Diagnostics Tests, Treatment and Procedures

8/6/2019 Diagnostics Tests, Treatment and Procedures

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DIFFERENT DIAGNOSTIC TEST

Tools that provide information about the client Commonly called Lab test May be used to help confirm a diagnosis, monitor an illness, and provide

valuable information about the clients response to treatment It involves three phases: pretest, intratest and the post-test

Pretest

-Major focus is client preparation

-Thorough assessment and data collection is needed

Intratest

- Focuses on specimen collection and performing or assisting with certain diagnostictesting

-Standard precautions and sterile technique is appropriate

Post Test

-The focus of this phase is nursing care of the client and follow-up activities andobservation

-Nurse compares the previous and current test results and modifies nursingintervention

-Nurse reports the results to the appropriate health team member

Different Diagnostic Test

1. Blood Test

-most common used and it provide valuable information about the hematologic systemand many other system.

-venipuncture (puncture of the vein) used to collect the blood specimen

- Phlebotomist a person who perform venipuncture

Complete Blood Count (CBC)

Basic screening test and one of the most frequently ordered blood test

It includes: Hbg (main intracellular protein of erythtocytes)

-it carries O2 to and removes CO2 from RBC-the Hgb test measures the total amount of Hgb in the blood-Normal: M- 13.8- 18g/dL F-12-16g/dL

Hct-measures percentage of RBC in the total blood volumes

Normal values: M-37-49% F- 36-46%


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-Creatinine produces relatively constant quantities by muscle and excretedby the kidney;

-increase body mass increase creatinine-the amount of creatinine in the blood relates to renal excretory function

Normal Value: 0.7- 1.5mg/dL

5. Pulmonary Function Test

a. Arterial Blood Gases Is another important diagnostic procedure that measure blood pH and arterial

oxygenation and carbon dioxide tension. Studies aid in assessing the ability of the lungs to provide adequate oxygen and

remove CO2 in the ability of the kidneys to reabsorb or excrete bicarbonate ionsto maintain normal body pHPaO2 (arterial oxygen tension)-indicates the degree of oxygenation of the bloodPaCO2 (arterial CO2 tension)- indicates the adequacy of alveolar ventilation

Serial ABG analysis also is a sensitive indicator of whether the lung has beendamage after chest trauma

b. Sputum Test Obtain for analysis to identify pathogenic organisms and to determine whether

malignant cells are present Periodic sputum examinations maybe necessary for patient receiving antibiotics

corticosteroids and immunosuppressive medications for prolong periods becausethis agents are associated with opportunistic infections.

6. Blood Chemistry

Examination of chemical constituents of blood can provide valuable screening

and help to establish a diagnosis


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Common Blood Chemistry Test

Test Significance Normal Values

Liver function Test

Alanineamino trasferase(ALT)formerly known asserum pyretic transaminase(SGPT)

Aspartate Aminotranferase (AST)- formerlyknown as serum gluctamic-oxaloacetic transaminase(SGOT)

Albumin

Alkaline Phosphatase

Ammonia

Bilirubin

Marker of hepatic injury;more specific of liverdamage than AST

Found in heart, liver andskeletal muscle and canalso be used to indicateliver injury.

Can also be used to

indicate liver injury

protein produce by the liver

Found in the tissue of theliver, bone, intestine, kidney

and placentaUsed as an index of liverand bone disease whencorrelated with other clinicalfindings

The liver convertsammonia, byproduct ofprotein metabolism intourea which is excreted by

the kidneys.

Results from thebreakdown of Hbg in theRBC; remove from the bodyby the liver, which excrete

Adult: men-10-15unit/Lwomen: 7-30unit/L

Adult: men- 10-40unit/Lwomen-9-25unit/L

Adults: 3.5-4.8g/dL or 35-48g/L

Panic value: less than1.5g/dL

Adults: 25-100unit/L

Adults: 35-65g/dL

Total: 0.3 mg/dL

Direct: 0.0- 0.2mg/dL

Indirect: 0.1- 1/0mg/dL


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Prothrombin

into the bile

a protein produce by theliver for clotting of blood

Panic value: >12mg/dL

11-13seconds

Critical value: >20seconds

for non anti-coagulatedpersons

Cardiac Markers

CK( creatinkinase) An enzyme found in theheart and skeletal muscles

Total: men:38-174unit/L

Women: 26-140unit/L

Myoglobin

Troponin I

Troponin T

After an MI, serum levels ofmyoglobin rise in 2-4 hrs,making it an early markerfor muscle damage in MI

Cardiac troponin is highlyconcentrated in the heartmuscle. This test is used inthe early diagnosis of MI.

After an MI, troponin Ibegins to increase in 4- 6hrs and remains elevatedfor 5-7days.

Troponin T begins toincrease in 3-4 hrs andremains elevated for 10-14days

5-7ng/ml

Troponin I: 1.5mg/ml

Troponin T:


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7. Capillary Blood Glucose

A capillary blood specimen is often taken to measure blood glucose when

frequent test are required or when a venipuncture cannot be perform Normal value:80-110mg/dL

8. Fecal Test

Basic examination of the stool includes inspecting the specimen for consistency,color, an occult (not visible blood).

Fecal Occult Blood testing

-One of the most commonly performed stool test

-useful in initial screening for several disorders, although it is used most frequently inearly cancer detection program

9. Urine Analysis

Provides important clinical information about kidney function and helps diagnoseother diseases such as diabetes

Lipoprotein Profile

Cholesterol

HDL-C

LDL

Triglycerides

Important screening test forheart disease

Class of lipoproteivsproduce by the liver andintestine

The good cholesterol

Up to 70% of the totalserum cholesterol ispresent in the LDL

The bad cholesterol

Test evaluate suspectedatherosclerosis andmeasures body ability tometabolize fat

Adultsdesirable:


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Urine culture and sensitivity also identify the anti-microbial therapy that is bestsuited for the particular strains identified.

Components:

1. Urine color

2. Urine clarity and odor

3. Urine pH and specific gravity

4. test to detect protein, glucose and ketone bodies in the urine

5. centrifugation to detect RBCs, WBC, cast, crystals and bacteria

Components Possible cause

1.Urine color

y Colorless to pale

yellow

y Yellow to milkywhite

y Bright yellow

y Pink to red

y Blue, blue green

y Orange to amber

y Brown to black

Due to diuretics, alcohol consumption, DM insipidus,

glycosuria, excess fluid intake, renal disease

Pyuria, infection, vaginal cream

Multiple vitamin preparation

Hgb breakdown, medications (phenytoin)

Pseudomonas species organisms, medication likeamitriptyline

Concentrated urine due to dehydration, fever, bile, excessbilirubin or carotene, medications

Old RBC, urobilinogen, bilirubin, melanin, extremelyconcentrated urine due to dehydration and medication suchas iron preparation

Normal Values:

TEST NORMAL VALUES

Color Pale yellow to amber

Turbidity Clear to slightly hazy


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Specific Gravity 1.015-1.025

pH 4.5-8.0

Glucose Negative

Ketones Negative

Blood NegativeProtein Negative

Bilirubin Negative

Urobilinogen 0.1-1.0

Nitrate for Bacteria Negative

Leukocyte Esterase Negative

Casts Occasional hyaline casts

Red Blood Cells Negative or rare

Crytals Acid Urine:

Amorphous urates

Uric acid

Calcium oxalate

Sodium acid Urates

Alkaline Urine

Amorphous phosphates

Calcium phosphate

Ammonium blurate

Triple phosphates

Calcium carbonate

White Blood Cells Negative or rare

Epithelial Cells Few

10. Imaging Studies

a. X-ray

Is used to reveal an extensive pathologic process in the lungs in the absent ofsymptoms

2 views1. Posterior-anterior projection2. Lateral projection

b. Computed Tomography


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Is an imaging method in which the lungs are scanned in successive layers by anarrow beam x-ray

The images produce, provide a cross sectional view of the chest May be used to define pulmonary nodules and small tumors

c. Magnetic Resonance Imaging Similar to CT scan except that magnetic fields and radio frequency signals areused intend of a narrow beam x-ray

It yields a much more detailed diagnostic image than CT because it visualizessoft tissue

Use to characterized pulmonary nodules to help stage bronchogenic carcinomaand to evaluate inflammatory activity in interstitial lung disease, acute pulmonaryembolism and chronic thrombolytic pulmonary hypertension

11. Aspirations and Biopsy

Aspiration Is the withdrawal of fluid that has abnormally collected or to obtained a specimen

Biopsy

Is the removal and examination of tissue Used to determine a diagnosis or detect malignancy

12. Lumbar Puncture

Is withdrawn through a needle inserted into the subarachnoid space of the spinalcanal between the 3rd and 4th vertebrae or between the 4th and 5th lumbarvertebrae

13. Abdominal paracentesis

Is carried out to obtain a fluid specimen for laboratory study and to relievepressure on the abdominal organs due to the presence of excess fluid

14. Thoracentesis

Used to remove excess fluid or air to ease breathing. Is also to introduced chemotherapeutic drugs intrapleural

15. ECG (Electrocardiogram)

ECG (electrocardiogram) is a test that measures the electrical activity of theheart.


