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Diagnostic testing unit 6
- 1. DIAGNOSTI C TESTING Unit -VI THAMARAI SELVI P M NURSING TUTOR
- 2. Preparing a client for diagnostic testing Phases of diagnostic testing Pre test Intra test Post test
- 3. Pre test Identity band Medical record for herbal supplements , allergies or prior reactions to dyes , contrast media, if so mention it in the file Consent Any physical or communication restriction Vital signs Orders – NPO, any premedications, dosage etc Physical and Psychological preparation Explanation of procedure If any IV access required, establish it In case of pediatrics, accompany the attender
- 4. Intra test Invasive diagnosis- protective barrier to be worn Positioning and draping In dye administration, skin allergy test to be conducted Relax the client during procedure Keep resuscitation supplies in hand Labelling of specimens Storage if necessary (ABG) Report any problems to the health care professional Safe client transportation out of the diagnostic area
- 5. Post test Clients on NPO, if awake and able to swallow, provide water Allow the client to express Clarify doubts to the patient and family Describe what to expect throughout the initial stages of recovery Documentation – in patient file…what specimen, dye, anaesthesia, who performed, when, how, why, if any complications arised, vital signs, transportation of patient……
- 6. Common investigations and clinical implications CBC Serum electrolytes LFT Lipid protein profile Serum – glucose – fasting, post prandial, HbA1c Capillary blood glucose, GRBS Urine – Albumin, Acetone, pH, Specific gravity, Culture , routine, timed urine specimen Sputum culture Overview of radiological and endoscopic procedures
- 8. CBC- Complete Blood Count It is a composite report of a number of peripheral blood tests It includes – their number, proportion, variety, concentrations and quality. Hematocrit, hemoglobin, RBC indices (MCV-mean corpuscular volume ,MCH -(Mean corpuscular hemoglobin, MCHC – Mean corpuscular volume concentration), WBC count, platelet count, and differential white blood cell count (neutrophils, eosinophils, basophils, lymphocytes and monocyte )
- 9. CBC- Complete Blood Count Equipment – alcohol swab, a purple topped tube, a needle and syringe or vacutainer Techniques – label the test tube, identify the client, collect 1ml -5ml sample of blood depending on the test, gently shake the tube Deliver the tube to the lab
- 10. RBC million/mm3 Men- 4.7-6.1 Women – 4.2-5.4 Infants and children - 3.8-5.5 New-borns 4.8-7.1 Erythropnoea Polycythemia or erythrocytosis Hemoglobin g/dl Men – 14-18 Women - 12-16, in pregnancy - >11 Children - 11-16 Newborns – 14-24 Aneamia WBC Cells /mm3 4500 -11000 Leucopenia Leucocytosis/ Leukemia Platelets Cells /mm3 1,50,000 -4,00,000 Thrombocytopenia thrombocytosis CBC- Normal range
- 11. Serum Electrolyte s It is a blood test that measures the levels of the body's mean electrolytes.
- 12. Tests Normal range Functions Additional information sodium 136-145 mEq/L Maintains Extra cellular volume, acid base balance, transmits nerve impulse Hyper/hypo natraemia Potassium 3.5-5.2 mEq/L Nerve conduction, muscular function, acid base balance Hyper/hypokalaemia Magnesium 1.6-3.0 mEq/L Protein synthesis, muscle contraction, glucose metabolism Hyper/hypomagnesemia Chloride 90-110 mEq/L Regulates flow of water and acid base balance -Ecclampsia, Cushing’s -Dehydration, burns Bicarbonate 22-26 mEq/L Maintains blood pH Acidosis and Alkalosis Phosphate 2.7-4.5 mg/dl Bone and teeth formation,metabolism Hyper/ hypophosphatemia Calcium 9-10.5 Mg/dl Bones, cardiac and skeletal muscle Hyper /hypo calcemia
- 13. LIVER FUNCTION TEST Helps to monitor liver diseases or liver damages
- 14. Tests Normal range Additional information ALT- Alanine transaminase (SGPT) 7-55U/L Elevation indicates hepatic damage AST- Aspartate transaminase ( SGOT) 8-48 U/L Increased levels indicates liver damage, muscle injury ALP- Alkaline phosphatase 40-129 U/L Increased in liver pathology Albumin Total protein 3.5- 5 g/dl 6.3-7.9g/dl Maintains oncotic pressure , reduced in nephrotic syndrome C- Reactive protein <10mg/L Elevated in inflammation Prothrombin time- PT 9.4-12.5 sec Measurement of blood coagulation Elevated in vitamin-K deficiency Bilirubin 0.1- 1.2mg/dl Jaundice is a sign of liver diseases GGT- Gamma glutamyltransferase 8-61 U/L Enzyme in blood. Increased in liver damage LDH- Lactate dehydrogenase 122-222 U/L Liver enzyme. Elevated in liver disease
- 15. RENAL FUNCTION TEST These tests check how good the kidney clear the waste from the body
- 16. Tests Reference range Additional information Blood urea nitrogen - BUN 5-25 mg/dl Product of protein metabolism. Elevated in dehydration and if persists after correction indicates renal disorders Serum creatinine 0.5- 1.5mg/dl Elevated creatinine indicates renal damage It is not affected by dehydration, hence an important test in detecting kidney functions Serum uric acid 3.5 -8.0 mg/dl 2.6-6.8mg/dl Increased levels indicates renal disorders eGFR 90 or higher – RFT is normal 60 or higher – mild loss of renal function 45-59 – moderate damage Glomerular filtration rate…calculates how much blood the glomeruli filters every minute..
