1. Common laboratory procedures include blood tests, urine and stool exams, imaging tests, and biopsies. Blood tests often involve blood draws to check electrolytes, blood counts, chemistries and more. 2. Imaging tests allow visualization of internal organs and structures and include procedures like X-rays, ultrasounds, CTs and MRIs. More invasive visualization tests include procedures like bronchoscopy, cystoscopy and angiography. 3. Biopsy and aspiration procedures remove fluid or tissue samples for examination and include lumbar puncture, abdominal paracentesis and bone marrow aspiration. These invasive procedures require informed consent.

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