Transcript Theory

Chapter 24
Diagnostic Tests and Specimen
Collection
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 24
Lesson 24.1
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
1)
Discuss appropriate psychosocial care and
teaching for patients undergoing diagnostic tests
or procedures.
2)
Prepare to perform a capillary blood glucose test,
a capillary hemoglobin test, a venipuncture, a
throat culture, an electrocardiogram, a urine
dipstick test, and a stool for occult blood test.
3)
Describe each of the categories of tests that are
commonly performed.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 3
Learning Objectives
Clinical Practice
1)
Provide pretest and post-test nursing care,
including appropriate teaching, for patients
undergoing diagnostic tests and procedures.
2)
Attend to psychosocial concerns of patients
undergoing various diagnostic tests.
3)
Perform a random blood glucose test using
capillary blood and a glucometer.
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Slide 4
Diagnostic Testing and the
Nursing Process

When diagnostic tests are ordered, the nurse
should:

Assess what the patient knows about the test
 Determine any special nursing measures needed
to protect the safety of the patient
 Assess wounds each shift for signs of infection
 Assess the patient for allergies to medication and
to iodine
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Slide 5
Diagnostic Testing and the Nursing
Process (cont’d)

Nursing diagnosis



Impaired urinary elimination related to dysuria and
foul-smelling urine
Pain related to raw, sore throat
Pain related to inflammation and swelling at
wound site
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Slide 6
Diagnostic Testing and the Nursing
Process (cont’d)

Planning

Verify that items needed are on hand
 Ensure that pretest medications are available
 Prepare to do patient teaching
 Prepare for treatments such as enemas or IV
starts
 Expected outcomes are written for the particular
nursing diagnosis associated with the problem for
which the test is being performed
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Slide 7
Diagnostic Testing and the Nursing
Process (cont’d)

Implementation

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
Make certain that the patient has received
adequate teaching about the test or procedure to
be performed
Carry out the pre- and post-test actions for the
particular test or procedure ordered
Obtain a signed consent for any invasive
procedure requiring one
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Slide 8
Diagnostic Tests
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Provide information about chemical reactions
affecting physiologic functioning of the body
Enable examination of blood, urine, and other
body fluids, which provides clues about the
functioning of various organs, body systems,
and mechanisms
Used to confirm diagnosis and guide
treatment
Provide information concerning changes in a
patient’s condition
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Slide 9
Laboratory Tests: Hematology


The study of blood and its components
Complete blood count (CBC)


Hematocrit
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The separation of blood and the amount of blood cells
in relation to the amount of plasma
Hemoglobin
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
Information about state of health or presence of illness
Capacity of blood to transport oxygen from lungs to
tissues
Platelets

Essential to blood clotting
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Slide 10
Laboratory Tests: Hematology (cont’d)
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During infection, the number and type of
white blood cells increase
Neutrophil counts can be significant
In severe infections, bone marrow releases
more granulocytes
Immature polymorphonuclear neutrophils are
released (called bands)
The result is a shift to the left (more bands)
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Slide 11
Laboratory Tests: Hematology (cont’d)
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Drug therapy may cause leukopenia (a
decrease in leukocytes)
Hemoglobin shows the capacity of the blood to
transport oxygen from the lungs to the tissues
A normal platelet count is essential to clotting
Warfarin therapy is guided by prothrombin time
(reported in INR numbers)
The erythrocyte sedimentation rate (ESR) gives
clues about inflammatory conditions
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Slide 12
Laboratory Tests:
Blood Chemistry Tests


To detect changes in biochemical reactions in the body
and determine a diagnosis
Blood glucose tests


Bilirubin, alanine aminotransferase (ALT), and alkaline
phosphatase (ALP)


Used to measure liver function
Blood urea nitrogen (BUN) and creatinine levels


Essential in the diagnosis and control of diabetes
Important indicators of kidney dysfunction
Lactate dehydrogenase (LDH), creatine kinase (CK),
and aspartate aminotransferase (AST)

Detect damage to striated and heart muscle
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Slide 13
Laboratory Tests:
Blood Chemistry Tests (cont’d)
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
Some institutions use automated
computerized blood chemistry testing
Examples of tests available

