common laboratory procedures

Common Laboratory Common Laboratory procedures:procedures:

Nursing Responsibilities and Nursing Responsibilities and ImplicationsImplications

3 Phases of Diagnostic testing3 Phases of Diagnostic testing

PretestPretestClient preparationClient preparation

Intra-testIntra-testspecimen collection and VS specimen collection and VS

monitoringmonitoring Post-testPost-test

Monitoring and follow-up Monitoring and follow-up nursing carenursing care

Related Nursing Related Nursing DiagnosesDiagnoses AnxietyAnxiety FearFear Impaired physical Impaired physical

mobilitymobility Deficient knowledgeDeficient knowledge

BLOOD TESTSBLOOD TESTS

CBCCBCHemoglobin, Hematocrit, Hemoglobin, Hematocrit,

WBC, RBC and plateletWBC, RBC and platelet Serum ElectrolytesSerum Electrolytes Arterial blood gasesArterial blood gases Blood ChemistryBlood Chemistry Drug and Hormone AssayDrug and Hormone Assay

Complete Blood CountComplete Blood Count

Specimen: Venous bloodSpecimen: Venous blood PretestPretest: obtain syringe, : obtain syringe,

tourniquet, vial with appropriate tourniquet, vial with appropriate anticoagulantanticoagulant

Intratest:Intratest: Cubital vein commonly Cubital vein commonly used for venipunctureused for venipuncture

Post-testPost-test: direct pressure and : direct pressure and observe for bleeding, label vialobserve for bleeding, label vial

Normal values for CBCNormal values for CBC

RBC (M) 4.7-6.1/ (F) 4.2-5.4RBC (M) 4.7-6.1/ (F) 4.2-5.4 Hgb (M) 14-18/ (F) 12-16 mg/dLHgb (M) 14-18/ (F) 12-16 mg/dL Hct (M) 42-52/ (F) 33-47 %Hct (M) 42-52/ (F) 33-47 % WBC 5-10,000 cells/cubic cmWBC 5-10,000 cells/cubic cm

Differential countDifferential count Neutrophils- 55- 70%Neutrophils- 55- 70% Lymphocytes- 20-40%Lymphocytes- 20-40% Monocytes- 2-5%Monocytes- 2-5% Eosinophils- 1-4%Eosinophils- 1-4%

Platelets 150,000-400,000Platelets 150,000-400,000

Table. 11.2Table. 11.2

CBCCBC

Normal WBC countNormal WBC count 5-10,000 cell/cm35-10,000 cell/cm3

Increased WBCIncreased WBC

(Leukocytosis)(Leukocytosis)More than 10, 000More than 10, 000

Increased Increased NeutrophilsNeutrophils

ACUTE bacterial ACUTE bacterial infectioninfection

Increased Increased LymphocytesLymphocytes

CHRONIC bacterial CHRONIC bacterial infectioninfection

VIRAL infectionVIRAL infection

Increased Increased EosinophilsEosinophils

PARASITIC PARASITIC infection infection

Serum ElectrolytesSerum Electrolytes

Specimen: venous bloodSpecimen: venous blood Pretest/Intratest/Post-test- samePretest/Intratest/Post-test- same

Commonly ordered:Commonly ordered: Sodium- 135-145 mEq/LSodium- 135-145 mEq/L Potassium- 3.5-5.0 mEq/LPotassium- 3.5-5.0 mEq/L Chloride- 95-105 mEq/LChloride- 95-105 mEq/L Magnesium- Magnesium- 1.3 to 2.1 mEq/L1.3 to 2.1 mEq/L Calcium- Calcium- 8 to 10 mg/dL8 to 10 mg/dL

Serum ElectrolytesSerum Electrolytes

Problems can beProblems can be HyperHyper if increased if increased HypoHypo if decreased if decreased

Blood ChemistryBlood Chemistry

Specimen: Venous blood, serumSpecimen: Venous blood, serum Pretest/Intratrest/Post-test-samePretest/Intratrest/Post-test-same Examined are enzymes, Examined are enzymes,

hormones, lipid profile BUN , hormones, lipid profile BUN , Creatinine, etc…Creatinine, etc…

Place Place patient on NPO for 8 hpatient on NPO for 8 h **CreatinineCreatinine is produced relatively is produced relatively

constant by muscles, excreted by constant by muscles, excreted by the kidneys and is thethe kidneys and is the RELIABLE RELIABLE Reflection of Renal StatusReflection of Renal Status


Normal values for :Normal values for :Creatinine: 0.7 to 1.4 mg/dLCreatinine: 0.7 to 1.4 mg/dLBUN: 10-20 mg/dLBUN: 10-20 mg/dLCreatinine clearance: 1.67 to 2.5 mL/sCreatinine clearance: 1.67 to 2.5 mL/sSerum uric acid: 2.5 to 8 mg/dLSerum uric acid: 2.5 to 8 mg/dLBlood osmolality= 250 to 290 mOsm/LBlood osmolality= 250 to 290 mOsm/L


