Anda di halaman 1dari 166

Common Laboratory procedures:

Nursing Responsibilities and Implications


3 Phases of Diagnostic testing Pretest Client preparation Intra-test
specimen collection and VS monitoring Post-test Monitoring and follow-up
nursing care
Related Nursing Diagnoses
Anxiety Fear Impaired

physical

mobility Deficient knowledge


BLOOD TESTS CBC Hemoglobin, Hematocrit, WBC, RBC and platelet Serum
Electrolytes Arterial blood gases Blood Chemistry Drug and Hormone Assay
Complete Blood Count

Specimen: Venous blood Pretest: obtain syringe, tourniquet, vial with appropriate
anticoagulant Intratest: Cubital vein commonly used for venipuncture Post-test:
direct pressure and observe for bleeding, label vial
Normal values for CBC

RBC (M) 4.7-6.1/ (F) 4.2-5.4 Hgb (M) 14-18/ (F) 12-16 mg/dL Hct (M) 42-52/ (F) 33-
47 % WBC 5-10,000 cells/cubic cm Differential count Neutrophils- 55- 70%
Lymphocytes- 20-40% Monocytes- 2-5% Eosinophils- 1-4% Platelets 150,000-
400,000
Table. 11.2
CBC
Normal WBC count Increased WBC (Leukocytosis) Increased Neutrophils Increased
Lymphocytes Increased Eosinophils 5-10,000 cell/cm3 More than 10, 000 ACUTE
bacterial infection CHRONIC bacterial infection VIRAL infection PARASITIC
infection
Serum Electrolytes
Specimen: venous blood Pretest/Intratest/Post-test- same Commonly ordered:
Sodium- 135-145 mEq/L Potassium- 3.5-5.0 mEq/L Chloride- 95-105 mEq/L
Magnesium- 1.3 to 2.1 mEq/L Calcium- 8 to 10 mg/dL
Serum Electrolytes Problems can be Hyper if increased Hypo if decreased
Blood Chemistry

Specimen: Venous blood, serum Pretest/Intratrest/Post-test-same Examined are


enzymes, hormones, lipid profile BUN , Creatinine, etc… Place patient on NPO for 8
h *Creatinine is produced relatively constant by muscles, excreted by the kidneys
and is the RELIABLE Reflection of Renal Status
Blood Chemistry Normal values for : Creatinine: 0.7 to 1.4 mg/dL BUN: 10-20 mg/dL
Creatinine clearance: 1.67 to 2.5 mL/s Serum uric acid: 2.5 to 8 mg/dL Blood
osmolality= 250 to 290 mOsm/L
Blood Chemistry
Enzymes/acids Uric acid SGOT/SGPT Purpose Gout detection Liver function test

Rheumatoid factor For Rheumatoid arthritis Anti-DNA antibody SLE diagnosis CK-MB,
LDH and Troponin Identifies Cardiac damage or muscle damage
Blood Chemistry
Coagulation studies PT
12-16 seconds

Purpose
Measures the effectiveness of Warfarin single The BEST screening test for
coagulation disorders Same as PTT,

PTT
60-70 seconds

aPTT
30-40 seconds

Bleeding time
1-9 minutes

measures effectiveness of HEPARIN Platelet Measures (more specific than function


PTT)
Others

Blood Chemistry

Purpose
Measures the rate at which the RBCs settle out of the anticoagulated blood
Elevates in inflammation auto To detect immune diseases

ESR (erythrocyte sedimentation rate) 10-20 mm/hour

Blood lipids Cholesterol= 150-200 hyperlipidemia mg/dL Triglycerides= 140-200


mg/dL
Diabetes Mellitus

DIAGNOSTIC CRITERIA FBS equal to or greater than 126 mg/dL (7.0mmol/L) (Normal 8
hour FBS80-109 mg/dL)
Diabetes Mellitus

