Elsevier items and derived items © 2005, 2001 by Elsevier Inc.

Elsevier items and derived items © 2005, 2001 by Elsevier Inc.

CHAPTER 24CHAPTER 24 Diagnostic Tests and Diagnostic Tests and Specimen CollectionSpecimen Collection

CHAPTER 24CHAPTER 24 Diagnostic Tests and Diagnostic Tests and Specimen CollectionSpecimen Collection


CHAPTER 24 THEORY CHAPTER 24 THEORY OBJECTIVESOBJECTIVES CORRECTLY USE THE TERMS LISTED FOR THIS CHAPTER.CORRECTLY USE THE TERMS LISTED FOR THIS CHAPTER. DESCRIBE EACH OF THE SEVEN CATEGORIES OF TESTS DESCRIBE EACH OF THE SEVEN CATEGORIES OF TESTS

THAT ARE COMMONLY PERFORMED.THAT ARE COMMONLY PERFORMED. DISCUSS APPROPRIATE PSYCHOSOCIAL CARE & DISCUSS APPROPRIATE PSYCHOSOCIAL CARE &

TEACHING FOR PATIENTS UNDERGOING DIAGNOSTIC TEACHING FOR PATIENTS UNDERGOING DIAGNOSTIC TESTS OR PROCEDURES.TESTS OR PROCEDURES.

EXPLAIN FACTORS TO BE CONSIDERED WHEN AN OLDER EXPLAIN FACTORS TO BE CONSIDERED WHEN AN OLDER ADULT IS TO UNDERGO DIAGNOSTIC TESTING.ADULT IS TO UNDERGO DIAGNOSTIC TESTING.

PREPARE TO PERFORM A CAPILLARY BLOOD GLUCOSE PREPARE TO PERFORM A CAPILLARY BLOOD GLUCOSE TEST, A VENIPUNCTURE, A THROAT CULTURE, A URINE TEST, A VENIPUNCTURE, A THROAT CULTURE, A URINE DIPSTICK AND STOOL FOR OCCULT BLOOD TEST.DIPSTICK AND STOOL FOR OCCULT BLOOD TEST.


Diagnostic Testing Diagnostic Testing and the Nursing Processand the Nursing ProcessDiagnostic Testing Diagnostic Testing and the Nursing Processand the Nursing Process

• When diagnostic tests are ordered, the nurse should: Assess the patient and establish the patient’s

knowledge levels. Determine any nursing procedures required to protect

the safety of the patient. Assess for patient allergies to iodine

• Nursing diagnosis will relate to Knowledge, Deficient, related to: …

(Cont’d…)


Diagnostic Testing Diagnostic Testing and the Nursing Processand the Nursing ProcessDiagnostic Testing Diagnostic Testing and the Nursing Processand the Nursing Process

(…Cont’d)

Planning• Verify that items needed for preparation are on

hand.• Check to see that pretest medications are on the

unit or available.• Prepare to do patient teaching. • Prepare for preprocedure treatments such as

enemas or IV starts.


Diagnostic TestsDiagnostic TestsDiagnostic TestsDiagnostic Tests

• Provide information about chemical reactions affecting physiologic functioning of the body

• Enable examination of blood, urine, and other body fluids, which provides clues about the functioning of various organs, body systems, and mechanisms

• Used to confirm diagnosis and guide treatment• Provide information concerning changes in a

patient’s condition


Laboratory TestsLaboratory TestsLaboratory TestsLaboratory Tests

Hematology Tests• Complete blood count (CBC)

Information about the state of health or presence of illness

Number of red blood cells (erythrocytes) Type and number of white blood cells (differential) Platelet count, PT, PTT, INR

(Cont’d…)



(…Cont’d)

• During infection, the number and type of white blood cells increase.

• Neutrophil counts can be significant.• In severe infections, bone marrow releases more

granulocytes.• Immature polymorphonuclear neutrophils are released

(called bands).• The result is a shift to the left (more bands).

