ENDOSCOPIES

Endoscope- This is an instrument used to exam/view interior of an organ or a hollow cavity.

It consists of a rigid or soft tube connected to a lens, which allows the person to look through the tube.

An endoscope is used in diagnosis of a wide range of ailments.

For the lung specialists, the endoscope used is known as Bronchoscope and is used to exam the trachea
and bronchial tree.

It can be used to locate tumors, constrictions, secretions areas or bleeding sites. It can also be used to
diagnose lung cancer, TB and other pulmonary diseases.

BRONCHOSCOPY
Def: This is the passage of a bronchoscope into the trachea and bronchi are performed mainly to aid
diagnosis, the main air passages can be inspected and specimens from a growth removed or pus can be
aspirated. In addition, foreign bodies that have been inhaled can be removed.

Objectives

Performed to detect a lesion, remove foreign bodies, obtain a biopsy or to facilitate a free air passage.

This investigation permits the direct viewing of the respiratory tract (larynx, trachea or bronchi) using a
fibreoptic instrument called a bronchoscope.

Indications
NB: This investigation is performed under a local anesthetic, usually in a special department or operating
theatre by a respiratory physician

Method
The procedure and its purpose are explained to the patient who is then asked to sign a consent form.
The patient is asked to remove any dentures, jewellery and clothing then to wear a gown. The patient
will have been asked to fast for 4-6 hours before hand.

Premeditations-
Includes a tropine usually prescribed and given about 1 hour before the investigation. The patient’s
throat is anaesthetized with local spray.

The patient is then asked to place himself in the sitting or supine position on the operating table. He is
asked to remain while the bronchoscope is passed down through the mouth or nose.

Bronchoscopy is sometimes required as a therapeutic measure to remove retained secretions after

operations.
LARYNGOSCOPY
Def: This is the insertion of the laryngoscope into the larynx (vocal box) to give a physician direct view of
the organ

Indications
It will assist in locating tumors, foreign bodies and nerve injury.

Procedure
The procedure is done in the hospital set up. The patient is starved prior to the procedure.

Local anesthesia is sprayed into the nose to decrease the discomfort.

The Feberoptic endoscope is inserted in to the nose down the throat into the larynx. The light and the
lens assist the physician to see the larynx.

A rigid laryngoscope end is inserted through the mouth.

NB: There is no serious risk although there will be soreness of the throat and nose and the patient may
cough small quantities of blood.

PROCTOSCOPY
Def: this is the examination of the rectum by use of a proctoscope.

Objective

-to detect rectal disorders

-to confirm diagnosis

Indications
1. Rectal prolapsed
2. Fissure inane(ano fissure)
3. Fistula in ano(opening into another organ)
4. Hemorrhoids
5. Enlarged prostate

Requirements of procedure
Refer to procedure manual pg128-129

OESOPHAGOSCOPY
Def: This is the viewing of the esophagus using oesophagoscope

Indications

-exam the esophagus

-take a biopsy

-to remove foreign bodies

NB:

The oesophagoscopy is a rigid not flexible tube.

This is done under general anesthesia.

Method
The patient lies on his back and the anesthesia administerial through an endotracheal tube. When
relaxation is complete, the head and neck are extended over the end of the table in order to straighten
the esophagus and a theatre nurse will support the head.

The purpose is to examine the esophagus, perhaps to take a biopsy or to remove foreign bodies in the
esophagus e.g. Fish bone.

After oesophagoscopy has been done no food or drink should be given for 3hours and aspirin mucilage
(gargles) is usually needed for some throat.

GASTROSCOPY
Def: This is the inspection of the interior part of the stomach using a gastro scope.

Indications
-peptic ulcer

-Pernicious anemia- these results from the inability of the bone marrow to produce normal RBCs
because of the lack of protein, which is, produced an intrinsic factor, which is responsible for absorption
of vit.B 12.

Cancer of the stomach from simple ulcers

-some doctors insist that the stomach should be emptied

-Atropine is given to diminish the secretions

- IV diazepam to sedate the patient

The procedure is conducted in theatre under local anesthesia.

Method
The gastro scope has a high carrying tip, which is screwed into a flexible metal in the middle portion in
which there are lenses

This section is enclosed in a rubber sheath

The upper portion carries the handle, eyepiece and a bellows for inflating the mouth. It is best
performed with local anesthesia.

No food or drink should be given 3hours afterwards when sensation will have returned to the mouth
and pharynx and swallowing can be undertaken without risk of fluid entering the airway.