DIAGNOSTIC CRITERIA OGTT value 1 and 2 hours post-prandial equal to or greater


than 200 mg/dL Normal OGTT 1 and 2 hours post-prandial- is
Diabetes Mellitus

DIAGNOSTIC CRITERIA RBS of equal to or greater than 200 mg/dL PLUS the 3

P’s
Diabetes Mellitus

DIAGNOSTIC CRITERIA Glycosylated hemoglobin (HbA1c) is a monitoring test to assess


the adherence to diabetic
Arterial Blood Gases

Specimen: arterial blood Pretest: obtain syringe with heparin, rubber stopper,
container with ice Intratest: usual site-radial artery, perform Allen’s test Post-
test: Apply direct pressure on site for 5-10 minutes, send specimen with occluded
needle on ice
Normal ABG values pH 7.35-7.45 pCO2 35-45 mmHg paO2 80-100 mmHg HCO3 22-
26 mEq/L Base excess -2 to +2 O2 sat 95-98%
ABG interpretation
Value pH paO2 SaO2 paCO2 HCO3 Normal 7.35-7.45 95-100 mmHg 95-98% 35-45 mmHg
Acidosi s Below 7.35 Alkalosi s Above 7.45

Respirat ory >45

22-26 mEq/L Metaboli


c <22

Respirat ory <35 Metaboli c >26


Urine Analysis Specimens Clean-voided urine for routine urinalysis Clean-
catch or midstream urine for urine culture Suprapubic and catheterized urine
for urine culture
Routine Urinalysis

Specimen: Clean voided Pretest: give clean vial and instruct to void directly into
the specimen bottle Intratest: Allow a 10 ml collection Post-test: prompt delivery
to laboratory *First voided urine in a.m. is highly concentrated, more uniform
concentration and with more acidic pH
Urine Culture: Normal is <100,000

Specimen: clean catch, midstream or catheterized urine Pretest: Instruct to wash


and dry genitalia/perineum with soap and water. (M)- circular motion, (F)front to
back direction Intratest: Midstream urine, 30-60 ml Post-test: Cap and label,
prompt delivery and documentation
Special Urine Collection

Infants Special urine bag Or cut a hole of the diaper (front for the boy,
middle for the girl) pulling out through the hole the special bag Children May
use potty chair or bedpan Give another vial to play with, allow parent to
assist Elderly Assistance may be required
Timed-urine collection

Collection of ALL urine voided over a specified time Refrigerated or with


preservative Pretest: Specimen container with preservative, receptacle for
collection, a post sign Intratest: At the start of collection, have patient void
and discard the urine At the end of collection period, instruct to completely void
and save the urine Post test: Documentation
Catheter specimen

Sterile urine Insert needle of the syringe through a drainage port Only done
with the rubber catheter not the plastic, silastic or silicone catheter.
Intratest: Clamp catheter x 30 mins if no urine Wipe area where needle will be
inserted 30-45° angle, 3 ml for culture Post-test : Unclamp catheter after
collection
Stool Analysis Occult Blood GUAIAC test Steatorrhea Ova/Parasites
Bacteria Viruses
General Nursing consideration for stool collection

Pretest: Determine purpose/s, obtain gloves, container and tongue blade Intratest:
Instruct to defecate in clean bed pan Void before collection Do not
discard tissue in bedpan Obtain 2.5 (1 inch) formed stool 15-30 ml of liquid
stool Post-test: prompt delivery
Occult Blood: Guaiac Test

Detect the presence of enzyme: Peroxidase (+) blue color positive guaiac
Restrict intake of red meats, some medications and Vitamin C for 3-7 days

FALSE (+): red meat, raw fruits and vegetables especially radish, turnip, melon
and horseradish; meds like aspirin, NSAIDS, iron and anticoagulants
FALSE (-): Vitamin C, ingested 250 mg per day from any source
Sputum Analysis

For Culture and sensitivity For sputum cytology For sputum AFB For monitoring of
the effectiveness of therapy
Sputum examination

Pretest: Morning specimen is collected Intratest: Mouthwash with plain water


Deeply inhale x 2 then cough Wear gloves in collecting specimen Expectorate
needed- 1-2 Tbsp or 15-30 ml Post-test: oral care and prompt delivery to lab
VISUALIZATION PROCEDURES Invasive procedures are direct methods and need CONSENT
Non-invasive procedures are indirect methods and may need written consent in
some instances
Visualization procedures They can be:

Radiographic procedures “Scopic” procedures


GIT Visualization
Barium Swallow- UGIS Pretest: written consent, NPO the night Intratest:
administer barium orally, then followed by X-ray Post-test: Laxative for
constipation, increased fluids, assess for intestinal obstruction , warn that
stool is light colored!
GIT Visualization
Barium Enema- LGIS Pretest: Informed consent, NPO the night, Enema the morning
Intratest: Position on LEFT side, administer enema, then Xray follow Post-
test: Cleansing enema , Laxative for constipation, assess for intestinal
obstruction
GIT Visualization
Esophagogastroscopy Pretest: Informed consent, NPO for 8 hours, warn that gag
reflex is abolished Intratest: Position on LEFT side during scope insertion
Post-test: NPO until gag returns. Monitor for complications
GIT Visualization

Anoscopy, proctoscopy, proctosigmoidoscopy, colonoscopy Pretest: Consent, NPO, and


enema administration the morning Intratest: Position on the LEFT side during scope
insertion Post-test: Monitor for complications
Gallbladder

Oral cholescystogram PTC ERCP Ultrasound


IV Cholecystogram

X-ray visualization of the gallbladder after administration of contrast media


intravenously Pre-test: Allergy to iodine and seafoods Intra-test: ensure patent
IV line Post-test: increase fluid intake to flush out the dye, Assess for delayed
hypersensitivity reaction to the dye like chills and N/V
Oral Cholecystogram

X-ray visualization of the gallbladder after administration of contrast media Done


10 hours after ingestion of contrast tablets Done to determine the patency of
biliary duct
Endoscopic retrograde cholangiopancreatography

Examination where a flexible endoscope is inserted into the mouth and via the
common bile duct and pancreatic duct to visualize the structures Iodinated dye can
also be injected after for the x-ray procedure
Endoscopic retrograde cholangiopancreatography

Pre-test: consent, NPO for 12 hours, Allergy to sea-foods, Atropine sulfate Intra-
test: Gag reflex is abolished, Position on LEFT side Post-test: NPO until gag
reflex returns, Position side lying and monitor for perforation and hemorrhage
Percutaneous Transhepatic Cholangiogram

Under fluoroscopy, the bile duct is entered percutaneously and injected with a dye
to observe filling of hepatic and biliary ducts
Ultrasound of the liver, gallbladder and pancreas

Consent MAY be needed Place patient on NPO!!! Laxative may be given to decrease
the bowel gas
Urinary Visualization
Non-invasive: KUB, IVP, Ultrasound Pretest: Elicit allergy to iodine and
seafood, NPO after midnight Intra-test: IV iodinated Dye is administered then
X-ray is taken Post-test: Increase fluids to flush the dye. Documentation, VS
monitoring
Urinary Visualization

Invasive: retrograde cystourethrogram Pretest: Elicit allergy to iodine and


seafood Intra-test: catheter is inserted with dye is administered then X-ray is
taken as patient voids Post-test: Increase fluids to flush the dye. Documentation,
VS monitoring
Pulmonary visualization

Invasive: Bronchoscopy, laryngoscopy Non-invasive: CXR and Scan


Bronchoscopy

Purpose: Diagnostic and therapeutic Pretest: Consent, NPO, client teaching, anti-
anxiety drugs Intratest: gag reflex is abolished, instruct to remain still during
procedure, FOWLER or SUPINE Post-test: NPO until gag reflex returns, monitor
patient for complication like perforation/bleed
Pulmonary function test

Test to determine lung volumes and capacities


LUNG VOLUMES

1. Tidal volume – TV 2. Inspiratory Reserve VolumeIRV 3. Expiratory Reserve


VolumeERV 4. Residual volume- RV
LUNG CAPACITIES
Lung volume + another lung volume 1. Inspiratory Capacity- IC 2. Functional
Residual CapacityFRC 3. Vital capacity- VC 4. Total Lung capacity- TLC
Pulmonary "Volumes” 1. Tidal Volume: -volume of air inspired or expired with
each normal breath, about 500ml 2. Inspiratory Reserve Volume -extra volume of
air than can be inspired over & beyond the normal tidal volume, about 3000ml
Pulmonary "Volumes”
3. Expiratory Reserve Volume -amount of air that can still be expired by
forceful expiration after the end of a normal tidal expiration -about 1100ml 4.
Residual Volume -volume of air still remaining in the lungs after the most
forceful expiration, averages about 1200ml
Pulmonary "Capacities:"
1. Inspiratory Capacity -equals TV + IRV, about 3500ml -amount of air that a
person can breathe beginning at the normal expiratory level & distending his lungs
to maximum amount 2. Functional Residual Capacity -equals ERV + RV -about
amount of air remaining in the lungs at the end of normal expiration, about 2300ml
Pulmonary "Capacities:"
3. Vital Capacity

