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NurseReview.Org Common Laboratory Procedures

  1. 1. Common Laboratory procedures: Nursing Responsibilities and Implications
  2. 2. 3 Phases of Diagnostic testing <ul><li>Pretest </li></ul><ul><ul><li>Client preparation </li></ul></ul><ul><li>Intra-test </li></ul><ul><ul><li>specimen collection and VS monitoring </li></ul></ul><ul><li>Post-test </li></ul><ul><ul><li>Monitoring and follow-up nursing care </li></ul></ul>
  3. 3. Related Nursing Diagnoses <ul><li>Anxiety </li></ul><ul><li>Fear </li></ul><ul><li>Impaired physical mobility </li></ul><ul><li>Deficient knowledge </li></ul>
  4. 4. Blood tests
  5. 5. BLOOD TESTS <ul><li>CBC </li></ul><ul><ul><li>Hemoglobin, Hematocrit, WBC, RBC and platelet </li></ul></ul><ul><li>Serum Electrolytes </li></ul><ul><li>Arterial blood gases </li></ul><ul><li>Blood Chemistry </li></ul><ul><li>Drug and Hormone Assay </li></ul>
  6. 6. Complete Blood Count <ul><li>Specimen: Venous blood </li></ul><ul><li>Pretest : obtain syringe, tourniquet, vial with appropriate anticoagulant </li></ul><ul><li>Intratest: Cubital vein commonly used for venipuncture </li></ul><ul><li>Post-test : direct pressure and observe for bleeding, label vial </li></ul>
  7. 7. Normal values for CBC <ul><li>RBC (M) 4.7-6.1/ (F) 4.2-5.4 </li></ul><ul><li>Hgb (M) 14-18/ (F) 12-16 mg/dL </li></ul><ul><li>Hct (M) 42-52/ (F) 33-47 % </li></ul><ul><li>WBC 5-10,000 cells/cubic cm </li></ul><ul><ul><li>Differential count </li></ul></ul><ul><ul><li>Neutrophils- 55- 70% </li></ul></ul><ul><ul><li>Lymphocytes- 20-40% </li></ul></ul><ul><ul><li>Monocytes- 2-5% </li></ul></ul><ul><ul><li>Eosinophils- 1-4% </li></ul></ul><ul><li>Platelets 150,000-400,000 </li></ul>
  8. 9. Table. 11.2
  9. 11. 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
  10. 12. Serum Electrolytes <ul><li>Specimen: venous blood </li></ul><ul><li>Pretest/Intratest/Post-test- same </li></ul><ul><li>Commonly ordered: </li></ul><ul><li>Sodium- 135-145 mEq/L </li></ul><ul><li>Potassium- 3.5-5.0 mEq/L </li></ul><ul><li>Chloride- 95-105 mEq/L </li></ul><ul><li>Magnesium- 1.3 to 2.1 mEq/L </li></ul><ul><li>Calcium- 8 to 10 mg/dL </li></ul>
  11. 13. Serum Electrolytes <ul><li>Problems can be </li></ul><ul><li>Hyper  if increased </li></ul><ul><li>Hypo  if decreased </li></ul>
  12. 14. Blood Chemistry <ul><li>Specimen: Venous blood, serum </li></ul><ul><li>Pretest/Intratrest/Post-test-same </li></ul><ul><li>Examined are enzymes, hormones, lipid profile BUN , Creatinine, etc… </li></ul><ul><li>Place patient on NPO for 8 h </li></ul><ul><li>* Creatinine is produced relatively constant by muscles, excreted by the kidneys and is the RELIABLE Reflection of Renal Status </li></ul>
  13. 15. Blood Chemistry <ul><li>Normal values for : </li></ul><ul><li>Creatinine: 0.7 to 1.4 mg/dL </li></ul><ul><li>BUN: 10-20 mg/dL </li></ul><ul><li>Creatinine clearance: 1.67 to 2.5 mL/s </li></ul><ul><li>Serum uric acid: 2.5 to 8 mg/dL </li></ul><ul><li>Blood osmolality= 250 to 290 mOsm/L </li></ul>
  14. 16. 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
  15. 17. 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
  16. 18. 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
  17. 19. Diabetes Mellitus <ul><li>DIAGNOSTIC CRITERIA </li></ul><ul><li>FBS equal to or greater than 126 mg/dL (7.0mmol/L) </li></ul><ul><ul><li>(Normal 8 hour FBS- 80-109 mg/dL) </li></ul></ul>
