SPECIALIZED NURSING PROCEDURES

BROAD OBJECTIVE
• The student will demonstrate competence in management of patients
undergoing specialized procedures.
SPECIFIC OBJECTIVES

By the end of the unit, the student will be able to:

• Describe the various aseptic special nursing
procedures

• Describe the nursing management before, during and

after the procedure

• Demonstrate ideal nursing skills involved in the care

of the patient during and after the procedures
ADVANCED/SPECIALIZED NURSING PROCEDURES
a) Aseptic technique
 Tracheostomy
 Abdominal paracentesis
 Lumbar puncture
 Bone marrow puncture
 Liver biopsy
 Renal biopsy
 Venous cut down
 Incision and drainage
 Ct..
 Endoscopy
 Bronchoscopy
 Upper GIT: oesophagoscopy
gastroscopy
 Lower GIT: Anoscopy
Proctoscopy
Colonoscopy/sigmoidoscopy
 Cytoscopy
 Ct..
b)Examination with radio opaque dyes and x-rays

 Barium swallow/barium meal

 Barium enema
 Cholecystogram/ cholangiogram
 Angiography/ venogram
 Electroencephalogram (EEG)
 Myelogram
c)Others
 electrocardiography
1. TRACHEOSTOMY
• A surgical procedure in which an opening is made into the trachea.
• An indwelling tube is inserted into the trachea, called a tracheostomy
tube.
• The hole in the neck that the tube passes through is commonly
known as a stoma.
• Can be either permanent or temporary
• It serves to ;-Provide an airway.
-To remove secretions from the lungs
• GA is used unless the patient is critical, or local anesthesia
Indications
• Patient’s inability to breath on their own e.g in
pulmonary failure
• A large object blocking the airway
• Inherited abnormality of the larynx or trachea
• Breathing in smoke, or other toxic gases that swell
and block the airway
• A tumor or cancer of the neck that presses the airway
• Severe neck or mouth injuries
Procedure

• Surgical procedure performed in operating room or I.C.U. where patient’s

ventilation can be well controlled and optimal asceptic technique can be
maintained
• A surgical opening is made between 2nd and 3rd tracheal rings,
• After trachea is exposed, a cuffed tracheostomy tube of an appropriate
size is inserted
• Cuff is an inflatable attachment to the tracheostomy tube that is
designed to occlude the space between the trachea walls and the tube,
to permit mechanical ventilation and minimize risk of aspiration.
• Tracheostomy tube is held in place by tapes fastened around the
patient’s neck
• Sterile gauze is usually placed between the tube and the skin to absorb
drainage and reduce the risk of infection.
 Nursing care

• Patient requires continuous monitoring and assessment

• Opening(stoma) must be kept patent by proper sunctioning of secretions
• After vital signs stabilize, put patient in semi-fowlers position to facilitate
ventilation, promote drainage, minimize edema, and prevent strain on
the suture lines.
• Analgesia and sedative should be administered with caution due to the
risk of suppressing the cough reflex
• Alleviate patients anxiety and provide effective means of communication.
Place a paper and pen or functional call light at all times near the
patient’s bed to ensure communication
• The nurse can also advise patient to occlude stoma when they want to
speak
 Changing the dressing
• Requirements:
Sterile gloves and clean gloves
Hydrogen peroxide
Normal saline solution/ sterile water
Cotton-tipped applicators
Twill tape(and type of tube prescribe if it’s to be changed)
Procedure

• Wash hands.
• Explain procedure to the patient.
• Put on clean gloves, remove and discard soiled dressings.
• Prepare sterile supplies: Hydrogen peroxide, normal saline solution,
or sterile water, cotton tipped applicators, dressing and tape.
• Don sterile gloves.
• Cleanse the wound and plate of the tracheostomy tube with sterile
cotton tipped applicators moistened with Hydrogen peroxide.
• Rinse with sterile saline solution
• Soak inner cannula in peroxide or sterile saline per
manufacturers instructions, rinse with saline solution and
ensure all dried secretions have been removed
• Dry and re-insert inner cannula or replace with new
disposable inner cannula.
• Place clean twill tape in position to secure the
tracheostomy tube by inserting one end of the tape
through the other side opening of the outer cannula.
Ct..
• Take the tape around the back of patient’s neck and thread it through
the opposite opening of the outer cannula. Bring both ends around so
that they meet on one side of the neck. Tighten the tape until only 2
fingers can be comfortably inserted under it. Secure with a knot.
• Remove soiled twill tape after a new tape is in place.
 Ct..

NOTE:
• Some long term tracheostomies with healed stomas
may not require a dressing, other tracheostomies do.
In such cases, use of sterile tracheostomy dressing,
fitting it securely under the twill tapes and flange of
tracheostomy tube so that the incision is covered
Tracheostomy sunctioning
• It’s done to maintain a clear airway since patient’s own cough
mechanism is deficient

Indications
• Accumulation of secretions in the lungs
• Increased production of secretions
• Mechanically ventilated patients
Humidifying and filtering the air

• Soak a thin piece of gauze in sterile normal saline and

place it across the opening
• Tape the gauze in position
• Change the gauze regularly as it will quickly dry out
Diet
• Give the patient fluid or soft diet initially until he/she
is accustomed to the tube, then they can have normal
diet.
Removal of tracheostomy sutures
• They are removed on the 7th day post operatively
Removal of tracheostomy tube
• Before removal, the patient is weaned from the tube
by;
a) The tube is covered with a dressing for increased
periods of time to monitor how the patient breaths
and tolerates
b) Corking(use of corks) with wide holes and reducing
to ones with smaller holes instead of application of
dressings. Then the tube is eventually removed, the
hole closes over and a dressing is applied.
 Observe patient carefully for signs of respiratory
distress.
 On discharge
If permanent, teach patient how to remove the
tracheostomy tube, how to clean it and how to
replace it.
• When outside, advise patient to wear loose
covering E.g. scarf for protection over the stoma.
Complications of tracheostomy

May occur early or late in tracheostomy tube management.

They include:
• Bleeding
• Pneumothorax
• Air embolism
• Recurrent laryngeal nerve damage
• Posterior tracheal wall penetration
Long term complications
• Airway obstruction from obstructions by secretions
• Protrusion of the cuff over the opening of the tube
• Infection
• Dysphagia
• Tracheal dilatation, ischemia, and necrosis
• Tracheoesophageal fistula
2. ABDOMINAL PARACENTESIS/
ABDOMINAL TAPPING
• This is the puncture of the abdomen and the withdrawal of fluid that has collected
in the peritoneal cavity.
• The fluid build up is called ascites
• It relieves abdominal pressure and obtains specimen for laboratory analysis.
Indications
i. For lab investigations i.e cause of ascites
ii. To check for certain types of cancer E.g liver cancer
iii. To remove large amounts of fluid that causes pain or difficulty in breathing or
that affects kidney or bowel(intestine) functioning.