Complications
-perforation of the stomach

If perforation occurs, feeding should be undertaken with a sterile indwelling esophageal catheter. The
temperature should be taken 4hourly for 24 hours after gastro copy and aspirin mucilage (gargles) is
usually ordered if the throat is sore.

TRACHEOSTOMY
This is the insertion of the endoscope into the trachea. This provides direct view of the trachea.

SIGMOIDOSCOPY
This is the examination of the rectum and sigmoid part of the large intestine.

COLONOSCOPY
This is the examination of the colon from the anus to the junction of the small intestines.

LAPAROSCOPY
This is the insertion of a scope (diameter 10mm) into the peritoneal cavity through a 2cm (3/4inch) sub
umbilical incision to allow visualization of the pelvic structures.

It is inserted through a small incision in the abdomen.

Indications
1. Orders of the following organs- uterus, uterine tubes, broad ligaments, rectal wall, sigmoid
colon, small intestines,
2. Pelvic masses
-performing minor operative procedures e.g. tubal sterilization, organ biopsy.

Patient care
Do all pre-operative care since patient will be put under either L.A or G.A.

Post care
As any patient who has undergone surgery
CYSTOSCOPY
Def: This is investigation, which permits direct viewing of the urethra and bladder by inserting a hollow,
lighted, telescopic tube (cyst scope) through the urethra into the bladder.

Biopsy forceps, scissors or a cytology brush can also be inserted through the instrument

Objectives
-to make a diagnosis

-to inspect or obtain biopsy specimens of the ureter, bladder or urethra

-to measure bladder capacity

-to dilate the urethra and ureters

Method
Cystoscopy is performed in the operating theatre or cystoscopy clinic by an urologist.

The procedure takes about 25 minutes.

If cystoscopy is done in the operating theatre, a sedative injection is often ordered beforehand to allay
anxiety but less alarming atmosphere of an outpatient department, this is omitted.

If cystoscopy alone is contemplated, a local shave is not necessary, but if it may be followed by
operation, an abdominal and perineal shave should be given.

Just before the examination, the bladder must be emptied so that any which is removed from the
bladder.

RADIOLOGICAL EXAMINATION.
CT SCAN- computerized tomography.

CONTRAST MEDIA.

-BaS04

-Urografin

-Urovideo

-Uromiso

General procedure. Manual P0s24

RADIOLOGICAL EXAMINATION AND MANAGEMENT OF PATIENTS.

G.I.T

1. BARIUM SWALLOW

A radiological examination of esophagus using a contrast media.

OBJECTIVES AND INDICATION.

-Esophageal varies-enlarged superficial veins.

-Ca esophagus

-FB in esophagus.

PATIENT PREPARATION

-Psychological

-Accompany to X-ray department on the appointed day.

AFTERCARE

Give patient water to clean mouth.

2. BARIUM MEAL AND FOLLOW THROUGH

Stomach, duodenum, and small intestines.

-This is the radiological examination of the stomach and small intestines using a contrast media.

SPECIFIC INDICATIONS.

 CA stomach
 Peptic ulcer
 Duodenal ulcer
 Pyloric stenosis
 FB small intestines
 Acute gastritis.

PATIENT PREPATION
  Light meal for 2-3 days
 Liquid supper the night before
 Aperients tabs e.g. ducolax tabs 2x3
 Nil oral the midnight prior to the day of the examination.
 Starve 6-8 hrs
 Be sure of L.M.P
 Psychological care- patient may need to go back to the ward then the x-ray department after 1-2
hrs when the dye has reached the stomach and small intestines.
 Accompanying patient to x-ray department.

AFTERCARE

 Give aperients if ordered.

 Give water to clean the mouth.
 Observe that the patient passes BaSo4

COMPLICATION

 ABDOMINAL UPSET
 OBSTRUCTION
 CONSTIPATION

3. BARIUM ENEMA

This is the radiological examination of large intestines using a contrast media i.e. BaSO4

SPECIFIC INDICATION

 Coloric mass
 Polyps
 Mega colon- dilation or hypertrophy of the colon
 Diarrhea of unknown cause
 Partial obstruction of the colon
 Ulcerative colitis
 Diverticulitis
 Intussusceptions.

CONTRAINDICATIONS

Gross infection of the lower part of the rectum.

PATIENT PREPARATION.
Same as barium meal

Soap enema the morning before examination encourages the patient to retain the enema during the
procedure and allow him to go to the toilet immediately after the procedure.