  18. 20. Diabetes Mellitus <ul><li>DIAGNOSTIC CRITERIA </li></ul><ul><li>OGTT value 1 and 2 hours post-prandial equal to or greater than 200 mg/dL </li></ul><ul><li>Normal OGTT 1 and 2 hours post-prandial- is </li></ul><ul><ul><li>140 mg/dL </li></ul></ul>
  19. 21. Diabetes Mellitus <ul><li>DIAGNOSTIC CRITERIA </li></ul><ul><li>RBS of equal to or greater than 200 mg/dL PLUS the 3 P’s </li></ul>
  20. 22. Diabetes Mellitus <ul><li>DIAGNOSTIC CRITERIA </li></ul><ul><li>Glycosylated hemoglobin </li></ul><ul><li>(HbA1c) is a monitoring test to assess the adherence to diabetic medication </li></ul>
  21. 23. Arterial Blood Gases <ul><li>Specimen: arterial blood </li></ul><ul><li>Pretest : obtain syringe with heparin, rubber stopper, container with ice </li></ul><ul><li>Intratest : usual site-radial artery, perform Allen’s test </li></ul><ul><li>Post-test : Apply direct pressure on site for 5-10 minutes, send specimen with occluded needle on ice </li></ul>
  22. 24. Normal ABG values <ul><li>pH 7.35-7.45 </li></ul><ul><li>pCO2 35-45 mmHg </li></ul><ul><li>paO2 80-100 mmHg </li></ul><ul><li>HCO3 22-26 mEq/L </li></ul><ul><li>Base excess -2 to +2 </li></ul><ul><li>O2 sat 95-98% </li></ul>
  23. 25. 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
  24. 26. Urine exams
  25. 27. Urine Analysis <ul><li>Specimens </li></ul><ul><li>Clean-voided urine for routine urinalysis </li></ul><ul><li>Clean-catch or midstream urine for urine culture </li></ul><ul><li>Suprapubic and catheterized urine for urine culture </li></ul>
  26. 28. Routine Urinalysis <ul><li>Specimen: Clean voided </li></ul><ul><li>Pretest : give clean vial and instruct to void directly into the specimen bottle </li></ul><ul><li>Intratest: Allow a 10 ml collection </li></ul><ul><li>Post-test : prompt delivery to laboratory </li></ul><ul><li>* First voided urine in a.m. is highly concentrated, more uniform concentration and with more acidic pH </li></ul>
  27. 29. Urine Culture: Normal is <100,000 <ul><li>Specimen: clean catch, midstream or catheterized urine </li></ul><ul><li>Pretest : Instruct to wash and dry genitalia/perineum with soap and water. (M)- circular motion, (F)-front to back direction </li></ul><ul><li>Intratest: Midstream urine , 30-60 ml </li></ul><ul><li>Post-test: Cap and label, prompt delivery and documentation </li></ul>
  28. 30. Special Urine Collection <ul><li>Infants </li></ul><ul><ul><li>Special urine bag </li></ul></ul><ul><ul><li>Or cut a hole of the diaper (front for the boy, middle for the girl) pulling out through the hole the special bag </li></ul></ul><ul><li>Children </li></ul><ul><ul><li>May use potty chair or bedpan </li></ul></ul><ul><ul><li>Give another vial to play with, allow parent to assist </li></ul></ul><ul><li>Elderly </li></ul><ul><ul><li>Assistance may be required </li></ul></ul>
  29. 31. Timed-urine collection <ul><li>Collection of ALL urine voided over a specified time </li></ul><ul><li>Refrigerated or with preservative </li></ul><ul><li>Pretest: Specimen container with preservative, receptacle for collection, a post sign </li></ul><ul><li>Intratest: A t the start of collection, have patient void and discard the urine </li></ul><ul><li>At the end of collection period, instruct to completely void and save the urine </li></ul><ul><li>Post test: Documentation </li></ul>
