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Midterm Review
Patient Care Chapter 16: Care of Patients During Special Procedures
122
Health Care
Not Applicable
03/03/2013
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Term
The most common sites for insertion of the arterial catheter:
 Definition
R and L brachial arteries
R and L femoral arteries
Term
What is a stylet for?
 Definition
It prevents the return of blood flow when accessing and artery.
Term
What type of antiseptic is used to surgically prepare a site for catheter insertion?
 Definition
iodophor antiseptic
Term
(True or False) Treatment of diseased arteries may be performed at the time of the cardiac catheterization.
 Definition
True
Term
A ____ is an object that provides support and structure to a vessel, and it is oftentimes used when it is thought that restenosis might occur.
 Definition
stent
Term
What are some potential complications of procedures that involve cardiac catheterization?
 Definition
- cardiac arrhythmias
- embolic stroke
- allergic reactions to the contrast media
- infection at insertion site
- hemorrhage at insertion site
Term
Which organs are most commonly assessed via arteriography?
 Definition
- kidneys
- adrenal glands
- brain
- abdominal aorta
Term
The ____ is the typical route to access the vessels of the lower extremities for diagnosis of circulatory impairment of the lower extremities.
 Definition
aorta
Term
During arteriography, if the adrenal glands are the focus, fatal hypertensive crisis may occur if the patient has the disease _______________. Medication to prevent this is administered several days before the procedure.
 Definition
pheochromocytoma
Term
A potential complication of renal studies?
 Definition
renal failure
Term
For angiography of the heart, the patient must abstain from food and fluids for _ to _ hours before the procedure.
 Definition
4 - 8 hrs NPO
Term
For angiography in areas other than the heart the patient is often asked to:
 Definition
be well hydrated before the examination
Term
(True or False) before cardiac cath, angiography, or arteriography the patient is instructed to empty his/her bladder.
 Definition
True
Term
What is often identified and marked with a pen to enable quick assessment before and after angiography/arteriography/cardiac cath procedures.
 Definition
peripheral pulses
Term
Before cardiac cath/arteriography/angiography the pt should be informed that s/he might be asked to cough or take deep breaths during the procedure to ease feelings of:
 Definition
nausea or lightheadedness
(coughing may also correct arrhythmias)
Term
If the arteriography is of the adrenal glands, what must be monitored continually to assess for evidence of a malignant hypertensive crisis?
 Definition
blood pressure
Term
During angiography/arteriography/cardiac cath, what drug is sometimes administered in order to dilate the blood vessels?
 Definition
nitroglycerin
Term
Before a/n angiography/arteriography/cardiac cath procedure, the pt should be informed of the possible need for what type of Sx?
 Definition
coronary bypass surgery
Term
After angiography/cardiac cath, where does the pt ordinarily recover?
 Definition
- PACU
- coronary intensive care unit/coronary care unit (CICU/CCU)
- ICU
Term
After angiogram/cardiac cath, monitor the pt's pulse rate on the side of the invasive procedure every __ minutes for 1 hour and then every hour until an __ to __ hour period is complete and no complications have been detected.
 Definition
every 15 min - 1 hour
every hour thereafter for 8 - 12 hours
Term
After cardiac cath/angiography, the pt's blood pressure is monitored on which side?
 Definition
the side opposite the procedure
Term
After cardiac cath/angiography, the pt's blood pressure must be taken every __ min for 1 hour, and every hour thereafter for __ - __ hours unless complications have been detected.
 Definition
every 15 min - 1 hour every hour thereafter for 8 - 12 hours
Term
After cardiac cath/angiography, the pulses distal to the site of cath insertion must also be monitored at frequent, regular intervals for __ hours after the procedure.
 Definition
24 hrs
Term
After femoral catheterization, the pt should be instructed to move the ___ and _________ the feet frequently.
 Definition
- move toes
- dorsiflex feet
Term
After femoral cath, the pt should be instructed to keep the legs straight and ____.
