Spinal X-ray Test
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16.10 Pelvic Ultrasound
A pelvic ultrasound creates images of the bladder, ovaries, uterus, cervix, fallopian tubes, prostate gland, and seminal vesicles. There are three types of pelvic ultrasound tests:
1. Transabdominal ultrasound: the transducer is moved along the abdomen.
2. Transrectal ultrasound: the transducer is inserted into the rectum.
3. Transvaginal ultrasound: the transducer is covered with a latex sheath and inserted in the vagina.
Verify that the patient is not allergic to latex before a transrectal or transvaginal ultrasound is performed.
Why the Test Is Performed
The test assesses the cause of urinary disorders, the bladder, assesses for growths, pelvic inflammatory disease (PID), placement of intrauterine device (IUD), the size of pelvic organs and structures, the fetal position, and for the cause of infertility. The test also guides the healthcare provider when performing a biopsy.
Before Administering the Test
Assess if the patient:• Has ingested contrast material 2 days before the ultrasound
• Can lie still during the test
• Has a full bladder (transabdominal)
• Is allergic to latex (transrectal or transvaginal)
• Has removed jewelry and clothes from below the waist
• Signed a consent form, if the ultrasound is used for a biopsy
• Has been given an enema an hour before the test (transrectal)
• Can lie on his or her left side and bend his or her knees (transrectal)
• Has not drunk fluids four hours before the test (transvaginal)
• Is obese
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How the Test Is Performed
• Transabdominal ultrasound:
• The patient removes all jewelry from below the waist.
• The patient will remove all clothes from below the waist.
• The patient will be required to fill his or her bladder to push the intestines away from the pelvic organs. If the patient is unable to drink water, the healthcare provider will insert a catheter into the patient’s bladder and infuse sterile water.
• The patient will be required to sign a consent form if the ultrasound is used to guide the healthcare provider in taking a biopsy.
• The patient lies on his or her back.
• A conductive gel is placed on the abdomen.
• The transducer is placed over and moved around the abdomen.
• Transrectal ultrasound:
• The patient is given an enema an hour before the test.
• Verify that the patient is not allergic to latex.
• A latex sheath is placed over the ultrasound transducer.
• The patient lies on his or her left side with knees bent.
• The ultrasound transducer is lubricated and then inserted into the patient’s rectum to capture the image.
• Transvaginal ultrasound:
• The patient avoids drinking fluids four hours before the test.
• The patient lies on her back with hips raised.
• Verify before the test that the patient is not allergic to latex.
• The healthcare provider places a transducer covered with a latex sheath into the vagina to capture the image.
Teach the Patient
Explain why the ultrasound is being performed, that the patient will not feel any pain, that the patient must lie still during the test, that the patient cannot ingest contrast material 2 days before the test, and that the patient will require a full bladder. If the patient is unable to drink a sufficient volume of water, a urinary catheter will be inserted and sterile water will be placed into his or her bladder (transabdominal). The patient will be given an enema an hour before the test (transrectal) and will not urinate until after the test is concluded (transabdominal).
The patient must avoid drinking 4 hours before the test (transvaginal).
Inform the patient that conductive gel is placed on the skin over the abdomen and that it will be wiped off after the test is completed (transabdominal). The transducer is placed on and moved around the abdomen (transabdominal) and the ultrasound transducer may be covered in a latex sheath and inserted into the rectum or vagina (transrectal or transvaginal). If she feels short of breath during the test, the head of the bed will be raised or she will be repositioned on her side if the transvaginal procured is used.
Understanding the Test Results
The test takes 30 minutes or less and the results are ready immediately.
• Normal:
• Pelvic organs are normal size
• No growth
• No blockages
• Intrauterine device is in the expected position
• Abnormal:
• Unexpected size of one or more pelvic organs
• Growths are seen
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• Inflammation and infection noticed
• Unexpected fluid
• Blockage found
• Intrauterine device is not in the expected position
Solved Problems Ultrasound Scan
16.1 How does an ultrasound scan work?
High-frequency sound waves are transmitted by a transducer that is placed on the patient’s skin.
Sound waves penetrate the skin, bounce off of organs and structures in the patient’s body, and are detected by the transducer. Sound waves detected by the transducer are translated into an image that appears on the ultrasound screen.
16.2 Can an ultrasound scan identify a malignant growth?
An ultrasound can detect a growth but cannot differentiate between a malignant or benign growth, which is determined by a biopsy.
16.3 Can an ultrasound scan identify a cyst?
An ultrasound can differentiate between a solid growth and a fluid-filled cyst.
Benign Prostatic Hyperplasia Ultrasound
16.4 What is a benign prostatic hyperplasia?Middle-aged men might experience the urgency to void, hesitancy waiting for the urinary stream, or a weak urinary stream. These may be signs of an enlarged prostate that places pressure on the bladder and blocks the urinary stream. Noncancerous enlarged prostate is referred to as benign prostatic hyperplasia (BPH) or hypertrophy.
16.5 When might the benign prostatic hyperplasia ultrasound be ordered by the healthcare provider?
The benign prostatic hyperplasia ultrasound is used to help guide the healthcare provider when taking a biopsy of the prostate, which is commonly performed if the patient’s prostate-specific antigen (PSA) level is elevated.
16.6 What else can be assessed when performing a benign prostatic hyperplasia ultrasound?
The healthcare provider may also evaluate the bladder and kidneys while performing the benign prostatic hyperplasia ultrasound to determine urinary retention and kidney stones that may block urinary flow.
16.7 What should you teach the patient about the benign prostatic hyperplasia ultrasound scan?
Explain why the ultrasound is being taken, that clear gel will be placed on the ultrasound site to increase the conduction of sound, that the patient will not feel any pain, and that the patient must lie still during the test.
