Competency Appraisal 1 PDF

COMPETENCY APPRAISAL 1 BY: PROF. EVELYN M. BALANQUIT, MAN Diagnostic Procedures  ABDOMINAL ASSESSMENT PURPOSE: To determine the presence of mass, abnormal bowel sounds, lesions and other abnormalities in the abdominal region. NURSING KEYPOINTS: Position: Dorsal Recumbent...

COMPETENCY APPRAISAL 1 BY: PROF. EVELYN M. BALANQUIT, MAN Diagnostic Procedures  ABDOMINAL ASSESSMENT PURPOSE: To determine the presence of mass, abnormal bowel sounds, lesions and other abnormalities in the abdominal region. NURSING KEYPOINTS: Position: Dorsal Recumbent Sequence of Assessment: Inspection, Auscultation, Percussion, Palpation; start palpating from RLQ to RUQ to LUQ, to LLQ. Palpation is done last because it can possibly alter the bowel rhythms and may therefore give rise to abnormal sounds No to palpation to patients with Wilm's tumor and abdominal aortic aneurysm  Arterial blood gas analysis PURPOSE: To monitor the patient's response to oxygen therapy and detects the presence of acid-base imbalance. NURSING KEYPOINTS: No to Suctioning prior to obtaining blood specimen Assess for bleeding and hematoma at the puncture site Apply firm pressure at the puncture site for 5-10 minutes Specimen should be placed in iced-container Assess for metabolic alkalosis for patient with vomiting, and on the other hand, observe for signs and symptoms of metabolic acidosis for patients with diarrhea.  Barium enema PURPOSE: To assess the large intestines NURSING KEYPOINTS: Provide a Liquid diet before the procedure Ensure that a laxative is given before the procedure to promote better visualization, and after the procedure to prevent constipation Report to the doctor if bowel movement does not occur in 2 days Instruct the patient to increase fluids and eat foods rich in fiber The patient should also increase intake of fluids  Barium swallow PURPOSE: To assess for the esophagus, stomach, and some portion of the small intestines. NURSING ALERT: NPO for 6-8 hours before the procedure Withhold anticholinergic and narcotics for 24 hours before test Laxative is administered after the procedure to counteract the constipating effects of the barium Instruct patient to increase fluids and intake of fiber-rich foods  Cardiac catheterization PURPOSES: To measure oxygen concentration, saturation, tension and pressure in various chambers of the heart. To determine a need for cardiac surgery. NURSING KEYPOINTS: Check for informed consent Assess allergy to iodine NPO for 6-8 hours before the procedure Check for distal pulses after the procedure Check for bleeding at the arterial puncture site and apply pressure Keep a 20 lbs. sandbag at the bedside as a pressure instrument if bleeding occurs Keep the patient flat on bed with the lower extremities hyperextended for 4-6 hours Neurovascular assessment must be performed distal to the catheter insertion site and report any abnormal findings  Catheterization, urinary PURPOSE: To determine residual urine and obtain sterile specimen NURSING KEYPOINTS: The procedure is sterile Maintain a close system The drainage bag must always be below the bladder to avoid back flow of urine The catheter bag should not be allowed to lie on the floor Do not allow the drainage spout to touch the collection receptacle or on the toilet bowl when draining it Provide urine acidification  Chest X-RAY PURPOSE: To detect abnormalities of the organs in the thoracic area NURSING KEYPOINTS: Remove any metallic object before the procedure Lead shield for women of childbearing age  CT Scan PURPOSE: Provides photograph of tissue densities with the use of radiation. NURSING ALERT: If contrast medium will be used, assess for any allergy to iodine and instruct the patient to be on NPO for 4 hours prior to the procedure Assess for any fear of close spaces (claustrophobia) This procedure is contraindicated to patients who are pregnant and obese (>300 lbs.) Let the patient lie still during the whole course of the procedure  CVP (Central Venous Pressure) monitoring PURPOSE: It measures the pressure of the Right Atrium NURSING KEYPOINTS: The nurse should place the zero level of the manometer at the level of the right atrium at the 4th intercostal space to get an accurate reading Instruct the client to avoid coughing and straining as it alters the readings Normal CVP reading is 2-12 mmHg (when the tube is at the superior vena cava)  Cystoscopy Purpose: To assess the bladder and urethra NURSING KEYPOINTS: Check for the informed consent. If general anesthesia will be used, have the client on NPO; liquid diet if local anesthesia will be used. Monitor intake and output. After: Force fluids as prescribed. Administer sitz bath for abdominal pain. Pink-tinged or tea-colored urine is expected within 24-48 hours Notify the doctor if bright red urine or clots  Doppler ultrasound PURPOSE: Evaluates patency of veins and arteries in the lower extremities. NURSING KEYPOINT: Inform the patient that it is painless.  