 Definition
still
Term
After femoral cath, assess the extremities for:
 Definition
- coldness
- cyanosis
- pallor
- numbness
- size comparison of extremities
- tingling
(Instruct pt to inform nurse if any of these signs/symptoms occur)
Term
(True or False) After femoral cath, a feeling of wetness at the site of insertion is perfectly normal.
 Definition
False: the pt should inform the nurse if this happens because it may indicate hemorrhaging
Term
After femoral cathing, how long should the pt remain at bedrest in order to prevent hemorrhage.
 Definition
10 - 12 hrs
Term
S/P femoral cath, the pt should be instructed to do what when coughing or sneezing.
 Definition
Apply pressure at the insertion site
Term
S/P femoral cath, do not raise the patient's head more than __ degrees.
 Definition
20
Term
(True or False) S/P brachial cath, the arm on the side of insertion is kept straight with an armboard for several hours, but the patient may be up as soon as his/her vital signs are stable.
 Definition
True
Term
Regardless of cath site, the pt must be monitored for __ hours for signs of external bleeding or for bleeding into the tissues surrounding the insertion site.
 Definition
24 hrs
Term
S/P angiography/cardiac cath, the pt should be instructed to increase fluid intake to prevent:
 Definition
dehydration and hypotension
Term
What is a contraindication to instructing a pt to increase fluid intake?
 Definition
CHF
Term
Before administering contrast media, explain to the pt that s/he may have feelings of:
 Definition
- nausea
- warmth
- flushing
- metallic taste
Term
(True/False) If a pt feels pain during a CT procedure s/he should notify the tech immediately.
 Definition
True
Term
Pts who are to have a CT of the bowel and abdominal organs are allowed nothing to eat or drink __ - __ hours prior to the examination.
 Definition
4 - 6 hrs (in ppt, it says NPO after midnight)
Term
Pts who are to have a CT of the bowel and abdominal organs are sometimes given barium mixed with __ oz of OJ to drink prior to the scan.
 Definition
Barium w/ 8 oz OJ
Term
(True/False) Pts who have received sedative or antianxiety meds may not drive themselves home.
 Definition
True
Term
After a CT exam w/ contrast, the pt should be observed for at least _ hour/s for adverse reaction and for general instability before being discharged.
 Definition
1 hr
Term
After CT w/ contrast, instruct the pt to increase fluid intake to at least ____ mL and avoid caffeine for the next __ hours to aid in excretion of the agent from the body and to prevent dehydration.
 Definition
3000 mL increased fluid intake
avoid caffeine
(24 hrs)
Term
What is US used for?
 Definition
- fetal monitoring
- diagnosing brain disorders
- renal pathology
- vascular aneurysms
- pathological conditions of internal organs
Term
US: if pt has tendency to have large amounts of gas in the bowel s/he should be instructed to eat low residue foods for __ - __ hours before the exam and should be scheduled in the morning before breakfast.
 Definition
low residue foods 24 - 36 hrs prior to exam
Term
(True/False) In US, scars, obesity, and large amounts of gas prevent good visualization of bodily structures.
 Definition
True
Term
US: wound dressings must be removed, but lubricating gel cannot be applied over an open wound. What can the physician order so that the exam can be done?
 Definition
a clear sterile patch to be worn over the open wound
Term
(True/False) Some MRI procedures use iodinated contrast agents.
 Definition
False
Term
Antianxiety medication is often prescribed to assist in relieving pt anxiety during an MRI exam. When is antianxiety medication not allowed?
 Definition
antianxiety meds may not be given if blood flow is to be assessed because the meds may interfere with normal blood flow
Term
The most common sites for insertion of the arterial catheter:
 Definition
R and L brachial arteries
R and L femoral arteries
Term
What is a stylet for?
 Definition
it prevents the return of blood flow when accessing an artery
Term
What type of antiseptic is used to surgically prepare a site for catheter insertion?
