EXAMINATION USING RADIO OPAQUE

DYES(CONTRAST MEDIA) AND XRAYS.

Gastro intestinal tract:
• The entire GIT can be examined by x-rays following
introduction of barium sulphate , a
tasteless,odourless, non-grannular absolutely
insoluble and non-absorbable powder opaque to x-
rays, ingested in form of a thin aqueous suspension
• The dyes take the shape of the organ
• Barium sulphate is used as a contrast media
 a) Upper GIT
BARIUM SWALLOW/MEAL:
Barium swallow or upper GIT series is an x-ray used to
examine the upper digestive tract(esophagus, stomach,
and small intestines). Because these organs are normally
not visible on x-rays, barium should be swallowed, a
liquid that does show up on the x-ray
The barium temporarily coats the lining of the
esophagus, stomach, and intestines making the outline
of these organs visible on x-ray
 Indications

To check position, patency, and calibre of the esophagus

Presence or absence of right atrial enlargement causing pressure
on the esophagus
Esophageal varices- enlarged veins
Ulcers, tumors, and abnormalities in the stomach
Patency of the pylorus and duodenum
To assess the rate of gastric emptying and activity of small
intestines
Check for causes of inflammation of intestines and swallowing
 Patient preparation

• Starve the patient from midnight

• A laxative is given to clear the intestinal tract
• Smoking is discouraged the morning of the examination because it stimulates
gastric motility
Procedure
The patient is given barium meal to swallow. He may also be asked to swallow
some tablets that ‘fizz’(cause air bubbles to be released in the stomach)
The x-ray technician asks the patient to stand or lie in different positions over
the next few minutes, to help spread around the barium sulphate.
Most x-ray pictures are taken when the patient lies on the back on the table,
the x-ray machine or table is moved few times so it can take pictures of all
internal structures
 Ct..

through the esophagus and stomach and notes

abnormalities of the outline and in filling and emptying
of the stomach.
As the barium passes through the small intestine a
further x-ray examination is made to assess the rate of
gastric emptying and the activity of the small intestines
Advice the patient to hold breath during x-ray
After care
• Advice the patient to drink more water than usual
to help clear out the barium and to prevent
constipation, which may be a side effect of the test
• Tell the patient that their stool may appear light in
color for a couple of days but it clears off
spontaneously.
• After the test, the patient should eat normally and
resume their normal activities
 b)Lower GIT:
Barium enema
• This is a special x-ray of the large intestine which includes
colon and rectum.(barium enema-white chalky material)
Indications
Diagnose and evaluate the extent of inflammatory bowel
disease such as ulcerative colitis and crohn’s disease
Polyps can be diagnosed though can’t be removed like in
colonoscopy.
Other bowel problems diagnosed are:
 Ct..
• Diverticulosis(small pouches formed on colon wall that can get
inflammed)
• Intussusception-happens when one part of the bowel slides into the next.
• Acute appendicitis or twisted loop of bowel(volvulus)
• Intestinal obstruction
• Colon cancer
Patient preparation
Clear fluids are given the day before operation or keep the patient nil per
oral after midnight
A laxative is given E.g. magnesium citrate and warm water enemas to
 Procedure

• Explain the procedure to the patient

• The patient lies on x-ray table and preliminary x-ray is taken, the pt is
asked to lie on the side while a well lubricated enema tube is inserted
into the rectum
• As the enema enters the body, pt might have the sensation that they
have to have a bowel movement
• The barium sulfate enema is then allowed to flow into the colon
• A small balloon at the tip of the enema tube may be inflated to the
help keep the barium sulfate inside.
• The flow of the barium sulfate is monitored by radiologist on x-ray
 Ct..

• Air may be puffed into the colon to distend it and provide

better images (known as double contrast exam)
• The patient is asked to move to different positions and table
is slightly tipped to get different views
Note
• If there is suspected bowel perforation, a water soluble
contrast is used instead of barium. This is because contrast
may leak to the peritoneal cavity and water soluble material,
compared to barium is less obscuring at laparatomy
 After care

• An evacuating enema or laxative is given to

facilitate barium removal
• Stool softeners may be given incase of constipation
Complications
• Bowel perforation(rare)
• constipation
 ANGIOGRAPHY

•This is the radiographic study of the blood

vessels
•An angiogram uses a radio-opaque substance
or contrast medium to make the blood vessels
visible under x-ray .
•The key ingredient in most radiographic
contrast media is iodine
 Purpose of angiography
❖Detect narrowing (stenosis) or blockages in blood vessels(occlusions)
❖Diagnose atherosclerosis
❖To reveal site of aneurysm, cerebral tumors, valvular defects etc.
❖To map renal anatomy in transplant donors
❖Tumor, blood clot or arterio-venous malformations(abnormal tangles of
arteries and veins) in the brain
❖After penetrating trauma E.g. stab wound an gunshots to detect blood
vessels injury.
❖To check position of shunts and stents placed by physicians into blood
vessels
 Precautions

