Ultrasound

UltrasoundUltrasound

What is an What is an Ultrasound?Ultrasound?

Quick diagnostic test done to Quick diagnostic test done to examine the inner bodyexamine the inner body

Commonly ultrasound uses sound Commonly ultrasound uses sound wave to depict soft tissuewave to depict soft tissue

Most commonly this procedure is Most commonly this procedure is non-invasive non-invasive

The Doppler ultrasound is to used The Doppler ultrasound is to used to measure blood flow and pressure to measure blood flow and pressure by using high frequency soundsby using high frequency sounds

the ultrasound cannot seethe ultrasound cannot seeall areas of the bodyall areas of the body

How does it work?How does it work?

It makes detailed pictures of the It makes detailed pictures of the internal structures in the body by internal structures in the body by using the frequency of the sound using the frequency of the sound waves .waves . Despite the minimal risks of this Despite the minimal risks of this

diagnostic procedure the sound waves diagnostic procedure the sound waves do not travel well through bone or air.do not travel well through bone or air.

The Ultrasound and The Ultrasound and Doppler ultrasoundDoppler ultrasound

Nursing ImplicationsNursing Implications There are no special implications There are no special implications for this testfor this test Inform the patient of why they need Inform the patient of why they need this test and of what to expectthis test and of what to expect Commonly takes 30min to 1 hourCommonly takes 30min to 1 hour In some cases there are special In some cases there are special

procedures that need to be done to procedures that need to be done to ensure that the organ can be seen wellensure that the organ can be seen well

There is no special care that is needed There is no special care that is needed after the ultrasound is completed.after the ultrasound is completed.

Who uses it?Who uses it?

There are multiple reasons toThere are multiple reasons to

have an ultrasound done some are:have an ultrasound done some are: Dx of gallbladder diseaseDx of gallbladder disease Guide a needle biopsyGuide a needle biopsy Dx certain forms of infection and cancerDx certain forms of infection and cancer Evaluate abnormalities of the muscles Evaluate abnormalities of the muscles

and tendonsand tendons Evaluate a fetusEvaluate a fetus

PicturesPictures

X-RAY

What is it? What is it used for?

Quick Painless test using radiation waves

Used to view the structures inside the body

How does it work?

Small doses of radiation beams passed through the body Absorbed differently in bone, air, fat, &

muscle Some use contrast Multiple Views

Nursing Implications

Prepare the patient for the x-ray Informing them of possible position

changes

Who it can & cannot be used on

It is can be used on all people except Pregnant women.

Pictures

CT ScanCT ScanComputed Tomography Computed Tomography

ScanScan

CT scan showing the liver

CT Scan: What is it?CT Scan: What is it?

A noninvasive medical procedure that A noninvasive medical procedure that helps diagnose medical conditionshelps diagnose medical conditions

In the past only seen through surgery In the past only seen through surgery or autopsyor autopsy

Internal organs, Internal organs, bones, soft tissue and bones, soft tissue and blood vesselsblood vessels Greater clarity,Greater clarity,more detail more detail Than X-rayThan X-ray

CT Scan: How does it CT Scan: How does it work?work?

• 2D cross sectional image2D cross sectional image• Electromagnetic energy from all Electromagnetic energy from all

angelsangels• Different body parts absorb beams Different body parts absorb beams

differentlydifferently• Contrast material (dye)Contrast material (dye)

enhances imagesenhances images

CT Scan: Used ForCT Scan: Used For

Diagnose cancers, CV disease, Diagnose cancers, CV disease, infectious disease, appendicitis, infectious disease, appendicitis, trauma and muscular-skeletal trauma and muscular-skeletal disordersdisorders

CT scan: EquipmentCT scan: Equipment Large box-like machine with Large box-like machine with

hole in the middlehole in the middle

Pt. lies on narrow table that Pt. lies on narrow table that

slides in and out of this holeslides in and out of this hole

X-ray tube and electronic x-rayX-ray tube and electronic x-ray

detectors rotate around you (gantry)detectors rotate around you (gantry)

Computer processes the information and is Computer processes the information and is operated by a technologist who works scanners operated by a technologist who works scanners and monitors the examand monitors the exam

CT Scan: Nursing CT Scan: Nursing Interventions and Client Interventions and Client

TeachingTeaching Comfortable clothing (gownComfortable clothing (gown

may be providedmay be provided Metal objects (jewellery, glasses, dentures, etc.)Metal objects (jewellery, glasses, dentures, etc.) Fast from food or drink (especially if dyes are Fast from food or drink (especially if dyes are

being used)being used) Allergies and medicationAllergies and medication Medical conditions (asthma, diabetes, heart Medical conditions (asthma, diabetes, heart

disease, thyroid problems, etc.)disease, thyroid problems, etc.) *Pregnant woman need to inform the physician *Pregnant woman need to inform the physician

prior to the scan (or even the possibility of prior to the scan (or even the possibility of pregnancy)pregnancy)

Nursing Interventions: Nursing Interventions: Client Teaching -During Client Teaching -During

