Clinical case

1. LABORATORY & DIAGNOSTIC PROCEDURES
Diagnostic/
Laboratory
Procedure
Date
ordered/
Date done
Indication/ Purposes Result Analysis and
interpretation of
results ( related to
the disease )
Nursing
responsibilities
prior to, during
and after the
procedure
HbA1c xx A blood test that reflects
average blood glucose
levels over a period of
approximately two to three
months.
Result:
HbA1c of 9.0 %
Normal range:
(4% - 6%)
Reference:
Hinkle, J.L. &
Cheever, K.H.
(2018). Brunner &
Suddarth's
Textbook of
Medical-Surgical
Nursing (14th ed.).
Philadelphia:
Wolters Kluwer.
Shows elevation
which indicates
poor control of her
type 2 diabetes
mellitus.
Before
Check and verify
the doctor’s order.
Confirm the patient
using two patient
identifiers
according to the
hospital policy.
Explain the
procedure to the
patient and its
purpose.
After:
Send the sample to
the laboratory
immediately.
Apply direct
pressure to the
venipuncture site

2. until the bleeding
stops.
Assess the
venipuncture site
for hematoma
formation.

3. Diagnostic/
Laboratory
Procedure
Date
ordered/
Date done
Indication/ Purposes Result Analysis and
interpretation of
results ( related to
the disease )
Nursing
responsibilities
prior to, during
and after the
procedure
C-Peptide Test xx C – peptide test is a blood
test that assesses the
amount of insulin being
produced by the body. This
is used to tell the
difference between insulin
the body produces and
insulin that is injected into
the body.
Result:
Blood c-peptide
levels are
undetectable (<0.01
ng/ml)
Normal range:
(0.8 to 3.1 ng/ml)
Reference:
Leighton E,
Sainsbury CA,
Jones GC. A
Practical Review of
C-Peptide Testing
in Diabetes.
Diabetes Ther. 2017
Jun;8(3):475-487.
doi:
10.1007/s13300-
017-0265-4. Epub
2017 May 8. PMID:
28484968; PMCID:
PMC5446389.
This indicates that
the patient’s
pancreas is
producing little or
no insulin.
Before
Check and verify
the doctor’s order.
Confirm the patient
using two patient
identifiers
according to the
hospital policy.
Explain the
procedure to the
patient and its
purpose.
Instruct the patient
to restrict foods and
fluids for 8–12
hours before a C-
peptide blood test.
After:
Send the sample to
the laboratory
immediately.
Apply direct
pressure to the

4. venipuncture site
until the bleeding
stops.
Assess the
venipuncture site
for hematoma
formation.

5. Diagnostic/
Laboratory
Procedure
Date
ordered/
Date done
Indication/ Purposes Result Analysis and
interpretation of
results ( related to
the disease )
Nursing
responsibilities
prior to, during
and after the
procedure
Abdominal
computed
tomography
examination
xx An abdominal CT scan is
an imaging method. This
test uses x-rays to create
cross-sectional pictures of
the belly area.
Result:
The calculated a.)
visceral fat area is
162.6 cm^2, with
b.) a subcutaneous
fat area of 527.9
cm^2.
Normal findings:
Normal
morphology.
Reference:
Hinkle, J.L. &
Cheever, K.H.
(2018). Brunner &
Suddarth's
Textbook of
Medical-Surgical
Nursing (14th ed.).
Philadelphia:
Wolters Kluwer.
This indicates that
the patient’s current
body composition is
abnormal.
Before:
Check and verify
the doctor’s order.
Confirm the patient
using two patient
identifiers
according to the
hospital policy.
Explain the
procedure to the
patient and its
purpose.
Assess the patient to
check for any
allergies to contrast
dye.
Instruct the patient
to not eat or drink
anything for three
hours before the
exam.

