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Specimen collection and diagnostic tests
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  • 1. Pr epar ed ByRekha Vi ndhya Sr ee. R. R.M . N .SN Hyder abad, I ndi a.
  • 2. Supplements, Must knows Know normal values first Disease conditions and the significance of certain laboratory data Positioning for this tests Purpose and nursing alert Specimen collection and patient preparation Post test resposibilities
  • 3. URINE Clean-catch urine specimen For routine urinalysis and culture and sensitivity test Perineal care before collection The best time to collect the specimen is early in the morning (first voided-specimen) Amount needed: 30-50 cc for urinalysis; 5-10 ml for culture and sensitivity test
  • 4. 24 hours urine specimen Discard the first voided urine Soak specimen in a container of ice Add preservative as ordered and indicate in the label the type of preservative added.
  • 5. Second voided urine specimen Ask the patient to urinate and discard the first urine specimen and offer a glass of water afterwards After few minutes, ask the client to void again and collect the specimen Catheterize urine specimen Clamp the catheter for 45 mins Practice aseptic technique Do not collect specimen from the urine bag Obtain 3-5 ml of specimen for culture and sensitivity test and 10-15 ml for urinalysis
  • 6. STOOL SPECIMENRoutine fecalysis Use to assess gross appearance, and presence of ova or parasite in the stool Sterile specimen container must be secured Instruct the client to defecate in the bedpan and obtain 1tbsp or 1 inch long stool specimen using a sterile tongue depressor Label the specimen and bring immediately to the laboratory
  • 7. Stool culture and sensitivity test This is done to assess for specific microorganisms and etiologic agents causing gastroenteritis, and bacterial sensitivity to various antibiotics Sterile technique must be employed Label the specimen properly and send immediately to the laboratory
  • 8. Guiac stool exam (occult blood) It detects bleeding at the gi tract and cancer of the stomach Meatless diet for 3 days prior to the procedure No to red or dark colored foods tom prevent false positive result No to iron: discontinue temporarily for 3 days prior to the procedure
  • 9. SPUTUM SPECIMEN Gross appearance Collect early morning specimen Sterile container must be used Mouth care before: gargle only with water (no to mouthwash, or toothpaste) Instruct the client to deep breath and hack-up sputum from the lungs.
  • 10. Sputum cultrure and sensitivity test Used to assess the etiologic agent causing respiratory tract infection and bacterial sensitivity to various antibioticsAcid fast bacillus (afb) staining To determine active ptb Sputum specimen is collected in 3 consecutive mornings Papanicolao or cytologic examination of the sputum To assess for cancer cells
  • 11. BLOOD SPECIMEN Blood tests that does not require fasting: Complete blood count Hemoglobin Hematocrit level test Clotting studies Enzyme studies Serum electrolyte studies
  • 12.  Requires fasting Fasting blood sugar Blood urea nitrogen Serum creatinine Serum lipids (cholesterol level, glyceride level)
  • 13. BODY SECRETIONS Culture and sensitivity test To assess causative agent causing infection, and bacterial sensitivity to various antibiotics Practice aseptic technique
  • 14. ARTERIAL BLOOD GAS ANALYSIS Purpose: to monitor the patient’s response to oxygen therapy and detects the presence of acid-base balance.Nursing keypoints: No to suctioning prior to obtaining blood specimen Assess for bleeding and hematoma at the puncture site
  • 15.  Apply firm pressure at the puncture site for 5- 10 minutes Specimen should be placed in iced-container Assess for metabolic alkalosis for patient with vomiting, and on the other hand, observe for signs and symptoms of metabolic acidosis for patients with diarrhea.
