diagnostic test khalid (p i h)

8/6/2019 Diagnostic Test Khalid (p i h)

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DIAGNOSTIC TEST PURPOSE NORMAL VALUES SIGNIFICANCE NURSINGCONSIDERATIO

NS

BLOOD UREANITROGEN

-To evaluate kidneyfunction and aid inthe diagnosis of renaldisease

-To aid in the assessof hydration

-8 to 20 mg/dl

Abnormal Results:

-Elevated levels:renal disease,reduced renal bloodflow (e.g. caused bydehydration),urinary tractobstruction, andincreased protein

catabolism (such asburns)

-Low levels: suggestsevere hepaticdamage,malnutrition, andover hydration

-Apply directpressure to thebleeding site.

-Inform thepatient that hemay resumetaking his usual

medications afterthe test.

-To evaluate liverfunction

To aid in thedifferential diagnosisof jaundice andmonitor its progress

-In adults, normal indirectserum bilirubin levels are1.1 mg/dl (SI, 19umol/L)

Abnormal Results:

-Elevated indirectserum bilirubinlevels usuallyindicate hepaticdamage

-High levels of

-Apply directpressure to thevenipuncture siteto stop bleeding.


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BILIRUBIN, SERUM,DIRECT ANDINDIRECT

-To aid in thediagnosis of biliaryobstruction andhemolytic anemia

-To determinewhether a neonaterequires anexchange transfusionor phototherapybecause of dangerously highunconjugatedbilirubin levels

indirect bilirubin arealso likely in severehemolytic anemia

-If hemolysis

continues, directand indirect bilirubinlevels may rise

-Other causes ofelevated indirectbilirubin levelsinclude congenitalenzyme deficienciessuch as GilbertsyndromeElevated directserum bilirubinlevels usuallyindicate biliaryobstruction

-If obstructioncontinues, directand indirect bilirubin

levels may rise

-In severe chronichepatic damage,direct bilirubinconcentrations mayreturn to normal ornear normal levels,but indirect bilirubinlevels remain


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elevatedthan 0.5mg/dl(SI,


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function disorders intravascularcoagulation,hemolytic disease ofthe newborn,schonlein-henoch

purpura, severehepatic disease(cirrhosis, forexample), or severedeficiency of factorsI,II,V,VII,VIII,IX, andXI.

48 hours toprevent furtherbleeding.

-Check the test

area frequently;keep the edgesof the cutsaligned tominimizescarring.

-Instruct thepatient thathe/she mayresume his/hermedication afterthe tests

HEMATOCRIT

-To aid diagnosis ofpolycythemia,anemia, or abnormalstates of hydration

-To aid in thecalculation of erythrocyte indices

-HCT is usually measuredelectronically; electronicresults are 3% lower thanmanual measurements

which trap plasma in thecolumn of packet RBCs

-In men, 42% to 52% (SI, .42 to 0.52)

-In women, 36% to 48%(SI, 0.36 to 0.48)

Abnormal Results:

-Low HCT suggestsanemia,hemodilution, ormassive blood loss

-High HCT indicatespolycythemia orhemoconcentrationcaused by blood lossand dehydration.

-Ensuresubdermalbleeding hasstopped before

removingpressure

-If largehematomadevelops at thevenipuncturesite, monitordistal pulses.


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UNSTABLEHEMOGLOBIN

-To detect of hemoglobin.

-Heat stability test result isnegative, isopropanol

solubility test result isstable

Abnormal Results:

-A positive heatstability test result

or unstable,solubility test result,especially withhemolysis, stronglysuggest thepresence of unstable Hb.

-Make sure thesubdermal

bleeding hasstopped beforeremovingpressure

-Instruct thepatient that hemay resumemedicationsstopped beforethe test.

-If a largehematomadevelops at thevenipuncturesite, monitorpulses distal tothe site.

