diagnostic test.pptx

7/27/2019 diagnostic test.pptx

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Diagnostic TestsSHUROUQ QADOSE


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Diagnostic and laboratory Tests:

Are tools that provide information about theclient, also run to find the cause of disease or

discomfort; tests used to make a diagnosis.

Purpose of diagnostic tests: Help to confirm a diagnosis

Monitor an illness

Provide valuable information about the clientsresponse to treatment


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Diagnostic testing involves three phases:-

Pretest

The major focus of the pretest phase is clientpreparation

The nurse must know what

equipment and supplies areneeded for the specific test

What type of sample will beneeded and how it will becollected?

Does the client need to stop oralintake for a certain number of

hours prior to the test?


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Does the test include

administration of contrast media

and if so, it is injected orswallowed?

Are medications given or

withheld? Is consent form required?

How long is the test?


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Intratest

It focuses on specimen collection and performing

or assisting with certain diagnostic testing.

The nurses uses of special standard

precautions and sterile techniques

Provide emotional and physical support while

monitoring the client as needed (e.g., V /S,

pulse oximetry, ECG).

Correct labeling, storage, and transportation of

the specimen to avoid invalid test results.


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Post test

The focus of this phase is on nursing care of theclient and follow up activities and

observations.

Compare the previous and current test results Modify nursing interventions as needed

Report the results to appropriate health team

members.


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Blood Tests

Complete Blood Count (CBC) which

includes:-Hemoglobin

Hgb test is a measure of the total amount ofhemoglobin in the blood

Hematocrit

Hct measures the percentage of red blood cellsin the total blood volume


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RBC count

The number of RBC per cubic millimeter

(mm3) of whole blood

WBC or leukocyte

The number of circulating WBC per cubic

millimeter of whole blood


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Serum Electrolytes

Ordered as a screening test for electrolyte andacidbase imbalance.

The most commonly ordered serum tests arefor sodium, potassium, chloride , andbicarbonate

Evaluate renal function Urea, Creatinine Urea, the end product of protein metabolism is

measured as BUN. Creatinine is produced inrelatively constant quantities by the muscles

and is excreted by the kidneys.


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Serum Osmolality

Serum Osmolality: is a measure of the solute

concentration of the blood. The particlesincluded are sodium ions, glucose, and urea.

It is estimated by doubling the serum sodium

Serum Osmolality values are used to evaluatefluid balance

Normal values are 280-300 mOsm/kg.

An increase in Osmolality indicates a fluid

volume deficit


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Drug monitoring

Is conducted when the client is taking a

medication with narrow therapeutic range suchas digoxin.

This includes monitoring drawing blood

samples for peak and trough levels todetermine if the blood serum levels of aspecific drug are at a therapeutic level and nota sub therapeutic or toxic level.

Peak level: the highest concentration of thedrug in the blood serum

Trough level: lowest concentration


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Arterial Blood Gases ABGs

Take specimen of the ABG from the radial, Brachial,

femoral arteries.

Need to apply pressure to the puncture side for about

5-10 minutes after removing the needle.


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Blood Chemistry

Certain enzymes such as Lactic dehydrogenaseLDH, Creatine Kinase CK , serumglucose,hormones such as thyroid hormone,cholesterol and triglycerides.

A common test is the glycosylate hemoglobinHbA1C, which is a measurement of bloodglucose that is bound to hemoglobin. HbA1C

is reflection of how well blood glucose levelshave been controlled during the prior 3 to 4months.


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Capillary Blood Glucose

Measure blood glucose when frequent tests are

required or a veinpuncture cannot be performed.

Less painful, easily performed


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Specimen Collection

Nurses always assume the responsibility for specimen

collection depending on the type of specimen and

skill required.


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Nursing responsibilities with specimencollection

Explain the purpose of specimen collection

and the procedure for obtaining the specimen. Provide client comfort, privacy, and safety.

Use the correct procedure for obtaining the

specimen collection. Note relevant information on the laboratory

requisition slip such as medication the client istaking that may affect the results.