6. Remove any metal
objects before the
procedure.
During:
Assist the patient to
lie flat on her back
with arms over the
head.
Instruct the patient
to hold very still and
her breath.
After:
Instruct the patient
to drink six to eight
glasses of water to
help flush the
contrast dye out of
her system.

8. Diagnostic/
Laboratory
Procedure
Date
ordered/
Date done
Indication/ Purposes Result Analysis and
interpretation of
results ( related to
the disease )
Nursing
responsibilities
prior to, during
and after the
procedure
Upper
gastrointestinal
endoscopy
xx Upper gastrointestinal
endoscopy is a diagnostic
and therapeutic procedure
that allows one to image,
assess, and treat GI
illnesses specifically in the
upper GI tract (esophagus,
stomach, duodenum,
jejunum).
Result:
No abnormalities in
the esophagus,
stomach, or
duodenum.
Normal findings:
No abnormalities in
the esophagus,
stomach, or
duodenum.
Reference:
Lemone, P., Burke,
K., Bauldoff, G.,
Gubrud, P., Levett-
Jones, T., Dwyer,
T., Moxham, L.,
Reid-Searle, K.,
Berry, K., Carville,
K., Hales, M.,
Knox, N. and
Raymond, D., 2017.
Medical-surgical
nursing: Critical
thinking for person-
centred care. 3rd ed.
This indicates that
there were no
abnormalities found
in the patient’s
upper GI during the
assessment.
Before:
Check and verify
the doctor’s order.
Confirm the patient
using two patient
identifiers
according to the
hospital policy.
Explain the
procedure to the
patient and its
purpose.
Instruct patient to
observe NPO for 8
to 12 hours before
the procedure to
prevent aspiration
and allow for
complete
visualization of the
stomach.
Remove dentures
and partial plates to
facilitate passing the

9. Melbourne, VIC:
Pearson Australia.
scope and
preventing injury.
Advice the patient
to swallow once
while the endoscope
is being advanced
but do not talk, or
move tongue.
After:
Assess or test gag
reflex.
Place the patient in
the Sim’s position
until he or she is
awake and then in
semi- Fowler’s
position until ready
for discharge.
Observe for signs of
perforation, such as
pain, bleeding,
unusual difficulty
swallowing, and an
elevated
temperature.
Advise patient to
observe bed rest
until fully alert.

10. Monitor PR and BP
for changes that can
occur with sedation.

11. Diagnostic/
Laboratory
Procedure
Date
ordered/
Date done
Indication/ Purposes Result Analysis and
interpretation of
results ( related to
the disease )
Nursing
responsibilities
prior to, during
and after the
procedure
Complete blood
count
xx This is a group of tests that
evaluate cells that circulate
in the blood. This
procedure is used to detect
a variety of diseases and
conditions, such as
infection or anemia.
Result:
 Hemoglobin
- 8.55 g/dl
 Hematocrit
– 33%
 Neutrophils
– 68.0
 WBC – 4.5 x
10^3/ul
 Lymphocyte
s – 29.8
 Monocytes
– 9.2
 Eosinophil –
3.7%
 ESR – 18
mm/h
Normal range:
 Hemoglobin
– 12-16 g/dl
 Hematocrit
– 37-47 %
 Neutrophils
– 43.0 -76.0
 WBC – 4.8 x
10^3/ul
The following data
may indicate that
the patient is
suffering from
anemia.
Before:
Check and verify
the doctor’s order.
Confirm the patient
using two patient
identifiers
according to the
hospital policy.
Explain the
procedure to the
patient and its
purpose.
After:
Send the sample to
the laboratory
immediately.
Apply direct
pressure to the
venipuncture site
until the bleeding
stops.

