Diagnostic Procedure

Tetralogy of Fallot

By: Dexie James V. Dizon

Kristian Karl B. Kiw-is
Pulse oximetry

Description
 A small sensor placed on a finger or toe
measures the amount of oxygen in the
blood.

Purpose

Test used to measure the oxygen level (oxygen saturation) of

the blood. It is an easy, painless measure of how well oxygen is
being sent to parts of your body furthest from your heart, such
as the arms and legs.
Nursing Responsibilities
 Nursing care for a neonate with oximetry requires monitoring SaO2 trends, skin integrity, and perfusion.

 Technical problems may occur, and the battery must be charged at appropriate intervals. SaO2 trends related
to nursing procedures are important to consider before and during weaning of supplemental oxygen.

 Data were collected during rest between feedings and at least an hour after feeding. Stressful procedures
such as feeding or suctioning require time for recovery.

 Examination of SaO2 trends during procedures is useful to assess how the infant is oxygenating during
stress.

 Each infant should be individually assessed by the nurse and observations of SaO2 trends recorded.

 The data should then be relayed to the physician or nurse practitioner so that a collaborative approach may
be taken to establish guidelines based on the infant’s response.
Echocardiogram

 Echocardiogram, also known as echocardiography, or heart ultrasound is a noninvasive, painless

test that uses high-frequency sound waves to visualize the shape, size, and movement of the
structures of the heart. It is useful to evaluate patients with chest pain, enlarged cardiac
silhouettes on X-rays, electrocardiogram (ECG) changes unrelated to CAD, and abnormal heart
sounds on auscultation.

 In this test, a transducer directs ultrahigh-frequency sound waves toward cardiac structure, which
reflect these waves. The echoes are converted to images that are displayed on a monitor and
recorded on a strip chart or videotape. Results are correlated with clinical history, physical
examination, and findings from the additional test.
 Procedure
The following are the steps and processes on how an echocardiography or echocardiogram is performed:
Place patient in a supine position.
 Patient is placed in a supine position and a conductive gel is applied to the third or fourth intercostal space to the left of the sternum. The transducer is placed
directly over it.
Transducer is placed
 The transducer directs ultra-high-frequency sound waves towards cardiac structures, which reflect these waves; the transducer picks up the echoes, converts them
to electrical impulses, and relays them to an echocardiography machine for display.
Motion mode is used
 In motion mode (M-mode), a single, pencil-like ultrasound beam strikes the heart and produces a vertical view, which is useful for recording the motion and
dimensions of intracardiac structures.
Change in position
 In two-dimensional echocardiography, a cross-sectional view of the cardiac structures is used for recording the lateral motion and spatial relationship between
structures. For a left lateral view, the patient is placed on his left side.
Transducer is angled.
 The transducer is systematically angled to direct ultrasonic waves at specific parts of the patient’s heart.
Record findings.
 During the test, the screen is observed; significant findings are recorded on a strip chart recorder or a video tape recorder.
Doppler echocardiography.
 Doppler echocardiography also may be used where color flow stimulates red blood cell flow through the heart valves. The sound of blood flow also may be used to
assess heart sounds and murmurs as they relate to cardiac hemodynamics.
 Nursing Responsibilities