  • 16. BARIUM ENEMA Purpose: to assess the large intestinesNursing keypoints: Provide a liquid diet before the procedure. Ensure that a laxative is given before the procedure to promote better visualization, and after the procedure to prevent constipation
  • 17.  Report to the doctor if bowel movement does not occur in 2 days Instruct the patient to increase fluids and eat foods rich in fiber The patient should also increase intake of fluids
  • 18. BARIUM SWALLOW Purpose: to assess for the esophagus, stomach, and some portion of the small intestines.Nursing alert: Npo for 6-8 hours before the procedure Laxative is administered after the procedure to counteract the constipating effects of the barium Withhold anticholinergics and narcotics for 24 hours before the test Instruct patient to increase fluids and intake of fiber-rich foods
  • 19. CARDIAC CATHETERIZATION Purposes: to measure oxygen concentration, saturation, tension and pressure in various chambers of the heart. To determine a need for cardiac surgery.Nursing keypoints: Check for informed consent Assess allergy to iodine Npo for 6-8 hours before the procedure Check for distal pulses after the procedure
  • 20.  Check for bleeding at the arterial puncture site and apply pressure Keep a 20 lbs sandbag at the bedside as a pressure instrument if bleeding occurs Keep the patient flat on bed with the lower extremities hyperextended for 4-6 hours Neurovascular assessment must be performed distal to the catheter insertion site and report any abnormal findings
  • 21. CHEST X-RAY Purpose: to detect abnormalities of the organs in the thoracic areaNursing keypoints: Remove any metallic object before the procedure Lead shield for women of childbearing age
  • 22. CT SCAN Purpose: provides photograph of tissue densities with the use of radiation.Nursing alert: If contrast medium will be used, assess for any allergy to iodine and instruct the patient to be on npo for 4 hours prior to the procedure Assess for any fear of close spaces (claustrophobia) This procedure is contraindicated to patients who are pregnant and obese (>300 lbs) Let the patient lye still during the whole course of the procedure
  • 23. CVP (CENTRAL VENOUS PRESSURE) MONITORING Purpose: it measures the pressure of the right atriumNursing keypoints: The nurse should place the zero level of the manometer at the level of the right atrium at the 4th intercostals space to get an accurate reading Instruct the client to avoid coughing and straining as it alters the readings Normal CVP reading is 2-12 mm Hg ( when the tube is at the superior vena cava)
  • 24. CYSTOSCOPY Purpose: to assess the bladder and urethraNursing keypoints: Check for the informed consent. If general anesthesia will be used have the client on NPO; liquid diet if local anesthesia will be used.
  • 25.  Monitor intake and output. After: force fluids as prescribed. Administer sitz bath for abdominal pain. Pink-tinged or tea-colored urine is expected. Notify the doctor if bright red urine or clots occur.
  • 26. DOPPLER ULTRASOUND Purpose: evaluates patency of veins and arteries in the ower extremities.Nursing keypoint: Inform the patient that it is painless.
  • 27. ECG (ELECTROCARDIOGRAM) Purpose: records electrical waves of the heart.Nursing keypoints: Instruct the patient to lie still, breathe normally during the procedure Let the patient refrain from talking during the test. ST segment elevation or T wave inversion, indicates MI
  • 28. EEG (ELECTROENCEPHALOGRAM) Purposes: records the electrical activity of the brain, detects intracranial hemorrhage and tumorsNursing keypoints: Advise the client to shampoo hair before and after the procedure If the electrode gel is non removed by shampooing, the patient may use acetone Withhold stimulants, antidepressants, tranquilizers, and anticonvulsants for 24-48 hours prior to the test
  • 29. FASTING BLOOD SUGAR LEVEL Purpose: detects diabetes mellitusNursing keypoints: Normal blood sugar level is 80-120 mg/dl A blood sugar level of more than 140 mg./dl confirms diabetes.
  • 30. GASTRIC ANALYSIS Purposes: this test is used to detect ulcers, and to rule-out pernicious anemia. It may also be done to analyze acidity, appearance and volume of gastric secretionsNursing keypoints: In gastric ulcer, Hcl is normal, In duodenal ulcer, Hcl is elevated. Refrigerate gastric samples if not tested within 4 hours.
  • 31. IVP (INTRAVENOUS PYELOGRAPHY) Purpose: visualization of the urinary tractNursing keypoints: Check for the consent. NPO for 8-10 hours before the procedure Administer laxative to clear bowels before the procedure.
  • 32.  Check for allergy to iodine, seafoods or shellfish before the procedure since the procedure requires the use of iodine based dye. Keep epinephrine at the bedside to counteract possible allergic reaction. IVP requires the use of a contrast medium while KUB does not. Inform the patient about the possible salty taste that may be experienced during the test. Increase fluid intake after the procedure to facilitate excretion of the dye.
  • 33. KUB Purpose: determines the size, shape and position of kidneys, ureters and bladder. Nursing keypoint: No special preparation needed.
  • 34. LIVER BIOPSY Purpose: to determine liver disorders.Nursing keypoints: Check for the consent. Obtain the result of blood tests before biopsy since bleeding may occur Let the patient assume left side or supine during biopsy
  • 35.  Instruct the patient to inhale, exhale and hold breath during the insertion of to stabilize position of the liver and prevent accidental puncture of the diaphragm Position the patient on the right side after liver biopsy with pillows underneath to prevent bleeding Bed Rest for 24 hours after the procedure
  • 36. LUMBAR PUNCTURE Purpose: to withdraw csf to determine abnormalities.Nursing keypoints: Before the procedure: empty bladder and bowel. Position: c-position. (fetal posistion) During the procedure: Needle is inserted between l3 - l4 or l4-l5 to prevent accidental puncture to the spinal cord since the spinal cord ends at l2. After: position the patient flat for 6-12 hours to prevent spinal headache. Increase fluid intake.