ECG (Electrocardiogram) PURPOSE: Records electrical waves of the heart. NURSING KEYPOINTS: Instruct the patient to lie still, breath normally during the procedure Let the patient refrain from talking during the test. ST segment elevation or T wave inversion, indicates MI  EEG (Electroencephalogram) PURPOSES: Records the electrical activity of the brain Detects intracranial hemorrhage and tumors NURSING KEYPOINTS: Advise the client to shampoo hair before and after the procedure If the electrode gel is not removed by shampooing, the patient may use acetone Withhold stimulants, antidepressants, tranquilizers, and anticonvulsants for 24-48 hours prior to the test  Fasting Blood Sugar level PURPOSE: Detects diabetes mellitus NURSING KEYPOINTS: Normal blood sugar level is 80-120 mg./dl A blood sugar level of more than 140 mg./dl confirms diabetes.  Gastric analysis PURPOSES: This test is used to detect ulcers, and to rule-out pernicious anemia. It may also be done to analyze acidity, appearance and volume of gastric secretions NURSING KEYPOINTS: In gastric ulcer, HCl is normal, In duodenal ulcer, HCl is elevated. Refrigerate gastric samples if NOT tested within 4 hours.  IVP ( Intravenous Pyelography) PURPOSE: Visualization of the urinary tract NURSING KEYPOINTS: Check for the consent. NPO for 8-10 hours before the procedure Administer laxative to clear bowels before the procedure. Check for allergy to iodine, seafoods or shellfish before the procedure since the procedure requires the use of iodine based dye. Keep epinephrine at the bedside to counteract possible allergic reaction. IVP requires the use of a contrast medium while KUB does not. Inform the patient about the possible salty taste that may be experienced during the test. Increase fluid intake after the procedure to facilitate excretion of the dye.  Liver biopsy PURPOSE: To determine liver disorders. NURSING KEYPOINTS: Check for the consent. Obtain the result of blood tests before aspiration since bleeding may occur Let the patient assume left side or supine during biopsy Instruct the patient to inhale, exhale and hold breath during the insertion of needle to stabilize position of the liver and prevent accidental puncture of the diaphragm Position the patient on the right side after liver biopsy with pillows underneath to prevent bleeding Bedrest for 24 hours after the procedure  Lumbar Puncture PURPOSE: To withdraw CSF to determine abnormalities. NURSING KEYPOINTS: Check for the consent. Before the procedure: empty bladder and bowel. Position: C-position. (fetal position) During the procedure: needle is inserted between L3 -L4 or L4-L5 to prevent accidental puncture to the spinal cord since the spinal cord ends at L2. After: Position the patient flat for 6-12 hours to prevent spinal headache. Increase fluid intake.  MAMMOGRAPH PURPOSE: Detects the presence of breast tumor. NURSING KEYPOINTS: Instruct the patient not to use deodorant, talcum powder, lotion, perfume or any ointment on the day of exam as these may give false-positive result Let the patient know that her breasts will be compressed between 2 x-ray plates Provide teachings related to Self-breast examination Done 7 days after menstruation Position: lying down with pillow under the shoulder of the breast being examined or sitting in front of a mirror while raising the hands of the side of the breast being examined.  Mantoux test PURPOSE: A test to determine exposure to TB NURSING KEYPOINTS: A positive test yields an induration of 10 mm. or more for foreign born children below 4 years old An induration of 5 mm or more is considered positive in patients with HIV, with treated TB, and if he has had a direct exposure TB Patients. BCG may cause false positive reaction. Assess for previous history of PTB and report immediately to the doctor Result is read after 48-72 hours  MRI (Magnetic Resonance Imaging) PURPOSE: Provides cross-sectional images of brain tissues, more detailed than a CT scan. NURSING KEYPOINTS: Contraindications: pregnant women, obesity (more than 300 lbs.), claustrophobic patients, patients with unstable vital signs patients with metal implants like pacemaker, hip replacements and jewelry  Paracentesis PURPOSES: To assess the contents of the peritoneal fluid NURSING KEYPOINTS: Check for consent. Patient is weighed before and after procedure. Instruct the patient to void prior to the procedure to prevent accidental puncture of the bladder During the procedure, instruct the patient to sit up with feet resting on footstool. Evaluate the effect of the procedure by assessing: Weight Abdominal girth Respiratory rate/Pulse rate Notify the physician if the urine becomes bloody, pink or red.  