Before the procedure

The following interventions are done prior and during the study:
 Explain the procedure to the patient. Inform the patient that echocardiography is used to evaluate the
size, shape, and motion of various cardiac structures. Tell who will perform the test, where it will take
place, and that it’s safe, painless, and is noninvasive.
 No special preparation is needed. Advise the patient that he doesn’t need to restrict food and fluids for
the test.
 Ensure to empty the bladder. Instruct patient to void prior and to change into a gown.
 Encourage the patient to cooperate. Advise the patient to remain still during the test because
movement may distort results. He may also be asked to breathe in or out or to briefly hold his breath
during the exam.
 Explain the need to darkened the examination field. The room may be darkened slightly to aid
visualization on the monitor screen, and that other procedure (ECG and phonocardiography) may be
performed simultaneously to time events in the cardiac cycles.
 Explain that a vasodilator (amyl nitrate) may be given. The patient may be asked to inhale a gas with
a slightly sweet odor while changes in heart functions are recorded.
During the procedure After the procedure
The nurse should be aware of these post-procedure nursing
The following are the nursing considerations during
interventions after an echocardiogram, they are as follows:
echocardiogram:
 Inform that a conductive gel is applied to the Remove the conductive gel from the patient’s skin. When the
chest area. A conductive gel will be applied to procedure is completed, remove the gel from the patient’s chest
his chest and that a quarter-sized transducer will wall.
be placed over it. Warn him that he may feel
minor discomfort because pressure is exerted to Inform the patient that the study will be interpreted by the
keep the transducer in contact with the skin. physician. An official report will be sent to the requesting
 Position the patient on his left side. Explain that physician, who will discuss the findings with the patient.
transducer is angled to observe different areas of
the heart and that he may be repositioned on his Instruct patient to resume regular diet and activities. There is no
left side during the procedure. special type of care given following the test.
 Electrocardiogram (ECG
or EKG)
 Electrocardiography is the most commonly used
test for evaluating cardiac status, graphically
records the electrical current (electrical
potential) generated by the heart. This current
radiates from the heart in all directions and, on
reaching the skin, is measured by electrodes Purpose of Electrocardiography (ECG)
connected to an amplier and strip chart recorder.
The standard resting ECG uses five electrodes to • To help identify primary conduction abnormalities, cardiac
measure the electrical potential from 12 different arrhythmias, cardiac hypertrophy, pericarditis, electrolyte
leads; the standard limb leads (I,II,III), the imbalances, myocardial ischemia, and the site and extent of
augmented limb leads (aVf, aVL, and aVr), and myocardial infarction.
the precordial, or chest, leads (V1 through V6). • To monitor recovery from an MI.
• To evaluate the effectiveness of cardiac medication.
• To assess pacemaker performance
• To determine effectiveness of thrombolytic therapy and the
resolution of ST-segment depression or elevation and T-wave
changes.
Patient Preparation for Electrocardiography (ECG)
 Explain to the patient the need to lie still, relax, and breathe normally during the procedure.
 Note current cardiac drug therapy on the test request form as well as any other pertinent clinical
information, such as chest pain or pacemaker.
 Explain that the test is painless and takes 5 to 10 minutes.
Implementation
 Place the patient in a supine or semi-Fowler’s position.
 Expose the chest, ankles, and wrists.
 Place electrodes on the inner aspect of the wrists, on the medical aspect of the lower legs, and on
the chest.
 After all electrodes are in place, connect the lead wires.
 Press the START button and input any required information.
 Make sure that all leads are represented in the tracing. If not, determine which electrode has come
loose, reattach it, and restart the tracing.
 All recording and other nearby electrical equipment should be properly grounded.
 Make sure that the electrodes are firmly attached.
Nursing Interventions
 Disconnect the equipment, remove the electrodes, and remove the gel with a moist cloth
towel.
 If the patient is having recurrent chest pain or if serial ECG’s are ordered, leave the
electrode patches in place.

Interfering Factors
 Improper lead placement.

Complications
 Skin sensitivity to the electrodes.
 Chest X-ray

 Chest X-ray (Chest radiography, CXR) is one of the

most frequently performed radiological examinations.
A chest x-ray is a painless, non-invasive test that uses
electromagnetic waves to produce visual images of the
heart, lungs, bones, and blood vessels of the chest. Air
spaces normally seen in the lungs appear dark on the
chest films. A basic chest x-ray includes a
posteroanterior (PA) view, in which x-rays pass from
the back to the front of the body and a left lateral view.
Other projections such as lateral decubitus, lordotic
views, or oblique views can also be requested. For
critically ill patients who cannot leave the nursing unit, A chest X-ray can show the structure of the
a portable x-ray machine is performed at the bedside heart and lungs. A common sign of tetralogy of
using anteroposterior (AP) projections with an addition Fallot on an X-ray is a boot-shaped heart,
of a lateral decubitus view if a free flow fluid or air is because the right ventricle is enlarged.
suspected.
 Procedure
The Items are removed
 Patients will be asked to remove any clothing, jewelry, or other articles that may interfere with
the study.
Appropriate clothing is given
 Patients will be provided by an X-ray gown to wear.
Positioning the patient
 The patient in a standing or sitting position will face the cassette or image detector with hands on
hips, inhale deeply, hold one’s breath until the X-ray image is made. For a lateral view, the chest
is position on the left side against the image holder with hands raised above the head.
Images are taken
 The x-ray technician will stand behind a protective shield while the films are being developed
within a few minutes. procedure for chest x-rays is as follows:
 Before Chest X-ray After Chest X-ray
The following are the nursing interventions before chest x-ray:
The nurse should note the following
nursing interventions after chest x-ray:
 Remove all metallic objects. Items such as jewelry, pins, buttons
etc can hinder the visualization of the chest.
• No special care. Note that no special
 No preparation is required. Fasting or medication restriction is care is required following the procedure
not needed unless directed by the health care provider.
 Ensure the patient is not pregnant or suspected to be pregnant. • Provide comfort. If the test is facilitated
X-rays are usually not recommended for pregnant women unless at the bedside, reposition the patient
the benefit outweighs the risk of damage to the mother and properly.
fetus.
 Assess the patient’s ability to hold his or her breath. Holding
one’s breath after inhaling enables the lungs and heart to be seen
more clearly in the x-ray.
 Provide appropriate clothing. Patients are instructed to remove
clothing from the waist up and put on an X-ray gown to wear
during the procedure.
 Instruct patient to cooperate during the procedure. The patient is
asked to remain still because any movement will affect the
clarity of the image.
 Cardiac Catheterization