- 17. LIPID PROFILE
- 18. Lipid profile It is a blood test that evaluates the risk of cardiovascular disorders such as heart diseases, heart attack and stroke by measuring the level of specific fat molecules known as lipids in the blood
- 19. Tests Reference range Additional information Total cholesterol mg/dl Normal - <200mg/dl Borderline high – 200-239 High - >240mg/dl Total amount of cholesterol in the blood LDL - Low density lipoprotein mg/dl Optimal -<100mg/dl Near optimal – 100-129 Borderline high- 130-159 High – 160-189 Very high - 190 “Bad cholesterol” – causes atherosclerosis HDL – High density lipoprotein mg/dl >40 mg/dl >60mg/dl will protect against heart disease “Good cholesterol” –it removes LDL cholesterol, keeps arteries open, allows greater blood flow VLDL- Very low density lipoprotein mg/dl Normal - 2-30 mg/dl VLDL carries triglycerides, bad cholesterol which causes plaque deposits on the artery walls. Triglycerides mg/dl Normal < 150mg/dl Borderline high -150-199 High – 200-499 mg/dl Very high - >500 mg/dl Excess calories are stored as triglycerides
- 20. Blood glucose
- 21. The breakdown of carbohydrates produces glucose, a simple sugar that the body uses as fuel for its cells Glucose must be transported into the cells via insulin A blood glucose test is a method to determine how much sugar, is in the blood. This is prescribed to identify diabetes as well to control diabetes in people with type 1 and type 2 diabetes.
- 22. Blood glucose tests FBS- Fasting blood sugar: Monitors blood glucose after at least 8 hours without eating. Used as an initial test to identify pre diabetes and diabetes RBS- Random blood sugar: It is without consideration when the patient last had a meal 2 hour post prandial blood sugar: Examines blood sugar exactly 2 hours after the patient finish eating
- 23. Blood glucose tests HbA1C- Hemoglobin A1C: It is used to calculate the average blood sugar during the previous 2 to 3 months. Glucose sticks to hemoglobin for as long as the red blood cells are alive. Red blood cells live about 3 months (OGTT) - Oral glucose tolerance test : It is frequently used to identify pregnancy related diabetes.
- 26. Lancet device
- 27. Test Normal range Additional information FBS <100mg/dl 100-125mg/dl- Pre diabetes >125mg/dl – Diabetes (on 2 occasions) 8-12 hours fasting needed PPBS <140mg/dl 2 hours after the meal RBS < or = to 200mg/dl Anytime , or no consideration with food HbA1C Normal -< 5.7% Pre diabetes– 5.7-6.4% Diabetes- >6.4% 97% -98% of normal adult Hb is made of Hb A. HbA1c is a subgroup which has undergone some changes due to the addition of glucose molecule. This is called as glycoselated hemoglobin
- 29. The digestive system excrete feces, a waste product of digestion, through the GI tract Studies of feces can help diagnose GI problems Eg. Bacterial infections, GI bleeding, obstruction, inflammatory bowel diseases, malabsorption, parasite disease, and colon cancer An adult excretes 100-300 grams of feces every day Normal feces contains water, undigested matter, intestinal secretions, a lot of bacteria, bile, epithelial cells, white blood cells, gastric secretions, pancreatic juices, and inorganic substances like calcium and phosphorus.