Enzymes/acidsEnzymes/acids PurposePurpose

Uric acidUric acid Gout detectionGout detection

SGOT/SGPTSGOT/SGPT Liver function testLiver function test

Rheumatoid factorRheumatoid factor For Rheumatoid For Rheumatoid arthritisarthritis

Anti-DNA antibodyAnti-DNA antibody SLE diagnosisSLE diagnosis

CK-MB, LDH and CK-MB, LDH and TroponinTroponin

Identifies Cardiac Identifies Cardiac damage or muscle damage or muscle damagedamage

Blood ChemistryBlood ChemistryCoagulation Coagulation studiesstudies

PurposePurpose

PTPT12-16 seconds12-16 seconds

Measures the Measures the effectiveness of effectiveness of WarfarinWarfarin

PTTPTT60-70 seconds60-70 seconds

The BEST single The BEST single screening test for screening test for coagulation disorderscoagulation disorders

aPTTaPTT30-40 seconds30-40 seconds

Same as PTT, Same as PTT, measures measures effectiveness of effectiveness of HEPARINHEPARIN

(more specific than (more specific than PTT)PTT)

Bleeding timeBleeding time1-9 minutes1-9 minutes

Measures Platelet Measures Platelet functionfunction

Blood ChemistryBlood ChemistryOthersOthers PurposePurposeESR (erythrocyte ESR (erythrocyte sedimentation rate)sedimentation rate)

10-20 mm/hour10-20 mm/hour

Measures the rate at Measures the rate at which the RBCs settle which the RBCs settle out of the anti-out of the anti-coagulated bloodcoagulated blood

Elevates in Elevates in inflammation auto inflammation auto immune diseases immune diseases

Blood lipidsBlood lipids

Cholesterol= 150-200 Cholesterol= 150-200 mg/dLmg/dL

Triglycerides= 140-200 Triglycerides= 140-200 mg/dLmg/dL

To detect To detect hyperlipidemiahyperlipidemia

Diabetes MellitusDiabetes Mellitus

DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA

FBS equal to or greater FBS equal to or greater than 126 mg/dL than 126 mg/dL (7.0mmol/L) (7.0mmol/L) (Normal 8 hour FBS- (Normal 8 hour FBS- 80-109 mg/dL)80-109 mg/dL)



OGTT value 1 and 2 hours OGTT value 1 and 2 hours post-prandial equal to or post-prandial equal to or greater than 200 mg/dLgreater than 200 mg/dL

Normal OGTT 1 and 2 Normal OGTT 1 and 2 hours post-prandial- ishours post-prandial- is140 mg/dL140 mg/dL


DIAGNOSTIC DIAGNOSTIC CRITERIACRITERIA

RBS of equal to or RBS of equal to or greater than 200 greater than 200

mg/dL mg/dL PLUS the 3 PLUS the 3 P’sP’s



Glycosylated hemoglobinGlycosylated hemoglobin

(HbA1c) is a monitoring (HbA1c) is a monitoring test to assess the test to assess the adherence to diabetic adherence to diabetic medicationmedication

Arterial Blood GasesArterial Blood Gases Specimen: arterial bloodSpecimen: arterial blood PretestPretest: obtain syringe with : obtain syringe with

heparin, rubber stopper, heparin, rubber stopper, container with icecontainer with ice

IntratestIntratest:: usual site-radial usual site-radial artery, perform artery, perform Allen’s testAllen’s test

Post-testPost-test: Apply direct : Apply direct pressure on site for 5-10 pressure on site for 5-10 minutes, send specimen with minutes, send specimen with occluded needle on iceoccluded needle on ice

Normal ABG valuesNormal ABG values

pH 7.35-7.45pH 7.35-7.45 pCO2 35-45 mmHgpCO2 35-45 mmHg paO2 80-100 mmHgpaO2 80-100 mmHg HCO3 22-26 mEq/LHCO3 22-26 mEq/L Base excess -2 to +2Base excess -2 to +2 O2 satO2 sat 95-98% 95-98%

ABG interpretationABG interpretationValueValue NormalNormal AcidosisAcidosis AlkalosiAlkalosi

sspH 7.35-7.45 Below

7.35Above 7.45

paO2paO2 95-100 95-100 mmHgmmHg

SaO2SaO2 95-98%95-98%paCO2 35-45

mmHgRespiratory >45

Respiratory<35

HCO3 22-26 mEq/L

Metabolic<22

Metabolic>26

Urine AnalysisUrine Analysis

SpecimensSpecimens Clean-voided urine for Clean-voided urine for

routine urinalysisroutine urinalysis Clean-catch or midstream Clean-catch or midstream

urine for urine cultureurine for urine culture Suprapubic and Suprapubic and

catheterized urine for urine catheterized urine for urine cultureculture

Routine UrinalysisRoutine Urinalysis

Specimen: Clean voidedSpecimen: Clean voided PretestPretest: give clean vial and : give clean vial and

instruct to void directly into the instruct to void directly into the specimen bottlespecimen bottle

Intratest:Intratest: Allow a 10 ml collection Allow a 10 ml collection Post-testPost-test: prompt delivery to : prompt delivery to

laboratorylaboratory **First voided urine in a.m. is highly First voided urine in a.m. is highly

concentrated, more uniform concentrated, more uniform concentration and with more concentration and with more acidic pHacidic pH