 Cardiac catheterization involves passing a catheter

into the right or left side of the heart. Catheterization
can determineblood pressure and blood flow in the
chambers of the heart, permits blood sample
collection, and record films of the heart’s ventricles
(contrast ventriculography) or arteries (coronary
arteriography or angiography).

Purpose of Cardiac Catheterization

 Catheterization of the heart’s left side assesses the
patency of the coronary arteries, mitral and aortic • To evaluate valvular insufficiency or stenosis, septal
valve function, and left ventricular function. defects, congenital anomalies, myocardial function,
Catheterization of the heart’s right side assesses myocardial blood supply, and cardiac wall motion.
tricuspid and pulmonic valve function and pulmonary
artery pressures. • To aid in diagnosing left ventricular enlargement, aortic
root enlargement, ventricular aneurysms, and
intracardiac shunts.
 Patient Preparation
 Explain the procedure to the patient.
 Tell him to restrict fluids for at least 6 hours before the test.
 Inform him that the test takes 1 to 2 hours.
 Tell him that he may receive a mild sedative but will remain conscious during the procedure.
 Have the patient to void just before the procedure.
 Check the patient history for hypersensitivity to shellfish, iodine, or contrast media used in other diagnostic tests. Discontinue any
anticoagulant therapy as ordered.
Implementation
 The patient is placed supine on padded table and his heart rate and rhythm, respiratory status, and blood pressure are monitored
throughout the procedure.
 An I.V. line is started, if not already in place, and a local anesthetic is injected at the insertion site.
 A small incision is made into the artery or vein, depending on whether the test is for the left or right.
 The catheter is passed through the sheath into the vessel and guided using fluoroscopy.
 In the right-sided catheterization, the catheter is inserted into the antecubital or femoral vein and advanced through the vena cava
into the right side of the heart and into the pulmonary artery.
 If left-sided heart catheterization, the catheter is inserted into the brachial or femoral artery and advanced retrograde through the
aorta into the coronary artery ostium and left ventricle.
 When the catheter is in place, contrast medium is injected to make visible the cardiac vessels and structures.
 Nitroglycerin is given to eliminate catheter-induced spasm or watch its effect on the coronary arteries.
 After the catheter is removed, direct pressure is applied to the incision site until bleeding stops, and a sterile dressing is applied.
 Nursing Interventions
 Monitor the patient’s heart rate and rhythm, respiratory and pulse rates, and blood pressure
frequently.
 Monitor the patient’s vital signs every 15 minutes for 2 hours after the procedure, every 30
minutes for the next 2 hours, and then every hour for 2 hours.
 If no hematoma or other problems arise, begin monitoring every 4 hours. If vital signs are
unstable, check every 5 minutes and notify the practitioner.
 Observe the insertion site for a hematoma or blood loss. Additional compression may be
necessary to control bleeding.
 Check the patient’s color, skin temperature, and peripheral pulse below the puncture site.
 Enforce bed rest for 8 hours. If the femoral route was used for catheter insertion, keep the
patient’s leg extended for 6 to 8 hours.
 If medications were withheld before the test, check with the practiotner about resuming
their administration.
 Administer prescribed analgesics.
 Make sure a posttest ECG is scheduled to check for possible myocardial damage.
 Precautions
 Coagulopathy, impaired renal function, and debilitation usually contraindicate
catheterization of both sides of the heart. Unless a temporary pacemaker is inserted to
counteract induced ventricular asystole, left bundle-branch block contraindicates
catheterization of the right side of the heart.
 If the patient has valvular heart disease, prophylactic antimicrobial therapy may be
indicated to guard against subacute bacterial endocarditis.

Complications
 Ineffective endocarditis in a patient with vulvular heart disease.
 Myocardial infarction, arrhythmias, cardiac tamponade, pulmonary edema, hematoma,
blood loss, adverse reaction to contrast media, and vasovagal response.
Thank you for Listening!!