  30. 32. Catheter specimen <ul><li>Sterile urine </li></ul><ul><li>Insert needle of the syringe through a drainage port </li></ul><ul><li>Only done with the rubber catheter not the plastic, silastic or silicone catheter. </li></ul><ul><li>Intratest : Clamp catheter x 30 mins if no urine </li></ul><ul><ul><li>Wipe area where needle will be inserted </li></ul></ul><ul><ul><li>30-45 ° angle, 3 ml for culture </li></ul></ul><ul><li>Post-test : Unclamp catheter after collection </li></ul>
  31. 33. Stool Exams
  32. 34. Stool Analysis <ul><li>Occult Blood  GUAIAC test </li></ul><ul><li>Steatorrhea </li></ul><ul><li>Ova/Parasites </li></ul><ul><li>Bacteria </li></ul><ul><li>Viruses </li></ul>
  33. 35. General Nursing consideration for stool collection <ul><li>Pretest : Determine purpose/s, obtain gloves, container and tongue blade </li></ul><ul><li>Intratest: </li></ul><ul><ul><li>Instruct to defecate in clean bed pan </li></ul></ul><ul><ul><li>Void before collection </li></ul></ul><ul><ul><li>Do not discard tissue in bedpan </li></ul></ul><ul><ul><li>Obtain 2.5 (1 inch) formed stool </li></ul></ul><ul><ul><li>15-30 ml of liquid stool </li></ul></ul><ul><li>Post-test : prompt delivery </li></ul>
  34. 36. Occult Blood: Guaiac Test <ul><li>Detect the presence of enzyme: Peroxidase </li></ul><ul><li>(+) blue color  positive guaiac </li></ul><ul><li>Restrict intake of red meats, some medications and Vitamin C for 3-7 days </li></ul><ul><li>FALSE (+): red meat , raw fruits and vegetables especially radish, turnip, melon and horseradish; meds like aspirin, NSAIDS, iron and anticoagulants </li></ul><ul><li>FALSE (-): Vitamin C, ingested 250 mg per day from any source </li></ul>
  35. 37. Sputum Exams
  36. 38. Sputum Analysis <ul><li>For Culture and sensitivity </li></ul><ul><li>For sputum cytology </li></ul><ul><li>For sputum AFB </li></ul><ul><li>For monitoring of the effectiveness of therapy </li></ul>
  37. 39. Sputum examination <ul><li>Pretest: Morning specimen is collected </li></ul><ul><li>Intratest: </li></ul><ul><ul><li>Mouthwash with plain water </li></ul></ul><ul><ul><li>Deeply inhale x 2 then cough </li></ul></ul><ul><ul><li>Wear gloves in collecting specimen </li></ul></ul><ul><ul><li>Expectorate needed- 1-2 Tbsp or 15-30 ml </li></ul></ul><ul><li>Post-test : oral care and prompt delivery to lab </li></ul>
  38. 40. Visualization: DIRECT and INDIRECT
  39. 41. VISUALIZATION PROCEDURES <ul><li>Invasive procedures are direct methods and need CONSENT </li></ul><ul><li>Non-invasive procedures are indirect methods and may need written consent in some instances </li></ul>
  40. 42. Visualization procedures <ul><li>They can be: </li></ul><ul><li>Radiographic procedures </li></ul><ul><li>“ Scopic” procedures </li></ul>
  41. 43. GI tract Visualization
  42. 44. GIT Visualization <ul><li>Barium Swallow- UGIS </li></ul><ul><li>Pretest: written consent, NPO the night </li></ul><ul><li>Intratest: administer barium orally, then followed by X-ray </li></ul><ul><li>Post-test: Laxative for constipation, increased fluids, assess for intestinal obstruction , warn that stool is light colored! </li></ul>
  43. 47. GIT Visualization <ul><li>Barium Enema- LGIS </li></ul><ul><li>Pretest: Informed consent, NPO the night, Enema the morning </li></ul><ul><li>Intratest: Position on LEFT side, administer enema, then X-ray follow </li></ul><ul><li>Post-test: Cleansing enema , Laxative for constipation, assess for intestinal obstruction </li></ul>