In case of suspected obstruction omit the aperients but carry out the colonic lavage.

GALLBLADDER.

CONTRAST MEDIA

 UROGRAPHIN
 UROVIDES
 UROMISO

COLECYSTOGRAM AND COLANGIOGRAM

This is the radiological examination of the bile ducts, gallbladder or both using a contrast media.

INDICATION

Cholethiasis

Cholecystitis

NURSE DUTY

 Prepare the patient psychologically

 Prepare physically as per instruction
 Aperients 36 hrs before examination.
 Low residue diet a day before examination.

NERVOUS SYSTEM

MYLOGRAM

This is the radiological examination of the spinal canal by use of contrast media injected into the canal
directly after lumbar puncture.

SPECIFIC INDICATIONS

 Paralysis
 Prolapsed intervertebrae disc
  Localized tumor, which may be processing on the spinal cord.

CONTRAINDICATIONS

 Patient highly sensitive to contrast media

 Trauma to the side of interest

Patient with gross obesity

Patient with raised intracranial pressure

PREPARATION

Prepare as for patient undergoing GA

Aid lumbar pressure

N.B CT scan is now preferred

POSTCARE

Post operative care as for if from GA as for patient done who has been done LP.

COMPLICATION

Herniation

Persistent leakage of CSF

Infections e.g. meningitis

Laceration.

BRAIN CNS

PNEUMOVENTRICULOGRAM.

This is the radiological examination of the ventricles of the brain. Brain is filled with air and x-ray is
taken. Air is introduced through a lot or cisternae puncture.

INDICATIONS.
Tumors

N .B CT scan has replaced the above x-ray.

CAROTID ANGIOGRAM

This is the radiological examination of the brain’s blood vessels

Indications

Hematoma

Aneurysm

Before craniotomy

Tumors maybe displaces blood vessels.

PATIENT PREPARATIONS

Prepare as for patient undergoing GA.

CARE OF PATIENT DURING AND AFTER PROCEDURE

 Observe vital signs

 Swelling out the site where the contrast media is injected.
 Position of the patient
 Oozing from the site
 Later observe signs of meningitis
 Observe for neurologic deficit maybe caused by thrombosis blocking proper circulation.

HYSTEROSALPHINGIOGRAM

This is the radiological examination to visualize the uterus and fallopian tube. Dye is injected through the
vagina. The contrast media is urografin 10cc

INDICATIONS

 Blocked tubes
 Retroverted uterus
 Fibroids
 Infertility
  Tumors
 Congenital malformations

CONTRAINDICATION

 Pregnancy
 Recent Dand C
 Acute vaginitis
 Menstrual flow

PATIENT Preparation

Make sure uterus is not gravid

Analgesic a day before

Empty the bladder and bowel

After exam, give analgesics

INTRAVENOUS UROGRAM (PYELOGRAM)

This is the radiological exam to demonstrate the kidneys, uterus and bladders using a contrast media.

INDICATIONS

 Renal failure
 Renal stones
 Ectopic kidneys
 Renal infections
 Tumors of bladder and kidney
 Pylonephritis.
 Heamaturia

PATIENT PREPARATION

Light meals 3 days

Ducolax tabs 2x3

Psychological preparations

Accompany patient to x-ray room

May need enema on the evening before examination

Nil per oral for six hrs

Empty bladder

DURING PROCEDURE

Observe for allergic reaction

Have an emergency tray

No special care after procedure

RETROGADE PYELOGRAM

This is the radiological examination of structures of pelvic calceal system of the kidney, ureter and
bladder at time by use of contrast media introduced through a catheter in the urinary bladder.

INDICATION

 If IVP has failed

 Obstruction of ureters
 Urethral blockage
 Ruptured pelvic area membrane

METHOD

A cathertirizing cystoscope is passed and a urethra catheter passed into one or both ureter

Sodium iodide is injected along the catheter 10 ml at a time with the patient feels discomfort at the loins
as kidney pelvis is stretched.

CONTRAINDICATIONS

Asthmatic patients

Patients with gross urinary infections.

ULTRASOUND

Deep-sited organs are visualized by recording the reflection of ultrasonic waves directly into tissues in
this radiologic technique.
INDICATIONS

Cirrhosis

Hepatitis

Hepatocellular Ca

Cysts

Metastasis.