- 30. Techniques of collecting the sample Within an hour it should be sent to lab or else refrigerated Drugs like antibiotics and antacids can hinder bacterial development Stool sample gathered in a bedpan or plastic hat container placed in the toilet It should not contain any water or urine Using gloves, 2 clean tongue blades used to take sample from the centre of the feces , put into the container. If any blood, pus, microbes sample should contain the same
- 31. Techniques of collecting the sample Formed feces- sample should be of walnut size, unformed feces – 15 to 20ml. Physical and chemical, Biological , microscopic analysis will be done
- 32. Toilet hat
- 33. Physical analysis Analysis of the quantity, colour, consistency, odour and shape of the stool, also parasites if found
- 34. Physical analysis of stool Characteristic variation Condition Colour Black Upper GI bleeding, Iron or coal ingestion Dark brown Hemolytic anemia and high meat Gray, silvery Steatorrhea, pancreatic diseaseses Pasty and gray- white Bile duct obstruction Red Hemorrhoids , lower GI bleed Consistency Mucoid, watery, no blood Irritable bowel syndrome Mucoid and bloody Inflammatory bowel disease, ulcerative colitis (UC) Loose, purulent with necrotic Diverticulitis, UC, parasitic infection and bacillary dysentry
- 35. Chemical analysis To detect the presence of: Occult blood- GI bleeding, malignancy, ulcerative colitis and hemorrhoids Test for carbohydrates – metabolic or intestinal abnormalities. Negative is normal Test for bile – hemolytic anemia or rapid passage of feces in GI tract. Negative is normal Test for trypsin – pancreatic disorders . Negative is normal in adults and children over age 2.. Positive is normal in children younger than 2
- 36. Microscopic examination of stools Leucocytes, lipids and parasites are detected in feces via microscopic examination Test Normal Abnormal Leukocytes Stool does not contain leucocytes Bacterial diarrhoea, ulcerative colitis Fats <60- normal sized droplets Triglycerides 1-5% Fatty acids – 5-15% Increased triglycerides- pancreatic enzyme insufficiency Increased fatty acids with normal triglyceride – malabsorption syndrome Parasites No parasite present Protozoa – dysentry, peritonitis, perforation Hookworms – anaemia Pinworm – irritation and itching around anus Tapeworms – diarrhoea, epigastric pain, weight loss
- 38. Urine analysis Urine is an ultrafiltrate of plasma that contains a variety of chemicals carried by blood Urine samples are simple to collect and give the practitioner data to assess the client’s health
- 39. Urine routine analysis Macroscopic analysis and microscopic analysis are 2 main parts of a routine urinalysis Macroscopic analysis comprises colour, appearance, odour, specific gravity, pH, protein, glucose, ketones, blood, bilirubin and urobilinogen, nitrite and leukocyte esterase. Microscopic analysis includes RBC’s ,WBC’s, epithelial cells, casts and crystals and others such as bacteria, yeast, mucus, spermatazoa and parasites
- 40. Urine – Macroscopic analysis Characteristics Normal findings Colour Pale yellow to amber Appearance Clear to slightly cloudy Odour Mildly aromatic Specific gravity 1.001-1.035 pH 4.5- 8.0 Protein Negative Glucose Negative Other sugars Negative Ketones Negative Blood Negative Bilirubin Negative
- 41. Urine – Microscopic analysis Test Normal findings Red bllod cells 0-3 per high – power field (HPF) White blood cells 0-4 per HPF Epithelial cells Few Casts Occasional (hyaline or granular) Crystals Occasional (uric acid, urate, phosphate, or calcium oxalate)
- 42. Routine urinalysis - Volume The amount of urine excreted in a 24 hour period can be a useful tool clinical diagnosis Average 24 hour urine volume is 1200-1500ml Normal range can be 600-1700ml Diuresis – increase in urine volume Anuria –no urine output or <100ml/day Oliguria –low urine output < 400ml/day Polyuria – excessive urine output >3000ml/day
- 43. Routine urinalysis - Colour The pigment urochrome, which is produced by endogenous metabolic process, is the primary cause of colour of urine. Colour includes– light yellow, straw, yellow, dark yellow and amber Examining the sample in bright light on a white background will help in determining the urine colour.