  44. 49. GIT Visualization <ul><li>Esophagogastroscopy </li></ul><ul><li>Pretest: Informed consent, NPO for 8 hours, warn that gag reflex is abolished </li></ul><ul><li>Intratest: Position on LEFT side during scope insertion </li></ul><ul><li>Post-test: NPO until gag returns. Monitor for complications </li></ul>
  45. 51. GIT Visualization <ul><li>Anoscopy, proctoscopy, proctosigmoidoscopy, colonoscopy </li></ul><ul><li>Pretest: Consent, NPO, and enema administration the morning </li></ul><ul><li>Intratest: Position on the LEFT side during scope insertion </li></ul><ul><li>Post-test: Monitor for complications </li></ul>
  46. 54. Gallbladder <ul><li>Oral cholescystogram </li></ul><ul><li>PTC </li></ul><ul><li>ERCP </li></ul><ul><li>Ultrasound </li></ul>
  47. 55. IV Cholecystogram <ul><li>X-ray visualization of the gallbladder after administration of contrast media intravenously </li></ul><ul><li>Pre-test: Allergy to iodine and sea-foods </li></ul><ul><li>Intra-test: ensure patent IV line </li></ul><ul><li>Post-test: increase fluid intake to flush out the dye, Assess for delayed hypersensitivity reaction to the dye like chills and N/V </li></ul>
  48. 57. Oral Cholecystogram <ul><li>X-ray visualization of the gallbladder after administration of contrast media </li></ul><ul><li>Done 10 hours after ingestion of contrast tablets </li></ul><ul><li>Done to determine the patency of biliary duct </li></ul>
  49. 60. Endoscopic retrograde cholangiopancreatography <ul><li>Examination where a flexible endoscope is inserted into the mouth and via the common bile duct and pancreatic duct to visualize the structures </li></ul><ul><li>Iodinated dye can also be injected after for the x-ray procedure </li></ul>
  50. 61. Endoscopic retrograde cholangiopancreatography <ul><li>Pre-test: consent, NPO for 12 hours, Allergy to sea-foods, Atropine sulfate </li></ul><ul><li>Intra-test: Gag reflex is abolished, Position on LEFT side </li></ul><ul><li>Post-test: NPO until gag reflex returns, Position side lying and monitor for perforation and hemorrhage </li></ul>
  51. 65. Percutaneous Transhepatic Cholangiogram <ul><li>Under fluoroscopy, the bile duct is entered percutaneously and injected with a dye to observe filling of hepatic and biliary ducts </li></ul>
  52. 67. Ultrasound of the liver, gallbladder and pancreas <ul><li>Consent MAY be needed </li></ul><ul><li>Place patient on NPO!!! </li></ul><ul><li>Laxative may be given to decrease the bowel gas </li></ul>
  53. 68. urinary visualization
  54. 69. Urinary Visualization <ul><li>Non-invasive: KUB, IVP, Ultrasound </li></ul><ul><li>Pretest: Elicit allergy to iodine and seafood, NPO after midnight </li></ul><ul><li>Intra-test: IV iodinated Dye is administered then X-ray is taken </li></ul><ul><li>Post-test: Increase fluids to flush the dye. Documentation, VS monitoring </li></ul>
  55. 72. Urinary Visualization <ul><li>Invasive: retrograde cystourethrogram </li></ul><ul><li>Pretest: Elicit allergy to iodine and seafood </li></ul><ul><li>Intra-test: catheter is inserted with dye is administered then X-ray is taken as patient voids </li></ul><ul><li>Post-test: Increase fluids to flush the dye. Documentation, VS monitoring </li></ul>
  56. 74. Pulmonary test
