Dolojol, Mary Anne Juliet C.

16-1-86903

Nursing Responsibilities

1) Recommendations for the early detection of cancer in asymptomatic persons.

Suggest performing routine screening tests and it should be based on whether
these tests are adequate to detect a potentially curable cancer in an otherwise
asymptomatic person and are also cost-effective. Screening should be based on an
individual’s age, sex, family history of cancer, ethnic group or race, previous
iatrogenic factors (prior radiation therapy or drugs such as DES), and history of
exposure to environmental carcinogens.

2) Skin
Skin Assessment
Obtain a history of the patient's skin condition from the patient, caregiver, or previous
medical records. Go over the detailed family history with the patient or patient's
family, and make sure all skin conditions are reviewed.

3) Brain
MRI Patient Care Considerations
 Explain procedure to patient and assess ability to remain still in a closed space;
sedation may be necessary if the patient is claustrophobic. The test takes
approximately 1 hour.
 Evaluate patient for contraindications to MRI: implanted devices, such as
implanted defibrillators that may malfunction; cochlear implants; or metallic
surgical clips used on brain aneurysms.
 Devices that may interfere with the exam or potentially pose a risk include
artificial heart valves, implanted drug infusion ports, infusion catheters,
intrauterine devices, pacemakers and neurostimulators, metallic implants such as
prosthetic valves or joints, and metal pins, screws, plates, or surgical staples.
 Make sure that all jewelry, ECG or monitor leads, hearing aids, pins/hairpins,
removable dental work, and metal objects (including metal-containing
transdermal patches) are removed.
 Kidney disease and sickle cell anemia may contraindicate MRI with contrast
material.
 Check with MRI technician about the use of equipment, such as ventilator or
mechanical IV pump, in MRI room.
 Earplugs may be used to muffle loud thumping and humming noises during
imaging.
 Evaluate the patient for claustrophobia, and teach relaxation techniques to use
during test or advocate for use of open MRI. Be ready to administer sedation, if
necessary.
 It is recommended that nursing mothers not breastfeed for 36
to 48 hours after MRI with contrast.

CT Scan Patient Care Considerations

 Describe test to patient and family, including that table will slide into
doughnut-shaped scanner and patient must lie still during test. The test usually
takes about 30 minutes, but may take longer.
 Be alert to allergies to iodine or other radiographic contrast media that might be
used during testing.
 For scans performed with contrast, informed consent and IV access required.
 Patient should take nothing by mouth (NPO) for 4 hours prior to scan. Blood urea
nitrogen and creatinine should be evaluated 24 to 48 hours before test.
 Hydrate patient well to facilitate excretion of contrast, if used.
 Consider the contraindication of radiologic studies for the pregnant patient,
especially computed tomography (CT) scans with contrast media.

4) Breast
Patient Education on breast self examination

 Examine breasts once per month, just after the menstrual period because breasts
are less engorged and a tumor is easier to detect, and at regular monthly intervals
after the cessation of menses.

 Compare findings with the opposite breast.

 Remind patient that 90% of breast lumps are not cancerous.

 Do not neglect men when teaching BSE—1% of breast cancers occur in men.

Mammography
Nursing and Patient Care Considerations

 Recommend regular screening based on established guidelines. Tell patients that

routine screening mammography has been shown to reduce mortality from breast
cancer. Procedure takes approximately 15 minutes.

 Remind patients not to apply deodorant, cream, or powder to breast, nipple, or

underarm areas on examination day.

 Advise that some discomfort may be felt from compressing the breast.
Patients should have an opportunity to become informed about the benefits,
limitations, and potential harms associated with regular screening.

 Overdiagnosis of clinically insignificant disease is possible. Benefits are thought

to outweigh the exposure to low dose of radiation.

 Alert patient that extra views do not imply that the patient has breast cancer.

5) Cervix/Uterus
Pap smear
Nursing and Patient Care Considerations

 Pap test should not be performed during menses, unless the liquid-based system is
used.

 Instruct patient not to use douche, medication, tampon, or cream in the vagina
and to avoid sexual intercourse for 48 hours before the examination.

 Recommend regular screening.

a. Recommend starting Pap testing at age 21.
b. Recommend testing every 3 years from ages 21–65 for women without risk
factors such as DES exposure.
c. For those aged 30–65 wanting to extend the screening interval, screen with a
combination of HPV testing and cytology every 5 years.
d. Discontinue screening after age 65 if adequate negative prior screening and no
history of CIN 2 or greater within the last 20 years.
e. Discontinue after total hysterectomy if no dysplasia or cancer.

 Make sure that patient obtains results. If patient has an abnormal smear, explain
that this is not always conclusive but requires further testing based on age, such
as repeat Pap test, HPV testing, colposcopy, biopsy, or conization. Encourage
patient to return for further testing.
 Yearly examination for breast cancer screening, detection of other genital cancers,
infections, reproductive problems, and contraception management may be
indicated.

HPV Test

 Advise patient to discuss HPV with her partner. He should receive treatment for
visible lesions. Screening for other STDs in both patient and partner is
recommended.

 Make sure patient realizes that even though lesions may be gone, she may still
transmit HPV to new sexual partners.