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Uses of ECG

1. It is used for symptoms such as dyspnea (difficulty inbreathing), chest pain (angina), fainting, palpitations or whensomeone can feel that their own heart beat is abnormal.

2. The test can show evidence of disease in the coronary arteries

3. Used to assess if the patient has had a heart attack or evidence of aprevious heart attack.

4. An ECG can be used to monitor the effect of medicines used for

coronary artery disease.

5. An ECG reveals rhythm problems such as the cause of a slow or fast

heart beat.

6. To demonstrate thickening of a heart muscle (left ventricular

hypertrophy), for example due to long-standing high blood pressure.

Waveforms of ECG:

P wave - represents the electrical impulse starting in the sinus node and

spreading through the atria.

QRS complex represents ventricular depolarization.

T waves represents ventricular repolarization (when the cells regain a negative

charge; also called the resting state)

U wave is thought to represent repolarization of the Purkinje fobers, but it

sometimes is seen in patients with hypokalemia, hypertension, or heart disease.

PR interval is measured from the beginning of the P wave to the beginning of

the QRS complex and represents the time needed for sinus node stimulation,

arterial depolarization, and conduct through an AV node before ventricular

depolarization.

ST segments represents early sign of ventricular repolarization, lasts from the

end of the QRS complex to the beginning of the T wave.

QT interval represents the total time for ventricular depolarization and

repolarization, is measured from the beginning of the QRS complex to the end of

the T wave.

TP interval is measured from the end of the T wave to the beginning of the

next P wave, an isoelectric period.

PP interval is measured from the beginning of one P wave to the beginning of

the next.


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RR interval measured is from the one QRS complex to the next QRS complex,

The RR interval is used to determine ventricular rate and rhythm.

16. Papsmear(Papanicolaou smear)

Pap test is done during a pelvic exam.

Used to detect cervical cancer

Screening should start at age 21. After the first test:

y Woman should have a Pap smear ever 2 years to check for cervical cancer.

y If you are over age 30 or your Pap smears have been negative for 3 times in a

row, your doctor may tell you that you only need a Pap smear every 3 years.

y If you or your sexual partner has other new partners, then you should have a Pap

smear every 2 years.

y After age 65-70, most women can stop having Pap smears as long as they have

had three negative tests within the past 10 years.

17. Pregnancy Test

A pregnancy test attempts to determine whether or not a woman is pregnant.

Pregnancy Signs and Symptoms

1. Presumptive Signs felt by the mother

(MACFLUQ)

2. Probable Signs observed by the examiner

(CHUPBOGS)

3. Positive Signs definitive signs of pregnancy

(heartbeat, movement, sonography, home pregnancy test)

18. Breast Self Examination (BSE), Mammography

BSE (Breast Self Exam)


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Modality used for the early detection of breast cancer.

BSE is best performed after menses (day 5 to 7, counting the first day of

menses as a day 1)

ACS recommends that women, beginning in their early 20s, be told about

the benefits and limitations of BSE

Mammography

Is a breast imaging technique that has been shown to reduce breast

cancer mortality rates.

Mammography may detect a breast tumor before it is clinically palpable.

ACS recommends mammography every year beginning at 40 years old.

Women who is in high risk, family history of breast cancer: (begin

screening 10 years earlier than the age at which the youngest family

member developed breast cancer but not before 25 years of age. (ex.

Grandmother diagnosed with breast cancer at 48 years of age, mother

diagnosed 38 years of age, then daughter should begin screening at age

of 28 years old)

18. Ultrasound

Ultrasound (also called sonography) is a diagnostic medical procedure that uses

high-frequency sound waves to produce dynamic visual images of organs,

tissues or blood flow inside the body.

Ultrasound has been used in a variety of clinical settings, including obstetrics and

gynecology, cardiology and cancer detection. The main advantage of ultrasound

is that certain structures can be observed without using radiation. Ultrasound can

also be done much faster than X-rays or other radiographic techniques

Uses:

used to look at human babies in the mothers womb

used to determine how thick objects such as metals and plastic


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seeing the inside of the heart to identify abnormal structures or

functions

measuring blood flow through the heart and major blood vessels

measuring blood flow through the kidney

seeing kidney stones

detecting prostate cancer early

19. Metabolic Screening

Newborn screening is the practice of testing every newborn forcertain harmful or

potentially fatal disorders that aren't otherwiseapparent at birth.

metabolicdisorders (often called "inbornerrors of metabolism") that interfere

with the body's use ofnutrients to maintain healthy tissues and produce energy.

Otherdisorders that screening can detect include problems withhormones or

the blood.

phenylketonuria(PKU) an enzyme needed to process the amino

acid phenylalanine, which is necessary for normal growth in kids and

for normal protein use throughout life. However, if too much

phenylalanine builds up, it damages the brain tissue and can

eventually cause substantial developmental delay.

Congenital Hypothyroidism - Affected babies don't have enough

thyroid hormone and so develop retarded growth and brain

development. (The thyroid, a gland at the front of the neck, releases

chemical substances that control metabolism and growth.)

Galactosemia - babies with galactosemia lack the enzyme that

converts galactose into glucose, a sugar the body is able to use.

Galactose can build up in the system and damage the body's cells

and organs, leading to blindness, severe mental retardation, growthdeficiency, and even death.

Sickle Cell Disease - is an inherited blood disease in which red blood

cells mutate into abnormal "sickle" shapes and can cause episodes of

pain, damage to vital organs such as the lungs and kidneys, and even

death. Young children with sickle cell disease are especially prone to


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certain dangerous bacterial infections, such as pneumonia

(inflammation of the lungs) and meningitis(inflammation of the brain

and spinal cord).

Biotinidase Deficiency- babies with this condition don't have enoughbiotinidase, an enzyme that recycles biotin (a B vitamin) in the body. The

deficiency may cause seizures, poor muscle control, immune system

impairment, hearing loss, mental retardation, coma, and even death. If the

deficiency is detected in time, however, problems can be prevented by

giving the baby extra biotin.

Congenital Adrenal Hyperplasia - is actually a group of disorders

involving a deficiency of certain hormones produced by the adrenal gland.

It can affect the development of the genitals and may cause death due to

loss of salt from the kidneys. Lifelong treatment through supplementationof the missing hormones manages the condition.

Maple Syrup Urine Disease (MSUD)- babies with MSUD are missing an

enzyme needed to process three amino acids that are essential for the

body's normal growth. When not processed properly, these can build up in

the body, causing urine to smell like maple syrup or sweet, burnt sugar.

MSUD can cause mental retardation, physical disability, and even death.

Tyrosinemia- babies with this amino acid metabolism disorder have

trouble processing the amino acid tyrosine. If it accumulates in the body, it

can cause mild retardation, language skill difficulties, liver problems, and

even death from liver failure.

Cystic Fibrosis - is a genetic disorder that particularly affects

the lungs and digestive system and makes kids who have it more

vulnerable to repeated lung infections

DIFFERENT DIAGNOSTIC PROCEDURES

1. Procedure for Blood Test

The complete blood count (CBC) test is performed by obtaining a fewmilliliters (one to two teaspoons) of blood sample directly from the patient. It canbe done in many settings including the doctor's


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1.1 The skin is wiped clean with an alcohol pad, and then a needle isinserted through the area of cleansed skin into to patient's vein (onethat can be visualized from the skin.)1.2 The blood is then pulled from the needle by a syringe or by aconnection to a special vacuumed vial where it is collected.

1.3 This sample is then taken to the laboratory for analysis.

2. Procedure for Blood GlucosePurposes:

To determine or monitor the blood glucose levels of clients in theblood for hyperglycemia or hypoglycemia.

To promote blood glucose regulation by the client To evaluate the effectiveness of insulin administration.

Assessment: The clients understanding of the procedure The clients response to the previous testing

Review the clients record for medications that may prolong thebleeding such the anticoagulants Assess the clients self care abilities that may affect the accuracy of

testEquipments:

Blood glucose meter (glucometer) Blood glucose reagent strip compatible with the meter 2 x 2 gauze Warm clothe or other warming device (optional) Antiseptic swab Disposable gloves Sterile lancet Lancet injector

Performance Introduce self and verify the clients identity. Explain the clients the

procedure that youre going to do. Discuss how the results will be used inplanning further care or treatments.

