Pemeriksaan

Diagnostik
Muhammad Nur Hasan, S.Kep., Ns
 TIU/TIK
 Mendefinisikan istilah yang berhubungan dengan
prosedur diagnostik
 Mendeskripsikan tujuan dan langkah-langkah
prosedur diagnostik
 Mengidentifikasi data yang dikaji dan dibutuhkan
untuk prosedur diagnostik
 Mengidentifikasi pendidikan kesehatan yang
dibutuhkan klien untuk melakukan pemeriksaan
diagnostik tertentu
 Mengidentifikasi persiapan pasien untuk
pemeriksaan diagnostik tertentu
 Mengidentifikasi peran perawat pada pemeriksaan
diagnostik tertentu
 Menggambarkan panduan untuk evaluasi dan
mencatat tanggung jawab klien untuk prosedur
diagnostik tertentu
 Pemeriksaan Diagnostik (Impuls
Elektrik)
 Elektrokardiografi

 Elektroensephalografi

 Elektromiografi
 Elektrokardiografi
 Alat untuk mendeteksi impuls
jantung
 Dilakukan pada pasien dengan
gangguan pada jantung
 Gelombang P, QRS, T
 Elektroensephalografi
 Mencatat aktivitas listrik pada otak
 Persiapan Pasien

Ruangan yang gelap

Pada saat klien tidur (pemeriksaan 1-2
jam)
Klien tidak distimulan dengan kopi,
depresan, dan alkohol
Hygiene pada daerah kepala
Dilakukan pada pasien trauma/injuri otak
(ex. Cedera kepala, stroke)
Pemeriksaan Diagnostik (Inspeksi
Visual/endoskopi)
 Thorakoskopi, pemeriksaan pleura, rongga
pleura, mediastinum dan perikardium
(bagian-bagian paru-paru dan jantung).
 Proktoskopi (sigmoidoskopi dan
proktosigmoidoskopi), untuk memeriksa
rektum dan kolon sigmoid.
 Laringoskopi, untuk memeriksa laring
(salah satu bagian saluran napas).
 Laparoskopi, untuk melihat lambung, hati,
dan organ-organ lain di dalam rongga
perut.
 Gastroskopi, untuk melihat dinding
dalam esofagus, lambung, dan usus
halus.
 Sistoskopi, untuk melihat saluran
kencing, kandung kencing dan
prostat.
 Kolposkopi, untuk memeriksa vagina
dan mulut rahim.
 Kolonoskopi, untuk memeriksa usus
besar.
 Bronkhoskopi, untuk melihat trachea
dan cabang-cabang bronkhus
(bagian dari saluran napas)
Laryngoscopy or bronchoscopy

Prosedur
• Jelaskan prosedur tindakan
• Jelaskan bahwa akan dilakukan anestesi lokal
(injeksi akan menimbulkan nyeri)
• Jelaskan tes akan dilakukan selama 30-60
menit
• Kaji TTV, sputum, dan karakter repirasi
• Anjurkan klien tidak memakai gigi palsu,
kalung, anting, dan pin
• Lakukan oral hygiene
• Cek ulang klien tidak alergi terhadap
medikasi
• Atur analgesik, sedativa, dan antianxiety,
medikasi untuk dry secretion
 Lanjutan
o Selama prosedur
Asistensi dokter
Monitor nadi dan respirasi
Beri support pada klien
 Post Presedur
 Monitor TTV setiap 30 menit
 Monitor cairan sampai terdapat tanda gag
reflex
 Posisikan lateral