 Procedure: NCK Manual

 Preparation
• Signed consent form
• Prepare patient by providing the necessary information and
instructions by offering re-assurance.
• Instruct the patient to void.
• Gather appropriate sterile equipment and collection of receptacles.
• Place the patient in upright position on the edge of the bed or in a
chair with feet supported on a stool.
• If the patient is confined in bed use fowlers position.
• Place sphygmomanometer cuff around patients arm
During the procedure

• Ensure privacy
• Shave the skin clean
• Record vital signs
• Maintain patency of IV lines, for emergency medications and fluids
• Observe the fluid color and measure quantity
• Immediately seal the puncture wound with sterile dressing
Nursing action post procedure

• Check rate of drainage and adjust to the required rate of

flow
• Return patient to bed or to a comfortable sitting position
• Measure, describe and record the fluid collected
• Label samples of fluid and send them to lab
• Monitor vital signs every 25 minutes for 1hr, every 30
minutes for 2hrs, every hour for 2hrs and then every
4hrs
NOTE:

BP and pulse may change as fluid shift occurs after removal of fluid.
An elevated temperature is a sign of infection
Assess for hypovolemia, electrolyte shifts, changes in mental status
and encephalopathy which may occur with removal of fluid and fluid
shifts and should be reported.
Check puncture site for leakage or bleeding , leakage of fluid may
occur because of changes in abdominal pressure and may contribute
to further loss of fluid if undetected
Leakage suggest a possible site of infection and bleeding may occur in
patients with altered clotting secondary to liver disease.
Patient teaching

• Need to monitor for bleeding or excessive drainage from puncture

site.
• Importance of avoiding heavy lifting or straining.
• Need to change position slowly
• Frequency of monitoring for fever
3.LUMBAR PUNCTURE(LP)/SPINAL
TAP)
• Refers to the insertion of a hollow tube needle under local anesthesia
into the subarachnoid space of the spinal canal to obtain CSF .
• Procedure performed to obtain information about cerebrospinal
fluid(CSF).
• The needle is inserted into the subarachnoid space between L3 and L4
or L4 and L5.
• The CSF should be clear and colorless.
• Pink, blood-tinged, or grossly bloody CSF may indicate a cerebral
contusion, laceration, or subarachnoid hemorrhage.
Indications

• Diagnostic to rule out bacterial meningitis, subarachnoid hemorrhage,

multiple sclerosis.
• Therapeutic e.g. treatment of pseudo tumor cerebri by relieving
increased intracranial pressure.
• Administer drugs e.g anesthetics,antibiotics.

Procedure: NCK Manual

Nursing care of the patient before the
procedure
• Determine whether written consent for the procedure has been
obtained.
• Explain the procedure to the patient and describe sensations that are
likely during the procedure
• Reassure the patient that the needle will not enter the spinal cord or
cause paralysis.
• Instruct the patient to void before the procedure to make them
comfortable.
Nursing care of the patient during the
procedure
• The nurse assists the patient to maintain the position to avoid sudden
movement, which can produce a traumatic (bloody) tap.
•The patient is encouraged to relax and is instructed to breathe normally
Nursing care of the patient after the
procedure
• Patient should remain in prone position for 3hrs after the procedure
to allow tissue surfaces along needle track to come back together to
prevent CSF leakage
• Encourage liberal fluid intake to reduce the risk of post-procedure
headache.
• The specimen should be labeled and sent to the lab with the request
form immediately as components have limited stability.
• Monitor the patient for complications of lumbar puncture; notify
physician if complications occur.
 Complications

A. Post lumbar puncture headache:

• Due to leakage of CSF and reduction in the brain, it’s the most frequent
complication in 11-25% of patients.
• It may be mild or severe(throbbing frontal or occipital).Can be accompanied
with nausea,vomiting and dizziness.
• It may occur a few hours later or after several days.
• It’s severe when the patient stands and reduces when they lie down.
Management:
Bed rest
Analgesics
Hydration with liberal administration of fluids especially those that contain
caffeine E.g coffee, tea, some sodas
 Ct..
Prevention of leakage
• Needle with a small gauge should be used for puncture
• Patient should remain prone for 3hrs
• If larger amounts of CSF has been withdrawn(more than 20mls)
then the patient should lie:
Prone for 2hrs
 Lateral for 2hrs
Prone or supine for 6hrs
Ct..
B) Herniation of cranial contents-A brain tumor or other space-
occupying lesion can increase pressure within the skull. This
can lead to compression of the brainstem, which links the
brain to the spinal cord, after a sample of cerebrospinal fluid is
removed.
C)Abscesses : collection of pus in tissues causing swelling and
inflammation around it.
D) Haematomas : Localized collection of blood within tissues
E) Meningitis
D) Back discomfort or pain
4. BONE MARROW
PUNCTURE(ASPIRATION)
• Bone marrow is the soft tissue inside bones that helps form blood
cells, it’s found in the hollow part of most bones.
Bone marrow aspiration is the removal of a small amount of this
tissue in liquid form for examination.
Sites
Pelvic bone at the iliac crest- Most common site in adults
Breast bone i.e. over the sternum
Tibia- Most common site in children younger than 18 months.
Procedure: NCK manual
Indications
 Patients in which the following conditions are
suspected;
• Leukaemia
• Anaemia
• Thrombocytopenia
• Hodgkin lymphoma
• Multiple myeloma and non-hodgkin lymphoma
 After care:

• Confine the patient in bed for an hour or longer as ordered by the

doctor
• Observe the puncture site for bleeding, if present apply pressure
and bandage
• Record the procedure in the patient’s cardex
• Label the specimen and take them to lab with request form
• Advise the patient not to make the biopsy site wet by showering
until 24 hrs are over
• If the bleeding soaks through the dressing, the patient should
report to hospital
• They should avoid vigorous activity or exercises for a day or two-
this helps minimize bleeding and discomfort
5. LIVER BIOPSY
Is a procedure where small pieces of liver tissue are removed in order
to be sent to lab for examination
It’s helpful in the diagnosis of diseases that affect the liver E.g liver
cirrhosis,cancer cells.
Purpose
i. Diagnosis: this allows establishment of very specific diagnosis
ii. Monitoring: monitoring effectiveness of therapy that the patient is
receiving for a liver disease. It can also provide warning if certain
therapies the patients are receiving are damaging to the liver
Indications