Perform the hand hygiene Provide clients privacy Prepare the equipment Select and prepare the vascular puncture sites. Avoid sites beside bones.

Wrap the finger first in a warm cloth, or hold a finger in a dependentposition. If the earlobe is used, rub it gently with a small piece of gauze.Rationale: These action increase the blood flow of the area, ensurean adequate specimen, and reduce the need for a repeat puncture.

Clean the site with antiseptic swab or soap and water allow it to drycompletely. Rationale: alcohol can affect accuracy and the site burnswhen punctured when wet with alcohol

Put on gloves.


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Place the injector, if used, against the site, and release the needle, thuspermitting it to pierce the skin. Make sure the lancet is perpendicular to thesite. Rationale: The lancet is designed to pierce the skin at a specificdepth when it is in a perpendicular position relatively to the skin.

Prick the site with the lancet, using a darting motion.

Gently squeeze the puncture site until a large drop of blood forms. Hold the reagent strip under the puncture site until adequate blood coversthe indicator square. The pad will absorb the blood and a chemicalreaction will occur. Do not smear the blood. Rationale: This will causean inaccurate reading.

Ask the client to apply pressure to the skin puncture site. Rationale:Pressure will assist hemostasis.

Expose the blood to the test strip for the period and the manner specifiedby the manufacturer. As soon as the blood is placed on the test strips.Rationale: The blood must remain in contact with the test pad for a

prescribed time to obtain accurate results.

Measure the blood glucose. After the designated time, most glucosemeters will display the glucose reading automatically. Correct timingensures accurate results.

Turn off the meter and discard the test strip and 2x2 gauze in a biohazardcontainer. Discard the lancet into sharps container.

Document the method of testing and results on the clients record. Check for orders for sliding scale insulin based on capillary glucose

results. Administer insulin as prescribed

3. Procedure for Getting Urine Specimen

Purpose: To determine the presence of microorganism, the type of organism(s),and the antibiotics to which the organisms are sensitive.

Assessment

y Determine the ability of the client to provide the specimen.

y Assess the color, odor and consistency of the urine and the presence ofclinical signs of urinary tract infection.

Equipment

y Clean gloves

y Antiseptic towelettes

y

Sterile specimen containery Specimen identification label

Performance

y Prior to performing to the procedure, introduce self and verify the clientsidentity using agency protocol. Explain to the client the procedure youregoing to do.

y Perform hand hygiene and observe other appropriate infection controlprocedures


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y Provide clients privacy

For an ambulatory client who is able to follow direction, instruct the client onhow to collect specimen.

y Assist the client to the bathroom

y Ask the client to wash and dry the genitals and perennial area with soap

and water.Rationale: Washing the perennial area reduces the

number of skin and transient bacteria, decreasing the risk of

contaminating the urine specimen.

y Instruct the client on how to clean the urinary meatus with antiseptic

towelettes. Rationale: The antiseptic further reduces the bacterial

contamination of the urinary meatus and the risk of contaminating

the urine

Female Clients:

Use each towelettes only once. Clean the perennial area from front

to back and discard the towelette. Rationale: Cleaning from fron to

back cleans the area of least contamination to the area of the greater

contamination.

Male Clients:

If uncircumcised, retract the foreskin slightly to expose the urinary

meatus.

Using circular motion, clean the urinary meatus and the distal

portion of the penis. Use each towelette only once, and then discard.

Clean several inches down the shaft of the penis. Rationale: This cleans

from the area of list contamination to the area of the greatest

contamination.

For a clients who requires assistance, prepare the client and equipment.

Wash the perineal area with soap and water, rinse, and dry.


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Assist the client on clean commode or bedpan. If using a bedpan or

urinal, position the client as upright as allowed or tolerated.

Rationale: Assuming a normal anatomic position for voiding

facilities urination.

Open the clean catch kit, taking care not to contaminate the inside

of the specimen container or lid. Rationale: It is important to

maintain sterility of the specimen container to prevent

contamination of the specimen

Put on clean gloves

Clean the urinary meatus and perineal area

Collect the specimen from a nonambilatory client or instruct an ambulatory client

on how to collect it.

Instruct the client to start voiding. Rationale: Bacteria in distalurethra and at the urinary meatus are cleaned by the firstmilliliters of urine expelled

Place the specimen container into the midstream of the urine andcollect the specimen, taking care not to touch the container to theperineum or penis. Rationale: It is important to avoidcontaminating the interior of the specimen container and thespecimen itself.

Collect the urine in the container Cap the container tightly, touching only the outside of the container

and the cap. Rationale: This prevents contamination or spillingthe specimen.

If necessary, clean the outside of the specimen container withdisinfectant. Rationale: This prevents transfer of microorganism toothers.

y Label the specimen and transport it to the laboratory Ensure that the specimen label is attached to the specimen cup, not

the lid, and the laboratory requisition provides the correctinformation. Place the specimen in a plastic bag that has abiohazard label on it. Attach the requisition securely to the bag.Rationale: Inaccurate identification or information on thespecimen container risks errors in diagnosis or therapy

Arrange for the specimen to be sent to the laboratory immediately.Rationale: Bacterial cultures must be started immediatelybefore any contaminating organisms can grow, multiply, and

produce falseresults.


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y Document Patients data

4. Procedure for Lumbar Puncture

y Before the procedure Explain the procedure to the client and support persons. The

primary care provider will be taking small sample of fluid from thelower spine.

Local anesthesia will be given Rationale: to minimize discomfort Expalan where and when it will occur and who will be present Explain that it will be necessary to lie in a certain position without

moving for about 15 minutes. A slight pin prick will be felt when thelocal anesthetic is injected and a sensation of pressure as the spinalneedle is inserted

Have the client empty the bladder and bowels prior to theprocedure. Rationale: to prevent unnecessary discomfort

Position and drape the client

Open the lumbar puncture sety During the Procedure

Stand in front of the client and support the back of the neck andknees if the client help remaining in still.

Reassure the client throughout the procedure by explaining what ishappening. Encourage normal breathing and relaxation

Observe the clients color, respirations, and pulse during theprocedure. Ask the client to report headache or persistent pain atthe insertion site.

Handle specimen tubes appropriately:

Wear gloves when handling test tubes Label the specimen tubes in sequence Send the CSF specimens to the lab immediately Place a small sterile dressing over the puncture site

5. Abdominal Paracentesis

y Before the Procedure Explain the procedure: obtaining the specimen usually take about

15 minutes. Emphasize the importance of remaining during theprocedure. Tell the client when and where the procedure will occurand who will be present.

Have the client void just before the paracentesis to reduce thepossibility of puncturing the urinary bladder.

Help the client assure a sitting position, in bed, in a chair, or on theedge of the bed supported by pillows.

Maintain the clients privacy and provide blanket for warmth


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y During the Procedure Assist and monitor the client: Support the client verbally and described the procedure as needed. Observe the client closely for signs of distress(e.g. abnormal pulse

rate, skin color, and blood pressure)

Observe sign of hypovolemic shock induce by the loss of fluid:pallor, dypnea, dyphoresis, drop in BP, and restless and increaseanxiety.

Place a small sterile dressing over the side of the incision after thecannula of aspirating needle is withdrawn.

6. Thoracentesis Procedure

y Before the Procedure Explain the procedure to the client normally, the client may

experience discomfort and a feeling of pressure when the needle isinserted. The procedure may bring considerable if breathing has

been difficult. The procedure takes only a few minutes, dependingprimarily on the time it takes for the fluid to drain from the pleuralcavity. To avoid puncturing the lungs it is important for the client notto cough while the needle is inserted. Explain when and where theprocedure will occur and who will be present.

Help position the client and cover the client as needed with a bathblanket.

y During the Procedure Support the client verbally described the steps of the procedure as

needed. Observe the client for the signs of distress, such as dypnea, pallor,

and coughing Collect drainage and laboratory specimen. Place a small sterile dressing over the site of the puncture

7. BiopsyBone Marrow Biopsy

y Before the Procedure Explain the procedure. The client may experience pain when the

morrow is aspirated pain and hear a crunching sound as the needleis pushed through the cortex of the bone. The procedure usuallytakes 15 to 30 minutes. Explain when and where the procedure willoccur, who will be present, and which site will be used.

Helps the client assume the supine position (with one pillow ifdesired) for a biopsy of the sternum (sterna puncture) or a proneposition for a biopsy of either iliac crest. Fold the bedclothes backor drape the client to expose the area.

y During the Procedure Monitor and support the client throughout Support the client in a supine position


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Check both risk for anything unusual Look for discharge in the nipple, puckering, dimpling or scaling in

the skin

Step2.