2. BILIARY SYSTEM

 JAUNDICE
 GALL STONES
 CA PANCREAS
 CA GALBLADDER

PATIENT PREPARATION

Starve for 6-8 hours

For biliary system patient should take fatty free food the day before

Avoid foods that produce gas the day before examination

3. ABDOMINAL ULTRASOUND

 ABDOMINAL MASSES
 ASCITES
 PERITONITIS
 PANCREATITIS

PREPARATION

Starve 6-8 hours

4. SPLEEN
 Splenic mass
  Splenomegally

5. RENAL U/S
 RENAL CYSTS/MASS
 PYELONEPHRITIS
 RENAL FAILURE
 RENAL CALCULI

PREPARATIONS
No special preparations required.

6 PELVIC

 Uterine fibroids
 Endometriosis
 Ovarian tube cysts
 Appendicitis
 Cystitis
 Benign prostate hypertrophy
 Pelvic abscess
 Undescended testes

PATIENT PREPARATION
Must have a full urinary bladder

Seven OBSTETRICS

Gestational age

IUFD

IUFR

Abortion

ELECTROENCEPHALOGRAM (EEG)
Readings can be influenced by the actions of the patient or physiological status .Therefore the patient is
prepared physically and psychologically by proper explanation. He should be told that the electrodes will
be placed on collodion and the amount of electricity passed is very minute. Therefore, there is no
danger of electric shock.

1. Withdraw all anticonvulsants, tranquiller and stimulants for at least 24hours-48hours (1-2days
prior to testing. This include:-coffee, tea, cola drinks and alcohol
2. The patient is asked not to skip meals as hypoglycemia affects the brain wave patterns.

During the procedure

At the beginning of the test, a baseline EEG reading is obtained by having the patient lie quietly in dimly
lit room with eyes closed. He is cautioned to avoid movement of the eyelids, mouth or tongue because
these activities can be particularly disruptive.

Provocative or stressing technique is sometimes used during the EEG testing.

These are particularly useful in the diagnosis of epilepsy because they can evoke seizure potentials on
the EEG. Patient asked to hyperventilate for 3-4 min then cool at bright light.

The two techniques most often used are-

1. Hyperventilation and”photic “stimulation which employs flickering lights to stimulate the brain.
With this technique, the patient should be informed so that he can avoid unduly apprehension
before and during the testing.
NB: The whole procedure takes 45-60min.
Patients the seizures do not stop taking their anti-seizures medication prior to testing.

ECHOCARDIOGRAPHY
Definition

Echocardiogram is the record produced by echocardiography size. It involves transmission of high

frequency sound waves into the heart through the chest wall of recording of return signals.

Echo: recording of the position and motion of the heart walls or internal structures of the heart and
neighboring tissue by the echo obtained from beams of ultrasonic waves directed through the chest
walls.

It utilizes ultra sound to delineate anatomical structures by recording on a graph the echoes from heart
structures.

Ultra sound is increasingly used as a diagnostic technique and has become of particular importance in
the field of cardiograph. The fact that the heart is continually moving and that abnormalities of motion
are of diagnostic importance gives echocardiography a particular advantages over other imaging
techniques

Echocardiography is particularly useful in detecting a number of abnormalities.

Indications

1. Pericardial effusion- shows the fluid as an echo lucent area between the epicardium and
endocardium
2. Rheumatic mitral valve diseases- shows an abnormal echo appearance of the valve
3. In studying directly the image of the left ventricle
4. Hypertrophic cardiomyopathy- thickening of the interventicular septum
5. Calcium in the aorta leading to aortic stenosis
6. The presence of various abnormal masses within the heart(vegetation associated with infective
endocarditis)

NURSING CARE
 Before the procedure
 Explain to the patient about the test that it is painless
 Gel applied on the skin, which helps to transmit the sound waves.
 Periodically the patient will have to turn on to the left side or hold breaths
 The procedure takes about 30-45minutes
 Fast the pt for 6-8hrs
 Remove jeweler and other metallic gadgets

Tran esophageal Echocardiography

In order to produce clear images of the lungs tissue and bone, TEE is done, where by the threading of a
small transducer through the mouth and into the esophagus to provide clearer images because waves
are passing through less tissue.

Complications
 Caused by sedation and impaired swallowing from topical anesthesia. A respiratory depression
and aspiration insertion

Contra-indication
-patients with permanent pace-maker
-patients with artificial heart valve and defibrillators
-because the magnetic field could cause malfunction.