Transvaginal Ultrasound and Hysterosonogram
16.8 Why might the healthcare provider order the transvaginal ultrasound and hysterosonogram?
When a woman has difficulty conceiving, the healthcare provider may perform a transvaginal ultrasound or a hysterosonogram.
16.9 What is a drawback of the transvaginal ultrasound?
The transvaginal ultrasound may not display scars or small tumors.
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16.10 What can the healthcare provider assess with a transvaginal ultrasound or a hysterosonogram?
The healthcare provider can assess the uterus, fallopian tubes, ovaries, endometrial cavity, uterine lining, and ovarian follicle development with a transvaginal ultrasound or a hysterosonogram. These tests can also help the healthcare provider to schedule intrauterine insemination and guide the healthcare provider when removing follicles.
16.11 What should you assess before the patient is administered the transvaginal ultrasound or a hysterosonogram?
Assess if the patient:
• Can lie still during the test
• Has an empty bladder prior to the test
16.12 How is the transvaginal ultrasound or a hysterosonogram performed?
The patient may be required to have an empty bladder prior to the scan or a full bladder, depending on what is being examined. The ultrasound transducer is inserted into the vagina. The healthcare provider performs the ultrasound scan from within the vagina. With a hysterosonogram, the uterus is filled with fluid prior to insertion of the transducer into the vagina.
16.13 What should you teach the patient about the transvaginal ultrasound or a hysterosonogram?
Explain why the ultrasound is being taken, that the patient must have an empty bladder before the scan, that the patient will not feel any pain, that the patient must lie still during the test, that the transducer is inserted into the vagina, and that the uterus will be filled with fluid if the healthcare provider orders a hysterosonogram.
16.14 What might be revealed by the transvaginal ultrasound or a hysterosonogram?
The transvaginal ultrasound or a hysterosonogram can reveal few follicles, uterine fibroids, ovarian cysts, hydrosalpinz, thick uterine lining, deformed uterine lining, enlarged uterus, or abnormal fallopian tubes.
Testicular Ultrasound
16.15 What is displayed by a testicular ultrasound?
The testicular ultrasound displays an image of the patient’s testicles and scrotum. Also displayed is the epididymis, which is the coiled tube behind the testicle that collects sperm. The testicular ultrasound also displays an image of the vas deferens, which is the tube that connects the prostate gland to the testicles.
16.16 What must you assess before the testicular ultrasound is administered?
• Assess if the patient:
• Can lie still during the test
• Has open skin in the scrotum
• A consent form must be signed if the patient is undergoing a testicular biopsy.
• The patient must remove all clothes from the waist down.
• Towels are used to lift the scrotum.
• Wipe the conductive gel from the patient’s skin when the test is completed.
16.17 How is the testicular ultrasound performed?
• A conductive gel is placed on the transducer or on the scrotum.
• The transducer is placed on the scrotum and moved around to capture the image.
• The patient may be asked to hold his breath for a few seconds while the image is being taken.
Abdominal Ultrasound
16.18 What is viewed by an abdominal ultrasound?
An abdominal ultrasound is ordered to view upper abdominal organs and structures. Viewed are the liver, gallbladder, spleen, pancreas, and kidneys. It is also ordered to assist the healthcare provider assess the abdominal aorta.
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16.19 Why is the abdominal ultrasound ordered by the healthcare provider?
The abdominal ultrasound assesses the liver, gallbladder, bile ducts, spleen, pancreas, kidneys, and abdominal aorta. The test also guides the healthcare provider when taking a biopsy or when performing a paracentesis.
16.20 What should you assess before the abdominal ultrasound is performed?
Assess if the patient:
• Can lie still during the test
• Has ingested barium for an upper GI test two days prior to the ultrasound scan
• Has had a barium enema for a lower GI test two days prior to the ultrasound scan
• Has removed jewelry from the abdominal area
• Has eaten a fat free dinner the night before the test
• Has not eaten 12 hours before the ultrasound scan
• Has drunk six glasses of water an hour before the ultrasound scan
• Has an open wound in the abdominal area
• Is obese
A consent form must be signed if the patient is undergoing a biopsy. The patient must remove all clothes from the waist down. Wipe the conductive gel from the patient’s skin when the test is completed.
16.21 What might be an abnormal result of the abdominal ultrasound?
An abnormal result of an abdominal ultrasound might be a growth on one or multiple organs, inflammation, infection or blockage of the bile ducts, enlarged aorta, or fluid appearing in the abdomen.
Breast Ultrasound
16.22 Why might a breast ultrasound be performed on younger women?
A breast ultrasound is sometimes performed on younger women whose breast tissues are dense, preventing details of the breast to show on a mammogram.
16.23 Why would a breast ultrasound be ordered following a mammogram?
A healthcare provider frequently orders a breast ultrasound to assess a lump identified by either palpation or from a mammogram. The breast ultrasound can distinguish between a solid mass and a cyst. If it is a solid mass, then the healthcare provider performs a biopsy to determine if the mass is benign or malignant.
16.24 What should you teach a patient who is to undergo a breast ultrasound?
Explain why the ultrasound is being taken, that the patient will not feel any pain, that the patient must lie still during the test, that the patient will have to remove all clothes from the waist up, that the patient will need to remove jewelry from the breast area, that conductive gel is placed on the breast and that it will be wiped off after the test is completed, that the transducer is placed on and moved around the breast, and that a consent form must be signed if the patient is undergoing a biopsy or drainage of a cyst.
16.25 Is a breast ultrasound an alternative to a mammogram?
A breast ultrasound does not replace an annual mammogram.
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