  57. 75. Pulmonary visualization <ul><li>Invasive: Bronchoscopy, laryngoscopy </li></ul><ul><li>Non-invasive: CXR and Scan </li></ul>
  58. 76. Bronchoscopy <ul><li>Purpose: Diagnostic and therapeutic </li></ul><ul><li>Pretest: Consent, NPO, client teaching, anti-anxiety drugs </li></ul><ul><li>Intratest : gag reflex is abolished, instruct to remain still during procedure, FOWLER or SUPINE </li></ul><ul><li>Post-test : NPO until gag reflex returns, monitor patient for complication like perforation/bleed </li></ul>
  59. 79. Pulmonary function test <ul><li>Test to determine lung volumes and capacities </li></ul>
  60. 82. LUNG VOLUMES <ul><li>1. Tidal volume – TV </li></ul><ul><li>2. Inspiratory Reserve Volume- IRV </li></ul><ul><li>3. Expiratory Reserve Volume- ERV </li></ul><ul><li>4. Residual volume- RV </li></ul>
  61. 83. LUNG CAPACITIES <ul><li>Lung volume + another lung volume </li></ul><ul><li>1. Inspiratory Capacity- IC </li></ul><ul><li>2. Functional Residual Capacity- FRC </li></ul><ul><li>3. Vital capacity- VC </li></ul><ul><li>4. Total Lung capacity- TLC </li></ul>
  62. 84. Pulmonary &quot;Volumes” <ul><li>1. Tidal Volume: </li></ul><ul><li>-volume of air inspired or expired with each normal breath, about 500ml </li></ul><ul><li>2. Inspiratory Reserve Volume </li></ul><ul><li>-extra volume of air than can be inspired over & beyond the normal tidal volume, about 3000ml </li></ul>
  63. 85. Pulmonary &quot;Volumes” <ul><li>3. Expiratory Reserve Volume </li></ul><ul><li>-amount of air that can still be expired by forceful expiration after the end of a normal tidal expiration </li></ul><ul><li>-about 1100ml </li></ul><ul><li>4. Residual Volume </li></ul><ul><li>-volume of air still remaining in the lungs after the most forceful expiration, averages about 1200ml </li></ul>
  64. 86. Pulmonary &quot;Capacities:&quot; <ul><li>1. Inspiratory Capacity </li></ul><ul><li>-equals TV + IRV, about 3500ml </li></ul><ul><li>-amount of air that a person can breathe beginning at the normal expiratory level & distending his lungs to maximum amount </li></ul><ul><li>2. Functional Residual Capacity </li></ul><ul><li>-equals ERV + RV </li></ul><ul><li>-about amount of air remaining in the lungs at the end of normal expiration, about 2300ml </li></ul>
  65. 87. Pulmonary &quot;Capacities:&quot; <ul><li>3. Vital Capacity </li></ul><ul><li>-equals IRV + TV + ERV or 1C + ERV, about 4600ml </li></ul><ul><li>-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 </li></ul><ul><li>4. Total Lung Capacity </li></ul><ul><li>-maximum volume to which the lungs can be expanded with the greatest possible effort </li></ul><ul><li>-volume of air in the lungs at this level is equal to FRC (2300ml) in young adult </li></ul>
  66. 88. Heart exams
  67. 89. Cardiac Visualization <ul><li>Invasive: angiography. Cardiac catheterization </li></ul><ul><li>Non-invasive: ECG, Echocardiography, Stress ECG </li></ul>
  68. 90. The Cardiovascular System LABORATORY PROCEDURES <ul><li>ECHOCARDIOGRAM </li></ul><ul><li>Non-invasive test that studies the structural and functional changes of the heart with the use of ultrasound </li></ul><ul><li>No special preparation is needed </li></ul>
  69. 91. 2 D-echocardiogram
  70. 92. Angiography <ul><li>Pretest: informed consent, allergy to dyes, seafood and iodine </li></ul><ul><li>Intratest: Monitor VS </li></ul><ul><li>Post-test: maintain pressure dressing over puncture site </li></ul><ul><li>Immobilize for 6 hours </li></ul>