Rinne's test PURPOSE: Used to differentiate between conductive and sensorineural hearing losses. NURSING KEYPOINTS: The vibrating tuning fork is shifted between two positions: against the mastoid bone (bone conduction) and two inches from the opening of the ear canal (air conduction). In conductive hearing loss, bone conduction lasts longer than air conduction.  Schilling's test PURPOSE: Used to detect Vitamin B12 absorption. NURSING KEYPOINTS: Excretion of 8%-40% of ingested radioactive vitamin B12 within 24 hours is normal; excreting more than 40% indicates pernicious anemia. Requires 24-hour urine specimen. Keep the patient NPO except for water, 8-12 hours before the test.  Sputum exam PURPOSE: Determines the presence microorganisms in the sputum. NURSING KEYPOINTS: Instruct patient to rinse mouth with water (no to mouth wash or tooth paste) Specimen is collected upon rising Amount required: 15 ml Instruct the patient to take several deep breaths and then cough deeply.  Stool analysis PURPOSE: Assessment of bacteria, virus, malabsorption and blood. NURSING KEYPOINT: Avoid aspirin, indomethacin, steroids, dark colored foods, red meat and vitamin C three days before the test as these may give a false positive result.  Swan-ganz catheterization PURPOSE: Used to monitor pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP) NURSING KEYPOINTS: The catheter has four lumens (one for CVP, one for fluid infusion and venous access for blood samples, one for monitoring PAP and PCWP and the last lumen is used for inflation and deflation of the balloon. If a fifth lumen exists, it is used for measuring oxygen saturation of the blood. The normal adult PAP systolic and diastolic pressure is 20 to 30 mm Hg. The normal PCWP is 8-13 mm Hg. The only time the balloon should be inflated after it is in place is when obtaining further PCWP readings.  Suctioning PURPOSE: To obtain sputum sample and clear the airway. NURSING KEYPOINTS: Hyperoxygenate the patient before and after the procedure. Apply intermittent suction on withdrawal of the catheter. Do not suction the patient for more than 15 seconds.  Thoracentesis PURPOSE: Aspiration of fluid and /or air from the pleural space. NURSING KEYPOINTS: Check the consent. Position: Sitting on the side of the bed with feet on a chair, leaning over a bedside table. If the patient cannot sit, he lie on his affected side with hands of that side resting on opposite shoulder. Instruct the patient not to cough, breath deeply or move during the procedure. After the procedure: Position the patient on the unaffected side/ puncture site up. Check for bleeding at the puncture site and monitor respiratory function Notify the physician if signs of pneumothorax, air embolism and pulmonary edema occur  Tonometry PURPOSE: Measures intraocular pressure. NURSING KEYPOINTS: Normal reading is 12-21 mm. Hg. A reading of 25 mm./Hg. indicates glaucoma.  Urinalysis PURPOSE: To assess characteristics of urine. NURSING KEYPOINTS: First voided morning sample preferred: 15 ml. Use clean container Decreased specific gravity: diabetes insipidus Increased specific gravity: diabetes mellitus, dehydration, SIADH (+) Protein: PIH, nephrotic syndrome. (+) Glucose: Diabetes mellitus, Infection  Urine collection, 24 hour PURPOSE: Determines the excretion of substances from the kidneys, adrenal glands and the stomach. NURSING KEYPOINT: Required for ACTH test and Schilling's test. Discard the first voided urine  Weber test PURPOSE: Used to detect the presence of unilateral hearing loss. NURSING KEYPOINTS: The tuning fork is set into vibration and placed on the patients' forehead or teeth. Placement on the teeth is generally more reliable, even when the patient has false teeth.  X-ray PURPOSE: Provides radiological data for assessment of certain organs and bones. NURSING KEYPOINTS: Assess the patients' exposure level to radiation Instruct patient to remove all jewelry and other metallic objects before the procedure.