Transport the specimen to the laboratorypromptly to have more correct results.

Report abnormal results to the health careprovider


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Stool Specimens

Reasons for testing feces include the

following:

To determine the presence of occult blood

hidden blood. This test is referred to as the

guaiac test.

To analyze for dietary products and digestive

secretions. An excessive amount of fat in the

stool (steatorrhea) can indicate faulty

absorption of fat from the small intestine.

Decreased amount of bile in stool indicate

obstruction in bile flow from liver and

gallbladder to the intestine.


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To detect the presence of ova and parasites.

When collecting specimen for parasites, it is

important to send the specimen as soon as

possible while it is still warm.

To detect the presence of bacteria or viruses,

so the container must be sterile and aseptic

technique in collection.


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Collecting Stool Specimens

Before obtaining the specimen, the nurse must

determine the reason for the collecting the stool

specimen and the correct method of obtaining and

handling.

Nurse need to give the clients the following

instructions: Defecate in a clean bedpan or bedside commode.

Do not contaminate the specimen by urine or

menstrual discharge.

Do not place toilet tissues in the bedpan after

defecation.

Notify the nurse as soon as possible after defecation

to send the specimen as soon as possible.


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When obtaining the specimen the nurse

should:-

Follow medical aseptic techniquemeticulously.

Wear disposable gloves to prevent hand

contamination and take care not to contaminatethe outside of the specimen container.

Use one or two clean tongue blades to transfer

the specimen to the container. The amount of stool to be sent depends on the

purpose for which the specimen is collected.


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Label the specimen and the laboratory

requisition have the correct information on

them. Sends the specimen to the laboratory

immediately.

Document all relevant information, date, timeof collection and all nursing assessments

color, odor, consistency and amount of feces.


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Testing Feces for Occult Blood

Use of chemical reagent substance to detect thepresence of the enzyme peroxidase in the hemoglobin

molecule.

A blue color indicates a guaiac positive result, that is,

the presence of occult blood. No color change or anycolor other than blue is a negative finding, indicating

the absence of blood in the stool.


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Certain foods, medications, and vitamin C canproduce incorrect test results.

False positive results can occur if the client hasrecently ingested (a) red meat (b) rawvegetables or fruits, (c) certain medicationsthat irritate the gastric mucosa and causebleeding such as aspirin, NSAID,anticoagulants.

Falsenegative results can occur if the clienthas taken more than 250mgper day of vitamin

C up to 3 days before the testeven ifbleeding is present.


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Positive guaiac test shown on right, as

would be seen for this patient. Negativeresult (on left) included for comparison.


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Urine Specimens

The nurse is responsible for collecting urine specimens

for a number of tests: Clean voided specimens forroutine urinalysis, cleancatch or midstream urine

specimens for urine culture, timed urine specimen,

indwelling catheter specimen.


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Clean voided Urine Specimen

Usually done on the first voided specimen in the

morning At least 10 ml of urine sufficient for routine analysis

Client who is disabled, seriously ill or disoriented mayneed to use a bedpan or urinal in bed, these need

special instructions: The specimen must be free of fecal

contamination

Dont discard the toilet tissue in bedpan

Put the lid tightly on the container to preventspillage of the urine.

If the outside of container is contaminated, cleanit with a disinfectant.


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The nurse must:- Make sure that the specimen label with laboratory

requisition carry the correct information and

attach them securely to the specimen.


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Clean-Catch or Midstream Urine Specimen

It is collected when a urine culture is ordered toidentify microorganisms causing urinary tract

infection. Care is taken to ensure that the specimen isas free as possible from contamination around theurinary meatus.

Cleancatch specimens are collected into a sterilespecimen container with a lid.

Clean the urinary meatus with antiseptic solution

Instruct the client to start voiding

Collect 30-60 ml of urine in the container.

Label the specimen and transport it to the laboratory.


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Timed Urine Specimen

It requires collection of all urine produced and

voided over a specific period of time, ranging

from 1-2 hours to -24 hours. Each voiding of

urine is collected in a small, clean container

and then emptied immediately into the largerefrigerated bottle or carton.