  71. 94. arteriography
  72. 95. Cardiac Catheterization <ul><li>Introduction of catheter into heart chambers </li></ul><ul><li>Pretest: informed consent, allergy to dyes, seafood and iodine, NPO 8-12 hours </li></ul><ul><li>Intra-test: Empty bladder, Monitor VS, explain palpitations </li></ul><ul><li>Post-test: maintain pressure dressing over puncture site </li></ul><ul><li>Immobilize for 6-8 hours with extremity straight </li></ul>
  73. 96. Spinal column
  74. 97. Myelography <ul><li>Radiographic examination of the spinal column and sub-arachnoid space to help diagnose back pain causes </li></ul><ul><li>Pre-test: Consent, NPO, allergy to seafoods </li></ul><ul><li>Intra-test: like LT </li></ul><ul><li>Post-test: supine for 12 hours </li></ul>
  75. 98. Myelography
  76. 99. Arthroscopy <ul><li>Insertion of fiber optic scope into the joint to visualize it, perform biopsy </li></ul><ul><li>Performed under OR condition </li></ul><ul><li>After care: Dressing over the puncture site for 24 hours to prevent bleeding </li></ul><ul><li>Limit activity for several days (7 usually) </li></ul>
  77. 101. Arthrogram <ul><li>X-ray visualization of the joint after introduction of contrast medium </li></ul><ul><li>Pre-test: consent, allergy to seafoods </li></ul><ul><li>Post-test: Dressing over puncture site and limit joint activity </li></ul>
  78. 103. Electromyelography <ul><li>Records the electrical activity in muscles at rest and during involuntary and electrical stimulation </li></ul><ul><li>Detects disorders such as MG, MS and Parkinson’s </li></ul><ul><li>Explain the use of electrode inserted into the muscles </li></ul><ul><li>Mild discomfort may be experienced </li></ul><ul><li>About 45 minutes for one muscle </li></ul>
  79. 105. Scans
  80. 106. CT scan <ul><li>Painless, non-invasive, x-ray procedure </li></ul><ul><li>Mechanism: distinguish density of tissues </li></ul>
  81. 108. MRI <ul><li>Painless, non-invasive, no radiation </li></ul><ul><li>Creates a magnetic field </li></ul><ul><li>Contraindications: </li></ul><ul><ul><li>(+) pacemaker </li></ul></ul><ul><ul><li>(+) metal prosthesis </li></ul></ul><ul><li>Client teaching: </li></ul><ul><ul><li>Lie still during the procedure for 60-90 minutes </li></ul></ul><ul><ul><li>Earplugs to reduce noise discomfort </li></ul></ul><ul><ul><li>Claustrophobia </li></ul></ul><ul><ul><li>No radiation </li></ul></ul>
  82. 109. MRI
  83. 110. PET scan
  84. 111. Bone Scan
  85. 112. Aspiration and Biopsy
  86. 113. ASPIRATION AND BIOSPY <ul><li>Aspiration : withdrawal of fluid </li></ul><ul><li>Biopsy : removal and exam of tissue </li></ul><ul><li>Invasive procedure needs INFORMED CONSENT </li></ul>
  87. 114. Lumbar Puncture <ul><li>Withdrawal of CSF from the arachnoid space </li></ul><ul><li>Purpose: diagnostic and therapeutic </li></ul><ul><li>To obtain specimen, relieve pressure and inject medication </li></ul><ul><li>Pretest: consent, empty bladder </li></ul>
  88. 115. Lumbar Puncture <ul><li>Intra-test: Site used-between L4/L5 </li></ul><ul><ul><li>Position- flexion of the trunk </li></ul></ul><ul><li>Post-test: Flat on bed (8-12 hours) </li></ul><ul><ul><li>Offer fluids to 3 Liters </li></ul></ul><ul><ul><li>Oral analgesic for headache </li></ul></ul><ul><ul><li>Monitor bleeding, swelling and changes in neurologic status </li></ul></ul>
