diagnositc testing

8/2/2019 Diagnositc Testing

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DIAGNOSITCTESTING

BY: JERVY P. BERANRDINO, RN, MSN


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DIAGNOSTIC TESTING

Also known as laboratory Testing

Are tools that provide information about thecleint

PURPOSE:

Used for basic screening as part of wellnesscheck

Used to help confirm a diagnosis

Monitor an illness

Provide valuable information about the clients

response to the treatment


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DIAGNOSTIC TESTINGPHASES

PRETEST

The major focus is the client preparation

A thorough assessment and data collectionassist the nurse in determining communicationand teaching strategies

The nurse needs to know what equipment and

supplies are needed for the specific test


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INTRATEST

This phase focuses on specimen collection andperforming or assisting with certain diagnostic

testing The nurse uses standard precautions and sterile

technique as appropriate

During the procedure the nurse providesemotional and physical support while monitoringthe client as needed

The nurse ensures correct labeling, storage, and

transportation of the specimen to avoid invalid testresult


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POST-TEST

The focus of this phase is on nursing care ofthe client and follow-up activities and

observations

The nurse compares the previous and currenttest results and modifies nursing interventions

as needed.


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BLOOD TESTS

Provide valuable information about thehematologic system and many other bodysystem

A VENIPUNCTURE(puncture of a vein forcollection of a blood specimen) can beperformed by various members of the

healthcare team A PHLEBOTOMIST, a person from a

laboratory who performs venipuncture, usuallycollects the blood specimen for the test

ordered by the primary care provider


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BLOOD TESTS

COMPLETE BLOOD COUNT (CBC)

SERUM ELECTROLYTES

BLOOD CHEMISTRY

SERUM OSMOLALITY

DRUG MONITORING

ARTERIAL BLOOD GASES

CAPILLARY BLOOD GLUCOSE


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COMPLETE BLOOD COUNT

COMPONENT NORMAL FINDINGS

Red Blood Cell (RBC) countThe number of RBCs per cubicmillimeter (mm3)

Men:4.6-6.0 million/mm3

Women:4.0-5.0 million/mm3


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Hemoglobin (Hgb)Composed of a pigment (heme), whichcontains iron, and a protein (globin)

Men:13.5-18 g/dL

Women: 12-15 g/dL

Anemia is classified when the hemoglobin levelfalss below 10.5 g/dL


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Hematocrit (Hct)The hematocrit or packed cell volume(Hct, PCV, or crit) is a fast way todetermine the percentage of RBCs inthe plasma

The Hct is reported as a percentagebecause it is the proportion of RBCs tothe plasma

Men:40-54%

Women:36-46%


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RBC INDICES

Mean Corpuscular Volume (MCV)The mean or average size of the individualRBC

Mean Corpuscular Hemoglobin (MCH)Amount of Hgb present in one cell

Mean Corpuscular Hemoglobin ConcentrationThe proportion of each cell occupied by hgb.

Men: 80-90Women: 78-102

25-35 pg

31-37%


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White Blood Cell (WBC) CountCount of the total number of WBCs in acubic millimeter of blood

4,500 11,000/mm3


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WBC DIFFERENTIAL COUNT:The proportion of each of the five types ofWBCs in a sample of 100 WBCs

Neutrophils

Lymphocytes

Monocytes

Eosinophils

Basophils

50-70%

25-45%

4-6%

1-3%

0.4-1.0%


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Platelet CountPlatelets are fragments of cytoplasm thatfunction in blood coagulation

150,000-350,000/mm3


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SERUM ELECTROLYTES


SODIUM

POTASSIUM

CHLORIDE

CALCIUM

MAGNESIUM

PHOSPHATE

135-145 meq/L

3.5-5.3 meq/L

95-105 meq/L

4.5-5.5 meq/L or 8.5-10.5 mg/dL

1.5-2.5 meq/L

1.8-2.6 meq/L


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BLOOD CHEMISTRY

TEST NORMAL FINDINGS SIGNIFICANCE

LIVER FUNCTION TESTS

ALT (Alanine AminoTransferase)

Men: 10-55 unit/LWomen: 7-20 unit/L

Marker of hepatic injury More specific of liver

damage than AST

AST (Aspartate AminoTransferase)


Found in heart, liver, andskeletal muscle.

