Other Diagnostic Studies



Other Diagnostic Studies



Chapter Objectives


On completion of this chapter, you will be able to:


1. Define the terms in the vocabulary list.


2. Write the meaning of the abbreviations in the abbreviations list.


3. Describe the purpose of electrodiagnostics, and describe the indications that would initiate a doctor’s order for a patient to undergo an electrodiagnostic procedure.


4. State the difference between a noninvasive procedure and an invasive procedure.


5. Describe the purposes of an electroencephalogram (EEG) and a quantitative electroencephalogram (QEEG).


6. State the category of medication (provide an example) that should be noted on the requisition when ordering an EEG.


7. Identify and describe the purpose of three evoked potentials.


8. Describe the purpose(s) of performing a caloric study, an electromyogram (EMG), and a nerve conduction study (NCS).


9. Explain the general purpose of cardiovascular electrodiagnostic procedures.


10. State the category of medication (provide an example) that should be noted on the requisition when an ECG is ordered.


11. List and describe three noninvasive cardiovascular electrodiagnostic procedures.


12. List and describe one cardiovascular nuclear medicine procedure and two cardiovascular ultrasound procedures.


13. Discuss the purpose of cardiac catheterization and the purpose of inserting a Swan-Ganz catheter and an arterial line (art-line or a-line).


14. Identify and discuss the purposes of at least three vascular plethysmography procedures.


15. Identify at least three vascular ultrasound studies, and discuss the purpose of each.


16. List at least six endoscopic procedures and the body parts visualized, and discuss the importance of patient preparation before a visual examination of the gastrointestinal system.


17. Identify three gastrointestinal studies that may be performed in the endoscopy department.


18. Discuss the general function of the cardiopulmonary (respiratory care) department, list at least four cardiopulmonary procedures, and identify the category of medication (provide an example) that would need to be noted when ordering arterial blood gas (ABG) monitoring.


19. Discuss the function of the sleep study department, and list a patient’s symptoms that would initiate a doctor’s order for a sleep study.



Vocabulary



Ankle Brachial Index


A noninvasive study to measure the difference in blood pressure between the upper and lower extremities.


Apnea


The cessation of breathing.


Arterial Blood Gases


A diagnostic study to measure arterial blood oxygen, carbon dioxide, base excess, bicarbonate, and pH (acidity) to assess and manage a patient’s respiratory and metabolic status.


Arterial Doppler Ultrasound


Type of ultrasound that uses the same method as vascular Doppler except that it is designed specifically for testing outer extremities such as arms and legs.


Arterial Plethysmography


A manometric test that is usually performed to rule out occlusive disease of the lower extremities; may also be used to identify arteriosclerotic disease in the upper extremity.


Arterial Stiffness Index


A noninvasive test that determines the flexibility and health of the arterial wall.


B-mode scanning


An image made up of a series of dots, each indicating a single ultrasonic echo. The position of a dot corresponds to the time elapsed, and the brightness of a dot corresponds to the strength of the echo.


Caloric Study


A test performed to evaluate the function of cranial nerve VIII. It also can indicate disease in the temporal portion of the cerebrum.


Capillary Blood Gases


A diagnostic study performed primarily on infants. Blood is obtained from the infant’s capillary arterial vessel, usually from the heel.


Capsule Endoscopy


A noninvasive endoscopic study. A small capsule that is swallowed by the patient transmits and records pictures of the esophagus and small intestine.


Cardiac Stress Test


A noninvasive study that provides information about the patient’s cardiac function.


Color Doppler


A form of sonography or echocardiology: colorization is used to identify the direction and speed (velocity) of blood flow.


Doppler Ultrasound


A procedure used to monitor moving substances or structures, such as flowing blood or a beating heart.


Echo


The reflection of an ultrasound wave back to the transducer from a structure in the plane of the sound beam.


Electrocardiogram (EKG or ECG)


A graphic recording of the electrical impulses that the heart generates during the cardiac cycle.


Electroencephalogram (EEG)


A graphic recording of the electrical activity of the brain.


Electromyogram (EMG)


A record of muscle contraction produced by electrical stimulation. Used in the assessment of patients with diffuse or localized muscle weakness.