 Definition
iodophor antiseptic
Term
(True or False) Treatment of diseased arteries may be performed at the time of the cardiac catheterization.
 Definition
True
Term
A ____ is an object that provides support and structure to a vessel, and it is oftentimes used when it is thought that restenosis might occur.
 Definition
stent
Term
What are some potential complications of procedures that involve cardiac catheterization?
 Definition
- cardiac arrhythmias
- embolic stroke
- allergic reactions to the contrast media
- infection at insertion site
- hemorrhage at insertion site
Term
Which organs are most commonly assessed via arteriography?
 Definition
- kidneys
- adrenal glands
- brain
- abdominal aorta
Term
The ____ is the typical route to access the vessels of the lower extremities for diagnosis of circulatory impairment of the lower extremities.
 Definition
aorta
Term
During arteriography, if the adrenal glands are the focus, fatal hypertensive crisis may occur if the patient has the disease _______________. Medication to prevent this is administered several days before the procedure.
 Definition
pheochromocytoma
Term
A potential complication of renal studies?
 Definition
renal failure
Term
For angiography of the heart, the patient must abstain from food and fluids for _ to _ hours before the procedure.
 Definition
4 - 8 hrs NPO
Term
For angiography in areas other than the heart the patient is often asked to:
 Definition
be well hydrated before the examination
Term
(True or False) Before cardiac cath, angiography, or arteriography the patient is instructed to empty his/her bladder.
 Definition
True
Term
What is often identified and marked with a pen to enable quick assessment before and after angiography/arteriography/cardiac cath procedures?
 Definition
peripheral pulses
Term
Before cardiac cath/arteriography/angiography the pt should be informed that s/he might be asked to cough or take deep breaths during the procedure to ease feelings of:
 Definition
nausea or lightheadedness
(coughing may also correct arrhythmias)
Term
If the arteriography is of the adrenal glands, what must be monitored continually to assess for evidence of a malignant hypertensive crisis?
 Definition
blood pressure
Term
During angiography/arteriography/cardiac cath, what drug is sometimes administered in order to dilate the blood vessels?
 Definition
nitroglycerin
Term
Before a/n angiography/arteriography/cardiac cath procedure, the pt should be informed of the possible need for what type of Sx?
 Definition
coronary bypass surgery
Term
After angiography/cardiac cath, where does the pt ordinarily recover?
 Definition
- PACU
- coronary intensive care unit/coronary care unit (CICU/CCU)
- ICU
Term
After angiogram/cardiac cath, monitor the pt's pulse rate on the side of the invasive procedure every __ minutes for 1 hour and then every hour until an __ to __ hour period is complete and no complications have been detected.
 Definition
every 15 min - 1 hour
every hour thereafter for 8 - 12 hours
Term
After cardiac cath/angiography, the pt's blood pressure is monitored on which side?
 Definition
the side opposite the procedure
Term
After cardiac cath/angiography, the pt's blood pressure must be taken every __ min for 1 hour and every hour thereafter for __ - __ hours unless complications have been detected.
 Definition

every 15 min - 1 hour

every hour thereafter for 8 - 12 hours
Term
After cardiac cath/angiography, the pulses distal to the site of cath insertion must also be monitored at frequent, regular intervals for __ hours after the procedure.
 Definition
24 hrs
Term
After femoral catheterization, the pt should be instructed to move the ___ and _________ the feet frequently.
 Definition
- move toes
- dorsiflex feet
Term
After femoral cath, the pt should be instructed to keep the legs straight and ____.
 Definition
still
Term
After femoral cath, assess the extremities for:
 Definition
- coldness
- cyanosis
- pallor
- numbness
- size comparison of extremities
- tingling
(Instruct pt to inform nurse if any of these signs/symptoms occur)
Term
(True or False) After femoral cath, a feeling of wetness at the site of insertion is perfectly normal.
 Definition
False: the pt should inform the nurse if this happens because it may indicate hemorrhaging
Term
After femoral cathing, how long should the pt remain at bedrest in order to prevent hemorrhage.