-equals IRV + TV + ERV or 1C + ERV, about 4600ml -maximum amount of air that a
person can expel from the lungs after filling the lungs to their maximum extent &
expiring to the maximum extent 4. Total Lung Capacity -maximum volume to which
the lungs can be expanded with the greatest possible effort -volume of air in
the lungs at this level is equal to FRC (2300ml) in young adult
Cardiac Visualization
Invasive:

angiography. Cardiac catheterization Non-invasive: ECG, Echocardiography,


Stress ECG
The Cardiovascular System LABORATORY PROCEDURES

ECHOCARDIOGRAM Non-invasive test that studies the structural and functional


changes of the heart with the use of ultrasound No special preparation is needed
2 D-echocardiogram
Angiography

Pretest: informed consent, allergy to dyes, seafood and iodine Intratest: Monitor
VS Post-test: maintain pressure dressing over puncture site Immobilize for 6 hours
Cardiac Catheterization

Introduction of catheter into heart chambers Pretest: informed consent, allergy to


dyes, seafood and iodine, NPO 8-12 hours Intra-test: Empty bladder, Monitor VS,
explain palpitations Post-test: maintain pressure dressing over puncture site
Immobilize for 6-8 hours with extremity straight
Myelography

Radiographic examination of the spinal column and subarachnoid space to help


diagnose back pain causes Pre-test: Consent, NPO, allergy to seafoods Intra-test:
like LT Post-test: supine for 12 hours
Arthroscopy

Insertion of fiber optic scope into the joint to visualize it, perform biopsy
Performed under OR condition After care: Dressing over the puncture site for 24
hours to prevent bleeding Limit activity for several days (7 usually)
Arthrogram

X-ray visualization of the joint after introduction of contrast medium Pre-test:


consent, allergy to seafoods Post-test: Dressing over puncture site and limit
joint activity
Electromyelography

Records the electrical activity in muscles at rest and during involuntary and
electrical stimulation Detects disorders such as MG, MS and Parkinson’s Explain
the use of electrode inserted into the muscles Mild discomfort may be experienced
About 45 minutes for one muscle
CT scan
Painless,

non-invasive, xray procedure Mechanism: distinguish density of tissues


MRI

Painless, non-invasive, no radiation Creates a magnetic field Contraindications:


(+) pacemaker (+) metal prosthesis Client teaching: Lie still during the
procedure for 60-90 minutes Earplugs to reduce noise discomfort
Claustrophobia No radiation
ASPIRATION AND BIOSPY Aspiration: withdrawal of fluid Biopsy: removal and exam
of tissue Invasive procedure needs INFORMED CONSENT
Lumbar Puncture

Withdrawal of CSF from the arachnoid space Purpose: diagnostic and therapeutic To
obtain specimen, relieve pressure and inject medication Pretest: consent, empty
bladder
Lumbar Puncture

Intra-test: Site used-between L4/L5 Position- flexion of the trunk Post-test:


Flat on bed (8-12 hours) Offer fluids to 3 Liters Oral analgesic for
headache Monitor bleeding, swelling and changes in neurologic status
Abdominal Paracentesis

Withdrawal of fluid from the peritoneal space Purpose: diagnostic and therapeutic
Pretest: consent, empty bladder
Position:

sitting Site: midway between the umbilicus and symphysis


Abdominal Paracentesis

Intratest: 1,500 ml maximum amount collected at one time, Monitor VS Post-test:


monitor VS, bleeding complication
Measure

abdominal girth and

weight
Thoracentesis
Removal of fluid from the pleural space Purpose: Diagnostic and therapeutic
Pretest: Consent, teach to avoid coughing Position: sitting with arms above head
Thoracentesis

Intra-test: Support and observation Post-test: Assess VS Position Post-


procedure: lie on the UNAFFECTED SIDE with head elevated 30° x 30 minutes to
facilitate expansion of the affected lungs
Bone marrow Biopsy