Urine Culture: Normal is <100,000 Urine Culture: Normal is <100,000

Specimen: clean catch, midstream Specimen: clean catch, midstream or catheterized urineor catheterized urine

PretestPretest: Instruct to wash and dry : Instruct to wash and dry genitalia/perineum with soap and genitalia/perineum with soap and water. (M)- circular motion, (F)-water. (M)- circular motion, (F)-front to back directionfront to back direction

Intratest:Intratest: Midstream urineMidstream urine, 30-60 , 30-60 mlml

Post-test:Post-test: Cap and label, prompt Cap and label, prompt delivery and documentationdelivery and documentation

Special Urine CollectionSpecial Urine Collection

InfantsInfants Special urine bagSpecial urine bag Or cut a hole of the diaper (front for Or cut a hole of the diaper (front for

the boy, middle for the girl) pulling the boy, middle for the girl) pulling out through the hole the special bagout through the hole the special bag

ChildrenChildren May use potty chair or bedpanMay use potty chair or bedpan Give another vial to play with, allow Give another vial to play with, allow

parent to assistparent to assist ElderlyElderly

Assistance may be requiredAssistance may be required

Timed-urine collectionTimed-urine collection Collection of Collection of ALL urineALL urine voided over a voided over a

specified timespecified time RefrigeratedRefrigerated or with preservative or with preservative Pretest:Pretest: Specimen container with Specimen container with

preservative, receptacle for collection, a preservative, receptacle for collection, a post signpost sign

Intratest: Intratest: AAt the start of collection, have t the start of collection, have patient void and patient void and discard the urinediscard the urine

At the end of collection period, At the end of collection period, instruct to completely void and instruct to completely void and save the save the urineurine

Post test: Post test: Documentation Documentation

Catheter specimen Catheter specimen

Sterile urineSterile urine Insert needle of the syringe through a Insert needle of the syringe through a

drainage portdrainage port Only done with the rubber catheter not Only done with the rubber catheter not

the plastic, silastic or silicone catheter.the plastic, silastic or silicone catheter. IntratestIntratest: Clamp catheter x 30 mins if no : Clamp catheter x 30 mins if no

urineurine Wipe area where needle will be Wipe area where needle will be

insertedinserted 30-4530-45° angle, 3 ml for culture° angle, 3 ml for culture

Post-testPost-test : Unclamp catheter after : Unclamp catheter after collectioncollection

Stool AnalysisStool Analysis

Occult BloodOccult Blood GUAIAC test GUAIAC test SteatorrheaSteatorrhea Ova/ParasitesOva/Parasites BacteriaBacteria VirusesViruses

General Nursing consideration General Nursing consideration for stool collectionfor stool collection

PretestPretest: Determine purpose/s, obtain : Determine purpose/s, obtain gloves, container and tongue bladegloves, container and tongue blade

Intratest:Intratest: Instruct to defecate in clean bed panInstruct to defecate in clean bed pan Void before collectionVoid before collection Do not discard tissue in bedpanDo not discard tissue in bedpan Obtain 2.5 (1 inch) formed stoolObtain 2.5 (1 inch) formed stool 15-30 ml of liquid stool15-30 ml of liquid stool

Post-testPost-test: prompt delivery: prompt delivery

Occult Blood: Guaiac TestOccult Blood: Guaiac Test Detect the presence of enzyme: Detect the presence of enzyme:

PeroxidasePeroxidase (+) blue color(+) blue color positive guaiac positive guaiac Restrict intake of red meats, some Restrict intake of red meats, some

medications and Vitamin C for 3-7 daysmedications and Vitamin C for 3-7 days FALSE (+):FALSE (+): red meatred meat, raw fruits and , raw fruits and

vegetables especially radish, turnip, vegetables especially radish, turnip, melon and horseradish; meds like aspirin, melon and horseradish; meds like aspirin, NSAIDS, iron and anticoagulantsNSAIDS, iron and anticoagulants

FALSE (-): Vitamin C, ingested 250 mg FALSE (-): Vitamin C, ingested 250 mg per day from any sourceper day from any source

Sputum AnalysisSputum Analysis

For Culture and sensitivityFor Culture and sensitivity For sputum cytologyFor sputum cytology For sputum AFBFor sputum AFB For monitoring of the For monitoring of the

effectiveness of therapyeffectiveness of therapy

Sputum examinationSputum examination

Pretest:Pretest: Morning specimen is Morning specimen is collectedcollected

Intratest:Intratest: Mouthwash with Mouthwash with plain waterplain water Deeply inhale x 2 then coughDeeply inhale x 2 then cough Wear gloves in collecting Wear gloves in collecting

specimenspecimen Expectorate needed- 1-2 Tbsp or Expectorate needed- 1-2 Tbsp or

15-30 ml15-30 ml Post-testPost-test: oral care and prompt : oral care and prompt

delivery to labdelivery to lab

VISUALIZATION VISUALIZATION PROCEDURESPROCEDURES

InvasiveInvasive procedures are procedures are direct direct methods and need methods and need CONSENTCONSENT