Watch closely in the mirror as you clasp your hands behind yourhead and press your hands forward

Note any changes in the contour

Step3.

Next, press your hands firmly on your hips and bow slightly towardthe mirror as you pull your shoulders and elbows forward.

Note any change in the contour of your breast.

Step4.

Raise your left arm. Use 3 or 4 fingers of your right hand to feel your left breast firmly,

carefully, and thoroughly Beginning at the outer edge press the flat part of your fingers in

small circle, moving the circle slowly around the breast for graduallytowards the nipple.

Be sure to cover the whole breast Pay special attention to the area between the breast and the under

arm, including the under arm itself

Feel for any unusual lamps of masses under the skin. If you have any spontaneous discharge during the month whetheror not during BSE see your doctor.

Repeat the examination on your right breast.

Step5. Step 4 should be repeated lying down. Lie on the back with your left hand over your head and a pillow

folded towel under the left shoulder (this position flattens yourbreast and make it easier to check)

Use the same circular motion describe above Repeat on the right breast.

9. Ultrasound procedure

y The patient supine position on an examination table

y A clear water-based gel is applied to the area of the body being studied tohelp the transducer make sure contact with the body and eliminate airpockets between the transducer and the skin.


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y The sonographer (ultrasound technologist) or radiologist then presses thetransducer firmly against the skin in various locations, sweeping over thearea of interest or angling the sound beam from a farther location to bettersee an area of concern.

y Doppler sonography is performed using the same transducer.

y When the examination is complete, the patient may be asked to dress andwait while the ultrasound images are reviewed

y Most ultrasound examinations are completed within 30 minutes to an hour.10. ECG

y Identify the areas where the ECG leads are to be placed. One lead is placedon the right pectoral muscle just below the clavicle, another between the leftshoulder and clavicle and one on the subject's left side on about the fifth rib.

Additional areas are required for 12-lead machines

y Clean the first area with gauze. Alcohol may be used but is notnecessary.

y Abrade the area slightly with a scrub pad.

y Locate the sternum on the patient, and trace down to the bottom. Place the"V1" lead of the ECG on the patient's chest directly to the right of the bottomof the sternum. Place the "V2" lead to left of the sternum.

y Place the "V3" lead one inch down and one inch to the left of the "V2" lead,and secure with another pad.

y Place the "V4" lead one inch down and one inch over from the "V3" lead sothat the "V3" and "V4" leads make a kind of circle around the heart area.Place the "V5" and "V6" lead straight out and left of the "V4" one inch apart.Secure all leads with ECG pads.

POTENTIAL COMPLICATIONS OF DIAGNOSTIC TEST

1. CT scan

For patients who suffer an acute reaction to the contrast materials associated

with a CT scan, the reaction may involve bronchospasm, resulting in difficulty with

respiration, even in the few minutes after administration. In addition, because the ionic

agent creates a greater health risk, it is quite likely t his complication may be associated

with a toxic effect to the kidneys. If you are diabetic or suffer from pre-existing renal

complications, these types of adverse complications are of special concern and should

be considered prior to undergoing the CT scan with contrast.

For some patients, undergoing CT scan with contrast, the adverse reaction maynot present until the procedure is well underway, or even after the procedure is

complete. Other adverse reactions associated with a CT scan with contrast include

fatigue, malaise, fever, chills, nausea and vomiting. Often, these symptoms mimic the

influenza virus.

2. MRI


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Some individuals may feel anxious while having the MRI scan performed. Those

individuals who have cardiac pacemakers, metal clips that have been applied to vessels

to prevent blood clot complications (ferromagnetic aneurysm clips), intrauterine metallic

implants, or other metal implants, are contraindicated for MRI scans and may suffer

complications if they do undergo MRI scans, since the scanner may interfere with the

proper functioning of the ferromagnetic device. Another possible complication

is allergy or abnormal reaction to the contrast medium that may be used during some

MRI procedures, although that is rare.

Breathing Problems

According to KidsHealth, a patient may experience breathing problems after

undergoing a lumbar MRI. The breathing problems can be a result of the introduction of

certain medications like sedatives or due to the injection of contrast medium into the

veins. This is a serious situation that indicates the body's intolerance for contrast

medium as well as sedatives and thus needs medical attention.

3. Liver biopsy

Serious problems from a liver biopsy are rare. Problems can include:

y Bleeding, this may need blood transfusions or surgery to correct.y A collapsed lung (pneumothorax).y Injury to the intestines, gallbladder, or kidney.y Infection in the belly (peritonitis).y Signs of shock.

y Severe pain in your chest, shoulder, or belly.y Moderate to severe difficulty breathing.y A lot of bleeding from the needle site.y A fast or skipping heartbeat.y A fever.y Shortness of breath.y Increasing pain at the needle site.y Blood in your stool.y Swelling or bloating in your belly.

4. Bone marrow biopsy

Bleeding

A complication that can occur after a bone marrow biopsy is bleeding. After the

biopsy, the doctor generally applies pressure and a bandage to the incision site to

manage any bleeding. If a patient has a history of a bleeding disorder, there may be a

higher risk of bleeding after a bone marrow biopsy, as noted by Beth Israel Deaconess

Medical Center.


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Infection

Another complication that can occur after a bone marrow biopsy is infection.

Before the procedure the doctor cleans the skin with antiseptic cleaner and the doctor

uses sterile instruments during the procedure to withdraw the bone marrow. If a patient

has an infection in the skin or bloodstream prior to the procedure, however, there is ahigher risk of infection.

Pain

The physician uses a pain-numbing medication before the procedure because

the biopsy can be uncomfortable or painful. According to MayoClinic.com, the patient

may also feel pain at the biopsy site for a while after the procedure. The physician will

tell the patient which pain relievers are appropriate to use because aspirin may increase

the risk of bleeding.

Allergic Reaction to Medications

Some physicians give the patient an anti-anxiety medication before the

procedure to help the patient relax and as noted, the doctor also uses a local anesthetic

over the area. According to MayoClinic.com, patients may have complications with the

medications used for sedation and pain management such as nausea, an irregular

heartbeat or even an allergic reaction. The physician will watch for any signs of this

complication and treat as needed.

5. Thoracentesis

Pneumothorax. This is a condition in which air collects in the pleural space (the space

between the lungs and chest wall). Sometimes air comes in through the needle, or the

needle makes a hole in a lung. Usually, a hole will seal itself. If enough air gets into the

pleural space, however, the lung can collapse. Your doctor may need to put a tube in

your chest to remove the air and let the lung expand again.

y Pain, bleeding, bruising, or infection where the needle or tube was inserted. In rarecases, bleeding may occur in or around the lungs. Your doctor may need to put a tubein your chest to drain the blood. In some cases, surgery may be needed.

y Liver or spleen injuries. These complications are very rare.

6. Abdominal paracentesis

Complications are rare, but no procedure is completely free of risk. If you are planning

to have an abdominal paracentesis, your doctor will review a list of possible

complications, which may include:

y Bleeding


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y Infectiony Accidental piercing of structures in the abdomen

Some factors that may increase the risk of complications include:

y Bleeding disorder

y Poor nutritiony Pregnancyy Full bladdery Infection in the area where the paracentesis instrument will be insertedy

7. Lumbar Puncture

Despite being a very important diagnostic tool, lumbar puncture procedure is not without

its share of complications and side effects. However, if properly carried out, serious

lumbar puncture side effects are very rare. Therefore, it is generally considered as a

safe procedure to collect cerebrospinal fluid, as well as to administer medications into

this fluid to treat several diseases. The common side effects of the procedure areexplained below.

Headache

Headache is the one of the most commonly observed lumbar puncture complications,

which can affect about 40% of people, who have gone through the procedure. Lumbar

puncture headache is generally experienced near the base of the skull or at the front of

the head. Such headaches usually resolve within a few days. In the meantime, regular

pain killers or analgesics can be used to relieve the pain. Generally, such headaches

are not considered as serious lumbar puncture problems.

Cerebrospinal Fluid Leakage

Headaches persisting for several days, that do not go away with bed rest can be an

indicator of cerebrospinal fluid leak, which takes place while collecting its sample. Such

a situation necessitates treatment like epidural blood patch, where the blood of the

patient is injected into the site of the leakage. As a result, the blood clots are formed at

the particular site, which seal off the leakage caused by lumbar puncture.

