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Common Laboratory Procedures

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Common Laboratory Procedures Common Laboratory Procedures Presentation Transcript

  • Common Laboratory procedures: Nursing Responsibilities and Implications pinoynursing.webkotoh.com
  • 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
  • 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 PARASITIC infection Increased Eosinophils CHRONIC bacterial infection VIRAL infection Increased Lymphocytes ACUTE bacterial infection Increased Neutrophils More than 10, 000 Increased WBC (Leukocytosis) 5-10,000 cell/cm3 Normal WBC count
  • 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 SLE diagnosis Anti-DNA antibody For Rheumatoid arthritis Rheumatoid factor Gout detection Uric acid Identifies Cardiac damage or muscle damage CK-MB, LDH and Troponin Liver function test SGOT/SGPT Purpose Enzymes/acids
  • Blood Chemistry Measures Platelet function Bleeding time 1-9 minutes Same as PTT, measures effectiveness of HEPARIN (more specific than PTT) aPTT 30-40 seconds The BEST single screening test for coagulation disorders PTT 60-70 seconds Measures the effectiveness of Warfarin PT 12-16 seconds Purpose Coagulation studies
  • Blood Chemistry To detect hyperlipidemia Blood lipids Cholesterol= 150-200 mg/dL Triglycerides= 140-200 mg/dL Measures the rate at which the RBCs settle out of the anti-coagulated blood Elevates in inflammation auto immune diseases ESR (erythrocyte sedimentation rate) 10-20 mm/hour Purpose Others
  • Diabetes Mellitus
    • DIAGNOSTIC CRITERIA
    • FBS equal to or greater than 126 mg/dL (7.0mmol/L)
      • (Normal 8 hour FBS- 80-109 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
      • 140 mg/dL
  • 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 medication
  • 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 Metabolic >26 Metabolic <22 22-26 mEq/L HCO3 Respiratory <35 Respiratory >45 35-45 mmHg paCO2 95-98% SaO2 95-100 mmHg paO2 Above 7.45 Below 7.35 7.35-7.45 pH Alkalosis Acidosis Normal Value
  • Urine exams
  • 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: A t 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 Exams
  • 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 Exams
  • 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: DIRECT and INDIRECT
  • 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
  • GI tract Visualization
  • 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 X-ray 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 sea-foods
    • 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
  • 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 test
  • 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 Volume- IRV
    • 3. Expiratory Reserve Volume- ERV
    • 4. Residual volume- RV
  • LUNG CAPACITIES
    • Lung volume + another lung volume
    • 1. Inspiratory Capacity- IC
    • 2. Functional Residual Capacity- FRC
    • 3. Vital capacity- VC
    • 4. Total Lung capacity- TLC
  • Pulmonary &quot;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 &quot;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 &quot;Capacities:&quot;
    • 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 &quot;Capacities:&quot;
    • 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
  • Heart exams
  • 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
  •  
  • arteriography
  • 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
  • Spinal column
  • Myelography
    • Radiographic examination of the spinal column and sub-arachnoid space to help diagnose back pain causes
    • Pre-test: Consent, NPO, allergy to seafoods
    • Intra-test: like LT
    • Post-test: supine for 12 hours
  • Myelography
  • 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
  •  
  • Scans
  • CT scan
    • Painless, non-invasive, x-ray 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
  • MRI
  • PET scan
  • Bone Scan
  • Aspiration and Biopsy
  • 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
  • Thoracentesis
  •  
  • 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
  • Others
  • 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, 4 th ICS
    • 3. Instruct the client to be relaxed and avoid coughing and straining.
  •  
  • Tubes and drainage
  • Tubes
    • Levine
    • Salem Sump tube
    • Gastrostomy tube
    • Jejunostomy tube
  • Salem Sump tube
  •  
  • T-tube
  • Drainage
    • Penrose Drain
    • Hemovac
    • Pleuravac
    • Jackson-Pratt
  • Hemovac
  • Jackson-Pratt
  • Penrose
  • 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
    • Normal is POSITIVE 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…
  • END