Non-invasiveNon-invasive procedures procedures are are indirectindirect methods and methods and may need written consent may need written consent in some instancesin some instances

Visualization proceduresVisualization procedures

They can be:They can be:

Radiographic proceduresRadiographic procedures

““Scopic”Scopic” procedures procedures

GIT VisualizationGIT Visualization Barium Swallow- UGISBarium Swallow- UGIS Pretest: written consent, NPO Pretest: written consent, NPO

the nightthe night Intratest: administer barium Intratest: administer barium

orally, then orally, then followed by X-rayfollowed by X-ray Post-test: Laxative for Post-test: Laxative for

constipation, increased fluids, constipation, increased fluids, assess for intestinal obstruction assess for intestinal obstruction , warn that stool is light colored!, warn that stool is light colored!

GIT VisualizationGIT Visualization Barium Enema- LGISBarium Enema- LGIS Pretest: Informed consent, NPO Pretest: Informed consent, NPO

the night, Enema the morningthe night, Enema the morning Intratest: Position on Intratest: Position on LEFT side, LEFT side,

administer enema, then X-ray administer enema, then X-ray followfollow

Post-test: Cleansing enema , Post-test: Cleansing enema , Laxative for constipation, assess Laxative for constipation, assess for intestinal obstruction for intestinal obstruction

GIT VisualizationGIT Visualization

EsophagogastroscopyEsophagogastroscopy Pretest: Informed consent, Pretest: Informed consent,

NPO for 8 hours, warn that NPO for 8 hours, warn that gag reflex is abolishedgag reflex is abolished

Intratest: Position on Intratest: Position on LEFT LEFT side during scope insertionside during scope insertion

Post-test: NPO until gag Post-test: NPO until gag returns. Monitor for returns. Monitor for complicationscomplications

GIT VisualizationGIT Visualization Anoscopy, proctoscopy, Anoscopy, proctoscopy,

proctosigmoidoscopy, proctosigmoidoscopy, colonoscopycolonoscopy

Pretest: Consent, NPO, and enema Pretest: Consent, NPO, and enema administration the morningadministration the morning

Intratest: Position on the Intratest: Position on the LEFT LEFT side during scope insertionside during scope insertion

Post-test: Monitor for Post-test: Monitor for complicationscomplications

GallbladderGallbladder

Oral cholescystogramOral cholescystogram PTCPTC ERCPERCP UltrasoundUltrasound

IV CholecystogramIV Cholecystogram

X-ray visualization of the X-ray visualization of the gallbladder after administration of gallbladder after administration of contrast media intravenously contrast media intravenously

Pre-test: Allergy to iodine and sea-Pre-test: Allergy to iodine and sea-foodsfoods

Intra-test: ensure patent IV lineIntra-test: ensure patent IV line Post-test: increase fluid intake to Post-test: increase fluid intake to

flush out the dye, Assess for flush out the dye, Assess for delayed hypersensitivity reaction delayed hypersensitivity reaction to the dye like chills and N/Vto the dye like chills and N/V

Oral CholecystogramOral Cholecystogram

X-ray visualization of the X-ray visualization of the gallbladder after gallbladder after administration of contrast administration of contrast mediamedia

Done 10 hours after ingestion Done 10 hours after ingestion of contrast tabletsof contrast tablets

Done to determine the Done to determine the patency of biliary ductpatency of biliary duct

Endoscopic retrograde Endoscopic retrograde cholangiopancreatographycholangiopancreatography

Examination where a flexible Examination where a flexible endoscope is inserted into the endoscope is inserted into the mouth and via the common bile mouth and via the common bile duct and pancreatic duct to duct and pancreatic duct to visualize the structuresvisualize the structures

Iodinated dye can also be Iodinated dye can also be injected after for the x-ray injected after for the x-ray procedureprocedure

Endoscopic retrograde Endoscopic retrograde cholangiopancreatographycholangiopancreatography Pre-test: consent, NPO for 12 Pre-test: consent, NPO for 12

hours, Allergy to sea-foods, hours, Allergy to sea-foods, Atropine sulfateAtropine sulfate

Intra-test: Gag reflex is Intra-test: Gag reflex is abolished, Position on LEFT abolished, Position on LEFT sideside

Post-test: NPO until gag reflex Post-test: NPO until gag reflex returns, Position side lying returns, Position side lying and monitor for perforation and monitor for perforation and hemorrhageand hemorrhage

Percutaneous Transhepatic Percutaneous Transhepatic CholangiogramCholangiogram Under fluoroscopy, the bile duct Under fluoroscopy, the bile duct

is entered percutaneously and is entered percutaneously and injected with a dye to observe injected with a dye to observe filling of hepatic and biliary ductsfilling of hepatic and biliary ducts

Ultrasound of the liver, Ultrasound of the liver, gallbladder and pancreasgallbladder and pancreas

