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Diagnostic Tests


Title: Diagnostic Tests Author: Shoruq Last modified by: hp Created Date: 11/4/2007 10:19:07 AM Document presentation format: On-screen Show (4:3) Other titles – PowerPoint PPT presentation

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Title: Diagnostic Tests

Diagnostic Tests

  • 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 clients
    response to treatment

  • Diagnostic testing involves three phases-
  •   Pretest
  • The major focus of the pretest phase is client
  • 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
    certain number of hours prior to the test?

  • 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
  • Compare the previous and current test results
  • Modify nursing interventions as needed
  • Report the results to appropriate health team

  • 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

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  • 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

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  • 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
  • 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
  • A common test is the glycosylate hemoglobin
    HbA1C, which is a measurement of blood glucose
    that is bound to hemoglobin. HbA1C 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 performed

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  • 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

  • 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
  • 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.

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  • 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
    determine the reason for the collecting the stool
    specimen and the correct method of obtaining and
  •  Nurse need to give the clients the following
  • 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
  • Notify the nurse as soon as possible after
    defecation to send the specimen as soon as

  • 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

  • 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

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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

  • Clean voided Urine Specimen
  • Usually done on the first voided specimen in the
  • At least 10 ml of urine sufficient for routine
  • 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
  • Dont 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

  • 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.

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  • 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
    performed, time started, and time of completion.
  • Provide a clean receptacle to collect urine
  • Post signs in the clients chart, room, alerting
    the person to save all urine during the specified
  • 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 time and add them in the container.
  • Record collection of the specimen, timed started
    and completed.

  • 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,
  • Specific gravity is indicator of urine
    concentration, or the amount of solutes present
    in the urine
  • Normally 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).

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  • Glucose urine is tested for glucose to screen
    clients for diabetes mellitus and to assess
    clients for abnormal glucose to tolerance during
  • 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.

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  • 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 (Barium enema).

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Barium Swallow
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
    and urethra.

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  • Clients with cardio pulmonary Alterations
  • ECG Electrocardiography, recording of the
    hearts electrical activity.
  • Electrocardiogram Detect arrhythmias and
    alteration in conduction indicative of myocardial
    damage, enlargement of the heart, or drug

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  • Stress electrocardiography Assess the clients
    response to an increased cardiac workload during
  • 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.

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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

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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.

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  • Magnetic Resonance Imaging (MRI)
  • Is a noninvasive diagnostic scanning
    technique in which the client is placed in a
    magnatic field. MRI provides a better contrast
    between normal 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

  • 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

    malignancy. Both
    aspiration and biopsy it needs sterile
  • Determine if the facility requires a signed
    informed- consent from the aspiration / biopsy

  • 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.

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  • 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

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  • 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.

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  • 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

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  • Liver biopsy
  • It is performed at the clients 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.

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