 Inspeksi sputum

 Observasi klien terhadap tanda adanya

dyspnea, stridor, nafas pendek
 Administrasikan anestesi jika dibutuhkan

 Menghubungi petugas kesehatan jika ada

kesulitan bernafas dan darah pada sputum
 Esophagoscopy, gastroscopy,
duodenoscopy
 Jelaskan pada klien perasaan tidak
nyaman pada lambung
 Administrasikan oral simethicone
sebelum tes (mengurangi udara pada
daerah lambung)
 Jika atropine diberikan maka lakukan
monitor pada Heart rate
 Post Prosedur
 Inspeksi emesis
 Jika kesulitan menelan persistent,
nyeri, demam, vomitus, dan black
stool untuk menghubungi dokter/
perawat
 Cystoscopy
 Kaji TTV, frekuensi urunaria, disuria,
jumlah, dan konsistensinya
 Administrasikan enema jika diorderkan

 Puasa selama 6-8 jam atau hanya cairan

IV
 Prosedur
 Monitor VS, urinaria, bandingkan dengan
data dasar
 Posisi lateral
 Inspeksi adanya darah dalam urin
 Laporkan keadekuatan urin selama 8 jam
 Peningkatan cairan untuk mengurangi
iritasi pada jaringan urin
 Administrasikan analgesik
 Laporkan jika ada kesulitan BAK persisten,
darah segar, nyeri, dan panas
 Anoscopy, proctoscopy,
sigmoidoscopy, colonoscopy
 Kaji TTV dan konsistensi feces
 Yakinkan preexamination diet yang tepat dan intake
cairan
 Administrasikan laxative
 Administrasikan enema
 Ensure the voids before the examination
 Administer sedativa
 Explain
 That the client will experience the sensation of
having to move bowels due to the pressure of
instrument
 That the client may experience some abdominal
cramping when air is introduced to distend the bowel
 Post Prosedure
 Support knee-chest position
 Monitor pulse and respiration

 Label spesimen

 Support klien emotionally

 Inspect the stool for blood

 Allow the client to rest

 Provide fluids and food

Examinations Involving Removal of
Body Fluids and Tissue

 Lumbal Puncture
 Abdominal paracentesis

 Thoracocentesis

 Pericardial aspiration

 Bone Morrow Biopsy

 Liver Biopsy
 Lumbal Puncture (LP, Spinal Tap)
 Insertion of a needle into the
subarachnoid of spinal canal
withdraw cerebrospinal fluid (CSF)
 For diagnostic or therapeutic reasons

 The site is ussually between the third

and fourth lumbar vertebrae
 For the infant or small child is
ussually lower
 Nursing Intervention
 Vital’s sign
 Pertinent health status (e.g. level of consciousness
and neurologic status)
 Determine drug allergies, particularly to local
anesthetics and skin antiseptics
 Explain: prosedure, when, where, who, and how
long
 Have the client empty the bladder and bowel to
prevent unnecessary discomfort
 Position the client laterally with the head bent
toward the chest, the knees flexed onto abdoment,
and the back at edge of the bed or examining table.
 Lanjutan
 Support the position
 Encourage the client to breathe
normally and relax, excessive muscle
tension, coughing, or change in
breathing can increase CSF pressure
 Post Prosedure
 Assist the client to a dorsal recumbent
position
 Assist VS

 Ensure that CSF spesiments are

corectly labeled
 Record the prosedure include the date
and time, the name of the physician,
the color, character, and amount of
CSF
 Abdominal Paracentesis
 Abdominal paracentesis is the
removal of fluid from the peritonela
cavity
 In some disease; cirrhosis of the
liver
 Normally the fluid about 1500 ml
 Abdominal paracentesis

Merupakan pemeriksaan tambahan

yang sangat berguna untuk menentukan
adanya perdarahan dalam rongga
peritoneum. Lebih dari 100.000
eritrosit/mm dalam larutan NaCl
yangkeluar dari rongga peritoneum
setelah dimasukkan 100--200 ml larutan
NaCl 0.9% selama 5 menit, merupakan
indikasi untuk laparatomi
 Nursing Intervention
 VS