Back Pain and Nerve Injury

Back pain can also be experienced by some individuals after lumbar puncture. Lumbar

puncture back pain is usually felt in the lower back region. In addition to these, nerve

injury can affect about 1 in 1000 people after going through the procedure. However, in

most of the cases, such nerve injuries are not of severe nature.

Other Complications

Trauma or injury to the spinal cord or the spinal nerve roots can be termed as one of

the serious problems after lumbar puncture. Sometimes, spinal or epidural bleeding as

well as paraplegia or paralysis of the lower half of the body can also take place. Apart


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from these, spinal hematomas, subarachnoid cysts, cranial neuropathies

and seizures are some other notable lumbar puncture complications. But their

occurrence has been observed to be less frequent.

Major complications of lumbar puncture are more likely to arise in patients, who

have been suffering from conditions like bleeding problems, brain tumor, epidural

infection and bleeding inside the brain. Therefore, this procedure is not recommended

for such individuals. It is also not recommended for the individuals, who take blood

thinning medications. More on lumbar puncture side effects.

8. Nuclear imaging

Complications associated with nuclear imaging include a slight risk of developing

angina or arrhythmias.

Prostate biopsy

Infection

According to the Mayo Clinic, infection is the most common complication of a

prostate biopsy. In addition to infection of the prostate, the biopsy procedure can also

cause a urinary tract infection in rare cases.

Bleeding

Bleeding at the biopsy site is common after the procedure, and up to half of men

also notice blood in their sperm. The Mayo Clinic says both of these situations are

normal and not cause for concern unless the bleeding is heavy.

Urinary Retention

Some men may have trouble urinating after a prostate biopsy. This is usually a

minor complication that resolves itself; however, in rare cases, it may be severe enough

to require a catheter.

Pain

To access the prostate, the doctor must go in either through the rectum or, less

commonly, through the penis or perineum. This can cause slight pain during the

procedure and soreness afterward. This is not cause for concern unless the pain is

severe.

9. X-ray

Excessive exposure to x-rays can permanently damage organs such as the ovaries and

testes, eyes, and thyroid gland. X-ray exposure can also increase the risk of cancer.


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This risk is minimized by focusing and limiting the x-ray beam, as well as shielding the

sensitive organs, when possible. X-rays are harmful to the fetus and any woman of

childbearing age should be tested for pregnancy if there is even a small possibility that

she is pregnant.

Occasionally, there are adverse reactions to x-ray contrast media; these range from a

transient flushing to a drop in blood pressure and heart rate to anaphylaxis (a life-

threatening allergic reaction). Barium sulfate, a contrast material used to visualize

the gastrointestinal tract, can leak into the abdominal cavity if a perforation of the

intestine is present, creating a serious inflammation (peritonitis). With arteriography,

bleeding from the arterial puncture site can occur, as can damage to the artery itself.

10. Colonoscopy

Perforation

This is perhaps the most severe of all colonoscopy complications and it has beenknown to occur in patients who are more than 60 years of age. This is basically a tear or

a hole in the intestine. This risks is however, very rare in occurrence and it happens as

a result of a puncture inflicted on the colon wall by a medical instrument. Perforation

may also occur if the air that is introduced into the colon results in excessive expanding

of the colon walls because of the pressure from within. Severe cases of perforation

have surgery as an available treatment, while, cases which are mild can be treated by

antibiotics, careful monitoring and bowel rest.

Bleeding

Out of all colonoscopy dangers, this one has its occurrence in about 1 out of every 1000

cases. During the procedure, medical instruments are inserted inside the body in order

to take tissue samples for the removal of polyps. There are 30 - 50% chances of

bleeding to occur within 2 - 7 days after any removal of polyps during the procedure. In

most cases, the bleeding resolves on its own, however, there might be the requirement

of medical intervention, if the case is severe.

Complications from Anesthetic Medications

Often, patients are given sedative medicines during the procedure, in order to make

them more comfortable. Here, the patient may be awake, but he would not be able to

recall much about the procedure performed on him. Colonoscopy complications, here,

include those related to allergic reaction and respiratory problems. Nausea, vomiting,low blood pressure and reaction at the injection side are some of the other rare but

possible risks which can occur due to the administration of such kinds of medications.

Postpolypectomy Syndrome

During a colonoscopy, when polyps are gotten rid of the colon, it is known as

polypectomy. This procedure caters to a risk which is known as postpolypectomy

syndrome. This results due to the burning of the polyps off the intestinal wall.


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The colnoscopy risks which are related to this case, include fever, abdominal pain and

an elevated white blood cell count, and they usually occur from few days or weeks after

the procedure.

Infection

Another rare one, among the many colonoscopy complications, is infection. This may

occur in an event wherein, the medical instruments have not been sterilized properly.

This is considered as the rarest of all complications, as doctors take utmost care in

seeing to it that the medical equipments are proper and up to the mark.

11. Bronchoscopy

After the bronchoscopy, the patient will be monitored for vital signs such as heart

rate, blood pressure, and breathing, while resting in bed. Sometimes patients have an

abnormal reaction to anesthesia. All saliva should be spit into a basin so that it can be

examined for the presence of blood. If a biopsy was taken, the patient should not cough

or clear the throat as this might dislodge any blood clot that has formed and causebleeding. No food or drink should be consumed for about two hours after the procedure

or until the anesthesia wears off. Diet is gradually progressed from ice chips and clear

liquids to the patient's regular diet. There will also be a temporary sore throat and

hoarseness that may last for a few days.

The severe complications that occurred included the following:

(1) death: respiratory arrest and cardiac arrest occurred during bronchoscopy; the

patient could not be resuscitated;

(2) massive hemoptysis: the patient did not have hemoptysis before bronchoscopy or

had only blood-streaked sputum, but had massive hemoptysis (>200 ml) during or 1 h

after bronchoscopy;

(3) laryngospasm or tracheospasm or bronchospasm: laryngospasm or tracheospasm

or bronchospasm occurred before or after the bronchoscope passed through the glottis

which made it necessary to suspend the procedure;

(4) cardiac arrhythmia: during the procedure, the electrocardiogram monitor showed

various types of arrhythmia as follows: sinus tachycardia, atrial or ventricular premature

beats or premature nodal contraction, T wave changes, Q-T interval prolongation orcardiac arrest;

(5) pneumatothorax and/or subcutaneous emphysema: pneumatothorax and/or

subcutaneous emphysema occurred during or after the procedure and required suction

or drainage;

(6) esophagotracheal fistula;


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(7) tracheal perforation;

(8) airway obstruction: the airway was patent but became obstructed or narrowed after

the procedure.

TYPES OF THERAPHIES AND PROCEDURES

Intravenous Therapy

-is the giving of substances directly into a vein. The word intravenous simply

means "within a vein". Therapies administered intravenously are often called specialty

pharmaceuticals. It is commonly referred to as a drip because many systems of

administration employ a drip chamber, which prevents air entering the blood stream and

allows an estimate of flow rate. Intravenous therapy may be used to correct electrolyte

imbalances, to deliver medications, for blood transfusion or as fluid replacement to

correct, for example, dehydration.

Possible Complication:

Phlebitis

Phlebitis occurs when a blood vessel becomes inflamed after catheter insertion. While

no needle remains in the body, the site of the insertion can become red, warm or

swollen. This is more commonly associated with the delivery of medications that are

highly acidic or contain alkaline solutions. While phlebitis typically disappears after a few

days, the vein site can be changed or the vein can be accessed using a smaller needle.

Thrombophlebitis

This condition is similar to the inflammation that accompanies phlebitis; however, blood

clotting is also associated with it. Because IVs are typically placed in smaller veins, the

risks of deadly blood clots are minimized. The clot may be visible in the veins, and anti-

inflammatory medications, such as ibuprofen or acetaminophen, should be used. If the

clot or redness worsens, additional treatments should be given.

Infiltration

Infiltration occurs when the IV fluid leaks into the surrounding tissue. Infiltration is chiefly

caused by an improper catheter placement or when the catheter is dislodged.Symptoms of infiltration include swelling, pain or itching, burning, skin that is cool to the

touch or discoloration. If infiltration occurs, the IV should be removed, and the limb

should be elevated to promote patient comfort.

Hematoma


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If an IV punctures a vein, this can cause internal bleeding that result in a hematoma. A

hematoma typically occurs either when an IV catheter is inserted or when an IV catheter

is removed. The hematoma may resemble a lump or bump at the IV site, and should

disappear on its own in a few hours or a day.

Nerve Damage

When an IV is inserted, it is possible to pierce or penetrate a nerve. This should cause

an immediate, sharp pain that radiates through the arm. In addition to this pain,

symptoms include a reduction in hand or arm strength.

