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Chest X-Ray Katelynn Jurek What is a Chest X-Ray? “To assist in the evaluation of cardiac, respiratory, and skeletal structure within the lung cavity and diagnose multiple diseases such as pneumonia and congestive heart failure” (Nursing Central, 2013, paragraph 1.) It also “helps diagnose heart failure and can verify placement of pacemakers and pulmonary artery catheters” (Smeltzer, Bare, Hinkle & Cheever, 2010, p.707) “A chest x-ray is taken by a radiology technologist. It is then read by a radiologist. A family doctor, an internist, or a surgeon may review the chest x-ray” (Healthwise Staff, 2013, paragraph 1) The patient will stand with their front against an xray plate for the pictures. But they may be able to sit or lie down if necessary. It is important to remain still and the patient will be asked to take a deep breath and hold it for a few seconds. Most hospitals have portable x-ray machines and it will be done at the bedside. The x-ray typically takes between 5-15 minutes (Healthwise staff). To provide a clearer picture the patient may need to undress, everything but their underwear, and put on a gown. (Healthwise staff). Two views are usually taken. From the back (posterioanterior projection) and one from the side (lateral projection) of the body. Other positions may be necessary (Healthwise staff). Nurses Role Normal findings: Normal lung fields, cardiac size, mediastinal structures, thoracic spine, Positively identify patient Inform patient about procedure Obtain history including allergies Remove all metallic objects No food, drink, or medication restrictions Provide modesty for patients with cultural issues Reinforce information regarding the results of the test Identify if patient is pregnant ribs and diaphragm. Critical findings: Foreign body, malposition of tube, line or device, pneumonia, spine fracture, pneumothorax, pneumoperitoneum (Nursing Central, 2013). (Nursing Central, 2013) Chest X-Ray Current Research In the article “Routine chest x-rays in intensive care units: a systematic review and meta-analysis” the researchers reviewed studies from 1948 to 2011 to investigate any clinical changes in critically ill adults and children that received routine daily chest x-rays and those that had restrictive chest x-rays. Nine Interfering factors: Pregnancy, metallic objects in field, improper adjustment of equipment with obese and thin patients, incorrect positioning, and inability of patient cooperation because of age, pain or mental status. Population considerations: Positioning of paralyzed patients, working with children, and the elderly. Also, religious and cultural beliefs that are concerned with modesty (Nursing Central, 2013). studies were included with a total of 9,611 patients and 39,358 chest x-rays. In the conclusion of the article the analysis did not show any harm with the restrictive chest x-ray strategy. But this study could not make the determination that using the restrictive strategy would be as safe as using the routine tests. The confidence intervals were wide and harm could not be assessed (Ganapathy, Adhikari, Spiegelman & Scales, 2012). NCLEX Questions 1. When instructing the patient who is having a chest x-ray, all should be included except a. The test will take between 5-15 minutes . References b. All metal objects must be removed c. No medications may be given prior to x-ray Ganapathy, A., Adhikari, N., Spiegelman, J., & Scales, D. (2012). Routine chest x-rays in intensive care units: a systematic review and meta-analysis. Critical Care, 16(2), doi: 10.1186/cc11321 d. Take deep breath and hold during image and exhale after image is taken Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Medical-surgical nursing. (12 ed., Vol. 1, p. 707). Philadelphia, PA: Lippincott Williams and Wilkins. 2. Which one of these is not considered part of a nurse’s role for a patient that is having/had a chest x-ray? Healthwise Staff. (2013, January 16). Chest x-ray: How it is done. Retrieved from http://www.healthlinkbc.ca/kb/content/medicaltest/hw20 5975.html a. Identify if patient is pregnant or possibility b. Inform patient about the results of x-ray c. Identify patient Nursing Central. (2013). Chest x-ray. Unbound Medicine. Retrieved from mobile application. Answers: 1. C Nursing central 2. b nursing central d. Obtain history including allergies