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It is done for the following purposes: To assess the ability of the kidney to concentrate and

dilute urine.

To determine disorders of glucose metabolism such as

DM.

To determine levels of specific constitutes such asalbumin, creatinine.


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To collect the time urine specimen:

Obtain the specimen with preservative from thelaboratory. Label the container with identifying

information for the client, the test to beperformed, time started, and time of completion.

Provide a clean receptacle to collect urine(bedpan).

Post signs in the clients chart, room, alerting theperson to save all urine during the specified time.

At the start of the collection period, discard thefirst voiding

Save all urine produced during the time collectionperiod in the container.

At the end of collection, ask the pt to void the lasttime and add them in the container.

Record collection of the specimen, timed started

and completed.


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Urine Testing

Several simple urine tests are often done by nurses onthe nursing units. These include tests for specific

gravity, PH, and the presence of abnormal constituent

such as glucose, ketones, protein.

Specific gravityis indicator of urine concentration,or the amount of solutes present in the urine

Normally ranges from 1.010 to 1.025

PH is measured to determine the relative acidity oralkalinity of urine (7 is neutral, less than 7 is acidic,

greater than 7 is alkaline).


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Glucoseurine is tested for glucose to screen

clients for diabetes mellitus and to assess

clients for abnormal glucose to toleranceduring pregnancy.

Ketonesketones bodies a product of the

breakdown of fatty acids normally are notpresent in the urine.

Protein

Occult blood

Osmolalityis measure of the solute

concentration of urine. Normal values are 500

to 800 mOsm/kg.


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Sputum specimen

Sputum is the mucous secretion from the lungs,

bronchi, and trachea.

A sputum trap is used when the specimen is

obtained by suctioning.

Sputum collection for the following purposes:

For culture and sensitivity to identify a specific

microorganisms

For cytology to identify the origin, structure, function

and pathology of cells. For acid-fast bacillus for TB.

To assess the effectiveness of therapy.


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Throat Culture

A throat culture sample is collected from the mucosaof the oropharynx and tonsillar regions using a

culture swab.

Obtaining a throat culture is an invasive procedure

that requires the application of scientific knowledge

and potential problem solving to ensure client safety.


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Visualization Procedures

It includes indirect visualization (noninvasive) and

direct visualization (invasive) techniques forvisualizing body organ and system function.

Clients with Gastro intestinal Alteration:

Direct visualization techniques include: Anoscopy: viewing of the anal canal

Proctoscopy: viewing of the rectum

Proctosigmoidoscopy: viewing the rectum andsigmoid colon

Colonoscopy: viewing of the large intestine.


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Indirect visualization of the gastrointestinal tract is

achieved by:

X-rays of gastrointestinal tract can detect structure,obstructions, tumors, ulcers, inflammatory diseases or

other structural changes such as hiatal hernias.

Visualization of the tract is enhanced by the use of a

barium. For examination of the upper gastrointestinaltract or small bowel, the client drinks the barium

sulfate (barium swallow). For examination of the

lower gastrointestinal tract, the client is given an

enema containing the barium (Barium enema).


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Barium Swallow


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Upper endoscopy

Clients with Urinary Alterations


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Clients with Urinary Alterations

Visualization procedures also may be used to evaluateurinary function.

An X

ray of the KUB: Kidneys, Ureters, Bladder IVP (Intravenous pyelography)contrast medium

is injected intravenously.

Retrograde pyelographycontrast medium isinstilled directly into the kidney pelvis via the urethra,

bladder, and ureters following injection or instillationof the contrast medium, x- ray are taken to evaluateurinary tract structures.

Ultrasonography: noninvasive test that uses

reflected sound waves to visualize the kidney. Cystoscopy: a lighted instrument inserted through the

urethra to visualize the bladder, urethral orificesand urethra.


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Clients with cardio pulmonary Alterations

ECG: Electrocardiography, recording of the hearts

electrical activity.