Heat Therapy

-Heat therapy involves exposing part or all of the body to high temperatures. In

cancer treatment, it is used mainly usually to enhance other forms of therapy, such asradiation and chemotherapy. Heat may be applied to affected parts of the body along

with other treatments to help relieve certain kinds of pain or infections. Heat therapy

may also involve injecting substances to cause a fever, such as DNP

Potential complication:

May cause or worsen internal bleeding

During the process of heat therapy normal tissue surrounding the target tissue or organ

may be damage causing immediate death (necrosis). This complication will soon lead to

ruptured organ causing internal bleeding, also blood vessels have low tolerance to heat

causing it to burst out, rupture during the fever process.

Seizure

High temperature may stimulate seizure; this is theoretically based on altered

neurotransmitter.

Spread of infection

Hot compresses or soaks used to help treat skin infections can spread germs to others

if the container or compress is not thoroughly cleaned after use.

Intracellular hyperthermia

Is a patent pending, new method of heat delivery. Based on heating cells "from the

inside-out." This is accomplished by uncoupling a basic biologic process known as

oxidative phosphorylation, using DNP (chemical name 2-4-dinitrophenol) has caused a

number of deaths.


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Thrombolytic Therapy

- is a treatment used to break up dangerous clots inside your blood vessels. It is

not always successful. In up to 25 percent of patients, the treatment is unable to break

up the clot. This is especially true if the clot has been established for a long time. In

another 12 out of every 100 patients, the clot or blockage will re-form in the blood

vessel, especially if an underlying reason for the clot to form in the first place is not

found and treated.


Bleeding in the access site or elsewhere

This may due to the decrease clotting ability of the body, Thrombolytic therapy

decoagulates the clotted blood, if this becomes unsuccessful it becomes an obstruction

and can harm the blood vessel causing rupture that will lead to localized bleeding.

Low blood pressureThis is associated in bleeding problems.

Allergy to thrombolytic drugs

This is rare but allergy precautions are to be observed always.

Bleeding in the brain leading to stroke

This can also occur, but it is rare and affects fewer than 1 in 100 patients

Cryotherapy

-is the application of extreme cold to destroy abnormal or diseased tissue. Thecold is introduced through a probe which has liquid nitrogen circulating through it. To

destroy diseased tissue, the tissue is cooled to below -200 degrees Celsius. Other

procedures that control pain or bleeding are cooled to a lesser degree to prevent tissue

damage.

Possible Complications:

Tissue sloughing

A surface layer of flesh peeling away. Possible causes are extensive exposure to cold

object or substance

HyperpigmentationThis is due to the excessive destimulation of melanocyte causing wide range ofdiscoloration.

Change in sensation


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This is the result of exposure to cold substance, nerve damage may occur, but changesin sensation are mainly transient and will disappear after 1 month.

Atrophy of the targeted tissue.This would be the most to be watch out, this is due to the death of the nerve. Atrophy

will be observed after 3-4 days after the initial treatment.

Photodynamic Therapy (PDT or Blue Light Therapy)

- is a medical treatment that uses a photosensitizing drug (a drug that becomes

activated by light exposure) and a light source to activate the applied drug. The result is

an activated oxygen molecule that can destroy nearby cells. Precancerous cells and

certain types of cancer cells can be treated this way

Possible complication:

Sunburn reaction, burning sensation, skin discoloration, skin redness, unsightly scars,cosmetic disfigurement, skin discoloration, and prominent tiny blood vessels

(telangeictasia).

These symptoms are normal after the procedure. These are the normal response of the

skin once introduced to an irritating substance.

Pain, infection

These are the uncommon complication that brought by breakdown of tissue causing

proliferation of bacteria, that causes infection, though the procedure is mainly not painful

some patient experience severe pain after the process.

Biological therapy

-Biological therapy is treatment designed to stimulate or restore the ability of the

body's immune (natural internal defense) system to fight infection and disease.

Biological therapy is also called biotherapy or immunotherapy. Biological therapy often

involves the use of substances called biological response modifiers (BRMs).

Monoclonal antibodies, interferon, interleukin-2 (IL-2), and several types of colony-

stimulating factors (CSF, GM- CSF, and G-CSF) are forms of biological therapy.

Potential ComplicationFlu-like-symptoms:

Chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea

-this is caused by the natural response of the body to the substance introduced,

mainly these are easily manageable by treating the symptoms.


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Some patients develop a rash, and some bleed or bruise easily and have localized

swelling.

Interleukin therapy can cause this problem. , interferon, interleukin-2 (IL-2), colony-

stimulating factors (CSF, GM- CSF, and G-CSF) is the drug to watch for.

Brachytherapy

- Placing stents in arteries during angioplasty is very effective at keeping heart

blood vessels open. But, even when stents are implanted, arteries narrow again in 15%-

25% of people. This re-narrowing is called in-stent restenosis. Most restenosis is due to

scar tissue that forms in response to the injury created when the stent was implanted.

Some scar tissue is useful; it covers the metal stent and helps prevent blood clots from

forming. But, in some people, the process does not stop, and the scar tissue re-closes

the artery. When restenosis occurs, doctors can fix the problem by radiating the site ofre-narrowing. This is called brachytherapy.


Thrombosis

The formation or presence of a blood clot in a blood vessel. The vessel may be any vein

or artery as, for example a coronary (artery) thrombosis. The clot itself is termed a

thrombus. If the clot breaks loose and travels through the bloodstream, it is a

thromboembolism. This may due to the inability weakening of the blood vessel to

support blood causing minor obstruction that will lead to thrombus formation.

Cell therapy/ Stem cell therapy

-The prevention, treatment, cure or mitigation of disease or injuries in humans by

the administration of autologous, allogeneic or xenogeneic cells that have been

manipulated or altered ex vivo. The goal of cell therapy, overlapping with that of

regenerative medicine, is to repair, replace or restore damaged tissues or organs. This

treatment are usually accompanied by chemotherapy and radiation therapy.


Bone Marrow Suppression

High-dose chemotherapy directly destroys the bone marrow's ability to produce white

blood cells, red blood cells, and platelets. Patients experience side effects from low

numbers of white blood cells (neutropenia), red blood cells (anemia), and platelets

(thrombocytopenia). Patients usually need blood and platelet transfusions to treat

anemia and thrombocytopenia until the new graft begins producing blood cells. The


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duration of bone marrow suppression can be shortened by infusing an optimal number

of stem cells and growth factors that hasten the recovery of blood cell production.

Infections

During the 2 to 3 weeks it takes the new bone marrow to grow and produce white blood

cells, patients are susceptible to infection and require the administration of antibiotics to

prevent bacterial and fungal infections. Bacterial infections are the most common during

this initial period of neutropenia. Stem cells collected from peripheral blood tend to

engraft faster than bone marrow and may reduce the risk of infection by shortening the

period of neutropenia. The growth factor filgrastim also increases the rate of white blood

cell recovery and has been approved by the FDA use during allogeneic stem cell

transplant. Prophylactic antibiotics can also decrease the incidence of infection, which

commonly occurs after high-dose chemotherapy and allogeneic stem cell transplant.

CataractsCataracts occur in the overwhelming majority of patients who receive total body

irradiation in their treatment regimen. In patients who receive chemotherapy without

total body irradiation, cataracts are much less frequent. The onset of cataracts typically

begins 18-24 months following treatment. Patients who have received large doses of

steroids will have an increased frequency and earlier onset of cataracts. Patients are

advised to have slit lamp eye evaluations annually and early correction with artificial

lenses.

Infertility

The overwhelming majority of women who receive total body irradiation will be sterile.However, some prepubertal and adolescent females do recover ovulation and

menstruation. In patients who receive only chemotherapy preparative regimens, the

incidence of sterility is more variable and more age related, i.e., the older the woman is

at the time of treatment the more likely chemotherapy will produce anovulation. These

are important considerations because of the need for hormone replacement. All females

should have frequent gynecologic follow-up.

The overwhelming majority of men who receive total body irradiation will become sterile.

Sterility is much more variable after only chemotherapy regimens. Men should have

sperm counts done to determine whether or not sperm are present and should be

examined over time, as recovery can occur.

New cancers

Treatment with chemotherapy and radiation therapy is known to increase the risk of

developing a new cancer. These are called "secondary cancers" and may occur as a


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late complication of high-dose chemotherapy. Patients treated with high-dose

chemotherapy and allogeneic stem cell transplantation appear to have an increased risk

of developing a secondary cancer. In a report evaluating almost 20,000 patients treated

with allogeneic stem cell transplantation, 80 patients developed a new cancer. This

represents an approximate 2.5% greater risk compared to normal individuals

The longer patients survived after high-dose chemotherapy and allogeneic stem cell

transplantation, the greater the risk of developing a secondary cancer. Patients treated

with total body irradiation appear to be more likely to develop new cancer than those

treated with lower radiation doses or high-dose chemotherapy. High-dose

chemotherapy and allogeneic stem cell transplant is increasingly used to treat certain

cancers because it improves cure rates. Patients should be aware of the risk of

secondary cancer following high-dose chemotherapy treatment and discuss the benefits

and risks of high-dose chemotherapy with their primary cancer physician.