PLATELET COUNT

-To evaluate plateletproduction

-To assess theeffects of chemotherapy orradiation therapy onplatelet production

Adults: 140,000 to400,000/ul (SI, 140 to400x10/L)

Abnormal Results:

-A count below50,000/ul can causespontaneousbleeding, when thecount is below5,000/ul, fatalcentral nervoussystem bleeding ormassive GI

-Make sure thatsubdermalbleeding hasstopped beforeremovingpressure

-Tell the patientthat he may


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-To diagnose andmonitor severethrombocytosis orthrombocytopenia.

hemorrhage ispossible

-A decreased count(thrombocytopenia,

80 to 100 millionplatelets per ml) canresult from aplasticor hypoplastic bonemarrow; infiltrativebone marrowdisease, such asleukemia, ordisseminatedinfection.

-An increased count(thrombocytosis canresult fromhemorrhage,infectious disorders,iron deficiencyanemia, recentsurgery, pregnancy,splenectomy orinflammatorydisorders. In suchcases, the plateletcount returns tonormal after thepatient recoversfrom the primarydisorder

resume anymedicationsstopped beforethe test

-If a largehematomadevelops,monitor pulsesdistal to thevenipuncture site


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PROTHROMBINTIME

-To evaluate theextrinsic coagulation

system (factors V,VII,and prothrombin andfibrinogen)

-To monitor responseto oral anticoagulanttherapy

-PT should be 10-14seconds (SI. 10 to 14s)

depending on the sourceof tissue thromboplastinand the type of sensingdevices used to measureclot formation

-In a patient receiving oralanticoagulants, PT shouldbe from 1 to 2 times thenormal control value

Abnormal Results:

-Prolonged PT mayindicate deficiencies

in fibrinogen,prothrombin, factorsV, VII, or X (specificassays can pinpointsuch deficiencies),or vitamin K. it mayalso result fromongoing oralanticoagulanttherapy

-A prolonged PT thatexceeds 2 timesthe control valueusually indicatesabnormal bleeding

-Make suresubdermal

bleeding hasstopped beforeremovingpressure

-Instruct thepatient that hemay resume hisusual diet andmedicationsdiscontinuedbefore the test

-If a largehematomadevelops at thevenipuncturesite, monitorpulses distal tothe site.

URIC ACID, URINE

-To detect enzymedeficiencies andmetabolicdisturbances (suchas gout) that affecturic acid production

-250 to 750 mg/24 hours(SI, 1.48 to 4.43 mmol/d),depending on patientsdiet.

Abnormal Results:

-Increased levelsmay result fromchronic myeloidleukemia,polycythemia, vera,multiple myeloma,

-Instruct thepatient that hemay resume hisusual diet andmedications.


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-To help measure theefficiency of renalclearance and todetermine the risk of

stone formation

early remision inpernicious anemia,lymphosarcoma andlymphatic leukemiaduring radiotherapy,

or tubularreabsorptiondefects, such asfanconis syndromeand hepatolenticulardegeneration

-Decreased levelsoccur in gout (whenuric acid productionin normal butexcretioninadequate) and insevere renaldamage such asthat resulting fromchronicglorulonephritis,diabeticglomerulosclerosis,and collagendisorders

Nonstress, Fetal(NST, Fetal ActivityDetermination)

-The NST is amethod to evaluatethe viability of afetus. It documentsthe placentas abilityto provide an

-Explain theprocedure to theclient.

-Encourage theverbalization of


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adequate bloodsupply to the fetus.The NST can be usedto evaluate any high-risk pregnancy in

which fetal well-being may bethreatened. Thesepregnancies includesthose marked bydiabetes,hypertensive diseaseof pregnancy(toxemia),intrauterine growthretardation, Rh-factorsensitization, historyof stillbirth,postmaturity, or lowestriol levels.

the patientsfears. Thenecessity for thestudy usuallyraises realistic

fears in theexpectantmother.

-If the patient ishungry, instructher to eat beforethe NST is begun.Fetal activity isenhanced with ahigh maternalserum glucoselevel.