Consent MAY be neededConsent MAY be needed Place patient on NPO!!!Place patient on NPO!!! Laxative may be given to Laxative may be given to

decrease the bowel gasdecrease the bowel gas

Urinary VisualizationUrinary Visualization

Non-invasive: KUB, IVP, Non-invasive: KUB, IVP, UltrasoundUltrasound

Pretest: Elicit allergy to iodine Pretest: Elicit allergy to iodine and seafood, NPO after and seafood, NPO after midnightmidnight

Intra-test: IV iodinated Dye is Intra-test: IV iodinated Dye is administered then X-ray is administered then X-ray is takentaken

Post-test: Increase fluids to Post-test: Increase fluids to flush the dye. Documentation, flush the dye. Documentation, VS monitoringVS monitoring

Urinary VisualizationUrinary Visualization Invasive: retrograde Invasive: retrograde

cystourethrogramcystourethrogram Pretest: Elicit allergy to iodine Pretest: Elicit allergy to iodine

and seafoodand seafood Intra-test: catheter is inserted Intra-test: catheter is inserted

with dye is administered then with dye is administered then X-ray is taken as patient X-ray is taken as patient voidsvoids

Post-test: Increase fluids to Post-test: Increase fluids to flush the dye. Documentation, flush the dye. Documentation, VS monitoringVS monitoring

Pulmonary visualizationPulmonary visualization

Invasive: Bronchoscopy, Invasive: Bronchoscopy, laryngoscopylaryngoscopy

Non-invasive: CXR and ScanNon-invasive: CXR and Scan

BronchoscopyBronchoscopy Purpose: Diagnostic and Purpose: Diagnostic and

therapeutictherapeutic Pretest:Pretest: Consent, NPO, client Consent, NPO, client

teaching, anti-anxiety drugsteaching, anti-anxiety drugs IntratestIntratest: gag reflex is abolished, : gag reflex is abolished,

instruct to remain still during instruct to remain still during procedure, FOWLER or procedure, FOWLER or SUPINESUPINE

Post-testPost-test: NPO until gag reflex : NPO until gag reflex returns, monitor patient for returns, monitor patient for complication like perforation/bleedcomplication like perforation/bleed

Pulmonary function testPulmonary function test

Test to determine lung volumes Test to determine lung volumes and capacitiesand capacities

LUNG VOLUMESLUNG VOLUMES

1. Tidal volume – TV1. Tidal volume – TV 2. Inspiratory Reserve Volume- 2. Inspiratory Reserve Volume-

IRVIRV 3. Expiratory Reserve Volume- 3. Expiratory Reserve Volume-

ERVERV 4. Residual volume- RV4. Residual volume- RV

LUNG CAPACITIESLUNG CAPACITIES

Lung volume + another lung volumeLung volume + another lung volume 1. Inspiratory Capacity- IC1. Inspiratory Capacity- IC 2. Functional Residual Capacity- 2. Functional Residual Capacity-

FRCFRC 3. Vital capacity- VC3. Vital capacity- VC 4. Total Lung capacity- TLC4. Total Lung capacity- TLC

Pulmonary "Volumes”Pulmonary "Volumes”

1. 1. Tidal Volume:Tidal Volume: -volume of air inspired or -volume of air inspired or

expired with each normal expired with each normal breath, about 500mlbreath, about 500ml

2. 2. Inspiratory Reserve VolumeInspiratory Reserve Volume -extra volume of air than can -extra volume of air than can

be inspired over & beyond the be inspired over & beyond the normal tidal volume, about normal tidal volume, about 3000ml3000ml

Pulmonary "Volumes”Pulmonary "Volumes”

3. 3. Expiratory Reserve VolumeExpiratory Reserve Volume -amount of air that can still be -amount of air that can still be

expired by forceful expiration after expired by forceful expiration after the end of a normal tidal the end of a normal tidal expirationexpiration

-about 1100ml-about 1100ml4. Residual Volume4. Residual Volume -volume of air still remaining in -volume of air still remaining in

the lungs after the most forceful the lungs after the most forceful expiration, averages about 1200mlexpiration, averages about 1200ml

Pulmonary "Capacities:"Pulmonary "Capacities:"

1. Inspiratory Capacity1. Inspiratory Capacity -equals TV + IRV, about 3500ml-equals TV + IRV, about 3500ml -amount of air that a person can -amount of air that a person can

breathe beginning at the normal breathe beginning at the normal expiratory level & distending his expiratory level & distending his lungs to maximum amountlungs to maximum amount

2. Functional Residual Capacity2. Functional Residual Capacity -equals ERV + RV-equals ERV + RV -about amount of air remaining in -about amount of air remaining in

the lungs at the end of normal the lungs at the end of normal expiration, about 2300mlexpiration, about 2300ml

Pulmonary "Capacities:"Pulmonary "Capacities:"

3. 3. Vital CapacityVital Capacity -equals IRV + TV + ERV or 1C + ERV, -equals IRV + TV + ERV or 1C + ERV,

about 4600mlabout 4600ml -maximum amount of air that a person -maximum amount of air that a person

can expel from the lungs after filling the can expel from the lungs after filling the lungs to their maximum extent & lungs to their maximum extent & expiring to the maximum extentexpiring to the maximum extent