 Alcoholic liver
 Elevated liver enzymes of unknown origin
 Jaundice and billiary tract obstruction
 Hemochromatosis- when too much iron builds up in the
body. It can result from external factors, such as diet, or
genetic factors.
 Hepatomegally of undetermined cause
 Autoimmune liver disease
 Cancers of the liver and non cancerous tumor
 Chronic viral hepatitis
 Liver transplantation- to rule out rejection
Procedure
Requirements on trolley:
As for bone marrow biopsy with addition of the following
• Scapel or blade
• Specimen jar
• Menghini liver biopsy needle
Preparation
a) Ascertain the results of coagulation tests- prothrombin
time, partial thromboplastin time, and platelet count
b) Check for signed consent- confirm that informed consent
has been provided
Ct..
c) Take and record patient’s vital signs immediately before biopsy
d)Explain the procedure to the patient- steps of the procedure, sensations
expected, after-effects expected, restrictions of activity and monitoring
procedures to follow
Steps
• Support the patient during the procedure
• Expose the right side of the patients upper abdomen(right hypochondriac)
• Instruct the patient to inhale and exhale deeply several times finally to
exhale and to hold breath at the end of expiration(prevents puncturing of
the diaphragm and risk of lacerating the liver is minimized)
• The physician promptly introduces the biopsy needle by way of the trans
thoracic (inter costal) or trans abdominal (sub costal) route, penetrates the
liver, aspirates and withdraws. The entire procedure is completed within 5-
10 seconds.
• Instruct the patient to resume breathing
Nursing care post procedure
1)Immediately after biopsy, assist the patient to turn onto
the right side; place a pillow under costal margin, and
caution the patient to remain in this position,
recumbent and immobile, for several hours.
• Instruct the patient to avoid coughing or straining.
• In this position, the liver capsule at the site of
penetration is compressed against the chest wall, and
the escape of blood or bile through the perforation is
prevented.
2) Measure and record patients pulse, respiratory rate and
BP at 10-15 minutes intervals for the first hour , then 30
minutes for the next 2hrs, or until the patient stabilizes.
• Changes in vital signs may indicate; bleeding, severe haemorrhage
or bile peritonitis, most frequent complications of liver biopsy.
3) If the patient is discharged after the procedure, instruct the patient
to avoid heavy lifting and strenuous activity for one week.
Complication
• Fever
• Pain, swelling, redness or discharge around needle insertion site
• Chest pains
• Shortness of breathing
• Fainting or dizziness- sign of possible blood loss
• Nausea and vomiting
• Worsening abdominal pains – bleeding, leakage of bile
6.RENAL BIOPSY(NEEDLE BIOPSY OF
THE KIDNEY)
This is removal of a small piece of kidney tissue for examination. It can be
done through;
• Ultra sound guided kidney biopsy
• CT-guided kidney biopsy
• Or surgical biopsy
Indications
1) Protein in urine
2) Unexplained acute renal failure
3) Glomerulopathies
4) Transplant rejection
Contraindications

•Bleeding tendencies
•Uncontrolled hypertension
•Solitary kidney- one
functioning kidney
•Morbid obesity- BMI 40+
Procedure
Patient preparation
• Coagulation tests to identify patients at risk of post
biopsy bleeding
• Starve the patient for 6-8hrs(incase of nephrectomy)
• Establish an intravenous line
• Urine specimen is taken before biopsy for baseline data
• Sedation, if ordered is given
• Instruct the patient to hold his breath(to stop movement
of the kidney) during the insertion of biopsy needle. If
sedated place in prone with a sandbag under the
abdomen
Requirements

• Top shelf: sterile renal biopsy set containing;

• Towel and gloves
• Towel with a hole for draping
• Gauze and cotton wool swabs
• Sponge holding forceps
• Dissecting forceps
• Small curved scissors trocar and cannula
• Renal biopsy needle
• Glass slides
• Specimen jar gallipots
• receiver
Ct..
• 20mls and 5mls syringes and needles
• Scapel
Bottom shelf:
• 2% lignocaine
• Antiseptic lotions; methylated spirit, savlon, and iodine
• Assorted sizes of syringes and needles
• Receiver
• Mackintosh and towel
• Shoulder blanket
• Sandbag
• Strapping
• Shaving tray
• collodion
Steps

 Explain the procedure to the patient

 Place the patient in prone position and place a
sandbag under the abdomen
 Fold down the bed clothes and expose the lumbar
region
 Cover patient with shoulder blanket
 Protect the bed clothes with mackintosh and towel
 Wash hands
 Assist as required
 Skin is cleaned with antiseptic
Ct..

• The skin at the biopsy site is infiltrated with a local anaesthetic

• The biopsy needle is introduced just inside the renal capsule of
the outer quadrant of the kidney
• The location of the needle may be confirmed by fluoroscopy or
by ultra sound, in which case a special probe is used
• With open biopsy, a small incision is made over the kidney
allowing direct visualization .
• Preparation of open biopsy is similar to that of any major
abdominal surgery
• The doctor withdraws the biopsy needle and the specimen is
placed in the jar
• A very firm dressing is then applied over the puncture site
Post biopsy nursing care

Ask patient to remain in prone position for 1hr and

remain on bed rest for 24hrs to minimize the risk of
bleeding
Vital signs are taken every 5-15 minutes for the first
1hr, and then with decreased frequency as indicated.
Note;
• Kidney is a highly vascularised organ, bleeding can
occur through the puncture site and collect in peri-
renal space without being noticed and can lead to
shock.
A clot can form in ureters causing severe pain
Observe for any signs of shock
Take post biopsy urine specimen for comparison with baseline
Hb is assessed within 8hrs
Incase of excessive bleeding;
• Blood transfusion is commenced
• Surgical intervention to control haemorrhage and drainage or’
• Nephrectomy is done
Advise patient to avoid strenuous activity and heavy lifting for two
weeks to prevent trigger of delayed hemorrhage
Patient should report back incase of any signs or symptoms of
bleeding(haematuria, fainting, dizzyness)
END
SPECIALIZED PROCEDURES
 1. INTRAVENOUS CUTDOWN
• A medical procedure used to gain access to a vein when traditional
methods, such as peripheral IV cannulation, are not successful or
feasible.
• To create access for infusion or blood transfusion when it’s difficult to
get access into superficial veins.
• The most common site for IV cutdown is the saphenous vein at the
ankle. Other sites include the basilic vein in the upper arm or the
cephalic vein near the wrist.
Venous cutdown on saphenous vein
Indications
Emergency Situations: When rapid venous access is critical, such as in
cases of shock, trauma, or severe dehydration.
Failed Peripheral IV Access: When peripheral veins are not accessible
or attempts at cannulation have been unsuccessful.
Pediatric Patients: Especially in infants and young children where
peripheral veins may be difficult to access.
 Procedure