Electronystagmography


A test used to evaluate nystagmus (involuntary rapid eye movement) and the muscles that control eye movement.


Electrophysiologic Study (EPS)


A method of studying evoked potentials within the heart.


Endoscope


A tubular instrument (rigid or flexible) with a light source and a viewing lens for observation that can be inserted through a body orifice or through a small incision.


Endoscopy


The visualization of the interior of organs and cavities of the body with an endoscope. Biopsies may be obtained during an endoscopy. Endoscopic surgeries are discussed in Chapter 17.


Esophageal Manometry


Performed in the endoscopy department and is used to identify and document the severity of disease that affects the swallowing function of the esophagus and to document and quantify gastroesophageal reflux (also called esophageal function study or esophageal motility study).


Evoked Potential (EPs)


Tests used to evaluate specific areas of the cortex that receive incoming stimuli from the eyes, ears, and lower or upper extremities or sensory nerves.


Gastrointestinal (GI) Studies


Diagnostic studies related to the gastrointestinal system. GI studies often are performed in the endoscopy department.


Holter Monitor


A portable device that records the heart’s electrical activity and produces a continuous EKG or ECG tracing over a specified period.


Impedance Cardiography


A flexible and fast-acting noninvasive monitoring system that measures total impedance (resistance to the flow of electricity in the heart).


Impedance Plethysmography (IPG)


A noninvasive study that is performed to estimate blood flow and quantify blood volumes.


Invasive Procedures


Diagnostic or therapeutic techniques that require an incision and/or entry into a body cavity and/or interruption of normal body functions.


M-mode Echo


Image obtained with M-mode echocardiography that shows the motion (M) of the heart over time. 2D M-mode would be a two-dimensional study.


Narcolepsy


A chronic ailment that consists of recurrent attacks of drowsiness and sleep during the daytime.


Nerve Conduction Studies (NCSs)


Studies performed to identify peripheral nerve injury in patients with localized or diffuse weakness, to differentiate primary peripheral nerve disease from muscular injury, and to document the severity of injury in legal cases; often performed with electromyography.


Noninvasive Procedures


Diagnostic or therapeutic techniques that do not require the skin to be broken or a cavity or organ of the body to be entered.


Obstructive Sleep Apnea


The cessation of breathing during sleep.


Occlusion


A blockage in a canal, vessel, or passage of the body.


Quantitative Electroencephalogram (QEEG)


A procedure that uses digital pattern recognition to identify functional problems such as attention-deficit/hyperactivity disorder (ADHD) (also called brain-mapping).


Real-Time Imaging


An ultrasound procedure that displays a rapid sequence of images (like a movie) instantaneously while an object is being examined.


Rhythm Strip


A cardiac study that demonstrates the waveform produced by electrical impulses from the electrocardiogram.


Spirometry


A study conducted to measure the body’s lung capacity and function.


Telemetry


The transmission of data electronically to a distant location.


Tilt Table Test (TTT)


A cardiovascular study done with the use of a “tilt table” to test for syncope.


Transesophageal Echocardiography


A procedure used to assess the heart’s function and structures. A probe with a transducer on the end is inserted down the throat.


Two-dimensional (2D) M-Mode Echocardiogram


A technique used to “see” actual heart structures and their motions.


Vascular Doppler Ultrasound


Ultrasound procedure that takes real-time video showing how the patient’s blood is flowing through the arteries. This makes it easier to detect narrowing of the arteries, blockages, and blood clots. It also helps with monitoring the progression of arterial disease in a patient.


Vascular Duplex Scanning


Type of scanning procedure; called “duplex” because it combines the benefits of Doppler with B-mode scanning.


Venous Plethysmography


Procedure that measures changes in the volume of an extremity; usually performed on a leg to exclude DVT (deep vein thrombosis).





image EXERCISE 1


Write the abbreviation for each term listed.




image EXERCISE 2


Write the meaning of each abbreviation listed.




image HIGH PRIORITY


When the electronic medical record (EMR) with computer physician order entry (CPOE) is implemented, physicians’ orders are entered directly into the patient’s electronic record, and the diagnostic procedure order is automatically sent to the appropriate department. The health unit coordinator (HUC) may have tasks to perform, such as coordinating scheduling, ordering special diets, and so forth. An icon may indicate an HUC task, or it may signal a nurse request. When paper charts are used, the doctors’ orders are communicated by the ordering step of transcription via computer or by completion of a downtime requisition form. The HUC will have to communicate with the nutritional care department (by e-mail or telephone) when ordering a diet for a patient who has completed a diagnostic procedure that required him to be NPO (nothing by mouth).


