Dia nostic Tests

Dr. Raafat AL-Awadhi

Diagnostic and laboratory Tests:
Are tools that provide information about the
client, also run to find the cause of disease or
discomfort; tests used to make a diagnosis.
Purpose of diagnostic tests:
• Help to confirm a diagnosis
• Monitor an illness
• Provide valuable information about the
client's
response to treatment
Diagnostic testing involves three phases:-
Pretest
The major focus of the pretest phase is client
preparation
• The nurse
must know what equipment
and supplies are needed for
the specific test
• What type of
sample will be needed and
how it will be collected?
• Does the client
need to stop oral intake for a
Does the test include
• administration of contrast media and if so, it is
injected or swallowed?
• Are medications given or withheld?
• Is consent form required?
• How long is the test?
 Intratest
It focuses on specimen collection and performing
or assisting with certain diagnostic testing.
• The nurses uses of special standard
precautions and sterile
techniques
• Provide emotional and physical support while
monitoring the client as needed (e.g., V /S,
pulse oximetry, ECG).
• Correct labeling, storage, and transportation of
the specimen to avoid invalid test results.
Post
test
The focus of this phase is on nursing care of the
client and follow up activities
and observations.
• Compare the previous and current test
results
• Modify nursing interventions as needed
• Report the results to appropriate health team
members.
 Blood Tests

Complete Blood Count (CBC) which

includes:-
Hemoglobin
• Hgb test is a measure of the total amount of
hemoglobin in the blood
Hematocrit
• Hct measures the percentage of red blood cells
in the total blood volume
RBC count
• The number of RBC per cubic
millimeter (mm3) of whole blood
WBC or leukocyte
• The number of circulating WBC per cubic
millimeter of whole blood
0
0
Serum Electrolytes
• Ordered as a screening test for electrolyte and
acid — base imbalance.
• The most commonly ordered serum tests
are for “ sodium, potassium, chloride , and
bicarbonate”
• Evaluate renal function “ Urea, Creatinine”
• Urea, the end product of protein metabolism
is measured as BUN. Creatinine is produced
in relatively constant quantities by the muscles
and is excreted by the kidneys.
Serum Osmolality
• Serum Osmolality: is a measure of the solute
concentration of the blood. The particles
included are sodium ions, glucose, and
urea.
• It is estimated by doubling the serum
sodium
• Serum Osmolality values are used to
evaluate fluid balance
• Normal values are 280-300 mOsm/kg.
• An increase in Osmolality indicates a fluid
volume deficit
Drug monitoring
Is conducted when the client is taking a
medication with narrow therapeutic range such
as digoxin.
• This includes monitoring drawing blood
samples for peak and trough levels to
determine if the blood serum levels of a
specific drug are at a therapeutic level and
not a sub therapeutic or toxic level.
• Peak level: the highest concentration of the
drug in the blood serum
• Trough level: lowest concentration
Arterial Blood Gases “ABGs”

• Take specimen of the ABG from the radial,

Brachial, femoral arteries.
• Need to apply pressure to the puncture side for about
5-10 minutes after removing the needle.
Blood Chemistry
• Certain enzymes such as Lactic dehydrogenase
“LDH”, Creatine Kinase “CK” , serum
glucose, hormones such as thyroid hormone,
cholesterol and triglycerides.
• A common test is the glycosylate
hemoglobin “HbAlC”, which is a
measurement of blood glucose that is bound
to hemoglobin. HbAlC is reflection of how
well blood glucose levels have been
controlled during the prior 3 to 4 months.
Capillary Blood Glucose

• Measure blood glucose when frequent tests are

required or a veinpuncture cannot be performed.
• Less painful, easily performe@
Specimen Collection

