diagnositc testing
TRANSCRIPT
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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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DIAGNOSTIC TESTINGPHASES
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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DIAGNOSTIC TESTINGPHASES
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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COMPLETE BLOOD COUNT
COMPONENT NORMAL FINDINGS
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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COMPLETE BLOOD COUNT
COMPONENT NORMAL FINDINGS
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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COMPLETE BLOOD COUNT
COMPONENT NORMAL FINDINGS
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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COMPLETE BLOOD COUNT
COMPONENT NORMAL FINDINGS
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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COMPLETE BLOOD COUNT
COMPONENT NORMAL FINDINGS
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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COMPLETE BLOOD COUNT
COMPONENT NORMAL FINDINGS
Platelet CountPlatelets are fragments of cytoplasm thatfunction in blood coagulation
150,000-350,000/mm3
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SERUM ELECTROLYTES
COMPONENT NORMAL FINDINGS
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)
Men: 10-40 unit/LWomen: 9-25 unit/L
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
TEST NORMAL FINDINGS SIGNIFICANCE
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
Men: 1-94 unit/LWomen: 1-70 unit/L
Found primarily in theliver, kidney prostate andspleen. Is more specific
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BLOOD CHEMISTRY
TEST NORMAL FINDINGS SIGNIFICANCE
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
TEST NORMAL FINDINGS SIGNIFICANCE
BNP (Brain NatriureticPeptide, or B-Type NatriureticPeptide)
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BLOOD CHEMISTRY
TEST NORMAL FINDINGS SIGNIFICANCE
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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