Corticosteroid Therapy

- refers to the medical use of varying forms of corticosteroids to treat a variety of

conditions. Therapy might be undertaken for short periods of time to address something

like contact dermatitis, or some people will take one of the steroids most of the time for

chronic inflammatory conditions or to dull immune response. There are many ways

steroids can be delivered, and these include orally, topically, or via nasal or bronchial

inhalation.


Cataracts and GlaucomaCataracts and glaucoma are complications of oral corticosteroid therapy. Cataract is an

eye disease in which the natural lens of the eye gets clouded. Elevated pressure in the

eye due to steroids can also lead to glaucoma. In this eye disease, the optic nerve gets

damaged, causing blindness. Blurred vision may also occur as a side effect of these

drugs.

High Blood Sugar and High Blood Pressure

It is noted that long-term therapy with steroids can cause an increase in blood sugar

levels. This can, in turn, lead to diabetes or worsen an already existing condition. Most

hospitals/clinic states that individuals taking these drugs may also suffer from

hypertension, or high blood pressure.

Osteoporosis


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Is a condition in which bones get thin and weak, and are prone to breakage or fracture.

This is a complication of corticosteroid therapy because these drugs can cause loss of

calcium in the bones.

Weight Gain

By increasing the appetite, another complication of corticosteroid therapy is weight gain.

Fat deposits are especially seen in the abdomen, face and the back of the neck.

Other Complications

Sudden mood swings, nervousness and irritability are also often experienced by

individuals on corticosteroid therapy. An increase in body hair and a swollen, puffy face

may also be seen in these individuals. Corticosteroid therapy patients may be prone to

more infections, and may also experience muscle weakness. Problems sleeping, waterretention, acne and irritation in the stomach are also complications of these

medications. There may also be thinning of the skin that causes easy bruising and

slower wound healing.

Antiretroviral therapy

- The use of at least three antiretroviral (ARV) drugs to maximally suppress the

HIV virus and stop the progression of HIV disease. Huge reductions have been seen in

rates of death and suffering when use is made of a potent antiretroviral regimen.


Lipodystrophy

HIV-associated lipodystrophy is a syndrome that occurs in HIV-infected patients who

are being treated with antiretroviral medications. Although the term HIV-associated

lipodystrophy refers to abnormal central fat accumulation (lipohypertrophy) and

localized loss of fat tissue (lipoatrophy), some patients have only lipohypertrophy, some

have only lipoatrophy, and, less commonly, a subset of patients exhibits a mixed clinical

presentation.

DyslipidaemiaIt is a general term that refers to abnormal levels of lipids, a broad category of

compounds that encompass everything from vitamins to cholesterol, in the body. A

disorder of lipoprotein metabolism, including lipoprotein overproduction or deficiency.

Dyslipidemias may be manifested by elevation of the total cholesterol, the low-density

lipoprotein (LDL) cholesterol and the triglyceride concentrations, and a decrease in the

high-density lipoprotein (HDL) cholesterol concentration in the blood.


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Diarrhea

This is due to the disruption of normal gastrointestinal flora, thus his cause

overstimulation of peristalsis. Decreases in water absorption, causing watery stool.

POTENTIAL COMPLICATION FOR TREATMENT AND PROCEDURE

Intravenous Therapy

-is the giving of substances directly into a vein. The word intravenous simply

means "within a vein". Therapies administered intravenously are often called specialty

pharmaceuticals. It is commonly referred to as a drip because many systems of

administration employ a drip chamber, which prevents air entering the blood stream and

allows an estimate of flow rate. Intravenous therapy may be used to correct electrolyte

imbalances, to deliver medications, for blood transfusion or as fluid replacement to

correct, for example, dehydration.


Phlebitis

Phlebitis occurs when a blood vessel becomes inflamed after catheter insertion. While

no needle remains in the body, the site of the insertion can become red, warm or

swollen. This is more commonly associated with the delivery of medications that are

highly acidic or contain alkaline solutions. While phlebitis typically disappears after a few

days, the vein site can be changed or the vein can be accessed using a smaller needle.

Thrombophlebitis

This condition is similar to the inflammation that accompanies phlebitis; however, blood

clotting is also associated with it. Because IVs are typically placed in smaller veins, the

risks of deadly blood clots are minimized. The clot may be visible in the veins, and anti-

inflammatory medications, such as ibuprofen or acetaminophen, should be used. If the

clot or redness worsens, additional treatments should be given.

Infiltration

Infiltration occurs when the IV fluid leaks into the surrounding tissue. Infiltration is chiefly

caused by an improper catheter placement or when the catheter is dislodged.Symptoms of infiltration include swelling, pain or itching, burning, skin that is cool to the

touch or discoloration. If infiltration occurs, the IV should be removed, and the limb

should be elevated to promote patient comfort.

Hematoma


39/56

If an IV punctures a vein, this can cause internal bleeding that result in a hematoma. A

hematoma typically occurs either when an IV catheter is inserted or when an IV catheter

is removed. The hematoma may resemble a lump or bump at the IV site, and should

disappear on its own in a few hours or a day.

Nerve Damage

When an IV is inserted, it is possible to pierce or penetrate a nerve. This should cause

an immediate, sharp pain that radiates through the arm. In addition to this pain,

symptoms include a reduction in hand or arm strength.

Heat Therapy

-Heat therapy involves exposing part or all of the body to high temperatures. In

cancer treatment, it is used mainly usually to enhance other forms of therapy, such as

radiation and chemotherapy. Heat may be applied to affected parts of the body along

with other treatments to help relieve certain kinds of pain or infections. Heat therapymay also involve injecting substances to cause a fever, such as DNP

Potential complication:

May cause or worsen internal bleeding

During the process of heat therapy normal tissue surrounding the target tissue or organ

may be damage causing immediate death (necrosis). This complication will soon lead to

ruptured organ causing internal bleeding, also blood vessels have low tolerance to heat

causing it to burst out, rupture during the fever process.

SeizureHigh temperature may stimulate seizure; this is theoretically based on altered

neurotransmitter.

Spread of infection

Hot compresses or soaks used to help treat skin infections can spread germs to others

if the container or compress is not thoroughly cleaned after use.

Intracellular hyperthermia

Is a patent pending, new method of heat delivery. Based on heating cells "from the

inside-out." This is accomplished by uncoupling a basic biologic process known as

oxidative phosphorylation, using DNP (chemical name 2-4-dinitrophenol) has caused a

number of deaths.

Thrombolytic Therapy


40/56

- is a treatment used to break up dangerous clots inside your blood vessels. It is

not always successful. In up to 25 percent of patients, the treatment is unable to break

up the clot. This is especially true if the clot has been established for a long time. In

another 12 out of every 100 patients, the clot or blockage will re-form in the blood

vessel, especially if an underlying reason for the clot to form in the first place is not

found and treated.


Bleeding in the access site or elsewhere

This may due to the decrease clotting ability of the body, Thrombolytic therapy

decoagulates the clotted blood, if this becomes unsuccessful it becomes an obstruction

and can harm the blood vessel causing rupture that will lead to localized bleeding.

Low blood pressure

This is associated in bleeding problems.

Allergy to thrombolytic drugs

This is rare but allergy precautions are to be observed always.

Bleeding in the brain leading to stroke

This can also occur, but it is rare and affects fewer than 1 in 100 patients

Cryotherapy

-is the application of extreme cold to destroy abnormal or diseased tissue. The

cold is introduced through a probe which has liquid nitrogen circulating through it. Todestroy diseased tissue, the tissue is cooled to below -200 degrees Celsius. Other

procedures that control pain or bleeding are cooled to a lesser degree to prevent tissue

damage.

Possible Complications:

Tissue sloughing

A surface layer of flesh peeling away. Possible causes are extensive exposure to cold

object or substance

HyperpigmentationThis is due to the excessive destimulation of melanocyte causing wide range ofdiscoloration.

Change in sensation


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This is the result of exposure to cold substance, nerve damage may occur, but changesin sensation are mainly transient and will disappear after 1 month.