- 46. Routine urinalysis - Appearance Typically, urine appearance is clear or slightly cloudy Caused by presence of WBC, RBC, bacteria, and epithelial cells. These indicate infection or inflammation of the vaginal and urinary systems Mucus, sperm, prostatic fluid , menstrual and vaginal discharges , fecal debris, and external compounds like talcum powder, antiseptics can also cause cloudy urine
- 50. Routine urinalysis- Odour A fresh urine specimen has a light aromatic odour. As urine stands, the odour of ammonia predominates because of the breakdown of urea. Urine acquires distinct smells after ingesting particular foods and medicines Fruity smelling urine – starvation or uncontrolled DM related ketonuria Fishy smell – bacterial infection
- 51. Routine urinalysis- Specific gravity The ability of kidney to reabsorb water and compounds from the glomerular filtrate is indicated by specific gravity of urine Normal range is 1.001 – 1.035 Patients with over hydration – low specific gravity Dehydration , nephrosis – high specific gravity
- 52. Routine urinalysis- pH The ability of kidneys to maintain the body’s acid-base balance can be seen in the pH of the urine. Respiratory and metabolic acidosis- acidic urine expelled ie.. Low pH Respiratory and metabolic alkalosis – alkaline urine I expelled ie.. High pH Urinary pH is alos impacted by many meals and medications Normal pH varies from 4.6- 8.0
- 53. Routine urinalysis-Protein Only a small quantity of protein is typically present in urine. The proximal convoluted tubule reabsorb most of these filtered proteins. PROTEINURIA can occur in people after physical exertion or when dehydrated If persistent – then it is a sign of renal disease, systemic illness (CHF, Fever)
- 54. Routine urinalysis-Glucose Most cases, urine contains no glucose Majority of the glucose is reabsorbed by PCT. Only when plasma glucose levels are extremely high that the carrier mechanisms are exhausted, glucose will show up in the urine Uncontrolled diabetes mellitus is the most common cause of GLYCSOURIA Sample for urine to be collected before meals Glycosuria can be caused by food as well medication
- 55. Routine urinalysis-Ketones Ketones are not typically found in urine in quantifiable concentrations. It may be found in cases of excessive fat metabolism Ketones are found in diabetes mellitus where there is defective carbohydrate metabolism, or also by excessive carbohydrate loss such as diarrhoea and vomiting, dieting Ketonuria is a sign of systemic acidosis.
- 56. URINE TESTING
- 57. Urine testing (pH,Albumin, Specific gravity, Acetone) Urine pH A procedure to assess a solution’s alkalinity, neutrality or acidity . pH 7 is considered neutral Acidity is indicated by a pH below 7 Alkalinity by pH above 7 Normal pH of urine varies between 4.6-8
- 58. Urine pH- Procedure Different methods Litmus paper Nitrazine paper Dipstick method etc..
- 61. Dipstick method
- 62. Urine specific gravity- Urinometer
- 64. Urine - Acetone Principle: A purple colour complex or ring appear when acetone or acetoacelate due to reaction with alkaline sodium nitroprusside. Tests done are: Rothera’s test Lang’s test Acetest tablet testing Acetone powder test Ketostix , reagent strip test method
- 65. Rothera ‘s test
- 67. Urine – Protein Principle: Protein is precipitated out of the urine samples using a chemical, such as a strong acid , or it is heated until it coagulates out of solution. Tests done are: The Robert’s test The Heller test The sulphosalycylic acid test Acetic acid and heat test
- 68. Acetic acid and heat test
- 70. COLLECTION OF URINE SPECIMEN The specimen must be carefully procured, handled and maintained before analysis The technique for collection, the timing and the handling all affect the clinical information that can be gathered from a urine sample The specimen should be kept at 4 degree celsius as soon as feasible after collection, if urine testing cannot be done within 2 hours Specimens can be kept in the refrigerator for 6 to 8 hours without any significant changes to their constituent elements
- 71. METHODS OF URINE COLLECTION Random specimen collection- collected at any time. First morning sample – the first urine passed in the morning. This specimen has relatively high concentrations of biological components and analytes like protein and glucose Clean catch midstream urine – it is the preferable form of specimen for culture and sensitivity testing due to the decreased frequency of cellular and microbiological contamination Timed or 24 hour specimen – it is used in the metabolic evaluation of urinary stone disease, the assessment of proteinuria, the estimation of renal function via creatinine clearance.