Removal of specimen of bone marrow Purpose: diagnostic Pretest: consent, teach


that procedure is painful
Site:

POSTERIOR SUPERIOR ILIAC CREST (adult); PROXIMAL TIBIA (pedia) Position: prone
or lateral
Bone marrow Biopsy

Intratest: Monitor, maintain pressure dressing over punctured site X 10 mins Post-
test: Asses for discomfort, administer prescribed pain meds
Liver Biopsy Liver tissue obtained for diagnostic purpose Pretest: consent,
administer Vitamin K, monitor bleeding parameters, NPO 2 hours before procedure
Position: Supine or semi-fowlers with upper right quadrant of abdomen exposed
Liver Biopsy

Intra-test: Monitor VS Take few deep inhalation and exhalation and hold final
breath in exhalation x 10 seconds as needle is injected Post-test: monitor VS,
bleeding Position post-procedure: RIGHT side-lying with folded towel/pillow
under biopsy site for 4-6 hours
Papanicolau Smear

Done as screening test for cervical cancer, for culture Pre-test: no coitus for 2-
3 days, no menstrual bleeding Intra-test: Lithotomy, speculum with water for
lubrication, specimen obtained for cervix and vagina Post-test: monitor for
bleeding
The Cardiovascular System LABORATORY PROCEDURES

ELECTROCARDIOGRAM (ECG) A non-invasive procedure that evaluates the electrical


activity of the heart Electrodes and wires are attached to the patient
What the waves represent?

P wave= Atrial Depolarization QRS= Ventricular Depolarization T wave= Ventricular


REPOLARIZATION
LABORATORY PROCEDURES

CVP The CVP is the pressure within the SVC Reflects the pressure under which
blood is returned to the SVC and right atrium
LABORATORY PROCEDURES

CVP Normal CVP is 0 to 8 mmHg/ 4-10 cm H2O


LABORATORY PROCEDURES Measuring CVP 1. Position the client supine with bed
elevated at 45 degrees (CBQ) 2. Position the zero point of the CVP line at the
level of the right atrium. Usually this is at the MAL, 4th ICS 3. Instruct the
client to be relaxed and avoid coughing and straining.
Tubes

Levine Salem Sump tube Gastrostomy tube Jejunostomy tube


Drainage

Penrose Drain Hemovac Pleuravac Jackson-Pratt


Asked in the local boards
DRE Snellen’s

chart Weber’s test Rinnes’ test


DRE

Position: Left Lateral or Sim’s position with upper leg acutely flexed. Females
can also be examined in lithotomy Ask client to BEAR DOWN To accentuate rectal
fissure, prolapse ,polyps To relax the anal sphincter
Snellen’s Chart: test for visual acuity 20 ft or 6 m distance 3 readings: L, R
and Both eyes Report: 20/ xxx Numerator: denotes the distance from the chart
Snellen’s Chart: test for visual acuity
Denominator

denotes the distance from which the normal eye can read the chart 20/60: the
person can see at 20 feet, what a normal person can see at 60 feet.
Weber’s test

Test for lateralization and bone conduction Tuning fork is placed on top of head
NORMAL: sound is heard in BOTH ears, localized at the center of the head: WEBER
NEGATIVE
Weber’s test

Sound is heard BETTER in the affected ear: Bone conductive hearing loss Sound is
heard only or better on the NORMAL ear: Sensorineural heating loss ABNORMAL: WEBER
POSITIVE
Rinne’s Test

Test for AIR and BONE conduction Tuning fork is initially placed on the mastoid
process until no vibration is heard Tuning fork is now placed in front of the ear
until sound disappears
Rinne’s Test
Air

conduction is LONGER than bone conduction is POSITIVE

Normal

Rinne’s
Rinne’s Test

CONDUCTIVE HEARING LOSS: Bone conduction is GREATER than or equal to the AIR
conduction Abnormal is NEGATIVE RINNEs
Rinne’s Test

SENSORINEURAL HEARING LOSS: No bone conduction and air conduction vibration can
be assessed NEGATIVE RINNEs
Weber
Rinne’s
Rinne’s
FAILING TO PREPARE IS PREPARING TO FAIL…