ProcedureProcedure

Fast, easy and painlessFast, easy and painlessMild sedative may be used (as Mild sedative may be used (as ordered by physician)ordered by physician)

Offer patient reassurance Offer patient reassurance and explain procedureand explain procedure

Explain that the technologist can see, Explain that the technologist can see, hear and speak to them at all timeshear and speak to them at all times

For pediatric patients, parents wear For pediatric patients, parents wear lead apronlead apron

CT Scan: Not for…CT Scan: Not for…

Pregnant women Pregnant women If dye is used, nursing mothers should If dye is used, nursing mothers should

wait 24h before resuming feedingswait 24h before resuming feedings

Allergies to iodineAllergies to iodine

Limitations: a very large person may Limitations: a very large person may not fit in the scanner and the table has not fit in the scanner and the table has a limit of 450 lbsa limit of 450 lbs

CT of the HeadCT of the Head

PET SCANPET SCAN

What is a PET Scan?What is a PET Scan? PPositron ositron EEmission mission TTomographyomography A type of nuclear medicine imagingA type of nuclear medicine imaging

Non-invasive procedureNon-invasive procedure Uses small amounts of Uses small amounts of

radioactive material to detect radioactive material to detect diseasesdiseases

Locates abnormal metabolic Locates abnormal metabolic activity in the bodyactivity in the body

Measures body functions:Measures body functions: Blood flow, O2 use, cellular Blood flow, O2 use, cellular

glucose metabolismglucose metabolism Shows how well organs and tissues Shows how well organs and tissues

are functioningare functioning

PET/CT PET/CT ScanScan

How Does a PET Scan How Does a PET Scan Work?Work?

Radiotracer FDG is Radiotracer FDG is injected into a vein, injected into a vein, swallowed, or inhaledswallowed, or inhaled

Absorbed by the diseased Absorbed by the diseased tissues/ organs in the bodytissues/ organs in the body

Tracer gives of energy as Tracer gives of energy as gamma rays which is gamma rays which is detected by the PET detected by the PET scanner as FDG is broken scanner as FDG is broken down by cellsdown by cells

PET scan records this PET scan records this energy that is emittedenergy that is emitted

FDG PET Scan Lymphoma

The PET ScannerThe PET Scanner

Has round hole Has round hole in middle, with in middle, with short tunnelshort tunnel

Pt. lies on Pt. lies on narrow exam narrow exam table that slides table that slides in and out of in and out of tunneltunnel

Imaging Imaging information in information in separate roomseparate room

What is a PET Scan Used What is a PET Scan Used For?For?

To detect To detect cancer/cancer cancer/cancer spread in the spread in the body/return of body/return of cancer after Txcancer after Tx

Show blood flow to Show blood flow to the heart musclethe heart muscle

Show effects of an Show effects of an MI on parts of the MI on parts of the heart or part heart or part requiring a requiring a procedureprocedure

Evaluate brain Evaluate brain abnormalities/braiabnormalities/brain functionn function

May 2007 August 2007

Nursing Implications of PET Nursing Implications of PET ScanScan

PET shows cellular PET shows cellular glucose uptake glucose uptake

Pt. not to eat, glucose level Pt. not to eat, glucose level below 150mg/dLbelow 150mg/dL

Glucose too high = scan Glucose too high = scan rescheduledrescheduled

Diabetic Pts receive Diabetic Pts receive special instructions re: special instructions re: glucose level controlglucose level control

Ask Pt to remain calm, Ask Pt to remain calm, still, and quiet during scanstill, and quiet during scan

Keep Pt warmKeep Pt warm Assess Pt. For Assess Pt. For

claustrophobiaclaustrophobia

Nursing Implications of PET Nursing Implications of PET ScanScan

Teach your Pt:Teach your Pt: What the PET scan looks What the PET scan looks

likelike Fasting protocol specific to Fasting protocol specific to

your facilityyour facility Inform Pt. that scan will be Inform Pt. that scan will be

complete in 2hrscomplete in 2hrs Alert radiology staff if Alert radiology staff if

experiencing hives, experiencing hives, flushing, itching, difficulty flushing, itching, difficulty breathing during the scanbreathing during the scan

↑↑fluid intake after scan to fluid intake after scan to flush from bodyflush from body

Ask women if Ask women if breastfeeding/could be breastfeeding/could be pregnantpregnant

Magnetic Resonance ImagingMore commonly known as the

“MRI”

What Is An MRI? An MRI is a non invasive medical test that uses a

magnetic field, radio frequency pulses, and a computer to produce images of your inner body (including bone, soft tissues, and organs)

MRIs can better evaluate the body in comparison to X Ray, ultrasound, or CT Scans.

Roughly, about 20% of MRIs are ordered with contrast. MRI contrast is used in specific circumstances and  enhances the MRI scan images. Dye may be used if there is:

History of tumor, cancer, or surgery Looking for infection, inflammation, or cancer Evaluating blood vessels Investigate a finding on the pre-contrast part of the

scan

How Does an MRI Work?

The magnet aligns the hydrogen atoms’ protons in our body.

They are exposed to radio waves creating a faint picture.