Nurses always assume the responsibility for specimen

collection depending on the type of specimen and
skill required.
Nursing responsibilities with specimen
collection
• Explain the purpose of specimen collection
and the procedure for obtaining the specimen.
• Provide client comfort, privacy, and safety.
• Use the correct procedure for obtaining the
specimen collection.
• Note relevant information on the laboratory
requisition slip such as medication the client is
taking that may affect the results.
• Transport the specimen to the laboratory
promptly to have more correct results.
• Report abnormal results to the health
care
provider
Stool Specimens
• Reasons for testing feces include the
following:
• To determine the presence of occult blood
“hidden blood”. This test is referred to as
the guaiac test.
• To analyze for dietary products and
digestive secretions. An excessive amount of
fat in the stool (steatorrhea) can indicate
faulty absorption of fat from the small
intestine. Decreased amount of bile in stool
indicate obstruction in bile flow from liver
and gallbladder to the intestine.
• To detect the presence of ova and parasites.
When collecting specimen for parasites, it
is important to send the specimen as
soon as possible while it is still warm.
• To detect the presence of bacteria or viruses,
so the container must be sterile and
aseptic technique in collection.
Collecting Stool Specimens
Before obtaining the specimen, the nurse must
detemine the reason for the collecting the stool
specimen and the correct method of obtaining
and handling.
Nurse need to give the clients the following
instructions:
• Defecate in a clean bedpan or bedside commode.
• Do not contaminate the specimen by urine or
menstrual discharge.
• Do not place toilet tissues in the bedpan
after defecation.
• Notify the nurse as soon as possible after
defecation to send the specimen as soon as possible.
When obtaining the specimen the nurse
should:-
• Follow medical aseptic technique
meticulously.
• Wear disposable gloves to prevent hand
contamination and take care not to contaminate
the outside of the specimen container.
• Use one or two clean tongue blades to transfer
the specimen to the container.
• The amount of stool to be sent depends on the
purpose for which the specimen is collected.
• Label the specimen and the laboratory
requisition have the correct information on
them.
• Sends the specimen to the laboratory
immediately.
• Document all relevant information, date,
time of collection and all nursing assessments”
color, odor, consistency and amount of feces”.
Testing Feces for Occult Blood

• Use of chemical reagent substance to detect the

presence of the enzyme peroxidase in the hemoglobin
molecule.
• A blue color indicates a guaiac positive result, that
is, the presence of occult blood. No color change or
any color other than blue is a negative finding,
indicating the absence of blood in the stool.
• Certain foods, medications, and vitamin C can
produce incorrect test results.
• False positive results can occur if the client
has recently ingested (a) red meat (b) raw
vegetables or fruits, (c) certain medications
that irritate the gastric mucosa and cause
bleeding such as aspirin, NSAID,
anticoagulants.
• False — negative results can occur if the
client has taken more than 250mgper day of
vitamin C up to 3 days before the test — even
if bleeding is present.
 Positive guaiac test shown on right, as
would be seen for this patient. Negative
result (on left) included for comparison.
Urine Specimens
The nurse is responsible for collecting urine specimens
for a number of tests: Clean voided specimens for
routine urinalysis, clean — catch or midstream
urine specimens for urine culture, timed urine
specimen, indwelling catheter specimen.
Clean voided Urine Specimen
• Usually done on the first voided specimen in the
morning
• At least 10 ml of urine sufficient for routine
analysis
• Client who is disabled, seriously ill or disoriented may
need to use a bedpan or urinal in bed, these need
special instructions:
• The specimen must be free of fecal
contamination
• Don't discard the toilet tissue in bedpan
• Put the lid tightly on the container to prevent
spillage of the urine.
• If the outside of container is contaminated,
clean it with a disinfectant.
The nurse must:-
— Make sure that the specimen label with
laboratory
requisition carry the correct information
and attach them securely to the
specimen.
Clean-Catch or Midstream Urine Specimen
It is collected when a urine culture is ordered to
identify microorganisms causing urinary
tract infection. Care is taken to ensure that the
specimen is as free as possible from contamination
around the urinary meatus.
• Clean — catch specimens are collected into a
sterile specimen container with a lid.
• Clean the urinary meatus with antiseptic solution
• Instruct the client to start voiding
• Collect 30-60 ml of urine in the container.
• Label the specimen and transport it to the
laboratory.
Timed Urine Specimen
It requires collection of all urine produced and
voided over a specific period of time,
ranging from 1-2 hours to -24 hours. Each
voiding of urine is collected in a small, clean
container and then emptied immediately into
the large refrigerated bottle or carton.
It is done for the following purposes:
• To assess the ability of the kidney to concentrate
and dilute urine.
• To determine disorders of glucose metabolism such
as
DM.
• To determine levels of specific constitutes such as
albumin, creatinine.
To collect the time urine specimen:
— Obtain the specimen with preservative from the
laboratory. Label the container with
identifying information for the client, the test
to be perfoimed, time started, and time of
completion.
— Provide a clean receptacle to collect urine
(bedpan).
— Post signs in the client's chart, room, alerting the
person to save all urine during the specified
time.
— At the start of the collection period, discard
the first voiding
— Save all urine produced during the time
collection
period in the container.
— At the end of collection, ask the pt to void the last
Urine Testing