• Requirements:
• Equipment: Sterile gloves, antiseptic solution, scalpel,
small clamps, sutures, IV catheter or cannula, syringe
with saline, and local anesthetic.
• Patient Positioning: The patient should be positioned
comfortably, with the limb to be accessed
immobilized.
Steps

• Wheel the equipment to the bedside

• Explain the procedure to the patient
• Assist doctor or clinician as appropriate
• Support client during procedure(positioning and reassuring)
• Regulate fluids accordingly
• After the procedure clear equipment and dispose waste according to
the institutions policy of waste management
Post procedure
• Immobilize the limb by splinting and advise the patient to immobilize
it as well
• Observe for signs of complications.
• Evaluate patient’s condition and tolerance to procedure
• Document the procedure
2. INCISION AND DRAINAGE
• This is a minor surgical procedure for treating abscesses and boils by
removal of localized collection of pus.
• They can form in any loose tissue or subcutaneous tissue
• They release pus or pressure built up under the skin from abscesses,
boils or infected paranasal sinus
Importance
Helps alleviate pain,
Reduce infection
Promote healing by allowing the pus to escape from the abscess cavity
(i)Incision
• The skin has to be cleaned first with antiseptic before an incision is
made.
• Make a small incision over the most prominent part of the abscess,
where the skin is thinnest or most fluctuant.
• The incision should be large enough to allow drainage of the pus but
not so large as to create unnecessary tissue damage.
(ii)Drainage

• This is removal of fluid that has accumulated abnormally from a

cavity in the body E.g. serous fluid from a swollen joint, pus from an
internal abscess.
• Allow the pus to drain out of the abscess cavity. Use gentle pressure
or blunt dissection with hemostats or forceps to help express all the
pus.
A drain
• This is a device which is rubber, tube or wick used to draw fluid or
pus from internal cavity to the surface
• It can also be inserted during an operation to ensure any fluid
formed passes to the surface preventing accumulation and infection
or pressure in the operation site
Indications
• Soft tissue abscesses
Ct..
• Irrigation-Irrigate the abscess cavity with saline solution to flush out
any remaining pus and debris. This helps reduce the bacterial load
and promotes healing.
• Packing-In some cases, loosely pack the abscess cavity with sterile
gauze or a wick. This helps keep the incision open, allowing continued
drainage and preventing premature closure of the wound.
• Dressing-Apply a sterile dressing over the incision site to absorb any
drainage and protect the wound.
Post-procedure care
• Elevate area
• Wound care
• Antibiotics
• Pain management
• Follow up care
Complications
Infection
 Bleeding.
Incomplete Drainage: Failure to drain all pus, leading to recurrence of the abscess.
Scarring
3. ENDOSCOPIC PROCEDURES

• Endoscopy-This is the use of a hollow instrument to look inside the

body cavities or organs . It uses flexible tube that has a small
(camera)on the end of it.
• The instrument is referred to as an endoscope.
• An endoscope is passed through a natural body opening or via a small
incision. For example a laparascope is inserted through small surgical
incision in the pelvic or abdominal area
• If an ultra-sound probe is added to endoscope E.g. GIT endoscope this
is called endoscopic ultrasound
Endoscopic procedures for GIT
A. Fibroscopy/esophagogastroduodenoscopy,- Upper GIT
B. Anoscopy,
C. Proctoscopy,
D. Sigmoidoscopy,
E. Colonoscopy, Lower GIT
F. Small-bowel enteroscopy,
G. Endoscopy through ostomy.
Endoscopic procedures for respiratory
system
A. Bronchoscopy

Endoscopic procedures for urinary system

A. Cytoscopy
A)FIBROSCOPY(oesophagogastroduodenosc
opy)
• Fiberscopes are flexible scopes equipped with fiberoptic lenses.
• It visualizes the upper part of the GI tract up to duodenum
• It’s a minimally invasive procedure since it doesn’t require an incision into
one of the major body cavities and doesn’t require significant recovery
after procedure (unless sedation or anaesthesia have been used)
• It allows direct visualization of gastric mucosa through a lighted
endoscope for suspected gastric tumors and diseases .
• Colored photos or motion pictures can also be taken
• Mouth guard are used during the procedure to prevent the patient from
biting the scope
Ct..
• An esophagoscopy is a procedure to view the inside of the esophagus
• Gastroscopy is a procedure to view inside of stomach
• Duodenoscopy is a procedure to view duodenum .
• These procedures are performed as a single procedure and are
collectively referred to as an upper endoscopy or
oesophagogastroduodenoscopy(OGD)
Ct..
• Upper GI fibroscopy also can be a therapeutic procedure when it is
combined with other procedures.
• Therapeutic endoscopy can be used to remove common bile duct
stones, dilate strictures, and treat gastric bleeding and esophageal
varices.
• Laser-compatible scopes can be used to provide laser therapy for
upper GI neoplasms.
Endoscope
Purposes of OGD/Fibroscopy
• Examine esophagus for ulcers and tumors
• Taking biopsy
• Removal of foreign bodies
• Dysphagia or odynophagia(painful wallowing)
• Persistent nausea and vomiting
• Dyspepsia(discomfort in upper abdomen)
• Acute upper GIT bleeding
• Chronic anaemia/or iron deficiency anaemia after non gastro-intestinal origin has been
eliminated.
• Gastro-esophageal reflux with warning signs i.e. weight loss, dysphagia, bleeding and
anaemia
• Peptic ulcer disease
Nursing management before the procedure
• Starve the patient 6-12 hrs (NPO)
• Administer premedications e.g;Help the patient spray or gargle with a
local anaesthetic agent if prescribed
• Administer midazolam or diazepam intravenously just before the
scope is introduced.
• Administer atropine 0.6-1.0 mg IV/IM to reduce secretions,
• Give glucagon, if needed and prescribed, to relax smooth muscle.
• The nurse positions the patient on the left side to facilitate saliva
drainage and to provide easy access for the endoscope.
During the procedure
• Endoscope is passed smoothly and slowly in the areas being examined
• The procedure takes 10-20 minutes
• The doctor may inject moderate amount of air to expand the stomach
allowing better visualizaton
• Biopsy is taken for examination or images of the digestive tract are
taken for documentation of any abnormality; esophageal varices can
be banded, resecting or ablating mucosal tissue
After the procedure
• The nurse instructs the patient not to eat or drink until the gag reflex
returns (3-4 hours) to prevent aspiration of food or fluids into the
lungs.
• The nurse places the patient in the Simms position until he or she is
awake and then places the patient in the semi-Fowler's position until
ready for discharge.
• Observe for signs of perforation, such as pain, bleeding, unusual
difficulty swallowing, and an elevated temperature
Ct..
• Monitor the pulse and blood pressure for changes that can occur with
sedation.
• Test the gag reflex by placing a tongue blade onto the back of the
throat to see whether gagging occurs.
• After the patient's gag reflex has returned, offer lozenges, saline
gargle, and oral analgesics to relieve minor throat discomfort.
• Instruct the patient not to drive for 10 to 12 hours if sedation was
used.
Complications
• Bleeding
• Infection
• Perforation
• Cardiopulmonary problems
• Adverse reactions to medications
 B) ANOSCOPY AND PROCTOSCOPY
These are procedures for direct viewing of the lumen of the lower
bowel using;
• Anoscope ;- to examine the anal canal
• Proctoscope ;- for the rectum
Purpose
• To check presence of ulceration, tumors, polyps, and lesions
• To take a biopsy
• Removal of polyps
Indications of lower GIT endoscopy
• Gastrointestinal problems such as unexplained bleeding
• Persistent changes in bowel habits
• Anaemia
• Age 50yrs; 5yearly then 3 yearly
• To diagnose colitis or colon/rectal cancer
Preparation
• The patient should take only clear oral fluids and not to
consume any food for at least 24hrs before the exam
• Laxatives and enemas may be required before the start
of exam to clear the lower bowel
 Nursing management before the procedure
• Confirm patient's identity using two identifiers and verify the test to be done
• Explain the purpose of the test and how it is done.
• Explain who will perform the test and when it will be done
• Ensure patient has signed informed consent form
• Document and report all allergies
• Withhold food and fluid as indicated
• Administer laxative or enema before the procedure
• Inform the patient that, during the examination, the pressure exerted by the
instrument will create the urge to have a bowel movement
• Take vital signs
During the procedure
• Explain the procedure to the patient
• Put the patient in knee chest position with feet beyond the edge of
the bed, knees apart to give support, head resting on the couch, fore
arms on either side of the head and hands placed one on top of the
other above the head
• The patient is told of the progress and the possibility he might feel like
moving his bowel .
• The patient is then thanked for co-operation
Ct..

