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Stephen D. Krau
Diagnostic Testing:The Search for Real Evidence 1
Stephen D. Krau
A cornerstone in the quest for evidence is the use of diagnostic tests to deter-mine the underlying issue for any symptoms seen in a patient. Clearly, diag-nosis is not the final outcome in any patient scenario, but rather the beginning.The purpose of diagnostic testing is to provide evidence that will guide thehealth care provider in decision-making that will lead to achieving positivepatient outcomes. This article provides a process by which a diagnostictest can be evaluated within the parameters of a patient condition. Througha thorough understanding of the test, the critical care nurse can be moreeffective ineducating the patient,preparing the patient, and anticipating post-procedure nursing interventions for the patient undergoing diagnostic testing.
Electrodiagnostic Studies 7
Michelle L. Williams, Deborah Ellison, Grace Moodt, andFrancisca Cisneros Farrar
This article overviews electrodiagnostic tests that provide evidence-baseddata in the treatment and management of abnormalities in nerves andmuscles. There is a focused review on cardiac tests, nerve-conductiontests, low-back pain tests, seizure and epilepsy tests, and obstructivesleep apnea electrodiagnostic tests. Case reports demonstrate how theseelectrophysiologic tests can provide specific data about the location andunderlying causative factors of abnormalities in the nerves and musclesthat routine diagnostic tests cannot differentiate.
Endoscopy: A Guide for the Registered Nurse 19
Sandra R. Scholten
As an invasive procedure, endoscopic studies require patient care andconsiderations that are very similar to minor surgical procedures. Thereare some general guidelines that are applicable to all endoscopic proce-dures, and there are special considerations that are dictated by the spe-cific endoscopic procedure. It is important for the critical care nurse tounderstand the procedures because the differences and similarities ofeach procedure guide nursing actions to effect the best patient outcomes.
Bronchoscopy:What Critical Care Nurses Need to Know 33
Dixie L. Taylor
Although bronchoscopies have been performed for over a century and arerelatively safe when practice guidelines are followed, they are invasive anda real source of anxiety and fear for the patient. The role of the critical care
nurse is essential to a successful outcome. This article provides an over-view of the main diagnostic and therapeutic indications, contraindications,and possible complications. Also discussed are patient education; patientand staff safety; and considerations before, during, and after theprocedure.
Radiographic Studies in the Critical Care Environment 41
Maria A. Revell, Marcia Pugh, Tasha L. Smith, and Leigh Ann McInnis
Critical care patients present with or develop conditions that require imag-ing with a variety of radiographic methods. Technological advances suchas the introduction of digital imaging instead of screen-film radiographyhave improved image resolution, readability, management, and portabilityof results while maintaining confidentiality of patient information. Radio-graphic imaging in the critical care unit is an integral part of patient man-agement. It is imperative that the critical care nurse be cognizant ofradiographic studies and thus be able to collaborate with all health careproviders in the administration of quality patient care.
Angiography: From a Patient’s Perspective 51
Leigh Ann McInnis, Stephen D. Krau, and Lynn Parsons
In critical care, nurses are expected to react quickly to urgent and emer-gent situations. It is imperative that nurses have the ability to recognizesigns and symptoms in patients that require diagnostic intervention. Thisarticle begins with a brief description of angiography and its role in the crit-ical care environment. This is followed by a description and comparison ofseveral modalities used to evaluate the cerebral and carotid vessels. A re-lated case study, from a patient’s perspective, provides the context for thisdiscussion.
Nuclear Scan Studies in Critical Care 61
Leigh Ann McInnis, Maria A. Revell, and Tasha L. Smith
The field of nuclear cardiology has grown significantly over the past decade.This is a reflection of the value seen by providers in these safe and effectiveprocedures. Nuclear scan studies are noninvasive and versatile in their use-fulness. These studies assist in determining the likelihood of future cardiacevents, guide approaches to revascularization, and assist in evaluation ofthe adequacy of revascularization procedures. Critical thinking and deci-sion-making abilities are two key requirements for nurses in the criticalcare environment. Knowledge and understanding of the nuclear scan stud-ies indicated for patients help nurses advocate for those in their care.