- 72. METHODS OF URINE COLLECTION Specimen obtained using catheter- when a patient is confined to bed or is unable to urinate on their own Supra pubic aspiration specimens – it is used when a bedridden patient cannot be catheterized or a sterile specimen is required. The sample is obtained by inserting a needle through the abdominal wall into the bladder
- 73. General instructions in urine specimen collection Prevent contamination of specimen – instruct clearly not to touch the inner part of the container A fresh specimen to be obtained in a clean and dry container The concentrated first morning sample is the most suitable one to Ideal specimen for testing urine sugar is on that has been voided 2-3 hours after eating For mid stream clean catch urine- patients must first clean their urethra before voiding first part of their urine stream into the toilet
- 74. SPUTU M CULTUR E
- 75. SPUTUM CULTURE A sputum culture is a test that checks for bacteria or another type of organism that may be causing an infection in the lungs or the airways leading to the lungs. Sputum, also known as phlegm, is a thick type of mucus made in the lungs. Sputum is not the same as spit or saliva. Sputum contains cells from the immune system that help fight the bacteria, fungi, or other foreign substances in the lungs or airways. The thickness of sputum helps trap the foreign material. The cilia (tiny hairs) in the airways push it through the mouth and be coughed out.
- 76. SPUTUM CULTURE Normal respiratory flora include Neisseria catarrhalis, Candida albicans, diphtheroids, alpha-hemolytic streptococci, and some staphylococci INDICATIONS Detects the etiology of respiratory infection Confirmatory diagnosis of tuberculosis Monitoring the response to therapy for respiratory infections Identification of antibiotics who which the cultured organism is sensitive.
- 77. SPUTUM CULTURE INTERFERING FACTORS Inadequate specimen collection Delay in shipping specimen to the laboratory C&S to be performed prior to antimicrobial therapy to assess the efficacy of therapy
- 78. Pre- procedure Specimen to be collected in the morning after secretion have accumulated overnight Saliva or post nasal drainage should not be used Specimen to be taken by coughing or tracheal suctioning and deep from the respiratory tract Increase fluid intake at night helps to liquefy secretions Quantity to be kept in mind
- 79. Preparation for the procedure Assist in suppling extra fluids and proper humidification , unless contraindicated If the patient is prescribed nebulizer treatments, it is helpful to administer this treatment prior to the procedure to help mobilize secretions Assist with oral hygiene Keep sputum collecting containers available Oxygenation is needed for 20 -30 minutes before the procedure, if sample is to be taken via tracheal suctioning 100% O2 hyperventilation to be done both before and after the procedure
- 80. Preparation for the procedure It is also important to assess if the patient is experiencing pain related to coughing. For example, pain following chest or abdominal surgery can inhibit the patient from taking deep breaths and expectorating. In this case, pain medication should be provided prior to performing the procedure. Patients can also be encouraged to support surgical wounds with a pillow while coughing to provide additional support and comfort.
- 81. Procedure Nurse should wear gloves, a facemask, and potentially glasses or goggles Client should sit up straight, with support if necessary Client should take deep breaths twice or thrice and cough vigorously Any raised sputum needs to be immediately expectorated into a sterile container without touching the inside or rim of the container. The specimen should be at least 5 mL .Ask the patient to continue producing and expectorating sputum until this amount is achieved.
- 82. Procedure Assess the sputum specimen to ensure it is sputum and not saliva. Sputum appears thick and opaque, whereas saliva appears thin, clear, and watery. If a patient is unable to expectorate a sputum sample, other interventions may be required to mobilize secretions. It is often helpful to collaborate with a respiratory therapist for assistance in this situation. Interventions may include nebulizers, hydration, deep- breathing exercises, chest percussion, and postural drainage. If these interventions are not successful, a sputum sample may be obtained via oropharyngeal or endotracheal suctioning.[1],[2]
- 87. Radiologic studies It is frequently the first diagnostic tool or screening device used to uncover anomalies in the structure of the body’s soft and bone components It is based on the variations in body structure density. It is hazardous too. Which can be reduced with right protective measures
- 88. Radiologic studies Without contrast X rays Mammogr- - aphy KUB studies Obstruction series With contrast Angiography Biliary and gall bladder systems radiography- eg: cholecystography Radiography of digestive system- barium meal , barium enema Radiography of urinary system -IVP Radiographic examintion of encapsulated joint- myelography, hysterosalpingography CT scan, MRI scan Radio nucleide tests
- 89. Endoscopic studies It includes a variety of diagnostic techniques that involve inserting an endoscope through a natural or surgical incision into body cavities or organs Majority are flexible fibre optic scopes that may be put into smaller body cavities and organs, however rigid also are used. Eg: Bronchoscopy- visualize bronchial tree and lungs Cystoscopy- bladder Laparascope – abdominal cavity Colposcopy- vaginal and cervix Arthroscopy – joints etc,…
- 90. Thank you