(Cont’d…)



(…Cont’d)

• Drug therapy may cause leukopenia (a decrease in leukocytes).

• Hemoglobin shows the capacity of the blood to transport oxygen from the lungs to the tissues.

• A normal platelet count is essential to clotting.• Coumadin therapy is guided by prothrombin time (reported

in INR numbers).• The erythrocyte sedimentation rate (ESR) gives clues

about inflammatory conditions.


Chemistry TestsChemistry TestsChemistry TestsChemistry Tests

Chemistry tests are performed on:• Whole blood, plasma, and serum• Body fluids such as:

Urine, spinal fluid, gastric contents

• Chemistry tests provide information about biochemical reactions such as electrolyte balances and organ function.

(Cont’d…)


Chemistry TestsChemistry TestsChemistry TestsChemistry Tests

(…Cont’d)

• Some institutions use automated computerized blood chemistry testing.

• Examples of tests available are: Serum albumin, alkaline phosphatase (ALP),

aspartate aminotransferase (AST) Total bilirubin, serum calcium, cholesterol, glucose,

LDH, phosphate, total protein, BUN, uric acid


Blood GlucoseBlood GlucoseBlood GlucoseBlood Glucose

• Blood glucose is a test commonly performed at the bedside or in the physician’s office by the nurse.

• Guides insulin therapy for diabetics• Guidelines for performing test depend on

manufacturer of testing equipment• Requires a finger stick to obtain capillary blood• Review Skill 24-2


Serology TestsSerology TestsSerology TestsSerology Tests

• Based on analysis of serum• Used to diagnose both viral and bacterial diseases or

determine antibody levels for: Dysentery, rheumatic fever, typhoid, influenza,

rubella, and syphilis

• Can also be used to determine titers in response to vaccines

• May use radionuclides such as iodine-125 and iodine-131

(Cont’d…)


Serology TestsSerology TestsSerology TestsSerology Tests

(…Cont’d)

• Examples of serology tests ordered• Agglutination test for specific organisms• Antistreptolysin-O titer• Blood typing: ABO groups and Rh• Carcinoembryonic antigen assay (CEA)• Coombs’ test• C-reactive protein antiserum• Heterophil antibody titer• Tests for syphillis


UrinalysisUrinalysisUrinalysisUrinalysis

• Provides information about kidney function or other body functions and diseases

• Single, catheterized, or random specimens can be collected anytime, with no special preparation. First voided specimen is preferred.

• Urine deteriorates quickly and should be tested soon after collection.

(Cont’d…)



(…Cont’d)

Midstream collections• External genitalia are cleansed• A small amount of urine is passed.• Urine is collected from midvoiding in a sterile

container.• Used for cultures when a bladder infection is

suspected

(Cont’d…)



(…Cont’d)

Timed, long-period specimens• Collected over 12- or 24-hour period• Container may be kept on ice and has some form

of preservative.• Used to determine kidney function and possible

glomerulonephritis or acute tubular necrosis


Other Laboratory TestsOther Laboratory TestsOther Laboratory TestsOther Laboratory Tests

• Bacteriology• Histology• Cytology• Ova and parasites• Cultures from specimens of feces, blood, urine,

wound drainage, or samples of body tissue or fluids


UltrasonographyUltrasonographyUltrasonographyUltrasonography

• Records the reflection of sound wave directed into the tissues

• Used to diagnose pathologic conditions of Uterus, ovaries, prostate, heart, liver, kidneys,

pancreas, gallbladder, lymph nodes, thyroid, eyes, and peripheral blood vessels

• Often used in conjunction with nuclear medicine scans


Radiology ProceduresRadiology ProceduresRadiology ProceduresRadiology Procedures

• Most common test is radiation by x-ray• Produces images in varying densities on film after it

passes through the body• Commonly performed radiology procedures:

Chest x-ray Barium swallow and upper GI series KUB (kidneys, ureters, and bladder) Gallbladder series

(Cont’d…)


Radiology ProceduresRadiology ProceduresRadiology ProceduresRadiology Procedures

(…Cont’d)

• IVP (intravenous pyelogram)• X-ray of bony skeleton• Arthrogram• Myelogram• Radionuclide scan• Computed tomography (CT) scan


Magnetic Resonance ImagingMagnetic Resonance ImagingMagnetic Resonance ImagingMagnetic Resonance Imaging

• Noninvasive method of differentiating body tissue (commonly used for brain, knee joint, spine and spinal cord, and abdominal organs)

• Requires that all metal be removed from the patient• Contraindicated in patients with hip prostheses,

implanted pacemakers or defibrillators, artificial cardiac valves, or vascular clips or staples from recent surgery

(Cont’d…)


Magnetic Resonance ImagingMagnetic Resonance ImagingMagnetic Resonance ImagingMagnetic Resonance Imaging

(…Cont’d)

• Patient teaching is very important before this procedure; patient needs to know the duration of the test and that it requires being in a noisy environment.

• Patient may become claustrophobic during test.• Patient needs to know deep-breathing and

relaxation techniques.


Cardiopulmonary StudiesCardiopulmonary StudiesCardiopulmonary StudiesCardiopulmonary Studies

EKG/ECG • Diagnoses heart rhythms and heart disease; measures

electrical activity of the heartCardiac catheterization• An invasive procedure used to determine function of heart

valves, coronary artery blood flow, and oxygenation at different points in the heart and to diagnose coronary artery disease Abnormal blood in cardiac vessels can be detected as can

valvular dysfunction.

(Cont’d…)



(…Cont’d)

• Surgical procedure that requires consent• Procedure is performed under sterile technique in radiology or a

surgical suite.• Postprocedure requires checking insertion site every 10 to 15

minutes for possible bleeding.• If the femoral approach is used, the patient’s leg may be

immobilized for several hours. • New angioseal devices may preclude the need for post

procedure pressure.

(Cont’d…)



(…Cont’d)

Treadmill Stress Test• A cardiac-monitored ECG test• Patient is on a treadmill, which is used to increase

heart rate and blood pressure with controlled activity.• Test may be done with radioisotope imaging• Patient should avoid smoking, dairy products, or

drinking caffeine for 4 hours before the test.

(Cont’d…)



(…Cont’d)

• Angiography/Arteriography• Used to locate lesions, occluded vessels, tumors, and

malformed blood vessels• A contrast medium is injected during the procedure

(check for allergies).• Consent is required.• Patient should be NPO for at least 6 hours before the test.• Patient may be given preprocedure sedation.


Other TestsOther TestsOther TestsOther Tests

• Endoscopic examinations of: The stomach (gastroscopy) The sigmoid colon (proctosigmoidoscopy) The entire colon (colonoscopy) The bladder (cystoscopy) The gallbladder and common bile duct (endoscopic

retrograde cholangiopancreatograhy [ERCP])

(Cont’d…)


Other TestsOther TestsOther TestsOther Tests

(…Cont’d)

Electroencephalography (EEG)• Measures neurologic and physiologic activities of

the brain via the electrical discharges from the brain

• Performed to localize and diagnose brain lesions, scars, epilepsy, infections, or clots

• Performed to determine brain death in comatose patients on life support


Things to RememberThings to RememberThings to RememberThings to Remember

• All invasive tests requiring injection of a medium require a consent.

• Tests requiring premedication or sedation usually require a consent.

• Many tests have some form of preparation; review the laboratory manual for your facility to determine what must be done before the patient has the test and after the patient has had the test.

Elsevier items and derived items © 2005, 2001 by Elsevier Inc.

Health & Medicine

Transcript of Elsevier items and derived items © 2005, 2001 by Elsevier Inc.