  89. 118. Abdominal Paracentesis <ul><li>Withdrawal of fluid from the peritoneal space </li></ul><ul><li>Purpose: diagnostic and therapeutic </li></ul><ul><li>Pretest: consent, empty bladder </li></ul><ul><ul><li>Position: sitting </li></ul></ul><ul><ul><li>Site: midway between the umbilicus and symphysis </li></ul></ul>
  90. 119. Abdominal Paracentesis <ul><li>Intratest: 1,500 ml maximum amount collected at one time, Monitor VS </li></ul><ul><li>Post-test : monitor VS, bleeding complication </li></ul><ul><ul><li>Measure abdominal girth and weight </li></ul></ul>
  91. 121. Thoracentesis <ul><li>Removal of fluid from the pleural space </li></ul><ul><li>Purpose: Diagnostic and therapeutic </li></ul><ul><li>Pretest: Consent, teach to avoid coughing </li></ul><ul><ul><li>Position: sitting with arms above head </li></ul></ul>
  92. 122. Thoracentesis <ul><li>Intra-test: Support and observation </li></ul><ul><li>Post-test: Assess VS </li></ul><ul><ul><li>Position Post-procedure: lie on the UNAFFECTED SIDE with head elevated 30 ° x 30 minutes to facilitate expansion of the affected lungs </li></ul></ul>
  93. 123. Thoracentesis
  94. 125. Bone marrow Biopsy <ul><li>Removal of specimen of bone marrow </li></ul><ul><li>Purpose: diagnostic </li></ul><ul><li>Pretest : consent, teach that procedure is painful </li></ul><ul><ul><li>Site: POSTERIOR SUPERIOR ILIAC CREST (adult); PROXIMAL TIBIA (pedia) </li></ul></ul><ul><ul><li>Position: prone or lateral </li></ul></ul>
  95. 126. Bone marrow Biopsy <ul><li>Intratest: Monitor, maintain pressure dressing over punctured site X 10 mins </li></ul><ul><li>Post-test: Asses for discomfort, administer prescribed pain meds </li></ul>
  96. 127. Liver Biopsy <ul><li>Liver tissue obtained for diagnostic purpose </li></ul><ul><li>Pretest: consent, administer Vitamin K, monitor bleeding parameters, NPO 2 hours before procedure </li></ul><ul><ul><li>Position: Supine or semi-fowlers with upper right quadrant of abdomen exposed </li></ul></ul>
  97. 128. Liver Biopsy <ul><li>Intra-test : Monitor VS </li></ul><ul><ul><li>Take few deep inhalation and exhalation and hold final breath in exhalation x 10 seconds as needle is injected </li></ul></ul><ul><li>Post-test: monitor VS, bleeding </li></ul><ul><ul><li>Position post-procedure: RIGHT side-lying with folded towel/pillow under biopsy site for 4-6 hours </li></ul></ul>
  98. 129. Papanicolau Smear <ul><li>Done as screening test for cervical cancer, for culture </li></ul><ul><li>Pre-test: no coitus for 2-3 days, no menstrual bleeding </li></ul><ul><li>Intra-test: Lithotomy, speculum with water for lubrication, specimen obtained for cervix and vagina </li></ul><ul><li>Post-test: monitor for bleeding </li></ul>
  99. 130. Others
  100. 131. The Cardiovascular System LABORATORY PROCEDURES <ul><li>ELECTROCARDIOGRAM (ECG) </li></ul><ul><li>A non-invasive procedure that evaluates the electrical activity of the heart </li></ul><ul><li>Electrodes and wires are attached to the patient </li></ul>
  101. 135. What the waves represent? <ul><li>P wave= Atrial Depolarization </li></ul><ul><li>QRS= Ventricular Depolarization </li></ul><ul><li>T wave= Ventricular REPOLARIZATION </li></ul>
  102. 137. LABORATORY PROCEDURES <ul><li>CVP </li></ul><ul><li>The CVP is the pressure within the SVC </li></ul><ul><li>Reflects the pressure under which blood is returned to the SVC and right atrium </li></ul>
