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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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