  • 37. MAMMOGRAPHYPurpose: Detects the presence of breast tumor.Nursing keypoints: Instruct the patient not to use deodorant, talcum powder, lotion, perfume or any ointment on the day of exam as these may give false-positive result Let the patient know that her breasts will be compressed between 2 x-ray plates
  • 38.  Provide teachings related to self-breast examination Done 7 days after menstruation Position: lying down with pillow under the shoulder of the breast being examined or sitting in front of a mirror while raising the hands of the side of the breast being examined.
  • 39. MANTOUX TEST Purpose: a test to determine exposure to tbNursing keypoints: A positive test yields an induration of 10 mm. Or more for foreign born children below 4 years old An induration of 5 mm or more is considered positive in patients with HIV, with treated TB, and if he has had a direct exposure TB patients.
  • 40.  BCG may cause false positive reaction. Assess for previous history of PTB and report immediately to the doctor Result is read after 48-72 hours
  • 41. MRI (MAGNETIC RESONANCE IMAGING) Purpose: provides cross-sectional images of brain tissues, more detailed than a ct scan. Nursing keypoints: Contraindications: Pregnant women, Obesity (more than 300 lbs.), Claustrophobic patients, Patients with unstable vital signs Patients with metal implants like pacemaker, hip replacements and jewelries.
  • 42. PARACENTESIS Purposes: to assess the contents of the peritoneal fluidNursing keypoints: Check for consent. Instruct the patient to void prior to the procedure to prevent accidental puncture of the bladder During the procedure, instruct the patient to sit up with feet resting on footstool.
  • 43.  Patient is weighed before and after the procedure. Evaluate the effect of the procedure by assessing: Weight Abdominal girth Respiratory rate Pulse rate Notify the physician if the urine becomes bloody, pink or red.
  • 44. RINNE’S TEST Purpose: used to detect conductive hearing loss. To compare air conduction with bone conductionNursing keypoints: The vibrating tuning fork is shifted between two positions: against the mastoid bone (bone conduction) and two inches from the opening of the ear canal (air conduction). In conductive hearing loss, bone conduction lasts longer than air conduction.
  • 45. SCHILLING’S TEST Purpose: used to detect vitamin b12 absorption.Nursing keypoints: Excretion of 8%-40% of ingested radioactive vitamin b12 within 24 hours is normal; excreting more than 40% indicates pernicious anemia. Requires 24-hour urine specimen. Keep the patient NPO except for water, 8-12 hours before the test.
  • 46. SPUTUM EXAM Purpose: determines the presence of microorganisms in the sputum.Nursing keypoints: Instruct patient to rinse mouth with water ( no to mouth wash or tooth paste) Specimen is collected upon rising Amount required: 15 ml Instruct the patient to take several deep breaths and then cough deeply.
  • 47. STOOL ANALYSIS Purpose: assessment of bacteria, virus, malabsorption and blood.Nursing keypoint: Avoid aspirin, red meat and vitamin c three days before the test as these may give a false positive result.
  • 48. SWAN-GANZ CATHETERIZATION Purpose: used to monitor pulmonary artery pressure (pap) and pulmonary capillary wedge pressure (pcwp)Nursing keypoints: The catheter has four lumens (one for CVP, one for fluid infusion and venous access for blood samples, one for monitoring PAP and PCWP and the last lumen is used for inflation and deflation of the balloon.
  • 49.  If a fifth lumen exists, it is used for measuring oxygen saturation of the blood. The normal adult PAP systotic and diastolic pressure is 20 to 30 mm hg. The normal PCWP is 8-13 mm hg. The only time the balloon should be inflated after it is in place is when obtaining further PCWP readings.
  • 50. TONOMETRY Purpose: measures intraocular pressure.Nursing keypopints: Normal reading is 12-21 mm. Hg. A reading of 25 mm./hg. Indicates glaucoma.
  • 51. URINALYSIS Purpose: to assess characteristics of urine.Nursing keypoints: First voided morning sample preferred: 15 ml. Use clean container Decreased specific gravity: Diabetes Insipidus Increased specific gravity: Diabetes Mellitus, Dehydration, SIADH (+) protein: PIH, Nephrotic syndrome. (+) glucose: Diabetes Mellitus, Infection
  • 52. URINE COLLECTION, 24 HOUR Purpose: determines the excretion of substances from the kidneys, adrenal glands and the stomach.Nursing keypoint: Required for ACTH test and Schilling’s test. Discard the first voided urine
  • 53. X-RAY Purpose: provides radiological data for assessment of certain organs and bones.Nursing keypoints: Assess the patients ‘ exposure level to radiation Let the patient removed all jewelries and other metallic objects before the procedure