  103. 138. LABORATORY PROCEDURES <ul><li>CVP </li></ul><ul><li>Normal CVP is 0 to 8 mmHg/ 4-10 cm H2O </li></ul>
  104. 139. LABORATORY PROCEDURES <ul><li>Measuring CVP </li></ul><ul><li>1. Position the client supine with bed elevated at 45 degrees (CBQ) </li></ul><ul><li>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 </li></ul><ul><li>3. Instruct the client to be relaxed and avoid coughing and straining. </li></ul>
  105. 141. Tubes and drainage
  106. 142. Tubes <ul><li>Levine </li></ul><ul><li>Salem Sump tube </li></ul><ul><li>Gastrostomy tube </li></ul><ul><li>Jejunostomy tube </li></ul>
  107. 143. Salem Sump tube
  108. 145. T-tube
  109. 146. Drainage <ul><li>Penrose Drain </li></ul><ul><li>Hemovac </li></ul><ul><li>Pleuravac </li></ul><ul><li>Jackson-Pratt </li></ul>
  110. 147. Hemovac
  111. 148. Jackson-Pratt
  112. 149. Penrose
  113. 150. Asked in the local boards <ul><li>DRE </li></ul><ul><li>Snellen’s chart </li></ul><ul><li>Weber’s test </li></ul><ul><li>Rinnes’ test </li></ul>
  114. 151. DRE <ul><li>Position: Left Lateral or Sim’s position with upper leg acutely flexed. Females can also be examined in lithotomy </li></ul><ul><li>Ask client to BEAR DOWN </li></ul><ul><ul><li>To accentuate rectal fissure, prolapse ,polyps </li></ul></ul><ul><ul><li>To relax the anal sphincter </li></ul></ul>
  115. 152. Snellen’s Chart: test for visual acuity <ul><li>20 ft or 6 m distance </li></ul><ul><li>3 readings: L, R and Both eyes </li></ul><ul><li>Report: 20/ xxx </li></ul><ul><ul><li>Numerator: denotes the distance from the chart </li></ul></ul>
  116. 154. Snellen’s Chart: test for visual acuity <ul><ul><li>Denominator denotes the distance from which the normal eye can read the chart </li></ul></ul><ul><ul><li>20/60: the person can see at 20 feet, what a normal person can see at 60 feet. </li></ul></ul>
  117. 155. Weber’s test <ul><li>Test for lateralization and bone conduction </li></ul><ul><li>Tuning fork is placed on top of head </li></ul><ul><li>NORMAL: sound is heard in BOTH ears, localized at the center of the head: WEBER NEGATIVE </li></ul>
  118. 156. Weber’s test <ul><li>Sound is heard BETTER in the affected ear: Bone conductive hearing loss </li></ul><ul><li>Sound is heard only or better on the NORMAL ear: Sensorineural heating loss </li></ul><ul><li>ABNORMAL: WEBER POSITIVE </li></ul>
  119. 157. Rinne’s Test <ul><li>Test for AIR and BONE conduction </li></ul><ul><li>Tuning fork is initially placed on the mastoid process until no vibration is heard </li></ul><ul><li>Tuning fork is now placed in front of the ear until sound disappears </li></ul>
  120. 158. Rinne’s Test <ul><li>Air conduction is LONGER than bone conduction </li></ul><ul><li>Normal is POSITIVE Rinne’s </li></ul>
  121. 159. Rinne’s Test <ul><li>CONDUCTIVE HEARING LOSS: </li></ul><ul><ul><li>Bone conduction is GREATER than or equal to the AIR conduction </li></ul></ul><ul><ul><li>Abnormal is NEGATIVE RINNEs </li></ul></ul>
  122. 160. Rinne’s Test <ul><li>SENSORINEURAL HEARING LOSS: </li></ul><ul><ul><li>No bone conduction and air conduction vibration can be assessed </li></ul></ul><ul><ul><li>NEGATIVE RINNEs </li></ul></ul>
  123. 161. Weber
  124. 162. Rinne’s
  125. 163. Rinne’s
  126. 164. <ul><li>FAILING TO PREPARE </li></ul><ul><li>IS </li></ul><ul><li>PREPARING TO FAIL… </li></ul>
  127. 165. END