Electrocardiogram: Detect arrhythmias and

alteration in conduction indicative of myocardial

damage, enlargement of the heart, or drug effects.


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Stress electrocardiography:Assess the clients

response to an increased cardiac workload during

exercise.

Angiography: invasive procedure requiring informed

consent of the client. A radiopaque dye is injected

into the vessels to be examined. Using x-rays the flowthrough the vessels is assessed and areas of narrowing

or blockage can be observed.

Echocardiogram: noninvasive test that uses ultra

sound to visualize structures of the heart and evaluateleft ventricular function.


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Lung scan

Also known as V/Q (Ventilation / perfusion) scan,records emissions from radioisotopes that indicate

how well gas and blood are traveling through the

lungs.

Laryngoscopy and bronchoscopy are sterileprocedure. Tissue samples may also be taken for

biopsy.


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Computed Tomography (CT) or (CAT)


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Computed Tomography (CT) or (CAT)

Painless, noninvasive x-ray procedure that has the

unique capabilities of distinguishing minor

differences in the density of tissues. It produce a

threedimensional image of the organ or structure.


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Magnetic Resonance Imaging (MRI)

Is a noninvasive diagnostic scanning technique in

which the client is placed in a magnatic field. MRIprovides a better contrast between normal and

abnormal tissue than the CT scan. For visualization of

the brain, spine, limbs, and joints, heart, blood

vessels, abdomen and pelvis. The procedure lasts

between 60 and 90 minutes.


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Aspiration/Biopsy

Aspiration: withdrawal of fluid that has abnormallycollected such as pleural cavity, abdominal cavity.

Biopsy: removal and examination of tissues. Usually

performed to determine a diagnosis or to detectmalignancy. Both aspiration and biopsy it needs

sterile techniques.

Determine if the facility requires a signed informed-

consent from the aspiration / biopsy procedures


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Lumbar Puncture

In lumbar puncture LP CSF is withdrawn

through a needle inserted into the subarachnoidspace of the spinal canal between the third and

fourth lumbar vertebrae or between the fourth

and fifth lumbar vertebrae.


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Abdominal Paracentesis

Normally the body creates just enough peritonealfluid for lubrication. The fluid is continuously

formed and absorbed into the lymphatic

system.

Ascites: large amount of fluid accumulates in the

abdominal cavity.

Abd i l P i i d b i


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Abdominal Paracentesis: carried out to obtain a

fluid specimen for laboratory study and to

relieve pressure on the abdominal organs dueto the presence of excess fluid. A common site

for abdominal Paracentesis is the midway

between the umbilicus and the symphysispubis on the midline. Normally about 1,500 ml

is the maximum amount of fluid drained at one

time to avoid Hypovolemic shock.


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Thoracentesis

Normally, only sufficient fluid to lubricate the

pleura is present in the pleural cavity.However, excessive fluid can be accumulatingas a result of injury, infection, or otherpathology. It is performed to remove the

excess fluid or air to ease breathing. Also it isperformed to introduce chemotherapeuticdrugs intrapleurally.

This is usually a sitting position with the arms


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This is usually a sitting position with the arms

above the head, which spreads the ribs and

enlarges the intercostals space. Or in which theclient leans forward over a pillow.

A site on the lower posterior chest is often used

to remove fluid, and a site on the upperanterior chest is used to remove air.


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Bone Marrow biopsy

Biopsies are performed on many different types oftissues such as bone marrow, liver, breast, lymphnodes and lungs. The bones of the body commonlyused for a bone marrow biopsy are the sternum, iliaccrests, anterior or posterior iliac crest spines, and

proximal tibia in children. The posterior superior iliaccrest is the preferred site with the client placed proneor on the side. 1-2 ml of bone marrow was withdraw.


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Liver biopsy

It is performed at the clients bedside, in which asample of liver tissue is aspirated. A physicianinserted a needle in the intercostals space betweentwo of the right lower ribs and into the liver orthrough the abdomen below the right the right ribcage. The nurse applies pressure to the site to prevent

bleeding, often by positioning the client on the biopsysite.


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