4. Total Lung Capacity4. Total Lung Capacity -maximum volume to which the lungs -maximum volume to which the lungs

can be expanded with the greatest can be expanded with the greatest possible effortpossible effort

-volume of air in the lungs at this level is -volume of air in the lungs at this level is equal to FRC (2300ml) in young adultequal to FRC (2300ml) in young adult

Cardiac VisualizationCardiac Visualization

Invasive: angiography. Invasive: angiography. Cardiac catheterizationCardiac catheterization

Non-invasive: ECG, Non-invasive: ECG, Echocardiography, Echocardiography, Stress ECGStress ECG

The Cardiovascular SystemThe Cardiovascular SystemLABORATORY PROCEDURESLABORATORY PROCEDURES

ECHOCARDIOGRAMECHOCARDIOGRAM Non-invasive test that Non-invasive test that

studies the structural and studies the structural and functional changes of the functional changes of the heart with the use of heart with the use of ultrasoundultrasound

No special preparation is No special preparation is neededneeded

2 D-echocardiogram2 D-echocardiogram

AngiographyAngiography

Pretest: informed consent, Pretest: informed consent, allergy to dyes, seafood and allergy to dyes, seafood and iodineiodine

Intratest: Monitor VSIntratest: Monitor VS Post-test: maintain pressure Post-test: maintain pressure

dressing over puncture sitedressing over puncture site Immobilize for 6 hours Immobilize for 6 hours

Cardiac CatheterizationCardiac Catheterization

Introduction of catheter into heart Introduction of catheter into heart chamberschambers

Pretest: informed consent, allergy Pretest: informed consent, allergy to dyes, seafood and iodine, NPO to dyes, seafood and iodine, NPO 8-12 hours8-12 hours

Intra-test: Empty bladder, Monitor Intra-test: Empty bladder, Monitor VS, explain palpitationsVS, explain palpitations

Post-test: maintain pressure Post-test: maintain pressure dressing over puncture sitedressing over puncture site

Immobilize for 6-8 hours with Immobilize for 6-8 hours with extremity straightextremity straight

MyelographyMyelography

Radiographic examination of the Radiographic examination of the spinal column and sub-spinal column and sub-arachnoid space to help arachnoid space to help diagnose back pain causesdiagnose back pain causes

Pre-test: Consent, NPO, allergy Pre-test: Consent, NPO, allergy to seafoodsto seafoods

Intra-test: like LTIntra-test: like LT Post-test: supine for 12 hoursPost-test: supine for 12 hours

ArthroscopyArthroscopy

Insertion of fiber optic scope into Insertion of fiber optic scope into the joint to visualize it, perform the joint to visualize it, perform biopsy biopsy

Performed under OR conditionPerformed under OR condition After care: Dressing over the After care: Dressing over the

puncture site for 24 hours to puncture site for 24 hours to prevent bleedingprevent bleeding

Limit activity for several days (7 Limit activity for several days (7 usually)usually)

ArthrogramArthrogram

X-ray visualization of the joint X-ray visualization of the joint after introduction of contrast after introduction of contrast mediummedium

Pre-test: consent, allergy to Pre-test: consent, allergy to seafoodsseafoods

Post-test: Dressing over Post-test: Dressing over puncture site and limit joint puncture site and limit joint activity activity

ElectromyelographyElectromyelography

Records the electrical activity in Records the electrical activity in muscles at rest and during muscles at rest and during involuntary and involuntary and electrical electrical stimulationstimulation

Detects disorders such as MG, MS Detects disorders such as MG, MS and Parkinson’sand Parkinson’s

Explain the use of electrode inserted Explain the use of electrode inserted into the musclesinto the muscles

Mild discomfort may be experiencedMild discomfort may be experienced About 45 minutes for one muscleAbout 45 minutes for one muscle

CT scanCT scan

Painless, non-invasive, Painless, non-invasive, x-ray procedurex-ray procedure

Mechanism: distinguish Mechanism: distinguish density of tissuesdensity of tissues

MRIMRI Painless, non-invasive, no radiationPainless, non-invasive, no radiation Creates a magnetic fieldCreates a magnetic field Contraindications:Contraindications:

(+) pacemaker(+) pacemaker (+) metal prosthesis(+) metal prosthesis

Client teaching:Client teaching: Lie still during the procedure for 60-90 Lie still during the procedure for 60-90

minutesminutes Earplugs to reduce noise discomfortEarplugs to reduce noise discomfort ClaustrophobiaClaustrophobia No radiation No radiation

ASPIRATION AND BIOSPYASPIRATION AND BIOSPY

AspirationAspiration: withdrawal of : withdrawal of fluidfluid

BiopsyBiopsy: removal and exam : removal and exam of tissueof tissue

Invasive procedure needs Invasive procedure needs INFORMED CONSENTINFORMED CONSENT

Lumbar PunctureLumbar Puncture

Withdrawal of CSF from the Withdrawal of CSF from the arachnoid spacearachnoid space

Purpose: diagnostic and Purpose: diagnostic and therapeutictherapeutic

To obtain specimen, relieve To obtain specimen, relieve pressure and inject pressure and inject medication medication