• Suction may be done to remove secretions

• Biopsy may be taken
• Polyps may be removed and the area cauterized to
prevent bleeding
• The tissue removed is placed on moist gauze and then
in the appropriate container, labelled , and sent to the
pathology lab with the request form.
• After each use the tubes are washed thoroughly
• Disposable tubes should be disposed safely
C)COLONOSCOPY/SIGMOIDOSCOPY
• This is endoscopic examination of the large bowel and distal part of the
small bowel with an endoscope passed through the anus.(colonoscope)
• The colonoscope has a small camera attached to a flexible tube that can
reach and examine the entire length of the colon.
• Sigmoidoscopy- Examination of the sigmoid colon.
Indications
Diagnostic;
• Colon cancer, inflammatory bowel disease, GIT haemorrhage, ulceration,
polyps, and removal of biopsy; changes in bowel habit(unexplained).
Ct..

Prophylactic:
• Removal of polyps
Therapeutic:
• Removal of foreign bodies
Screening every 10yrs from 50yrs for colorectal cancer
Patient preparation
• Explain the procedure to the patient
• Starve the patient of solid foods for 3 days to empty the GIT
• Laxatives are given for two days
• On day of examination an enema is given until rectum is clear
• Narcotic analgesic may be ordered and administered
• Diazepam is given to sedate the patient
Procedure

• Sigmoidoscopy; position the patient in knee chest

• Colonoscopy; the patient lies on left side with legs
drawn up
• The first step is usually a digital rectal examination to
examine the tone of the anal sphincter and to
determine if the preparation is adequate
• Patient is sedated, the endoscope is then passed
through the anus up the rectum and colon(sigmoid,
descending, transverse, and ascending colon, the
caecum) and ultimately the terminal ileum
Ct..
• The bowel is ocassionally inflated with air to maximize
visibility(procedure that may give false sensation of need to
have a bowel movement)
• Biopsies are then taken for histology or examination and
diagnostic evaluation of colon is done.
Post procedure care
• Advise the patient to refrain from operating heavy machinery
until a day after the procedure
• The patient resumes other normal activities after effects of
sedation wear off E.g. eating and drinking normally
• Advise patient to report signs of, chills, fever, rectal
bleeding(more than a tablespoon) swelling or redness at IV site
or severe abdominal pain or bloating
Ct..

• Mild abdominal pain and bloating is expected after

the procedure

Complications
Perforation
Haemorrhage
Inflammation of the bowel
D) BRONCHOSCOPY
This is the direct inspection and examination of larynx(laryngoscopy), trachea
and bronchi through a flexible or rigid bronchoscope
PURPOSES
 DIAGONISTIC
• Lung growth, lymphnodes ,atelectasis or other changes seen on x-ray or
imaging tests
• Coughing up blood(haemoptysis)
• Suspected interstitial lung disease
• Cough that has lasted for more than 3months without any other
explanation
• To determine if a tumor can be removed surgically ( resected)
• To obtain a tissue for biopsy
• To diagnose lung rejection after lung transplant
Ct..
THERAPEUTIC
 To remove foreign bodies from the trachea
 Remove fluid or mucus plugs from airways
 Widen (dilate)blocked or narrowed airway
 Drain an abscess
 Treat cancer using a number of different techniques
 Wash out an airway (therapeutic lavage)
 Preparing for the procedure

Informed consent to be signed by the patient

Starve patient 6-12hrs
Explain procedure to patient to allay anxiety
Advise patient to avoid asprin, brufen and other
anticoagulants before the procedure
Ct..
Give pre-medication :
• atropine 0.6mg-1mg(iv,sc,im)
• Sedative(diazepam 5-10mg) or narcotic to inhibit stimulation of the
vagus nerve and prevent vomiting , suppress cough reflex ,sedate &
relieve anxiety.
 dentures are removed and all artificial prothesis
Assist in spraying local anaesthesia if its to be used
If a rigid bronchoscope is used general anaesthesia is given
 Post procedure care

• For an hour after the procedure observe patients vital signs

• Monitor and report changes in breathing , chest pain or oxygen
saturation levels ,hypertension , tachycardia, hemoptysis
• Patient should be nil per oral until cough reflex and effects of local
anaesthesia have worn off. Cracked ice is given to suck, later fluid.
• Observe for confusion and lethargy in elderly
• When the patient is no longer experiencing effects off sedation they
can be allowed to sit up
Complications
• Aspiration
• Bronchospasm
• Hypoxaemia
• Pneumothorax
• Bleeding
• Abrasion of lining of airways leading to swelling, inflammation and
infection
E) CYSTOSCOPY
• This is endoscopy of the urinary bladder via the urethra
• A cytoscope is used.
• Diagnostic cytoscopy is carried out using local anaesthesia, GA is
sometimes used for operative cytoscopic procedures.
• To enable clear visualization, sterile irrigation solution is instilled to
distend the bladder and wash away any clots.
Indications