Allergy Skin Testing:What Nurses Need to Know 75
Stephen D. Krau, Leigh Ann McInnis, and Lynn Parsons
Skin testing is a common procedure in any clinical setting. Critical carenurses will encounter skin testing in the inpatient and outpatient settings
primarily to test for patient allergies to environmental factors, or allergies tocertain medications. As there is a great deal of controversy about standardpractices surrounding the different tests, information about various allergytests and testing protocols is vital. Quality assurance standards should bemet to ensure adequacy of the skin testing technique. Persons performingskin tests should undergo evaluation of their technique. To improve thepredictive values of skin testing, and to ameliorate the incidence or sever-ity of adverse affects, it is important for the critical care nurse to under-stand the dynamics of the test and the possible risks, along withvariables that can confound the results. By doing this, nurses will improvenot only patient outcomes related to the testing itself but also the value andreliability of the most effective diagnostic tool available for allergic disease.
Ultrasound Studies 83
Melan Smith-Francis and Patty Orr
This article focuses on the clinical use of ultrasound with the obstetric,gynecologic, and trauma patient by reviewing recent case studies of theuse of ultrasound for diagnostic purposes. The article also summarizesthe American Institute of Ultrasound in Medicine (AIUM) guidelines foruse in several types of patients. The AIUM is a multidisciplinary associationwhose purpose is to ‘‘advance the art and science of ultrasound in medi-cine and research through educational, scientific, literary, and professionalactivities.’’ The organization provides guidelines in conjunction with manyprofessional organizations, such as the American College of Cardiologyand the American College of Obstetrics and Gynecology. AIUM alsoserves as an accrediting body for ultrasound practices.
Centesis Studies in Critical Care 95
Cathy A. Cooper
Critical care nurses have a vital role in caring for patients undergoing cen-tesis studies. Any centesis procedure involves puncturing a body cavity,joint, organ, or space with a hollow needle to withdraw fluid. All centesisstudies are invasive procedures, typically performed for either therapeuticor diagnostic purposes. Because there are a variety of centesis proce-dures that the critical care nurse might encounter, the following centesisprocedures are discussed in depth: amniocentesis, arthrocentesis, lumbarpuncture, paracentesis, pericardiocentesis, and thoracentesis. By becom-ing more familiar with each of these procedures, the critical care nursegains confidence in caring for clients when these procedures areindicated.
Tamara M. Robertson and Amy S. Hamlin
Voiding dysfunction has profound physical, emotional, and financial ram-ifications for patients and health care practitioners from all fields. The im-provement of diagnostic testing in the area of voiding dysfunction,
throughout decades, has resulted in improved patient outcomes. Thecomponents of urodynamic studies can allow practitioners an objectivemeasurement to assist in making a correct diagnosis, hence appropriateinterventions. An urodynamic study decreases the risk of a patient under-going unnecessary surgical procedures. Urodynamics is an invasiveprocedure, though with the maintenance of sterile technique and patienteducation it is generally well tolerated with few adverse effects.
Urinalysis: A Review of Methods and Procedures 121
There is much value in using urine as a diagnostic aid in the critical caresetting. As a noninvasive source of data, urine reveals a wealth of informa-tion about the body’s biochemical status. It is important for critical carenurses to understand the processes that occur in the renal system andto comprehend the depth of information that can be obtained throughan analysis of urine. This discussion provides an overview of commonurine tests and provides information for nurses about urine collectionmethods. The discussion will help the critical care nurse describe variousurine test procedures, common urine collection methods, nursing inter-ventions, and patient education important to each study.
Stool Studies:Tried,True, and New 129
Mary Ann Jessee
Much information can be obtained about a patient’s gastrointestinal andoverall nutritional status through stool samples. Important infectious pro-cesses and neoplastic processes are initially identified through diagnostictests and screening of stool samples. Although in some arenas they area source of embarrassment and distaste, the value of correctly obtainedsamples is unquestionable. Patient collaboration with a critical care nurseis integral to obtaining stool samples.