Atrophy of the targeted tissue.This would be the most to be watch out, this is due to the death of the nerve. Atrophy

will be observed after 3-4 days after the initial treatment.Photodynamic Therapy (PDT or Blue Light Therapy)- is a medical treatment that uses a photosensitizing drug (a drug that becomes

activated by light exposure) and a light source to activate the applied drug. The result is

an activated oxygen molecule that can destroy nearby cells. Precancerous cells and

certain types of cancer cells can be treated this way

Possible complication:

Sunburn reaction, burning sensation, skin discoloration, skin redness, unsightly scars,

cosmetic disfigurement, skin discoloration, and prominent tiny blood vessels

(telangeictasia).These symptoms are normal after the procedure. These are the normal response of the

skin once introduced to an irritating substance.

Pain, infection

These are the uncommon complication that brought by breakdown of tissue causing

proliferation of bacteria, that causes infection, though the procedure is mainly not painful

some patient experience severe pain after the process.

Biological therapy

-Biological therapy is treatment designed to stimulate or restore the ability of thebody's immune (natural internal defense) system to fight infection and disease.

Biological therapy is also called biotherapy or immunotherapy. Biological therapy often

involves the use of substances called biological response modifiers (BRMs).

Monoclonal antibodies, interferon, interleukin-2 (IL-2), and several types of colony-

stimulating factors (CSF, GM- CSF, and G-CSF) are forms of biological therapy.

Potential Complication

Flu-like-symptoms:

Chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea

-this is caused by the natural response of the body to the substance introduced,

mainly these are easily manageable by treating the symptoms.

Some patients develop a rash, and some bleed or bruise easily and have localized

swelling.


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During the 2 to 3 weeks it takes the new bone marrow to grow and produce white blood

cells, patients are susceptible to infection and require the administration of antibiotics to

prevent bacterial and fungal infections. Bacterial infections are the most common during

this initial period of neutropenia. Stem cells collected from peripheral blood tend to

engraft faster than bone marrow and may reduce the risk of infection by shortening the

period of neutropenia. The growth factor filgrastim also increases the rate of white blood

cell recovery and has been approved by the FDA use during allogeneic stem cell

transplant. Prophylactic antibiotics can also decrease the incidence of infection, which

commonly occurs after high-dose chemotherapy and allogeneic stem cell transplant.

Cataracts

Cataracts occur in the overwhelming majority of patients who receive total body

irradiation in their treatment regimen. In patients who receive chemotherapy without

total body irradiation, cataracts are much less frequent. The onset of cataracts typically

begins 18-24 months following treatment. Patients who have received large doses ofsteroids will have an increased frequency and earlier onset of cataracts. Patients are

advised to have slit lamp eye evaluations annually and early correction with artificial

lenses.

Infertility

The overwhelming majority of women who receive total body irradiation will be sterile.

However, some prepubertal and adolescent females do recover ovulation and

menstruation. In patients who receive only chemotherapy preparative regimens, the

incidence of sterility is more variable and more age related, i.e., the older the woman is

at the time of treatment the more likely chemotherapy will produce anovulation. Theseare important considerations because of the need for hormone replacement. All females

should have frequent gynecologic follow-up.

The overwhelming majority of men who receive total body irradiation will become sterile.

Sterility is much more variable after only chemotherapy regimens. Men should have

sperm counts done to determine whether or not sperm are present and should be

examined over time, as recovery can occur.

New cancers

Treatment with chemotherapy and radiation therapy is known to increase the risk of

developing a new cancer. These are called "secondary cancers" and may occur as a

late complication of high-dose chemotherapy. Patients treated with high-dose

chemotherapy and allogeneic stem cell transplantation appear to have an increased risk

of developing a secondary cancer. In a report evaluating almost 20,000 patients treated


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with allogeneic stem cell transplantation, 80 patients developed a new cancer. This

represents an approximate 2.5% greater risk compared to normal individuals

The longer patients survived after high-dose chemotherapy and allogeneic stem cell

transplantation, the greater the risk of developing a secondary cancer. Patients treated

with total body irradiation appear to be more likely to develop new cancer than those

treated with lower radiation doses or high-dose chemotherapy. High-dose

chemotherapy and allogeneic stem cell transplant is increasingly used to treat certain

cancers because it improves cure rates. Patients should be aware of the risk of

secondary cancer following high-dose chemotherapy treatment and discuss the benefits

and risks of high-dose chemotherapy with their primary cancer physician.

Corticosteroid Therapy

- refers to the medical use of varying forms of corticosteroids to treat a variety of

conditions. Therapy might be undertaken for short periods of time to address somethinglike contact dermatitis, or some people will take one of the steroids most of the time for

chronic inflammatory conditions or to dull immune response. There are many ways

steroids can be delivered, and these include orally, topically, or via nasal or bronchial

inhalation.


Cataracts and Glaucoma

Cataracts and glaucoma are complications of oral corticosteroid therapy. Cataract is an

eye disease in which the natural lens of the eye gets clouded. Elevated pressure in the

eye due to steroids can also lead to glaucoma. In this eye disease, the optic nerve getsdamaged, causing blindness. Blurred vision may also occur as a side effect of these

drugs.

High Blood Sugar and High Blood Pressure

It is noted that long-term therapy with steroids can cause an increase in blood sugar

levels. This can, in turn, lead to diabetes or worsen an already existing condition. Most

hospitals/clinic states that individuals taking these drugs may also suffer from

hypertension, or high blood pressure.

Osteoporosis

Is a condition in which bones get thin and weak, and are prone to breakage or fracture.

This is a complication of corticosteroid therapy because these drugs can cause loss of

calcium in the bones.

Weight Gain


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By increasing the appetite, another complication of corticosteroid therapy is weight gain.

Fat deposits are especially seen in the abdomen, face and the back of the neck.

Other Complications

Sudden mood swings, nervousness and irritability are also often experienced by

individuals on corticosteroid therapy. An increase in body hair and a swollen, puffy face

may also be seen in these individuals. Corticosteroid therapy patients may be prone to

more infections, and may also experience muscle weakness. Problems sleeping, water

retention, acne and irritation in the stomach are also complications of these

medications. There may also be thinning of the skin that causes easy bruising and

slower wound healing.

Antiretroviral therapy

- The use of at least three antiretroviral (ARV) drugs to maximally suppress the

HIV virus and stop the progression of HIV disease. Huge reductions have been seen in

rates of death and suffering when use is made of a potent antiretroviral regimen.


Lipodystrophy

HIV-associated lipodystrophy is a syndrome that occurs in HIV-infected patients who

are being treated with antiretroviral medications. Although the term HIV-associated

lipodystrophy refers to abnormal central fat accumulation (lipohypertrophy) and

localized loss of fat tissue (lipoatrophy), some patients have only lipohypertrophy, some

have only lipoatrophy, and, less commonly, a subset of patients exhibits a mixed clinical

presentation.

Dyslipidaemia

It is a general term that refers to abnormal levels of lipids, a broad category of

compounds that encompass everything from vitamins to cholesterol, in the body. A

disorder of lipoprotein metabolism, including lipoprotein overproduction or deficiency.

Dyslipidemias may be manifested by elevation of the total cholesterol, the low-density

lipoprotein (LDL) cholesterol and the triglyceride concentrations, and a decrease in the

high-density lipoprotein (HDL) cholesterol concentration in the blood.

DiarrheaThis is due to the disruption of normal gastrointestinal flora, thus his cause

overstimulation of peristalsis. Decreases in water absorption, causing watery stool.


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Management for Complications of Diagnostic tests

BleedingMgmt:

y

Apply pressure dressing over external bleeding sitey Increase IV infusion rate

y Blood transfusion- process of receiving blood products into one's circulation intravenously.- used in a variety of medical conditions to replace lost components of the blood.- used whole blood, but modern medical practice commonly uses only

components of the blood, such as red blood cells, white blood cells, plasma, clottingfactors, and platelets.

Peritoneal leakMgmt:

y Surgical suture

- medical device used to hold body tissues together after an injury or surgery.-It generally consists of a needle with an attached length of thread. A number

of different shapes, sizes, and thread materials have been developed over itsmillennia of history.

Iron deficiency AnemiaMgmt:

y Oral medications(ferrous sulfate, ferrous gluconate)

y O2 therapy for DOB

y Blood transfusion as neededIncreased ICP

Mgmt:

y Position: semi fowler's and lateral position to help drain CSF from subarachnoidspace of the spinal cord. It also promotes maximum lung expansion.

y Note: HOB at 90 degrees may cause brain herniation-adequate oxygenation to promote acid-base balance

y Note: Acidosis and alkalosis may increased ICP

y Safety- because patients have altered LOC and may have seizu

Documents

Diagnostics Tests, Treatment and Procedures