Several simple urine tests are often done by nurses on

the nursing units. These include tests for specific
gravity, PH, and the presence of abnormal constituent
such as glucose, ketones, protein.
• Specific gravity — is indicator of urine
concentration,
or the amount of solutes present in the urine
• Nomally ranges from 1.010 to 1.025
• PH is measured to determine the relative acidity or
alkalinity of urine (7 is neutral, less than 7 is acidic,
greater than 7 is alkaline).
• Glucose — urine is tested for glucose to
screen clients for diabetes mellitus and to
assess clients for abnormal glucose to
tolerance during pregnancy.
• Ketones — ketones bodies a product of
the breakdown of fatty acids normally are
not present in the urine.
• Protein
• Occult blood
• Osmolality — is measure of the solute
concentration of urine. Normal values are
500 to 800 mOsm/kg.
Sputum specimen
Sputum is the mucous secretion from the lungs,
bronchi, and trachea.
A sputum trap is used when the specimen is
obtained by suctioning.
Sputum collection for the following purposes:
• For culture and sensitivity to identify a
specific microorganisms
• For cytology to identify the origin, structure, function
and pathology of cells.
• For acid-fast bacillus for TB.
• To assess the effectiveness of therapy.
Throat Culture
A throat culture sample is collected from the mucosa
of the oropharynx and tonsillar regions using a
culture swab.
Obtaining a throat culture is an invasive procedure
that requires the application of scientific knowledge
and potential problem solving to ensure client safety.
 Visualization Procedures
It includes indirect visualization (noninvasive)
and direct visualization (invasive)
techniques for visualizing body organ and
system function.

Clients with Gastro intestinal Alteration:

Direct visualization techniques include:
• Anoscopy: viewing of the anal canal
• Proctoscopy: viewing of the rectum
• Proctosigmoidoscopy: viewing the
rectum and
sigmoid colon
• Colonoscopy: viewing of the large
intestine.
Indirect visualization of the gastrointestinal tract is
achieved by:
X-rays of gastrointestinal tract can detect structure,
obstructions, tumors, ulcers, inflammatory diseases
or other structural changes such as hiatal hernias.
Visualization of the tract is enhanced by the use of a
barium. For examination of the upper gastrointestinal
tract or small bowel, the client drinks the barium
sulfate (barium swallow). For examination of the
lower gastrointestinal tract, the client is given an
enema containing the barium tBarium enema).
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Stomach

Upper endoscopy
Clients with Urinary Alterations
Visualization procedures also may be used to evaluate
urinary function.
• An X — ray of the KUB: Kidneys, Ureters,
Bladder
• IVP (Intravenous pyelography) — contrast
medium
is injected intravenously.
• Retrograde pyelography — contrast medium is
instilled directly into the kidney pelvis via the urethra,
bladder, and ureters following injection or instillation
of the contrast medium, x- ray are taken to evaluate
urinary tract structures.
• Ultrasonography: noninvasive test that uses
reflected sound waves to visualize the kidney.
• Cystoscopy: a lighted instrument inserted through the
urethra to visualize the bladder, urethral orifices
 @e is
injected, and
an X-ray
is taken

Kidney

Renal pelvis

Kidney
Bladder
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Clients with cardio pulmonary Alterations

• ECG: Electrocardiography, recording of the heart's

electrical activity.
• Electrocardiogram: Detect arrhythmias and
alteration in conduction indicative of myocardial
damage, enlargement of the heart, or drug
effects.
• Stress electrocardiography: Assess the client's
response to an increased cardiac workload during
exercise.
• Angiography: invasive procedure requiring
informed consent of the client. A radiopaque dye is
injected into the vessels to be examined. Using x-
rays the flow through the vessels is assessed and areas
of narrowing or blockage can be observed.
• Echocardiogram: noninvasive test that uses ultra
sound to visualize structures of the heart and evaluate
left ventricular function.
 Coronary
Angiography