During-After the patientempties herbladder, placeher in the Simsposition.-Place anexternal fetalmonitor on thepatientsabdomen torecord the FHR. The mother canindicate fetalmovement bypressing a buttonon the fetal


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monitorwhenever shefeels the fetusmove.

-The FHR andfetal movementareconcomitantlyrecorded on atwo-channel stripgraph.

-Observe thefetal monitor forFHRaccelerationsassociated withfetal movement.

-If the fetus isquiet for 20minutes,stimulate fetalactivity byexternalmethods, such asrubbing orcompressing themothersabdomen, ringinga bell near theabdomen, orplacing the panon the abdomenand hitting the


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pan.

-Note that anurse performsthe NST in

approximately 20to 40 minutes inthe physiciansoffice or ahospital unit.

-Tell the patientthat nodiscomfort isassociated withthe NST.

After-If the resultsdetect anonreactivefetus, calmlyinform thepatient that sheis a candidate forthe CST.

SERUM URIC ACID-To confirm thediagnosis of gout

-To help detect renaldysfunction

In men, 3.4 to 7 mg/dlIn women,2.3 to 6 mg/dl

Abnormal Results:

-Increased uric acidlevels may indicategout or impairedkidney functions.

-Apply directpressure to thevenipuncture siteuntil bleedingstops.


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-Levels may alsorise in heart failure,glycogen storagedisease (type 1 vonGierkes disease),

infection, hemolyticand sickle cellanemia,polycythemia,neoplasms, andpsoriasis

-Low uric acid levelsmay indicatedefective tubularabsorption such as

acute hepaticatrophy.

-Inform thepatient that hemay resume heusual diet and

medicationsstopped beforethe test.

Urinalysis (UA)

-To screen thepatients urine forthe renal or urinarytract disease

-To help detectmetabolic orsystemic diseaseunrelated to renaldisorder

-To detectsubstances (drugs)

Color: straw to dark yellowOdor: slightly aromaticAppearance: clearSpecific gravity: 100

Protein- 0-8 mg/dl- 50-80

mg/24 hr (at rest)-


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erythematosus

Goodpastures syndrome

Heavy-metalpoisoning

Bacterialpyelonephritis

Nephrotoxicdrug therapy

Renal diseaseinvolving theglomeruli isassociatedwith

proteinuria.

Trauma.Protein can spillinto the urineas a result oftraumaticdestruction ofthe blood-urine barrier.

Macroglobulin

emia. Withincreasedglobulinwithin theblood,albumin issecreted in anattempt to tomaintain


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ocncotichomeostasis.

Multiplemyelomas.Classically,

mulptiplemyelomasproduce largeamounts ofprotein (e.g.,Bence-Jonesprotein) in theurine.

Preeclampsia

Congestive

heart failure The

pathophysiologic factors oftheseobservationsare many.Suffice it tosay thatalbumin leaksfrom the

glomeruli,which aretemporarilydamage bythis illnesses.

Orthostaticproteinuria.As many as20% of normal male


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patients havesmallamounts ofprotein in theurine when

urinespecimensare obtainedfrom patientsin the uprightposition. Thepathophysiology is notknown withcertainty. Itmay be

associatedwith passivecongestion ofkidney in theuprightposition. Thisphenomenonis can bediagnosed byobtaining aurinespecimenbefore arisingand anotherafter thepatient hasbeen up fortwo hours. The first hasno protein,


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the latterdoes.

Severemuscleexertion.

Prolongedmuscularexertion canbe associatedwith smallamount of protein in theurine.

Renal veinthrombosis.Congestion ofthe kidney isassociatedwithproteinuria.

Bladdertumors.Tumors of thebladdersecreteprotein into

the lumen ofthe bladder.

Urethritis orprostatitis.Inflammationin theperiurethralglands orurethra cancause


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proteinuria.

Amyloidosis.Oftenassociatedwith

proteinuria, itmay be osevere as tocausenephriticsyndrome.Usually,amyloidosis ofthe kidney isdue to othersevere,ongoingdisease.

diagnostic test khalid (p i h)

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