The magnetic field is produced by passing electricity through wire coils.

The photo produced is a thin slice, and can be interpreted at different angles.

Nursing Implications Teach your patient about the MRI,

including the common feeling of claustrophobia inside the machine.

Explain to patient they must stay very still and hold their breath while images are being taken, or the images will not be effective.

A mother who is given contrast dye may choose not to breast feed for 24 hours after the scan, however research suggests there will be no harm to the baby.

What Can An MRI Find? Tumours of the chest, abdomen or pelvis. Certain types of heart problems. Blockages or enlargements of blood vessels, including the

aorta, renal arteries, and arteries in the legs. Diseases of the liver, such as cirrhosis, and that of other

abdominal organs, including the bile ducts, gallbladder, and pancreatic ducts.

Diseases of the small intestine, colon, and rectum Cysts and solid tumours in the kidneys and other parts of the

urinary tract. Tumours and other abnormalities of the reproductive organs

(e.g., uterus, ovaries, testicles, prostate). Causes of pelvic pain in women, such as fibroids,

endometriosis and adenomyosis. Suspected uterine congenital abnormalities in women

undergoing evaluation for infertility. Breast cancer

Who Cannot Have An MRI?

Patients cannot have halter monitors, telemetry units, nerve stimulation units or a IV pump in the magnet room.

No metal can enter the exam room, clothing with metal snaps or pins should not be worn.

Heart pacemaker or pacing wires, cerebal aneurysm or Swan Ganz catheter. Pregnancy is a contraindication and will require patient consent for an MRI.

Photos of MRI’s

QUESTIONS?

ReferencesReferences

Black, J.M., Hawks, J.H., & Keene, A.M. (2001). Diagnostic assessment. Black, J.M., Hawks, J.H., & Keene, A.M. (2001). Diagnostic assessment. Medical-surgical Nursing. Medical-surgical Nursing. (198-199). (198-199). Philadelphia, Pennsylvania: W.B Saunders CompanyPhiladelphia, Pennsylvania: W.B Saunders Company

Coyne, K. MRI: A guided tour. Retrieved October 3, 2010, from http://www.magnet.fsu.edu/education/tutorials/magnetacademy/mri/fullarticle.html

CT scan. (2010). emedicinehealth. Retreived from hCT scan. (2010). emedicinehealth. Retreived from http://www.emedicinehealth.com/ct_ttp://www.emedicinehealth.com/ct_

scan/article_em.htmscan/article_em.htm

CT scan. (2010). Radiological Society of North America. Retrieved from http://www.radiologyCT scan. (2010). Radiological Society of North America. Retrieved from http://www.radiology

info.org/en/info.cfm?pg=bodyctinfo.org/en/info.cfm?pg=bodyct

Harris, T. (2010). How CT scan works. Harris, T. (2010). How CT scan works. Discovery Communications.Discovery Communications. Retrieved from Retrieved from http://health.howstuffworks.com/medicine/tests-treatment/cat-scan1.htmhttp://health.howstuffworks.com/medicine/tests-treatment/cat-scan1.htm

Holden, J. (January 11, 2009). What is an MRI with contrast (dye)? Retrieved October 3, 2010, from http://blog.remakehealth.com/blog_Healthcare_Consumers-0/bid/6788/What-is-an-MRI-with-contrast-dye

Lippincott’s Nursing Center.com. Eye on Diagnostics: PET-CT Scans Can Improve Care for Patients with Lippincott’s Nursing Center.com. Eye on Diagnostics: PET-CT Scans Can Improve Care for Patients with Cancer. Http://www.nursingcenter.com/library/static.asp?pageid=1012953 Cancer. Http://www.nursingcenter.com/library/static.asp?pageid=1012953

Magnetic resonance imaging (MRI scan). Retrieved October 3, 2010, from http://www.medicinenet.com/mri_scan/article.htm

Mayoclinic.com. Ultrasound. http://www.mayoclinic.com/health/ultrasound/MY00308Mayoclinic.com. Ultrasound. http://www.mayoclinic.com/health/ultrasound/MY00308

Malarkey, L., M., & McMorrow, M., E. (2005). Saunders Nursing Guide to Laboratory and Diagnostic Tests. St.Louis, MO: Elsevier Inc.

MRI of the body (chest, abdomen, pelvis). (March 15, 2010). Retrieved October 3, 2010, from http://www.radiologyinfo.org/en/info.cfm?pg=bodymr

MRI scan patient preparation. Retrieved Oct 3, 2010, from http://www.tdic.org/mri-patient-preperation.aspx PET Scan Vancouver. PET Scan Information. http://www.petscan.ca/petinfo.htmPET Scan Vancouver. PET Scan Information. http://www.petscan.ca/petinfo.htmRadiologyInfo.org. Positron Emission Tomography – Computed Tomography (PET/CT). RadiologyInfo.org. Positron Emission Tomography – Computed Tomography (PET/CT).

http://www.radiologyinfo.org/en/info.cfm?pg=Phttp://www.radiologyinfo.org/en/info.cfm?pg=P ET ET