12.  Lymphocyte
s – 17.0 –
48.0
 Monocytes
– 4.0-13.0
 Eosinophil –
0.0-5.0%
 ESR – < 20
mm/h
Reference:
Lemone, P., Burke,
K., Bauldoff, G.,
Gubrud, P., Levett-
Jones, T., Dwyer,
T., Moxham, L.,
Reid-Searle, K.,
Berry, K., Carville,
K., Hales, M.,
Knox, N. and
Raymond, D., 2017.
Medical-surgical
nursing: Critical
thinking for person-
centred care. 3rd ed.
Melbourne, VIC:
Pearson Australia.
Assess the
venipuncture site
for hematoma
formation.

13. Diagnostic/
Laboratory
Procedure
Date
ordered/
Date done
Indication/ Purposes Result Analysis and
interpretation of
results ( related to
the disease )
Nursing
responsibilities
prior to, during
and after the
procedure
Upper
gastrointestinal
endoscopy
xx Upper gastrointestinal
endoscopy is a diagnostic
and therapeutic procedure
that allows one to image,
assess, and treat GI
illnesses specifically in the
upper GI tract (esophagus,
stomach, duodenum,
jejunum).
Result:
No abnormalities in
the esophagus,
stomach, or
duodenum.
Normal findings:
No abnormalities in
the esophagus,
stomach, or
duodenum.
Reference:
Lemone, P., Burke,
K., Bauldoff, G.,
Gubrud, P., Levett-
Jones, T., Dwyer,
T., Moxham, L.,
Reid-Searle, K.,
Berry, K., Carville,
K., Hales, M.,
Knox, N. and
Raymond, D., 2017.
Medical-surgical
nursing: Critical
thinking for person-
centred care. 3rd ed.
This indicates that
there were no
abnormalities found
in the patient’s
upper GI during the
assessment.
Before:
Check and verify
the doctor’s order.
Confirm the patient
using two patient
identifiers
according to the
hospital policy.
Explain the
procedure to the
patient and its
purpose.
Instruct patient to
observe NPO for 8
to 12 hours before
the procedure to
prevent aspiration
and allow for
complete
visualization of the
stomach.
Remove dentures
and partial plates to
facilitate passing the

14. Melbourne, VIC:
Pearson Australia.
scope and
preventing injury.
Advice the patient
to swallow once
while the endoscope
is being advanced
but do not talk, or
move tongue.
After:
Assess or test gag
reflex.
Place the patient in
the Sim’s position
until he or she is
awake and then in
semi- Fowler’s
position until ready
for discharge.
Observe for signs of
perforation, such as
pain, bleeding,
unusual difficulty
swallowing, and an
elevated
temperature.
Advise patient to
observe bed rest
until fully alert.

15. Monitor PR and BP
for changes that can
occur with sedation.

16. Diagnostic/
Laboratory
Procedure
Date
ordered/
Date done
Indication/ Purposes Result Analysis and
interpretation of
results ( related to
the disease )
Nursing
responsibilities
prior to, during
and after the
procedure
Chest x-ray xx A chest x-ray is a
diagnostic radiology
procedure used to examine
chest structures and is
useful for diagnosing
conditions like kidney
failure.
Result:
Cardiomegaly upon
examination.
Normal findings:
Normal lung fields,
cardiac size and
shape, mediastinal
structures, thoracic
spine, ribs, and
diaphragm.
Reference:
Retrieved from
Davis's Lab &
Diagnostic Tests.
(2022).
https://nursing.unbo
undmedicine.com/n
ursingcentral/view/
Davis-Lab-and-
Diagnostic-
Tests/425293/all/C
hest_X_Ray
This indicates that
the patient’s heart is
enlarged due to the
nature of her
disease.
Before:
Check and verify
the doctor’s order.
Confirm the patient
using two patient
identifiers
according to the
hospital policy.
Explain the
procedure to the
patient and its
purpose.
Remove all metallic
objects.
Assess the patient’s
ability to hold his or
her breath.
Provide appropriate
clothing.
Instruct patient to
cooperate during the
procedure

17. After:
Provide comfort. If
the test is facilitated
at the bedside,
reposition the
patient properly.
Monitor PR and BP
for changes that can
occur with sedation.