• Patient's with kidney disease or injury may suffer

further kidney damage from the contrast media for
angiography
• Patient who have blood clotting problems
• Known allergy to contrast media
• Pregnant woman to avoid procedure
 HYSTEROSALPINGOGRAM
• A specialized X-ray procedure used to examine a woman's uterus and
fallopian tubes.
Purpose
1.Infertility Evaluation: Helps to determine if the fallopian tubes are
open and if the uterine cavity is normal.
2.Recurrent Miscarriages: Assesses the shape and structure of the
uterus.
3.Tubal Surgery Follow-up: Evaluates the success of tubal ligation or
reversal procedures.
4.Pre-IVF Assessment: Ensures the reproductive tract is in good
 Procedure
• Scheduled after menstruation and before ovulation to avoid the risk of
X-rays during early pregnancy.
• Patients may be advised to take pain relievers before the procedure to
minimize discomfort.
• The patient lies on an examination table with her legs positioned
similarly to a gynecological exam.
• A speculum is inserted into the vagina to visualize the cervix.The cervix
is cleaned, and a thin tube (cannula) is inserted through the cervix into
the uterus.A contrast dye is slowly injected through the cannula, filling
the uterine cavity and fallopian tubes.X-ray images (fluoroscopy) are
taken to visualize the flow of the dye through the uterus and fallopian
 Ct..
• The radiologist observes the movement of the
contrast dye.
• If the dye spills freely into the abdominal cavity, it
indicates that the fallopian tubes are open.
• If the dye does not pass through the tubes or if
there are irregularities in the uterine cavity, it may
suggest blockages, adhesions, or abnormalities.
 Risks and complications
• Discomfort or Pain: Cramping similar to menstrual cramps can occur.
• Infection
• Allergic Reaction: Some patients may have a reaction to the contrast dye.
• Spotting or Bleeding
Note
• Patients can usually resume normal activities shortly after the procedure.
• Mild cramping or spotting may occur for a day or two.
• It is advisable to avoid sexual intercourse, tampons, or douching for 24-48
hours to reduce infection risk.
 CARDIAC CATHETERIZATION
• A medical procedure used to diagnose and treat
certain cardiovascular conditions.
• During this procedure, a long, thin tube called a
catheter is inserted into an artery or vein in your
groin, neck, or arm and threaded through your
blood vessels to your heart.
• The process involves several key steps and serves
various diagnostic and therapeutic purposes
 Purposes of cardiac catheterization
1.Diagnosis:
1.Coronary Artery Disease: Identifies blockages in the coronary arteries.
2.Heart Valve Disease: Evaluates how well the heart valves are working.
3.Congenital Heart Disease: Detects abnormalities present from birth.
4.Cardiomyopathy: Assesses the function of the heart muscle.
2.Treatment:
1.Angioplasty: Opens blocked or narrowed coronary arteries.
2.Stent Placement: Keeps arteries open after angioplasty.
3.Heart Valve Repair or Replacement: Fixes damaged heart valves.
4.Ablation: Treats certain types of arrhythmias by destroying small areas of
heart tissue that are causing abnormal heart rhythms.
 Procedure
• Patients may be asked to fast for several hours before the procedure.
• An IV line is inserted to administer medications.
• Insertion:A local anesthetic is applied to numb the insertion site.A small incision
is made, and the catheter is inserted into a blood vessel.
• The catheter is guided through the blood vessels to the heart using X-ray imaging
(fluoroscopy).
• Once the catheter reaches the heart, various diagnostic tests can be performed.If
treatment is needed, additional tools can be passed through the catheter to
perform procedures like angioplasty or stent placement.Completion.
• After the procedure, the catheter is removed, and the insertion site is closed.
• Pressure is applied to the site to prevent bleeding.
 Risks and Complications
• While cardiac catheterization is generally safe, it does
carry some risks, including:
Bleeding or bruising at the catheter insertion site.
Infection.
Allergic reactions to the contrast dye used during the
procedure.
Damage to blood vessels.
Heart attack or stroke (rare).
 Post procedure

• Patients are usually monitored for a few hours after

the procedure.
• Most can go home the same day, but some may
need to stay in the hospital overnight.
• It is recommended to avoid strenuous activities for
a few days.
 STOMA CARE
• Stoma is an opening that is created to allow stool or urine to pass out of
the body.
• Common conditions that might necessitate a stoma are:
a)Imperforate anus: where there is no exit for the bowel or its contents.
b)Hirschsprungs disease: where the ganglion nerves are missing and
waste matter cannot easily pass.
c)Inflammatory bowel disease: this includes Crohns Disease and
Ulcerative Colitis, both inflammatory diseases of the intestines.
d)Neonatal necrotising enterocolitis: this occurs when a portion of the
bowel is dead and cannot function
e)Spina bifida
 A) Colostomy

• This is the most common stoma type.