Urinary tract infections

To assess the ureter and kidney pelves
Haematuria
Incontinence( loss of bladder control)
Unusual cells found in urine sample
To remove renal calculi(kidney stones)
Urinary blockage E.g. prostate enlargement and stricture
Unusual growth, polyp, tumor or cancer and obtain biopsy
Patient preparation

• Explain the procedure to the patient

• Patient may take 1-2 glasses of water (or as instructed) before
going for the examination
• They should not urinate for a sufficient period of time, such
that they are able to urinate prior to the procedure
Procedure
Patient lies on their back(supine) with their knees slightly
apart, they may also need to flex their knees especially when
doing rigid cytoscopy examination.
For flexible cytoscopy , local anaesthesia is used
Local anaesthesia is applied directly from a tube or needleless
syringe into the urinary tract
Ct..

• The doctor gently inserts the tip of the cytoscope into

the urethra and slowly guide it up the bladder
• The procedure is more painful for men than women
due to length and narrow diameter of the male
urethra, relaxing pelvic muscles helps ease this pain
• A sterile liquid(water, saline, glycine solution) will flow
through the cytoscope to slowly fill the bladder and
stretch it so that there is a better and clear view of
the bladder wall
• The procedure takes 15-20 minutes
After procedure care

• Relief of expected discomfort i.e burning and

frequency of micturation by encouraging patient to
increase oral fluid intake
• Warm bath or compresses also relieves the burning
feeling
• Incase of blood tinged urine –relieve this by
application of moist heat to the lower abdomen
• Warm sitz bath are also recommended for urinary
retention from edema
• An indwelling catheter may have to be inserted
4. UNDER WATER SEAL DRAINAGE (Chest
drain)
• A medical technique used to remove air, blood, or other fluids from the
pleural cavity while also preventing backflow of air/fluid into the pleural
space.
Components of UWSD System
Chest Tube: A flexible tube inserted into the pleural space.
Drainage Bottle: Contains water to create the underwater seal and collects
drained fluids.
Water Seal Chamber: Ensures that air cannot re-enter the pleural space, only
allowing fluid and air to exit.
Suction Control Chamber (optional): Regulates the amount of suction applied
to help with drainage
Components of a UWSD System
Procedure
• Insertion of Chest Tube: The chest tube is inserted through the chest wall
into the pleural space, typically under local anesthesia.
• Connection to Drainage Bottle: The tube is connected to the drainage
bottle, where the end of the tube is submerged in water, creating a seal.
• Air and Fluid Removal: Air and fluid from the pleural space travel
through the tube into the water-sealed chamber. The water seal
prevents air from flowing back into the pleural space.
• Monitoring: Bubbling in the water seal chamber can indicate the
presence of air in the pleural space. The amount and nature of the
drained fluid are monitored for changes.
Indications for UWSD
• Pneumothorax: To evacuate air from the pleural space.
• Haemothorax: To evacuate blood from pleural space
• Pleural Effusion: To drain excess fluid.
• Post-Thoracic Surgery: To remove residual air and fluids and to help
the lungs re-expand.
Nursing management
• Ensure that there is emergency equipment at bedside including (At
least two drain clamps per drain (For use in emergency only).
• Auscultate the chest at the start of every shift.
• Assess the chest tube and system tubing (i.e. for kinks, dislodgement
etc) as well as the drain dressing to ensure it is intact and for any signs
of infection.
• Check that the drain in not clamped (unless ordered by medical staff),
as this might result to tension pneumothorax.
Nursing management
• 4 hourly vital signs monitoring including respiratory effort.
• Ensure there is adequate pain relief.
• Drain tubing should always be secured to patient bed to prevent accidental
removal and anchored to the patient’s skin to prevent pulling of the drain.
• Remember that during transport, the tubing should not be clamped and
that the UWSD should remain below chest level.
• Dressing change should be done as ordered.
• The chest drain chamber needs to be replaced when it is ¾ full or when
the UWSD system sterility has been compromised e.g. accidental
disconnection.
Post procedure
• CXR should be performed post drain removal, ideally 2 hours post
(max 4 hours).
• Monitor vital signs closely (HR, SpO2, RR, Respiratory effort and BP)
on removal and then every hour for 4 hours post removal, and then as
per clinical condition
Possible complications for UWSD
• Pneumothorax
• Bleeding at the drain site
• Infection at the drain site
• Accidental disconnection of the system
• Accidental drain removal
• Retained drain during removal
END
 EXAMINATION USING RADIO OPAQUE
DYES(CONTRAST MEDIA) AND XRAYS.
Gastro intestinal tract:
• The entire GIT can be examined by x-rays following
introduction of barium sulphate , a
tasteless,odourless, non-grannular absolutely
insoluble and non-absorbable powder opaque to x-
rays, ingested in form of a thin aqueous suspension
• The dyes take the shape of the organ
• Barium sulphate is used as a contrast media
 a) Upper GIT
BARIUM SWALLOW/MEAL:
Barium swallow or upper GIT series is an x-ray used to
examine the upper digestive tract(esophagus, stomach,
and small intestines). Because these organs are normally
not visible on x-rays, barium should be swallowed, a
liquid that does show up on the x-ray
The barium temporarily coats the lining of the
esophagus, stomach, and intestines making the outline
of these organs visible on x-ray
 Indications

To check position, patency, and calibre of the esophagus

Presence or absence of right atrial enlargement causing pressure
on the esophagus
Esophageal varices- enlarged veins
Ulcers, tumors, and abnormalities in the stomach
Patency of the pylorus and duodenum
To assess the rate of gastric emptying and activity of small
intestines
Check for causes of inflammation of intestines and swallowing
 Patient preparation

• Starve the patient from midnight

• A laxative is given to clear the intestinal tract
• Smoking is discouraged the morning of the examination because it stimulates
gastric motility
Procedure
The patient is given barium meal to swallow. He may also be asked to swallow
some tablets that ‘fizz’(cause air bubbles to be released in the stomach)
The x-ray technician asks the patient to stand or lie in different positions over
the next few minutes, to help spread around the barium sulphate.
Most x-ray pictures are taken when the patient lies on the back on the table,
the x-ray machine or table is moved few times so it can take pictures of all
internal structures
 Ct..