 Abstinence, monogamy, and condoms are advisable to prevent transmission of all

STDs

Ultrasound

Nursing and Patient Care Considerations

 Explain to patient that a gel is applied to the skin over theselected area and a
wandlike transducer is swept across the area of interest.

 Radiographic pictures will be obtained.

Fine-Needle Aspiration

Nursing and Patient Care Considerations

 Inform patient of small risk of hematoma and infection.

 Adhesive bandage applied after procedure; usually no discomfort.

 Solid lesions may warrant an excisional biopsy.

Needle Biopsy

Nursing and Patient Care Considerations

 Inform patient of small risk of hematoma and infection.

 Tell patient that several passes may be necessary to obtain specimen, with minor
discomfort.

 Pressure dressing applied after procedure.

 Recommend use of acetaminophen or ibuprofen for post procedure

discomfort—usually minimal, if any.
Core Needle Biopsy

Nursing and Patient Care Considerations

 Inform patient that it is a 1-hour outpatient procedure that requires no special

preparation.

 The patient should dress comfortably and will need to remain still during the
procedure.

 Complications may include minor bleeding, hematoma, and infection.

 Explain that nonspecific, suspicious, or atypical findings may result in proceeding

to excisional biopsy.

 Remind patient that area in question will not be removed, only sampled.

6) Colon and Rectum

Fecal Occult Blood Test

 Advise patient not to collect specimen during menstruation or if hemorrhoidal
bleeding is present. Usually, at least 2 stool specimens need to be collected, on
separate occasions.

 Collect specimen or advise patient regarding proper collection of specimen.

 Put container with stool sample into plastic bag and deliver to
lab within 7 days

Flexible Sigmoidoscopy and Colonoscopy

Patient Instructions

The day before the procedure

 Begin clear liquid diet for the entire day. NO SOLID FOOD. Make sure to drink
plenty of fluids so you do not get dehydrated.

 You may continue to take clear liquids until midnight.

 Do not eat or drink anything after midnight.

The day of the procedure

 Take your heart and blood pressure medications with a small sip of water.

 Insulin doses should be cut in half. If you are on a sliding scale, please bring your
insulin with you.

 Do not forget to bring an adult driver with you.

Barium Enema

Nursing and Patient Care Considerations

 Explain to patient:
a. What the x-ray procedure involves.
b. That proper preparation provides a more accurate view of the tract and that
preparations may vary.
c. That it is important to retain the barium so all surfaces of the tract are coated
with opaque solution.

 Instruct patient on the objective of having the large intestine as clear of fecal
material as possible:
a. Patient may be given a low-fiber, low-fat diet 1 to 3 days before the
examination.
b. The day before examination, intake may be limited to clear liquids (no drinks
with red dye).
c. The day before the examination, an oral laxative, suppository, and/or cleansing
enema may be prescribed.

 Patient will be NPO after midnight the day of the procedure.

 Inform patient that barium may cause light-colored stools for

several days after the procedure

Endoscopy

Nursing and Patient Care Considerations

 Verify patient’s compliance with the pretest bowel preparation the day before the
procedure, usually an oral laxative (such as magnesium citrate) and a clear liquid
diet.

 Patient must be NPO after midnight.

 Explain to patient that a feeling of fullness will occur when water is introduced
into the GI tract. This eliminates air space and provides for high resolution.

 Observe patient for a change in vital signs, bleeding, pain, vomiting, and
abdominal distention or rigidity.

 Make sure that patients who have had endoscopic procedures requiring sedation
have a caregiver to drive them home after the procedure.
7) Lung
Low-Dose Helical CT Scan
Nursing and Patient Care Considerations

Nursing and Patient Care Considerations

 Be alert to allergies to iodine or other radiographic contrast

media that might be used during testing.

 For scans performed with contrast, informed consent and IV access required.

 Patient should take nothing by mouth (NPO) for 4 hours prior to scan. Blood urea
nitrogen and creatinine should be evaluated 24 to 48 hours before test.

 Hydrate patient well to facilitate excretion of contrast, if used.

Chest X-Ray

Nursing and Patient Care Considerations

 Should be taken upright if patient’s condition permits. Assist technician at

bedside in preparing patient for portable chest x-ray.

 Encourage patient to take deep breath, hold breath, and remain still as x-ray is
taken.

 Make sure that all jewelry, electrocardiogram (ECG) or monitor leads, and metal
objects (including metal-containing transdermal patches) in x-ray field are
removed so as not to interfere with film.

 Consider the contraindication of x-rays for pregnant patients.

8) Prostate
PSA (Prostate Specific Antigen) Test
Nursing and Patient Care Considerations

 No patient preparation is necessary.

 Current or recent UTI, prostatitis, digital rectal exam, or urethral instrumentation

can cause an artificial elevation of PSA.

 Clinical laboratories may differ slightly in methods used for determining PSA;
patients having serial PSA should be sent to the same laboratory.

9) Testiscular
Testiscular self examination
Patient Instructions

 Instruct patient to look for swelling. Instruct to hold penis out of the way and
examine the skin of the scrotum.
 Instruct to look and feel for any changes to the testicle. These could include hard
lumps, smooth rounded bumps, or new changes in the size, shape or consistency
of the testicle.

Sources:
 Nettina, S. (2015). Lippincott Manual of nursing practice: 10th Edition,
Lippincott Williams and Wilkins