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Serum albumin, ALP, AST
Total bilirubin, serum calcium, cholesterol,
glucose, LDH, phosphate, total protein, BUN, uric
acid
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Slide 14
Laboratory Tests: Blood Glucose
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Blood glucose commonly performed at the
bedside or in physician’s office by the nurse
Guides insulin therapy for diabetics
Guidelines for performing test depend on
manufacturer of testing equipment
Requires a fingerstick to obtain capillary
blood
Review Skill 24-2
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Slide 15
Laboratory Tests: Serology Tests
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Based on analysis of serum
Used to diagnose both viral and bacterial diseases or
determine antibody levels for:
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Also used to determine titers in response to vaccines
Radioimmunoassays
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Dysentery, rheumatic fever, typhoid, influenza, rubella,
and syphilis
Detect minute particles of protein in the blood
Blood typing and identification of blood factors may
also be carried out in the serology section of the
laboratory
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Slide 16
Laboratory Tests: Serology Tests (cont’d)

Examples of serology tests ordered

Agglutination test for specific organisms
 Antistreptolysin-O titer
 Blood typing: ABO groups and Rh
 Carcinoembryonic antigen assay (CEA)
 Coombs’ test
 C-reactive protein antiserum
 Heterophil antibody titer
 Tests for syphilis
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Slide 17
Laboratory Tests: Urinalysis
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Provides information about kidney function or
other body functions and diseases
Urine deteriorates quickly and should be tested
soon after collection
Urine composition varies according to fluid
intake and diet
Urine specimens can be classified as:

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Single, catheterized, or random specimens
Midstream specimens
Timed, long-period specimens
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Slide 18
Laboratory Tests: Urinalysis (cont’d)

Midstream collections
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External genitalia are cleansed
A small amount of urine is passed
Urine is collected from midstream voiding in a
sterile container
Used for cultures when a bladder infection is
suspected
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Slide 19
Laboratory Tests: Urinalysis (cont’d)

Timed, long-period specimens
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Collected over 12- or 24-hour period
Container may be kept on ice and has some form
of preservative
Used to determine kidney function and possible
glomerulonephritis or acute tubular necrosis
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Slide 20
Other Laboratory Tests
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Bacteriology
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Histology and cytology tests
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Blood, urine, feces, wound drainage, and other body fluids or
tissues cultured to identify the disease-causing organism
Aseptic technique must be maintained when collecting
specimens for culture and sensitivity
The study of tissues and cells
Detect carcinogenic, metabolic, vascular, and other changes
Ova and parasites
Cultures from specimens of feces, blood, urine, wound
drainage, or samples of body tissue or fluids
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Slide 21
Question 1
Which of the following is a nursing diagnosis used
when the patient needs teaching regarding diagnostic
tests?
1)
2)
3)
4)
Impaired verbal communication related to
changes in the mind
Readiness for enhanced communication related to
impaired vision
Deficient knowledge related to diagnostic tests
Impaired verbal communication related to hearing
aids
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Slide 22
Question 2
Which of the following tests is commonly
performed to detect changes in biochemical
reactions in the body and to determine a
diagnosis?
1)
2)
3)
4)
Hematology test
Blood chemistry test
Urinalysis
Serology test
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Slide 23
Chapter 24
Lesson 24.2
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
3)
Describe each of the categories of tests that
are commonly performed. (Continued)
Clinical Practice
4)
Perform patient teaching for a magnetic
resonance imaging (MRI) test.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 25
Ultrasonography


Records the reflection of sound waves
directed into the tissues
Used to diagnose pathologic conditions of:


Uterus, ovaries, prostate, heart, liver, kidneys,
pancreas, gallbladder, lymph nodes, thyroid, eyes,
and peripheral blood vessels
Often used in conjunction with nuclear
medicine scans
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Slide 26
Radiology Procedures
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Produce data to be used in diagnosis
X-ray: most common
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Fluoroscopy: examines movement


Produces image of the denser tissues by passing
rays through the part to expose a film
X-rays passed through the body part and projected
on a fluorescent screen
Cineradiography