Pretest:Pretest: consent, empty consent, empty bladderbladder

Lumbar PunctureLumbar Puncture

Intra-test:Intra-test: Site used-between Site used-between L4/L5L4/L5Position- flexion of the trunkPosition- flexion of the trunk

Post-test:Post-test: Flat on bed (8-12 Flat on bed (8-12 hours)hours)Offer fluids to 3 LitersOffer fluids to 3 LitersOral analgesic for headacheOral analgesic for headacheMonitor bleeding, swelling and Monitor bleeding, swelling and

changes in neurologic statuschanges in neurologic status

Abdominal ParacentesisAbdominal Paracentesis

Withdrawal of fluid from the Withdrawal of fluid from the peritoneal spaceperitoneal space

Purpose: diagnostic and Purpose: diagnostic and therapeutictherapeutic

Pretest:Pretest: consent, empty consent, empty bladderbladder Position: sittingPosition: sitting Site: midway between the Site: midway between the

umbilicus and symphysisumbilicus and symphysis

Abdominal ParacentesisAbdominal Paracentesis

Intratest:Intratest: 1,500 ml maximum 1,500 ml maximum amount collected at one time, amount collected at one time, Monitor VSMonitor VS

Post-testPost-test: monitor VS, : monitor VS, bleeding complicationbleeding complication Measure abdominal girth and Measure abdominal girth and

weightweight

ThoracentesisThoracentesis

Removal of fluid from the Removal of fluid from the pleural spacepleural space

Purpose: Diagnostic and Purpose: Diagnostic and therapeutictherapeutic

Pretest:Pretest: Consent, teach to Consent, teach to avoid coughingavoid coughingPosition: sitting with arms Position: sitting with arms

above headabove head

ThoracentesisThoracentesis

Intra-test:Intra-test: Support and Support and observationobservation

Post-test:Post-test: Assess VS Assess VSPosition Post-procedure: lie Position Post-procedure: lie

on the on the UNAFFECTED SIDEUNAFFECTED SIDE with head elevated 30with head elevated 30° x 30 ° x 30 minutes to facilitate minutes to facilitate expansion of the affected expansion of the affected lungslungs

Bone marrow BiopsyBone marrow Biopsy

Removal of specimen of bone Removal of specimen of bone marrowmarrow

Purpose: diagnosticPurpose: diagnostic PretestPretest: consent, teach that : consent, teach that

procedure is painfulprocedure is painful Site: POSTERIOR SUPERIOR Site: POSTERIOR SUPERIOR

ILIAC CREST (adult); ILIAC CREST (adult); PROXIMAL TIBIA (pedia)PROXIMAL TIBIA (pedia)

Position: prone or lateralPosition: prone or lateral

Bone marrow BiopsyBone marrow Biopsy

Intratest:Intratest: Monitor, maintain Monitor, maintain pressure dressing over pressure dressing over punctured site X 10 mins punctured site X 10 mins

Post-test:Post-test: Asses for Asses for discomfort, administer discomfort, administer prescribed pain medsprescribed pain meds

Liver BiopsyLiver Biopsy Liver tissue obtained for Liver tissue obtained for

diagnostic purposediagnostic purpose Pretest:Pretest: consent, consent,

administer Vitamin K, administer Vitamin K, monitor bleeding monitor bleeding parameters, NPO 2 hours parameters, NPO 2 hours before procedurebefore procedurePosition: Supine or Position: Supine or

semi-fowlers with upper semi-fowlers with upper right quadrant of right quadrant of abdomen exposedabdomen exposed

Liver BiopsyLiver Biopsy Intra-testIntra-test: Monitor VS: Monitor VS

Take few deep inhalation Take few deep inhalation and exhalation and hold and exhalation and hold final breath in exhalation x final breath in exhalation x 10 seconds as needle is 10 seconds as needle is injectedinjected

Post-test:Post-test: monitor VS, monitor VS, bleedingbleedingPosition post-procedure: Position post-procedure:

RIGHT side-lying with RIGHT side-lying with folded towel/pillow under folded towel/pillow under biopsy site for 4-6 hoursbiopsy site for 4-6 hours

Papanicolau SmearPapanicolau Smear

Done as screening test for Done as screening test for cervical cancer, for culturecervical cancer, for culture

Pre-test: no coitus for 2-3 Pre-test: no coitus for 2-3 days, no menstrual bleedingdays, no menstrual bleeding

Intra-test: Lithotomy, Intra-test: Lithotomy, speculum with speculum with water for water for lubrication, lubrication, specimen specimen obtained for cervix and vaginaobtained for cervix and vagina

Post-test: monitor for Post-test: monitor for bleedingbleeding

The Cardiovascular SystemThe Cardiovascular SystemLABORATORY PROCEDURESLABORATORY PROCEDURES

ELECTROCARDIOGRAM ELECTROCARDIOGRAM (ECG)(ECG)

A non-invasive A non-invasive procedure that evaluates procedure that evaluates the electrical activity of the electrical activity of the heartthe heart

Electrodes and wires are Electrodes and wires are attached to the patient attached to the patient

What the waves represent?What the waves represent?