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Lung scan
• Also known as V/Q (Ventilation / perfusion)
scan, records emissions from radioisotopes that
indicate
how well gas and blood are traveling through the
lungs.
• Laryngoscopy and bronchoscopy are sterile
procedure. Tissue samples may also be taken
for biopsy.
A bronchoscope is
used to view the
airways and check for
any abnormat1t1es
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Computed Tomography (CT) or (CAT)
Painless, noninvasive x-ray procedure that has the
unique capabilities of distinguishing minor
differences in the density of tissues. It produce a
three dimensional image of the organ or structure.
Г-îguze 28-1 5 Directiori of Computed Tomography Scan Rays
Magnetic Resonance Imaging (MRI)
Is a noninvasive diagnostic scanning technique in
which the client is placed in a magnatis field. MRI
provides a better contrast between noimal and
abnormal tissue than the CT scan. For visualization
of the brain, spine, limbs, and joints, heart,
blood vessels, abdomen and pelvis. The procedure
lasts between 60 and 90 minutes.
Aspiration/Biopsy

Aspiration: withdrawal of fluid that has abnormally

collected such as pleural cavity, abdominal cavity.
Biopsy: removal and examination of tissues. Usually
performed to determine a diagnosis or to detect
malignancy. Both aspiration and biopsy it needs
sterile techniques.

“Determine if the facility requires a signed informed-

consent from the aspirati‹›n I biopsy procedures”
Lumbar Puncture
In lumbar puncture “LP” CSF is withdrawn
through a needle inserted into the subarachnoid
space of the spinal canal between the third and
fourth lumbar vertebrae or between the fourth
and fifth lumbar vertebrae.
Figure 28-18 Lumbar puncture: position of client and insertion of
the needle into the subarachnoid space are skown
Abdominal Paracentesis
Normally the body creates just enough
peritoneal fluid for lubrication. The fluid is
continuously formed and absorbed into the
lymphatic system.
Ascites: large amount of fluid accumulates in the
abdominal cavity.
Abdominal Paracentesis: carried out to obtain a
fluid specimen for laboratory study and to
relieve pressure on the abdominal organs due
to the presence of excess fluid. A common site
for abdominal Paracentesis is the midway
between the umbilicus and the symphysis
pubis on the midline. Normally about 1,500 ml
is the maximum amount of fluid drained at one
time to avoid Hypovolemic shock.
 Thoracentesis
Normally, only sufficient fluid to lubricate the
pleura is present in the pleural cavity.
However, excessive fluid can be accumulating
as a result of injury, infection, or other
pathology. It is performed to remove the
excess fluid or air to ease breathing. Also it is
performed to introduce chemotherapeutic
drugs intrapleurally.
This is usually a sitting position with the arms
above the head, which spreads the ribs and
enlarges the intercostals space. Or in which the
client leans forward over a pillow.
A site on the lower posterior chest is often used
to remove fluid, and a site on the upper
anterior chest is used to remove air.
FÏuid is
rcmoз'od
euraJ
Bone Marrow biopsy
Biopsies are performed on many different types of
tissues such as bone marrow, liver, breast, lymph
nodes and lungs. The bones of the body commonly
used for a bone marrow biopsy are the sternum, iliac
crests, anterior or posterior iliac crest spines, and
proximal tibia in children. The posterior superior iliac
crest is the preferred site with the client placed prone
or on the side. 1-2 ml of bone marrow was withdraw.
 Bone Marrow Aspiration
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Liver biopsy
It is performed at the client's bedside, in which a
sample of liver tissue is aspirated. A physician
inserted a needle in the intercostals space between
two of the right lower ribs and into the liver or
through the abdomen below the right the right rib
cage. The nurse applies pressure to the site to prevent
bleeding, often by positioning the client on the biopsy
site.
Biopsy needíe 1s inserted
and a sample of the liver 1s
removed