Chapter 23 notes Flashcards
Diagnostic Examination?
-It may be performed by a health care provider at the patient’s bedside or in a specially equipped room for
therapeutic or diagnostic purposes
-The nurse knowledge and organization of the diagnostic procedure can be the keys to success
-Fundamental requirement to protect patient’s rights informed consent
Nurse’s Responsibilities?
-Reinforce provider’s explanation of the procedure confirm that the patient comprehends it,
and verify that written consent is not always necessary for an individual test informed verbal
consent may be adequate
-Anticipate the needs of the provider and have proper supplies read
-Keep the patient adequately informed of procedural details that could cause discomfort
-Assist the patient throughout the procedure
-Determine the patient is allergic to iodine
Patient Teaching?
-The nurse must be prepared to answer questions for which patient may need
Clarification
The patient needs to know if
-Nothing can be taken by mouth (NPO) after midnight
-Breakfast will be held until the examination is complete
-A special room or piece of equipment is required for the test
-Medication is needed before or during the test
Specimen Collection?
-All patients admitted to a health care facility have at least one laboratory specimen collected during hospitalization
-Laboratory examination of specimens of urine, stool, sputum, blood, and wound drainage provides important information about body functioning and contributes to the assessment of health status
-Laboratory tests can facilitate the diagnosis of health care problems, provide information about the stage and
activity of a disease process, and measure the response to therapy.
Guidelines for Specimen Collection Part 1?
-Consider the patient’s need and ability to participate in specimen collection procedures
-Recognize that the collection of a specimen may provoke anxiety embarrassment, or discomfort
-Provide support for patients who are fearful about the results of a specimen examination
-Recognize that children require clear explanation of procedures and that they need the support of their parents or a family member
-Obtain specimen in accordance with specific prerequisites as required
-Wear gloves when collecting specimens of blood or other body fluids
-Wash hands and other skin surfaces immediately and thoroughly if contaminated with blood or bod
Guidelines for Specimen Collection Part 2?
-Collect specimens in appropriate containers, at the correct time, and in the appropriate amount
-Properly label all specimens with the patient’s identification;complete laboratory requisition form as necessary
-Most specimens are transported to the laboratory in a separate outer plastic bag
-Deliver specimens to the laboratory within the recommended time or ensure that they are stored properly for later transport
-Use aseptic technique in all collections to prevent contamination, which can cause inaccurate test results
-Transport specimens under special conditions as required
Specimen Labeling?
- Properly label all specimens with the patient’s identification complete laboratory requisition form as necessary
-Label should include the following
-Patient’s name, date of collection, time of collection ,
initials of person who collected the specimen
Collecting Urine Specimens?
- Midstream
-Sterile
-24-hour urinary
Measuring Blood Glucose Levels?
-The use of a meter to measure blood glucose is a more meaningful test for use by persons with diabetes than testing urine for the presence of glucose
-A skin puncture can be easily performed by the patient at home and provides more accurate
information than does the urine glucose/acetone determination test
Collecting a Stool Specimen?
-Stool specimens are collected and examined for a variety of reasons
-Determine the presence of infection , bleeding , or hemorrhage
-Observe the amount , color consistency, and presence of fats
-Identify parasites, ova, and bacteria
Collecting a sputum specimen ?
-Sputum is secretions from the lungs
-It contains mucus, cellular debris, and microorganisms and may contain blood or
Pus
Many tests can be performed on sputum ?
-Culture
-Sensitivity
-Cytology
-Acid-fast bacillus
Obtain Culture?
Wound
-aerobic organisms
-anaerobic organism
Thorat
-swab
Phlebotomy can give information ?
-Veins are a major source of blood for laboratory
testing, as well as routes for IV fluids or blood
replacement
-The nurse should be skilled in venipuncture to
avoid unnecessary injury to veins
-Blood tests can yield valuable information about
nutritional, hematologic, metabolic, immune, and
biochemical status
-The nurse is often responsible for collecting
blood specimens; however, many institutions
have specially trained technicians to draw blood
Venipuncture?
-Venipuncture involves inserting a hollow-bore needle into the lumen of a large vein to obtain a specimen
-The nurse may use a needle and syringe or a special vacuum tube that allows the drawing of multiple
blood samples
-Assess for any special conditions that must be met before specimen collection if patient is to be NPO
Electrocardiogram ?
-An electrocardiogram (ECG or EKG) is a graphic representation of electrical impulses generated
by the heart during a cardiac cycle
-It identifies abnormalities that interfere with electrical conduction through cardiac tissue
-This procedure is usually done at the patient’s bedside, but it may be done in a specially equipped laboratory
specimen?
small sample of something , intended to show the nature of the whole
urinalysis consists of several tests, including determination?