MAGNETIC RESONANCE IMAGING (MRI)

This is a new imaging modality based on the use of high-powered magnetism. It is a method of
visualizing physiological distribution of protons within the body enabling very high quality anatomical
images to be obtained. This has rapidly caught the imagination of the radiological community
throughout the world. Unlike CT, it is capable of producing images within any plane.

In this technique, the patient is placed in a uniform high magnetic field. Radiofrequency current is used
to interpose brief pulses into the field causing changing magnetization of proton and a signal recorded
from the coil surrounding the magnetic computerized reconstruction of this pattern of signal allows a
water based image of the tissues of very high resolutions to be generated.

INDICATIONS

 Lesions e.g. multiple sclerosis

 Infections
 Infarctions
 Filtrative tumors.

CONTRAINDICATIONS

Patients with permanent pace makers

Patients with artificial heart valves and defibrillators

Implanted metal devices such as aneurism clips

This is because the magnetic field could cause malfunction.

CARE PRIOR TO THE PROCEDURE

Fast 6-8 hrs before procedure

Remove jewellery and other metal

It is important to warn patient that the close fitting scanners used in many MRI facilities may induce
feelings of claustrophobia and that the machine will make a knocking sound during the procedure.

The patient lies in a machine that constructs an image based on the magnetic field created between the
machine and the structure scanned.

The entire produce takes 30-90 minutes.

ADVANCED NURSING PROCEDURE

XRAYS
This is an electromagnetic energy that passes through structures producing an image in a
special film.
Short wave length penentrating rays of electromagnetic spectrum produced by electrical
equipement.
TYPES
Plain xray- taken on any part of the body requires non preparation , simple xray.
Contrast medium x ray – used when plain xray cannot show details of the body. The contrast
medium can be used to fill the body organ or cavity and makes it more dense hence the shape
becomes more distinct when viewed in an xray film. The nurse prepares the patient pre and post
the procedure.
COMPLICATIONS
Patients may have reactions e.g nausea , vomiting, skin rash.
Maybe severe –heart failure and kidney failure.
A lot of xray exposure can cause cell changes leading to cancer.
Patients with previous allergies must report to the radipographer.
Observe all patients for any reactions.

OBJECTIVES FOR XRAYS

 To aid in confirming diagnosis
 To check results following treatment
 To aid in outlining internal organs and detect deformity
 To locate foreign bodies.

INDICATIONS

Trauma

Suspected internal organ disease

Foreign bodies e.g in cavities.

REQUIREMENTS

Xray request form

Previous xray if required

PROCEDURE

Refer to procedure manual

VENOGRAM
 This is the radiogram of a vein filled with contrast media

Indication-tracing of the venous pulse

RADIOTHERAPY

This is the use of ionizing radiation to interrupt cellular growth

Other radio-ions like gamma rays cause effects on the tumor cells without affecting normal
tissues is suitable dosage employed

Gamma rays are electromagnetic waves similar to heat ,light, and X-ray of shorter wavelength
penentrate tissues more. Radium used must be applied and removed punctually since overdose
cause burning, deep ulcers and toxicity.

NURSING CONSIDERATION OF DEPARTMENT OF RADIOTHERAPY.

Allay fears about effects , actual procedure and equipements.

Attention to patients skin, nutritional status, general feeling of well being. Avoid using
ointments, lotions, soap or powder on the site of interest.

Gentle oral hygiene to remove debris and irritation.

For weakness and fatique assist with ADL and personal hygiene, explain that symptoms are due
to reaction not detororiation.

Bed rest

Specific instructions about safety from radiology department. Amount of time in patients room
shielding equipement, special precautions to be used.

COMPLICATIONS OF RADIATION /SIDE EFFECTS.

They are divided into general and local side effects

GENERAL SIDE EFFECTS

1. Radiation sickness- patient becomes nauseated or vomits . occur when large doses of
radiation are used e.g in rx of intra-abdominal or intra- thoracic.
2. Damage to the bone marrow- there is a drop in the W.B.C count affecting the first
lymphocytes and poly morphs platelets count fall and patient becomes anaemic.
3. Depressed white blood cells count <2000 and is accompanied by a low resistance to
infection
4. Bleeding tendencies due to fall in platelet count hence haemorrhage into the skin and other
tissues. Usually regular bllod counts are done in the radiotherapy department in patients
 undergoing extensive treatment especially the W.B.C in patient undergoing large field
radiation.
5. Erythma –the skin in the area irradiated becomes red following high dose irradiation. This is
followed by local pigmentation of skin atrophy development of telangioctasis reaction.