P wave= Atrial DepolarizationP wave= Atrial Depolarization

QRS= Ventricular Depolarization QRS= Ventricular Depolarization

T wave= Ventricular REPOLARIZATIONT wave= Ventricular REPOLARIZATION

LABORATORY PROCEDURESLABORATORY PROCEDURES

CVPCVP The CVP is the pressure The CVP is the pressure

within the SVCwithin the SVC Reflects the pressure Reflects the pressure

under which blood is under which blood is returned to the SVC and returned to the SVC and right atriumright atrium


CVPCVP Normal CVP is 0 to 8 Normal CVP is 0 to 8

mmHg/ mmHg/ 4-10 cm H2O4-10 cm H2O


Measuring CVPMeasuring CVP 1. Position the client supine with 1. Position the client supine with

bed elevated at bed elevated at 45 degrees (CBQ)45 degrees (CBQ) 2. Position the zero point of the 2. Position the zero point of the

CVP line at the level of the right CVP line at the level of the right atrium. Usually this is at the atrium. Usually this is at the MAL, MAL, 44thth ICS ICS

3. Instruct the client to be relaxed 3. Instruct the client to be relaxed and avoid coughing and straining.and avoid coughing and straining.

TubesTubes

LevineLevine Salem Sump tubeSalem Sump tube Gastrostomy tubeGastrostomy tube Jejunostomy tubeJejunostomy tube

DrainageDrainage

Penrose DrainPenrose Drain HemovacHemovac PleuravacPleuravac Jackson-PrattJackson-Pratt

Asked in the local Asked in the local boardsboards

DREDRESnellen’s chartSnellen’s chartWeber’s testWeber’s testRinnes’ testRinnes’ test

DREDRE

Position: Left Lateral or Sim’s Position: Left Lateral or Sim’s position with upper leg position with upper leg acutely flexed. Females can acutely flexed. Females can also be examined in lithotomyalso be examined in lithotomy

Ask client to Ask client to BEAR DOWNBEAR DOWN To accentuate rectal To accentuate rectal

fissure, prolapse ,polypsfissure, prolapse ,polyps To relax the anal sphincterTo relax the anal sphincter

Snellen’s Chart: test for Snellen’s Chart: test for visual acuity visual acuity

20 ft or 6 m distance20 ft or 6 m distance 3 readings: L, R and Both 3 readings: L, R and Both

eyeseyes Report: 20/ xxxReport: 20/ xxx

Numerator: denotes the Numerator: denotes the distance from the chartdistance from the chart

Snellen’s Chart: test for Snellen’s Chart: test for visual acuity visual acuity

Denominator denotes the Denominator denotes the distance from which the distance from which the normal eye can read the normal eye can read the chartchart

20/60: the person can see 20/60: the person can see at 20 feet, what a normal at 20 feet, what a normal person can see at 60 feet.person can see at 60 feet.

Weber’s testWeber’s test

Test for lateralization and Test for lateralization and bone conductionbone conduction

Tuning fork is placed on top Tuning fork is placed on top of headof head

NORMAL: sound is heard in NORMAL: sound is heard in BOTH ears, localized at the BOTH ears, localized at the center of the head: center of the head: WEBER WEBER NEGATIVENEGATIVE

Weber’s testWeber’s test

Sound is heard BETTER in the Sound is heard BETTER in the affected ear: Bone conductive affected ear: Bone conductive hearing losshearing loss

Sound is heard only or better Sound is heard only or better on the NORMAL ear: on the NORMAL ear: Sensorineural heating lossSensorineural heating loss

ABNORMAL: ABNORMAL: WEBER WEBER POSITIVEPOSITIVE

Rinne’s TestRinne’s Test

Test for Test for AIR and BONE AIR and BONE conductionconduction

Tuning fork is initially placed Tuning fork is initially placed on the mastoid process until on the mastoid process until no vibration is heardno vibration is heard

Tuning fork is now placed in Tuning fork is now placed in front of the ear until sound front of the ear until sound disappearsdisappears


Air conduction is Air conduction is LONGER than bone LONGER than bone conductionconduction

Normal is POSITIVE Normal is POSITIVE Rinne’sRinne’s


CONDUCTIVE HEARING CONDUCTIVE HEARING LOSS:LOSS:Bone conduction is Bone conduction is

GREATER GREATER than or equal to than or equal to the AIR conductionthe AIR conduction

Abnormal is NEGATIVE Abnormal is NEGATIVE RINNEsRINNEs


SENSORINEURAL SENSORINEURAL HEARING LOSS:HEARING LOSS:No bone conduction and No bone conduction and

air conduction vibration air conduction vibration can be assessedcan be assessed

NEGATIVE RINNEsNEGATIVE RINNEs

WeberWeber

Rinne’sRinne’s

FAILING TO PREPARE IS

PREPARING TO FAIL…

common laboratory procedures

Documents

blood chemistry

2 hours post

obtain syringe

diabetes mellitus

test

specimen

200 mg dl

greater