• A colostomy is an opening made into the large
intestine or colon.
• The stool can then pass from the stoma out of body
which tends to be solid in consistency but can
sometimes be liquid
 B) Ileostomy

• In an ileostomy the opening is made in the small

intestine -the ileum.
• An end or loop of the small intestine is brought
through the skin's surface on the abdomen and the
output then passes out through the stoma.
• Due to the fact that ileostomy output contains
digestive enzymes, this can be harmful to the skin
and so requires extra care when pouching.
 How to change a pouch
• For an open-ended pouch, empty the contents from pouch
into the toilet.
• Gently remove the pouch by pushing the skin down and
away from the adhesive skin barrier with one hand.
• With the other hand, pull the pouch up and away from the
stoma
• Clean the skin around the stoma with warm water. You
may also use soap but do not use soaps that have oil or
 How to empty a pouch
• Empty the pouch when it is one-third to one-half full.
• Do not wait until the pouch is completely full because this
could put pressure on the seal, causing a leak. The pouch may
also detach, causing all of the pouch contents to spill.
• Take the end of the pouch and hold it up. Remove the clamp
(if the pouch has a clamp system).
• You may need to make a cuff at the end of the pouch to keep it
from getting soiled
• Drain the pouch by squeezing
 Ct..

• Clean the cuffed end of the pouch with toilet paper

or a moist paper towel
• Undo the cuff at the end of the pouch.
• Replace the clamp or close the end of the pouch
 Nursing management
Regularly assess the stoma and peristomal skin during each appliance
change.
Monitor for signs of infection, such as unusual odor, discharge, or
pain.Educate the patient on identifying this signs.
Document any changes in the stoma’s appearance or function.
Teach the patient and their family members how to care for the stoma,
change the appliance, and recognize complications.
Discuss dietary modifications and fluid intake to manage output
consistency.
Advise on clothing choices to accommodate the stoma appliance discreetly.
 ELECTRO-ENCEPHALOGRAM(EEG)
• Is recording of electrical activity along the scalp
• The brain's spontaneous electrical activity is recorded over
a short period of time, 20-40 minutes from multiple
electrodes placed on the scalp
• The electrodes are connected to wires then a machine
which records electrical impulses, the results are printed
out or displayed on a computer monitor
• Different patterns of electrical impulses can denote various
 Indications
Evaluation of brain disorders
 Determine brain death
To determine whether to wean off anti-epileptic medications
Used to prove if some one on life support machine has no chance of
recovery
NOTE
• Most EEG show the type and location of the activity in the brain
during a seizure thus evaluates people with problems associated with
brain function E.g. confusion, coma, tumors, long term difficulties
with thinking or memory, or weakness of specific parts of the body
 Preparation for procedure
• Head is shaved or patient avoids hair styling products on
the day of exam
• Tranquilizers and stimulants are with held for 24- 48 hours
• Drinks that are stimulants are also withheld E.g. coffee,
tea, cola etc.
• Explain the procedure to the patient i.e. takes 45- 60
minutes, doesn't cause electric shock, it's a test not a form
of treatment
 Procedure
• Patient lies on the table, about 16-20 electrodes are attached to the scalp
with a conductive gel or paste
• Each electrode is attached to an individual wire
• Electrode location and names are specified by the international 10-20
system
• The patient is asked to relax, lies with eyes open, then later with eyes
closed
• The patient may be asked to breath deeply and rapidly or stare at a flashing
light, these activities produces changes in the brain wave patterns.
• If being evaluated for sleep disorder, EEG may be performed continouosly
through out the night when the patent is sleeping
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• The brain's electrical activity is recorded continously through out the exam on
special EEG paper.
• EEG results are interpreted by a neurologist .

• After procedure care

• •Instruct the patient when to resume medications especially anti-seizure
medications that had been with held
• Patient doesn't require recovery time but instruct them to report to hospital if;
Number of seizures increase
An altered mental status
Having new loss of function
 MALE CIRCUMCISION
• This is the surgical removal of foreskin, the fold of skin
that covers the glans penis by a trained and certified
health care provider.
Purpose
To remove appropriate foreskin
To prevent blood loss
To prevent infection
To eliminate pain
 Indications

Treatment of specific medical problems i.e foreskin

pulled back against penis.
Client’s own request
Partial prevention of HIV transmission to reduce
the risk of acquiring some infections and related
complications.
 Assessment
• Take client history.
• Take a targeted physical examination
• Vital signs
• Weight- dosage of anaesthetic agents
• Client’s understanding of the procedure
• Informed signed consent
• Possible risks associated with procedure.
• Availability of equipment
 Procedure
• With the client on the coach ,perform skin preparation and
draping to ensure asepsis.
• Administer local anaesthetic agent to eliminate pain( penile
ring block and penile dorsal nerve block).
• Assess and separate adhesions if any to reduce the risk of
accidental injury to the glans and ensure adequate skin
removal.
• Mark the intended incision line using a surgical marker pen.
• Perform surgical procedure using Dorsal slit technique.
 Postoperative care
• Check for any adverse reactions.
• Vital signs- 30 minutes post-surgery.
• Assess the dressing applied at the incision site.
• Pain assessment
• Discuss with the client on wound care and targeted
health information on post- male circumcision .
• Review the clients level of comfort, and give necessary
medicines and instructions.
ASSIGNMENT

•Read and make notes on;

1. CT Scan
2. MRI Scan
3. Electrocardiogram(ECG)