through the esophagus and stomach and notes

abnormalities of the outline and in filling and emptying
of the stomach.
As the barium passes through the small intestine a
further x-ray examination is made to assess the rate of
gastric emptying and the activity of the small intestines
Advice the patient to hold breath during x-ray
After care
• Advice the patient to drink more water than usual
to help clear out the barium and to prevent
constipation, which may be a side effect of the test
• Tell the patient that their stool may appear light in
color for a couple of days but it clears off
spontaneously.
• After the test, the patient should eat normally and
resume their normal activities
 b)Lower GIT:
Barium enema
• This is a special x-ray of the large intestine which includes
colon and rectum.(barium enema-white chalky material)
Indications
Diagnose and evaluate the extent of inflammatory bowel
disease such as ulcerative colitis and crohn’s disease
Polyps can be diagnosed though can’t be removed like in
colonoscopy.
Other bowel problems diagnosed are:
 Ct..
• Diverticulosis(small pouches formed on colon wall that can get
inflammed)
• Intussusception-happens when one part of the bowel slides into the next.
• Acute appendicitis or twisted loop of bowel(volvulus)
• Intestinal obstruction
• Colon cancer
Patient preparation
Clear fluids are given the day before operation or keep the patient nil per
oral after midnight
A laxative is given E.g. magnesium citrate and warm water enemas to
 Procedure

• Explain the procedure to the patient

• The patient lies on x-ray table and preliminary x-ray is taken, the pt is
asked to lie on the side while a well lubricated enema tube is inserted
into the rectum
• As the enema enters the body, pt might have the sensation that they
have to have a bowel movement
• The barium sulfate enema is then allowed to flow into the colon
• A small balloon at the tip of the enema tube may be inflated to the
help keep the barium sulfate inside.
• The flow of the barium sulfate is monitored by radiologist on x-ray
 Ct..

• Air may be puffed into the colon to distend it and provide

better images (known as double contrast exam)
• The patient is asked to move to different positions and table
is slightly tipped to get different views
Note
• If there is suspected bowel perforation, a water soluble
contrast is used instead of barium. This is because contrast
may leak to the peritoneal cavity and water soluble material,
compared to barium is less obscuring at laparatomy
 After care

• An evacuating enema or laxative is given to

facilitate barium removal
• Stool softeners may be given incase of constipation
Complications
• Bowel perforation(rare)
• constipation
 ANGIOGRAPHY

•This is the radiographic study of the blood

vessels
•An angiogram uses a radio-opaque substance
or contrast medium to make the blood vessels
visible under x-ray .
•The key ingredient in most radiographic
contrast media is iodine
 Purpose of angiography
❖Detect narrowing (stenosis) or blockages in blood vessels(occlusions)
❖Diagnose atherosclerosis
❖To reveal site of aneurysm, cerebral tumors, valvular defects etc.
❖To map renal anatomy in transplant donors
❖Tumor, blood clot or arterio-venous malformations(abnormal tangles of
arteries and veins) in the brain
❖After penetrating trauma E.g. stab wound an gunshots to detect blood
vessels injury.
❖To check position of shunts and stents placed by physicians into blood
vessels
 Precautions

• Patient's with kidney disease or injury may suffer

further kidney damage from the contrast media for
angiography
• Patient who have blood clotting problems
• Known allergy to contrast media
• Pregnant woman to avoid procedure
 HYSTEROSALPINGOGRAM
• A specialized X-ray procedure used to examine a woman's uterus and
fallopian tubes.
Purpose
1.Infertility Evaluation: Helps to determine if the fallopian tubes are
open and if the uterine cavity is normal.
2.Recurrent Miscarriages: Assesses the shape and structure of the
uterus.
3.Tubal Surgery Follow-up: Evaluates the success of tubal ligation or
reversal procedures.
4.Pre-IVF Assessment: Ensures the reproductive tract is in good
 Procedure
• Scheduled after menstruation and before ovulation to avoid the risk of
X-rays during early pregnancy.
• Patients may be advised to take pain relievers before the procedure to
minimize discomfort.
• The patient lies on an examination table with her legs positioned
similarly to a gynecological exam.
• A speculum is inserted into the vagina to visualize the cervix.The cervix
is cleaned, and a thin tube (cannula) is inserted through the cervix into
the uterus.A contrast dye is slowly injected through the cannula, filling
the uterine cavity and fallopian tubes.X-ray images (fluoroscopy) are
taken to visualize the flow of the dye through the uterus and fallopian
 Ct..
• The radiologist observes the movement of the
contrast dye.
• If the dye spills freely into the abdominal cavity, it
indicates that the fallopian tubes are open.
• If the dye does not pass through the tubes or if
there are irregularities in the uterine cavity, it may
suggest blockages, adhesions, or abnormalities.
 Risks and complications
• Discomfort or Pain: Cramping similar to menstrual cramps can occur.
• Infection
• Allergic Reaction: Some patients may have a reaction to the contrast dye.
• Spotting or Bleeding
Note
• Patients can usually resume normal activities shortly after the procedure.
• Mild cramping or spotting may occur for a day or two.
• It is advisable to avoid sexual intercourse, tampons, or douching for 24-48
hours to reduce infection risk.
 CARDIAC CATHETERIZATION
• A medical procedure used to diagnose and treat
certain cardiovascular conditions.
• During this procedure, a long, thin tube called a
catheter is inserted into an artery or vein in your
groin, neck, or arm and threaded through your
blood vessels to your heart.
• The process involves several key steps and serves
various diagnostic and therapeutic purposes
 Purposes of cardiac catheterization
1.Diagnosis:
1.Coronary Artery Disease: Identifies blockages in the coronary arteries.
2.Heart Valve Disease: Evaluates how well the heart valves are working.
3.Congenital Heart Disease: Detects abnormalities present from birth.
4.Cardiomyopathy: Assesses the function of the heart muscle.
2.Treatment:
1.Angioplasty: Opens blocked or narrowed coronary arteries.
2.Stent Placement: Keeps arteries open after angioplasty.
3.Heart Valve Repair or Replacement: Fixes damaged heart valves.
4.Ablation: Treats certain types of arrhythmias by destroying small areas of
heart tissue that are causing abnormal heart rhythms.
 Procedure
• Patients may be asked to fast for several hours before the procedure.
• An IV line is inserted to administer medications.
• Insertion:A local anesthetic is applied to numb the insertion site.A small incision
is made, and the catheter is inserted into a blood vessel.
• The catheter is guided through the blood vessels to the heart using X-ray imaging
(fluoroscopy).
• Once the catheter reaches the heart, various diagnostic tests can be performed.If
treatment is needed, additional tools can be passed through the catheter to
perform procedures like angioplasty or stent placement.Completion.
• After the procedure, the catheter is removed, and the insertion site is closed.
• Pressure is applied to the site to prevent bleeding.
 Risks and Complications
• While cardiac catheterization is generally safe, it does
carry some risks, including:
Bleeding or bruising at the catheter insertion site.
Infection.
Allergic reactions to the contrast dye used during the
procedure.
Damage to blood vessels.
Heart attack or stroke (rare).
 Post procedure