Adding a video camera to the fluoroscope equipment
and making a photographic record of the procedure
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Slide 27
Radiology Procedures (cont’d)

Commonly performed radiology procedures
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Chest x-ray
Barium swallow and upper GI series
KUB (kidneys, ureters, and bladder)
Gallbladder series
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Slide 28
Radiology Procedures (cont’d)
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IVP (intravenous pyelogram)
X-ray of bony skeleton
Arthrogram
Myelogram
Radionuclide scan
Computed tomography (CT) scan
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Slide 29
Radionuclide Scans
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Various organs and soft tissues of the body
attract and concentrate certain radionuclides
A radioactive substance is injected into a vein
After organ being scanned absorbs the
substance, a radioactivity scanner
(scintillator) is passed over the area where
the organ is located
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Slide 30
Computed Tomography
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Computer enhances x-rays and allows
examination of horizontal sections of the body
at various angles to define tissue density
Most CT scans noninvasive, but consent may
be required for scans using a contrast
medium
Data fed into the computer, which produces
images in shades of gray that indicate the
different densities of the organ
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Slide 31
Magnetic Resonance Imaging
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Noninvasive method of differentiating normal
from abnormal tissue in the body
Commonly used for the brain, knee joint, spine
and spinal cord, and abdominal organs
Patients with metal devices implanted in the body
cannot undergo this procedure because the
machine emits a strong magnetic field
Contraindicated in patients with hip prostheses,
implanted pacemakers or defibrillators, artificial
cardiac valves, or vascular clips or staples from
recent surgery
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Slide 32
Magnetic Resonance Imaging (cont’d)
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Patient teaching is very important before this
procedure; patient needs to know the
duration of the test and that it requires being
in a noisy environment
Patient may become claustrophobic during
test
Patient needs to know deep-breathing and
relaxation techniques
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Slide 33
Cardiopulmonary Studies
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EKG/ECG
Diagnoses heart rhythms and heart disease;
measures electrical activity of the heart
Consists of waves and lines that represent the
electrical activity during the cardiac cycle
P waves, QRS complex, and T wave

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The person trained in interpreting the tracing can
determine if the waves are normal or abnormal
Electrodes are applied to the skin
Vessels can be detected, as can valvular
dysfunction
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Slide 34
Cardiopulmonary Studies (cont’d)

Cardiac catheterization
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Determines function of heart, valves, coronary
circulation
Readings taken of oxygen concentration at
different sites, of pressure in different heart
chambers, and cardiac output
Abnormal blood flow through the heart and the
coronary vessels can be detected
A surgical procedure using surgical aseptic
techniques
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Slide 35
Cardiopulmonary Studies (cont’d)

Angiography and arteriography
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
Locate lesions, occluded vessels, tumors, and
malformed blood vessels
Contrast medium injected into an artery and x-rays
taken of the dye spreading through the vessels
Used to diagnose problems in arteries anywhere
in the body: heart, neck, brain, or extremities
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Slide 36
Cardiopulmonary Studies (cont’d)

Treadmill stress test
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Measures the cardiac heart rate and blood
pressure response to clinically controlled active
exercise
Used to diagnose heart capacity, to guide
convalescence from a myocardial infarction, and
to determine response to medical treatment
While having heart action continuously monitored
by ECG, the patient walks on a treadmill, pedals a
stationary bicycle, or climbs a set of stairs
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Slide 37
Cardiopulmonary Studies (cont’d)

