway abnormalities.
- To examine the larynx when indirect laryngoscopy is inadequate.
Direct Laryngoscopy Procedure Preparation - Make sure the patient has signed an appropriate consent form.
- Note and report all allergies.
- Check the patient's history for hypersensitivity to the anesthetic.
- Instruct the patient to fast for 6 to 8 hours before the test.
- Give the patient a sedative to help him relax and a drug to reduce secretions.
- Give a general or local anesthetic to numb the gag reflex.
- Explain that the study takes about 30 minutes; it takes longer if minor surgery is performed as part of the procedure.
Implementation - The patient is assisted into the supine position.
- A general anesthetic is given, or the mouth or nose and throat are sprayed with local anesthetic.
- The laryngoscope is inserted through the mouth.
- The larynx is examined for abnormalities.
- Specimens may be collected for further study.
- Minor surgery (polyp removal) may occur at this time.
Nursing Interventions - Place the conscious patient in semi-Fowler's position. Place the unconscious patient on his side with his head slightly elevated to prevent aspiration.
- Check the patient's vital signs according to facility protocol, or every 15 minutes until the patient is stable and then every 30 minutes for 2 hours, every hour for the next 4 hours, and then every 4 hours for 24 hours.
- Immediately report to the practitioner any adverse reaction to the anesthetic or sedative such as tachycardia, palpitations, hypertension, euphoria, excitation, and rapid, deep aspirations.
- Apply an ice collar per institution protocol to minimize laryngeal edema.
- Provide an emesis basin, and instruct the patient to spit out saliva rather than swallow it.
- Observe sputum for blood, and report excessive bleeding immediately.
- Instruct the patient to refrain from clearing his throat and coughing to prevent hemorrhaging at the biopsy site.
- Advise the patient to avoid smoking until his vital signs are stable and there's no evidence of comlications.
- Immediately report subcutaneous crepitus around the patient's face and neck, which may indicate tracheal perforation.
- Listen to the patient's neck with a stethoscope for signs of stridor and airway obstruction.
Interpretation Normal Results - No inflammation, lesions, strictures, or foreign bodies are found.
Abnormal Results - Combine with the results of a biopsy, abnormal lesions suggest possible laryngeal cancer or benign lesions.
- Narrowing suggests stricture.
- Inflammation suggests possible laryngeal edema secondary to radiation or tumor.
- Asynchronous vocal cords suggest possible vocal cord dysfunction.
Complications - Subcutaneous crepitus around the patient's face and neck – a sign of tracheal perforation.
- Airway obstruction in the patient with epiglottiditis.
- Adverse reaction to anesthetic.
- Bleeding.
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