Can also be used toindicate liver injury

Albumin

Alkaline Phosphatase

3.5-4.8 g/dl or35-48 g/L

25-100 unit/L

Is a protein produced bythe liver

Found in the tissues ofthe liver, bone, intestine,kidney, and placenta


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BLOOD CHEMISTRY


LIVER FUNCTION TESTS

Ammonia 15-45 mcg/dl The liver covertsammonia, a by-productof protein metabolism,into urea which isexcreted by the kidneys

Bilirubin 0.3-1.0 mg/dl Results from thebreakdown ofhemoglobin in the red

blood cells; removedfrom the body by theliver, which excretes itinto the bile

GGT (Gamma-GlutamylTransferase


Found primarily in theliver, kidney prostate andspleen. Is more specific


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BLOOD CHEMISTRY


CARDIAC MARKERS

CK (Creatinine Kinase) Men: 38-174 unit/LWomen: 26-140 unit/LISOENZYMES:MM (CK3): 96-100%MN (CK2): 0-6%BB (CK1): 0%

An enzyme found in theheart and skeletalmuscles. Has threeisoenzymes:MM (CK3)MN (CK2)BB (CK1)

Myoglobin 5-70 ng/ml After an MI, serum levels

of myoglobin rise in 2-4hours making it an earlymarker for muscledamage in MI

Troponin ITroponin T


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BLOOD CHEMISTRY


BNP (Brain NatriureticPeptide, or B-Type NatriureticPeptide)


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BLOOD CHEMISTRY


LIPOPROTEIN PROFILE

Cholesterol


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SERUM OSMOLALITY

Is a measure of the solute concentration of theblood

The particles included are sodium ions, glucose ,

and urea. Are used primarily to evaluate fluid balance

Normal Values: 280-300 mOsm/kg

An increase in serum osmolality indicates a fluidvolume deficit

A decrease in serum osmolality indicates a fluidvolume excess


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DRUG MONITORING

Is conducted when a client is taking amedication with a narrow therapeutic range


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ARTERIAL BLOOD GASES

C OO


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CAPILLARY BLOODGLUCOSE

Used to measure blood glucose


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SPECIMEN COLLECTION ANDTESTING

STOOL SPECIMEN

URINE SPECIMEN

SPUTUM SPECIMEN


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STOOL SPECIMEN

To determine the presence of occult (hidden)blood.

To analyze for dietary products and digestive.

Ex. An excessive amount of fat in the stool(steatorrhea) can indicate faulty absorption of fatfrom the small intestine.

To detect the presence of ova and parasites

When collecting specimens for parasites, it isimportant that the sample be transportedimmediately to the laboratory while it is still warm

To detect the presence of bacteria or viruses.

FECAL OCCULT BLOOD


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FECAL OCCULT BLOODTESTING

Is the test for occult blood

Guaiac Test (Hemoccult). Uses a chemicalreagent that detects the presence of the

enzyme peroxidase in the hemoglobinmolecule


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URINE SPECIMENS

TYPES:

Clean voided urine specimen

Clean-Catch or Midstream Urine Specimen

Timed Urine Specimen

Indwelling Catheter Specimen


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Clean Voided Urine Specimen

Is used for routine examination

First voided specimen in the morning is usedbecause it tends to have a higher, more

uniform concentration and more acidic pH 10 mL of urine is used

The specimen must be free of fecal

contamination The nurse must make sure that the specimen

label and laboratory requisition carry thecorrect information


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Clean-Catch or Midstream UrineSpecimen

Are collected when a urine culture is orderedto identify microorganisms causing UTI.

Clean-Catch specimens are collected in a

sterile specimen container with a lid.


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Timed Urine Specimen

Require collection of all urine produced andvoided over a specified period of time, rangingfrom 1 to 2 hours to 24 hours

Timed specimens generally either arerefrigerated or contain a preservative toprevent bacterial growth

Each voiding of urine is collected in a small.Clean container and then emptied immediatelyinto the large refrigerated bottle.


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Indwelling Catheter Specimen

Sterile urine specimens can be obtained fromclosed drainage system by inserting a sterileneedle attached to a syringe through a

drainage port in the tubing Aspiration of urine from catheters can be done

only with self-sealing rubber catheters

COMPONENTS OF URINE


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COMPONENTS OF URINETESTING

TEST NORMALFINDINGS

SIGNIFICANCE

Specific Gravity 1.010-1.025 Is the indicator of urine concentration or theamount of solutes (metabolic wastes andelectrolytes present in the urine

Urinary pH pH of 6 Determines the relative acidity or alkalinity ofurine and assess the clients acid-base status

Glucose negligible To screen clients for Diabetes Mellitus

Ketones Absent Ketone bodies are products of the breakdownof fatty acids

Found in the urine of clients with poorlycontrolled diabetes

Protein Absent Protein molecules normally are too large toescape from glomerular capillaries into thefiltrate

Occult Blood Absent When blood is present, it may be clearlyvisible or not visible occult


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