• Patients are usually monitored for a few hours after

the procedure.
• Most can go home the same day, but some may
need to stay in the hospital overnight.
• It is recommended to avoid strenuous activities for
a few days.
 STOMA CARE
• Stoma is an opening that is created to allow stool or urine to pass out of
the body.
• Common conditions that might necessitate a stoma are:
a)Imperforate anus: where there is no exit for the bowel or its contents.
b)Hirschsprungs disease: where the ganglion nerves are missing and
waste matter cannot easily pass.
c)Inflammatory bowel disease: this includes Crohns Disease and
Ulcerative Colitis, both inflammatory diseases of the intestines.
d)Neonatal necrotising enterocolitis: this occurs when a portion of the
bowel is dead and cannot function
e)Spina bifida
 A) Colostomy

• This is the most common stoma type.

• A colostomy is an opening made into the large
intestine or colon.
• The stool can then pass from the stoma out of body
which tends to be solid in consistency but can
sometimes be liquid
 B) Ileostomy

• In an ileostomy the opening is made in the small

intestine -the ileum.
• An end or loop of the small intestine is brought
through the skin's surface on the abdomen and the
output then passes out through the stoma.
• Due to the fact that ileostomy output contains
digestive enzymes, this can be harmful to the skin
and so requires extra care when pouching.
 How to change a pouch
• For an open-ended pouch, empty the contents from pouch
into the toilet.
• Gently remove the pouch by pushing the skin down and
away from the adhesive skin barrier with one hand.
• With the other hand, pull the pouch up and away from the
stoma
• Clean the skin around the stoma with warm water. You
may also use soap but do not use soaps that have oil or
 How to empty a pouch
• Empty the pouch when it is one-third to one-half full.
• Do not wait until the pouch is completely full because this
could put pressure on the seal, causing a leak. The pouch may
also detach, causing all of the pouch contents to spill.
• Take the end of the pouch and hold it up. Remove the clamp
(if the pouch has a clamp system).
• You may need to make a cuff at the end of the pouch to keep it
from getting soiled
• Drain the pouch by squeezing
 Ct..

• Clean the cuffed end of the pouch with toilet paper

or a moist paper towel
• Undo the cuff at the end of the pouch.
• Replace the clamp or close the end of the pouch
 Nursing management
Regularly assess the stoma and peristomal skin during each appliance
change.
Monitor for signs of infection, such as unusual odor, discharge, or
pain.Educate the patient on identifying this signs.
Document any changes in the stoma’s appearance or function.
Teach the patient and their family members how to care for the stoma,
change the appliance, and recognize complications.
Discuss dietary modifications and fluid intake to manage output
consistency.
Advise on clothing choices to accommodate the stoma appliance discreetly.
 ELECTRO-ENCEPHALOGRAM(EEG)
• Is recording of electrical activity along the scalp
• The brain's spontaneous electrical activity is recorded over
a short period of time, 20-40 minutes from multiple
electrodes placed on the scalp
• The electrodes are connected to wires then a machine
which records electrical impulses, the results are printed
out or displayed on a computer monitor
• Different patterns of electrical impulses can denote various
 Indications
Evaluation of brain disorders
 Determine brain death
To determine whether to wean off anti-epileptic medications
Used to prove if some one on life support machine has no chance of
recovery
NOTE
• Most EEG show the type and location of the activity in the brain
during a seizure thus evaluates people with problems associated with
brain function E.g. confusion, coma, tumors, long term difficulties
with thinking or memory, or weakness of specific parts of the body
 Preparation for procedure
• Head is shaved or patient avoids hair styling products on
the day of exam
• Tranquilizers and stimulants are with held for 24- 48 hours
• Drinks that are stimulants are also withheld E.g. coffee,
tea, cola etc.
• Explain the procedure to the patient i.e. takes 45- 60
minutes, doesn't cause electric shock, it's a test not a form
of treatment
 Procedure
• Patient lies on the table, about 16-20 electrodes are attached to the scalp
with a conductive gel or paste
• Each electrode is attached to an individual wire
• Electrode location and names are specified by the international 10-20
system
• The patient is asked to relax, lies with eyes open, then later with eyes
closed
• The patient may be asked to breath deeply and rapidly or stare at a flashing
light, these activities produces changes in the brain wave patterns.
• If being evaluated for sleep disorder, EEG may be performed continouosly
through out the night when the patent is sleeping
 Ct..
• The brain's electrical activity is recorded continously through out the exam on
special EEG paper.
• EEG results are interpreted by a neurologist .

• After procedure care

• •Instruct the patient when to resume medications especially anti-seizure
medications that had been with held
• Patient doesn't require recovery time but instruct them to report to hospital if;
Number of seizures increase
An altered mental status
Having new loss of function
 MALE CIRCUMCISION
• This is the surgical removal of foreskin, the fold of skin
that covers the glans penis by a trained and certified
health care provider.
Purpose
To remove appropriate foreskin
To prevent blood loss
To prevent infection
To eliminate pain
 Indications

Treatment of specific medical problems i.e foreskin

pulled back against penis.
Client’s own request
Partial prevention of HIV transmission to reduce
the risk of acquiring some infections and related
complications.
 Assessment
• Take client history.
• Take a targeted physical examination
• Vital signs
• Weight- dosage of anaesthetic agents
• Client’s understanding of the procedure
• Informed signed consent
• Possible risks associated with procedure.
• Availability of equipment
 Procedure
• With the client on the coach ,perform skin preparation and
draping to ensure asepsis.
• Administer local anaesthetic agent to eliminate pain( penile
ring block and penile dorsal nerve block).
• Assess and separate adhesions if any to reduce the risk of
accidental injury to the glans and ensure adequate skin
removal.
• Mark the intended incision line using a surgical marker pen.
• Perform surgical procedure using Dorsal slit technique.
 Postoperative care
• Check for any adverse reactions.
• Vital signs- 30 minutes post-surgery.
• Assess the dressing applied at the incision site.
• Pain assessment
• Discuss with the client on wound care and targeted
health information on post- male circumcision .
• Review the clients level of comfort, and give necessary
medicines and instructions.
ASSIGNMENT

•Read and make notes on;

1. CT Scan
2. MRI Scan
3. Electrocardiogram(ECG)