 Expainthe procedure to client

 Support the sitting position

 Support clint verbally

 A major concern is hypovolemic

shock
 Post Prosedure
 Asses the pulse rate, skin color, and
blood presure
 Observe hypovolemic shock (pallor,
dyspnea, diaphoresis, and a drop in
blood pressure
 Documentation
 Thoracocentesis
 Thoracocentesis is the withdrawal of
fluid or air from the pleural cavity
 For diagnostic and therapeutic
purpose
 In injury of thorax
 Nursing Intervention
 Asses vital sign, respiratory depth,
complaints of chest pain, breath sounds,
dyspnea, type and frequency of cough,
character and amount of sputum
 Support sitting position with arms above
the head
 VS

 The client’s cough, sputum, respiration

depth, breath sounds, and chest pain
 Bone Marrow Biopsi
A bone marrow biopsy is the removal
of a spesimen of bone marraw for
study in a laboratory
 For abnormal blood cell development
and detect anemia, leukemia, and
other disease of the blood
 The sites are sternum, the posterior
superior iliac crest
 Nursing Intervention
 Observe the VS,
 bleeding from the site (hematoma)
 Liver Biopsy
A liver biopsy is a short prosedure,
generally performed at client’s
bedside
 The site of insertion is either
between two of the right lower ribs
 Facilitate diagnosis of liver disease
and to gain information about
changes in liver tissue
 Nursing Prosedure
 Asses vital sign
 Determine any drug allergies

 Determine prothrombine time and platelet

count (administered vit K, IM)
 Administer sedativa

 Support a supine position

 Post prosedure

 Assist the client to a rihgt side-lying

position for several hours
 High-Tech Studies
 Roentgenography

 Nuclear Medicine (Radioisotop)

 Computed Tomography (CT Scan)

 Ultrasonography (Ultrasound)
 Roentgen ray (x rays)
 X rays are part of the spectrum of
electromagnetic radiation
 Contracst materials are introduced into the
body in four way to view spesific organs
• Orraly
• Intravenously
• Subarachnoid space for the spine and the
ventricles of the brain
• Through a nasotracheal tube or
bronchoscope for the bronchial tree
 Lanjutan
 Gastrointestinal tract: pharynx and
esophagus, upper gastrointestinal tract
(barium swallow), and lower
gastrointestinal tract (barium enema)
 Gallbladder (cholecystography) and bile
ducts (cholangiography)
 Urynary tract (IVP or IVU)
 Musculoskeletal system
 Central nervous system (myelography)
 Vascular System (angiography)
 Mammograpphy/xerography
Nuclear Medicine (Radioisotop)
 A basic principle is the body constituents
are dynamic, not static
 Isotopes enter into the same chemical
reactions and metabolic prossess
 Radioactive substances for spesific body
tissue are introduced orally or
intravenously
 Example, radioactive iodine given to
measure the function of the thyroid gland
 Lanjutan
 Orally or intravenous
 1-48 hours, isotope is assimilated by the
organ
 The scanning prosedure, during which the
client must remain still
 Scintillation scanning assess the function
of organ or detect a tumor
 Include thyroid, heart, brain, lung, liver,
spleen, bone marrow, bones, and kidney
Computed Tomography (CT Scan)
 Painless, non invasive x-ray
prosedure
 Pasien diberi kontras iodine IV,
proses scanning 1 jam
 Observasi raksi alergi terhadap
kontras
 Post tindakan: puasa 4-6 jam agar
tidak muntah
 Ultrasonography
 Acoustic densities or tissue
 Mengetahui ukuran, konsistensi
struktur internal
 Menunjukkan massa, cairan
inflamasi, stones
 Membedakan massa cystic atau
padat
 Membedakan batas lesi atau tempat
 Mendeteksi gerakan
 Guidelines
 Restless clients
 The nurse assures the client that there is
no need to fear exposure to radiation
 Check for allergies

 The nurse explains

 There is no discomfort

 The client will be asked to assume various

positions and must remain still while the
scans are taken
MRI
Angiografi
 Selesai
 Trima Kasih