 Definition
10 - 12 hrs
Term
S/P femoral cath, do not raise the patient's head more than __ degrees.
 Definition
20
Term
(True or False) S/P brachial cath, the arm on the side of insertion is kept straight with an armboard for several hours, but the patient may be up as soon as his/her vital signs are stable.
 Definition
True
Term
Regardless of cath site, the pt must be monitored for __ hours for signs of external bleeding or for bleeding into the tissues surrounding the insertion site.
 Definition
24 hrs
Term
S/P angiography/cardiac cath, the pt should be instructed to increase fluid intake to prevent:
 Definition
dehydration and hypotension
Term
What is a contraindication to instructing a pt to increase fluid intake?
 Definition
CHF
Term
This modality combines the qualities of radionuclide imaging with CT to study blood flow and volume and protein metabolism:
 Definition
PET
Term
This modality has had great success in use with studies of the brain, heart, and lungs, as well as assisting in diagnosis of Alzheimer's disease, brain tumors, cardiac disease, and most recently, the physiologic changes in psychiatric diseases:
 Definition
PET
Term
In this modality, the pt inhales or is injected w/ a radioisotope of an element that occurs naturally in the body such as oxygen, nitrogen, carbon, or fluorine. These isotopes emit subatomic particles called positrons (positively charged electrons):
 Definition
PET
Term
Pt prep for PET exam:
 Definition
- no caffeine, nicotine, or alcohol for 24 hours
- no sedative or tranquilizing drugs
- diabetic pts can receive insulin 3 - 4 hours before procedure
- pt must empty bladder immediately before exam
Term
S/P PET exam, instruct the pt to increase fluid intake for __ hours and to urinate frequently to eliminate the isotope from the body.
 Definition
24
Term
Pt prep for nuc med:
 Definition
- may need to abstain from eating or drinking for several hours
- pts who are pregnant, have renal or hepatic disease, or are allergic to iodine should be carefully screened before being scheduled for this diagnostic procedure
Term
The radioisotope used in nuc med is excreted within __ hours.
 Definition
24
Term
Before receiving a radioisotope, the pt should be told to expect to feel:
 Definition
flushed for a short period of time
Term
(True/False) A pt may receive multiple nuc med exams in one day.
 Definition
False: only one nuc med procedure can be done per day
Term
In nuc med, the isotope accumulates in areas of pathology that are called:
 Definition
hot spots
Term
In a nuc med bone scan, areas of decreased uptake of radionuclide may indicate circulatory impairment and are called:
 Definition
cold spots
Term
In nuc med, if the total concentration of the radionuclide is less than normal, a diagnosis of a generalized ____ disorder must be considered.
 Definition
renal
Term
The standard imaging device in nuc med is called the:
 Definition
gamma camera
Term
The pt should receive no other radiographic exams for __ - __ hours before and after a bone scan.
 Definition
24 - 48
Term
(True/False) S/P nuc med exam, the pt can immediately resume his/her usual dietary and medication pattern unless told otherwise by their physician.
 Definition
True
Term
For a bone scan, a radioactive tracer compound is administered intravenously ~ __ hour/s before the scan. The patient is instructed to drink large amounts of water and to urinate immediately before the scan.
 Definition
3 hrs
Term
After a bone scan, the pt should be instructed to:
 Definition
- increase fluid intake
- notify physician immediately if any sign of warmth, redness, or swelling at injection site
Term
This treatment is used to kill cancer cells, to control malignant tumors that can not be removed, to prevent spread of the tumor to the brain and spinal cord, and to decrease pain when the cancer metastasizes to the bones, brain, or soft tissues:
 Definition
radiation therapy
Term
(True/False) the intent of therapeutic radiation is not to kill all tumor cells immediately.
 Definition
True
Term
If a radiation therapy pt is in pain, s/he should take pain meds __ minutes before each treatment.