Note: Some hospital nutritional care departments require that all diet orders be submitted in writing via computer.



image HIGH PRIORITY


There are treatments and therapeutic procedures included in this chapter that may take place during diagnostic studies or that may be scheduled after these studies have been completed. These treatments and procedures are discussed in Chapter 17.



Electrodiagnostics


Background Information and Overview


Electrodiagnostics includes procedures used to evaluate the cardiovascular, nervous, and muscular systems to diagnose conditions and diseases. Indications to perform these procedures include numbness, tingling, weakness, muscle cramping, or pain. Most electrodiagnostic studies are performed with the use of electrical activity and electronic devices to evaluate disease or injury to a specified area of the body. Some type of electrode is applied to the patient to record electrical activity in most tests. Electrical impulses can be generated spontaneously or can be stimulated. The heart generates electrical impulses spontaneously during the cardiac cycle; these may be recorded by performing an electrocardiogram (ECG). Electrical impulses may be stimulated by an electrical shock applied to the body when an electromyogram (EMG) is performed. The most common electrodiagnostic procedures are discussed in this chapter and include tests done in various hospital departments.


Although electrodiagnostics are performed in several departments, other diagnostic tests visualize organs using sound waves; some tests are involve cameras to visualize the inside of hollow organs, and some tests include arterial blood draws or the use of specialized equipment. Many tests are noninvasive and do not require a consent form. Tests done in the cardiac cath lab (cardiovascular) or in the endoscopy department are invasive and may require a consent form and routine preprocedure preparation (“prep”). The tests discussed in this chapter are done in the following departments: neurodiagnostic studies (neurology), cardiovascular (cardiology), cardiopulmonary (respiratory), gastrointestinal (enterology), polysomnography (sleep studies), and endoscopy studies.


Noninvasive procedures involve a diagnostic or therapeutic technique that does not require that the skin be broken or a cavity or organ of the body be entered. Noninvasive procedures would not require the patient to sign a consent form. Invasive procedures involve a diagnostic or therapeutic technique that does require an incision or entry of a body cavity or organ. Invasive procedures require that the patient sign a consent form. Some invasive procedures require a routine preparation, an on-call medication, and/or a nothing-by-mouth (NPO) order or other dietary restriction orders, and some require sedation.



image HIGH PRIORITY


Downtime requisitions are included in this chapter for learning purposes. The Evolve website associated with the Skills Practice Manual for Health Unit Coordinating includes a simulated hospital computer program that may be used as well.



Neurodiagnostic Studies (Neurology)


Neurologic and Neuromuscular System Electrodiagnostics


Electrodiagnostic tests involving the neurologic system include procedures involving the brain, cranial nerves, and sensory pathways of the eyes, ears, and peripheral nerves. Electromyography, often performed with electroneurography, is used to diagnose diseases or conditions of the neuromuscular system. Neurologic electrodiagnostic procedures that may be performed include those discussed in the following sections.



Electroencephalography


An electroencephalogram (EEG) is a recording of the electrical activity of the brain. The procedure is performed to identify and assess patients with seizures and to study brain function. Results of the study may be used to diagnose brain tumors, epilepsy, other brain diseases, or injuries and to confirm brain death or cerebral silence (Fig. 16-1). The role of the health unit coordinator (HUC) is to communicate the order to the electroencephalography department via computer or by completion of a downtime requisition. Anticonvulsant medications such as phenobarbital (Luminal) and phenytoin (Dilantin) should be noted when a procedure involving the neurologic system is ordered (Fig. 16-2).


image
Figure 16-1 Electroencephalography. A, Electrodes are attached to the patient’s head (B) with wires leading to corresponding areas on the equipment to record brain wave activity. (From Chipps E, Clanin N, Campbell V: Neurologic disorders, St Louis, 1992, Mosby.)

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Apr 8, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Other Diagnostic Studies

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