Pulmonary function test (PFT)
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
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Provides information about respiratory function,
lung capacity, and diffusion of gases
Spirometers and other breathing devices may be
used
No special preparation is required
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Slide 38
Question 3
Which of the following diagnostic tests is a
noninvasive method of visualizing soft tissue
structures of the body?
1)
2)
3)
4)
Ultrasonography
X-rays
Magnetic resonance imaging (MRI)
Computed tomography
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Slide 39
Question 4
Melissa’s patient is going for an electrocardiogram.
Her patient is scared and wants Melissa to explain the
procedure. Which best describes an
electrocardiogram? An ECG is a:
1)
2)
3)
4)
record of the electrical activity of the heart.
record of the position and motion of the heart
produced by ultrasound waves.
graphic record of the heart sounds.
record of the direction and magnitude of the
forces of the heart during one heartbeat.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 40
Chapter 24
Lesson 24.3
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
3)
Describe each of the categories of tests that
are commonly performed. (Continued)
4)
Explain factors to be considered when an
older adult is to undergo diagnostic testing.
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Slide 42
Learning Objectives
Clinical Practice
5)
Describe how to prepare a patient for and assist with
aspiration procedures such as lumbar puncture,
thoracentesis, paracentesis, bone marrow aspiration,
and liver biopsy.
6)
Correctly use Standard Precautions whenever
obtaining or handling specimens for diagnostic tests.
7)
List the steps for assisting with a pelvic examination
and Pap test.
8)
Correctly fill out laboratory and test requisition forms.
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Slide 43
Gastroscopy

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Visual inspection of upper digestive tract and
stomach
Obtain specimens of gastric contents and perform
a biopsy on the stomach tissues
Local anesthetic is sprayed on the pharynx, and a
gastroscope is passed to the stomach
The scope has a fiberoptic system for its lens
Gastroscope may be equipped with a camera to
take color photographs
Washings to obtain specimens for cytology studies
or a biopsy specimen is taken
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Slide 44
Proctosigmoidoscopy




Visual inspection of the lower bowel to check
the lining for ulceration, polyps, tumors,
inflammation, and other abnormalities
The sigmoidoscope is inserted
The fiberoptic lens enables examiner to see
the structures; suction can remove secretions
Air may be introduced to inflate the lower
bowel to better view the wall, and biopsy
forceps may be used to remove a tissue
specimen
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Slide 45
Colonoscopy



Inspection of the entire large intestine for
polyps, areas of inflammation, and malignant
lesions
A long, flexible fiberoptic endoscope is
inserted anally and slowly advanced through
the large intestine
Should not be done sooner than 10 to 14
days after barium GI studies
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Slide 46
Cystoscopy



Visual inspection of the interior of the bladder
Collection of biopsy specimens, collection of
urine separately from each ureter, and
treatment of various conditions
Cystoscope passed through the urethra and
the bladder is visually inspected
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Slide 47
Endoscopic Retrograde
Cholangiopancreatography




Used to identify a cause of biliary obstruction
such as stricture, cyst, stones, or tumor
Endoscope is inserted through the mouth and
into the duodenum after intravenous sedation
A catheter is inserted into the pancreatic duct
via the endoscope and a contrast medium is
injected
X-rays are taken
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Slide 48
Aspirations



To obtain bone marrow, liver cells, spinal
fluid, abdominal fluid, or fluid in the chest
cavity
Usually performed at the bedside or in a
procedure room by the physician
Essential that the patient remain still during
the procedure
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Slide 49
Electroencephalography

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


Tracing of the brain waves
Neurologic and physiologic activity produces
electrical charges measured as brain waves
Localize and diagnose brain lesions, scars,
epilepsy, infections, blood clots, and abscesses
Also to determine brain death in comatose
patients on life support systems
Electrodes attached to scalp with skin glue or
paste, or a mesh cap containing the 19 to 25
electrodes is placed on the head
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Slide 50
Other Diagnostic Tests



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Blood specimens
Wound or throat culture
Random blood sugars
Hemoglobin levels
Urine dips
Papanicolaou smears
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Slide 51
Diagnostic Testing and the Older Adult



Older patients often react differently to
invasive tests
Older adults often have several problems that
may interfere with doing the procedure
Always ask older adults if they have
questions or need special accommodations
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Slide 52
Question 5
Melissa’s patient now needs an aspiration. She is
very nervous about this procedure as well. Melissa
explains to her patient that an aspiration is
performed by:
1)
2)
3)
4)
a flexible fiberoptic instrument.
injecting a needle into the abdomen.
extracting fluid or tissue from the patient.
inserting a needle through the chest wall into
the pleural space to remove air.
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Slide 53