 Definition
30
Term
What are the local reactions that may occur due to radiation therapy?
 Definition
- alopecia
- erythema
- loss of appetite
- alterations in oral mucous membranes (xerostomia and stomatitis)
- decreased salivation
- dysphagia
- chest pain
- cough
- esophageal irritation
- N/V/D
- blood dyscrasias
Term
What are the generalized systemic side effects that may occur due to radiation therapy?
 Definition
- fatigue
- nausea
- vomiting
- headache
Term
_____ therapy is a recent innovation in the treatment of pts with cancer. It has little effect on tissues that surround the area of interest. This allows for the dose to the tumor to be increased with no harmful effects to surrounding tissues.
 Definition
Proton
Term
Proton therapy is used as treatment for tumors of the:
 Definition
head, prostate, neck, and spinal cord (soon to be used for cervical, lung, bladder, esophagus, and melanomas)
Term
The American Cancer Society (ACS) recommends that women age __ and older have a screening mammogram every year and a yearly physical examination of the breasts.
 Definition
40
Term
Why can't a pt wear deodorant or powders in the axillary region when they have a mammogram?
 Definition
It may prevent adequate visualization.
Term
This is a noninvasive procedure that uses shock waves (generated by electric, piezoelectric, or electromagnetic discharge) directed at calculi that are meant to be fragmented so that the body can pass the calculi:
 Definition
extracorporeal lithotripsy
Term
This is an invasive procedure that is used to remove stones from the gallbladder or kidney after percutaneous insertion of an endoscope or nephroscope w/ visualization provided by use of a contrast agent and fluoroscopy. The stones are fragmented w/ ultrasonic waves:
 Definition
intracorporeal lithotripsy
Term
Contraindications to having a lithotripsy procedure of any kind:
 Definition
- pregnancy
- cardiac pacemaker
Term
S/P lithotripsy, the pt should inform their physician if any of the following happens:
 Definition
- excessive blood in urine
- decreased urine output
- fever
- increasing pain
Term
Pt prep for myelogram:
 Definition
- increase clear fluid intake x 4 hrs
- omit solid food x 4 hrs
- empty bladder/bowels before exam
- stop taking drugs 24 hrs prior
- seizure-prone pts to receive meds before exam
Term
Intrathecal (intraspinal) injections are given w/ a needle that is __ inches long with a __ - __ gauge lumen.
 Definition
3.5" long
16 - 25 gauge lumen
Term
For a lumbar myelogram, the pt is usually placed in the ____ position w/ a pillow placed under the abdomen to raise the lumbar area slightly.
 Definition
prone
Term
S/P myelogram, pt is monitored for __ - __ hours w/ the head of the bed slightly elevated at a __ - __ degree angle to avoid spinal headache.
 Definition
- monitored for 4 - 8 hrs
- head of the bed elevated 35 - 45 degrees during recovery
Term
Contraindications for myelogram:
 Definition
- multiple sclerosis
- meningitis
- Pott's disease
- infections or bloody subarachnoid fluid
- increased intracranial pressure
- recent myelogram
- seizures (sometimes)
Term
Pt instructions S/P myelogram:
 Definition
- increase fluid intake
- avoid strenuous activities
- avoid bending x 2 - 3 days
Term
Pt should notify physician immediately if s/he experiences any of the following S/P myelogram:
 Definition
- unable to urinate
- fever
- drowsiness
- stiff neck
- seizures
- paralysis
Term
List two possible complications of a myelogram:
 Definition
- arachnoiditis (inflammation of the delicate spinal cord covering) - meningitis
Term
DEXA measures:
 Definition
bone mineral loss
Term
A pt having a DEXA scan done cannot take any calcium supplements __ hours before the exam.
 Definition
24
Term
(True/False) a pt having a DEXA scan done cannot have had any barium studies done within a few days.
 Definition
True
Term
This type of exam utilizes images of the spine and hip areas in order to measure bone density:
 Definition
DEXA
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