-of pH, specific gravity, and the presence of any protein , glucose , ketones, blood, and white blood cells WBCs )
-In addition, a urine specimen sometimes is ordered for a culture and sensitivity test, which is used to diagnose and treat urinary tract infections
A midstream urine specimen?
is collected to perform a culture and sensitivity
A sterile urine specimen?
may be collected by inserting a straight catheter into the urinary bladder to remove urine or by obtaining a specimen from the port of an indwelling catheter with the use of sterile technique
Is it possible to measure residual?
urine ( urine left in the bladder after voiding ) at the time of catheterization.
COLLECTING A 24-HOUR URINE SPECIMEN?
- Tests of renal function and urine composition , such as measurements of levels of adrenocortical steroids , hormones , protein , and creatinine clearance , necessitate a 24- hour collection of urine -it has to be cold
When stool is to be examined for parasites , it must be taken immediately? .
to the laboratory for parasites to be examined under the microscope while they are alive
Arrange supplies if the patient is to collect the stool?
When a stool specimen is to be obtained , place the specimen hat toward the back of the toilet or commode-When a urine specimen is to be obtained, place the specimen hat toward the front
-A bedpan may use to collect a stool specimen if the patient is caution
A sputum specimen must be obtained from deep in a bronchial tree ?
-Expectoration of throat and mouth secretions not to be used as a sputum specimen because saliva with food particles does not produce desired results
-Early morning is the best time to collect sputum specimen , because the patient has not yet cleared the respiratory passages
Many tests are possible on sputum specimen?
culture
such as culture( a laboratory involving cultivation of microorganisms or cells in special growth medium )
Many tests are possible on sputum specimen
sensitivity ?
-sensitivity ( a laboratory method of determining the effectiveness of antibiotics , usually performed in conjunction with culture )
Many tests are possible on sputum specimen
cytologic ?
-cytologic analysis ( cytology is the study of cells , including their formation , origin structure , function , biochemical activities , and pathologic processes ) ; and examination
Many tests are possible on sputum specimen
-acid-fast bacillus ?
-acid-fast bacillus (the organism responsible for tuberculosis of the lung )
Collecting a Sputum Specimen by Suction?
- Some patients are not able to expectorate (eject mucus , sputum , or fluids from trachea and lungs by coughing or spitting )
-a sputum specimen , and nasotracheal suctioning is required to obtain a sputum specimen .
-Suctioning sometimes provokes coughing , which has potential to induce vomiting and constriction of pharyngeal , laryngeal , or bronchial muscles . In some cases ,)
OBTAINING A WOUND CULTURE?
The patient should be assessed for fever chills , malaise , and elevated WBC count , which indicate a possible systemic infection
OBTAINING A WOUND CULTURE Aerobic organisms?
- grow in superficial wounds exposed to the air, and anaerobic organisms tend to grow within body cavities -To collect an aerobic specimen , insert a sterile swab from the
-Culturette tube into wound secretions
-Then return the swab to the Culturette tube , cap the tube , and crush the inner ampule so that the medium for organism growth coats the swab tip
OBTAINING A WOUND CULTURE anaerobic specimen?
Anaerobic bacteria refers to the group of microorganisms that grow in the absence of oxygen
-deep in a body cavity , use a sterile syringe tip to aspirate visible drainage from the inner wound ; expel any air from the syringe and inject the syring
Venipuncture?
The most common method involves inserting a hollow-bore needle into the lumen of a large vein to obtain a specimen .
In some cases , a needle and syringe are used , and in others ,
A special vacuum cleaner?
tube is used to collect multiple blood samples
In the Vacutainer system, the tubes contain the necessary rubber stoppers that are color coded?
Red, lavender, blue, green, gray, and yellow are common colors
A tourniquet ?
a constricting device traditionally applied to control bleeding
-It prevents arterial blood flow to the part below the tourniquet and prevents venous blood from returning to the heart.
-The tourniquet is removed after the blood specimen is collected but before the needle is withdrawn from the vein.
-The tourniquet is applied 2 to 4 inches (5.08 to 10,16 ) above the elbow
Veins with the following characteristics are avoided?
-Small and narrow veins are usually fragile
-Weak veins are soft and do not rebound
-Sclerosed veins are hard and rigid
-Veins that are easy to roll when palpated difficult to pierce successfully with the needle
The electrocardiogram ( ECG )?
is a graphic representation of electrical impulses generated by the heart during a cardiac cycle; it identifies abnormalities that interfere with electrical conduction through cardiac tissue .
-If the patient has large amounts of hair , it is sometimes necessary to clip or shave the hair at the lead placement site
Chest (precordial leads)?
look picture
V_{1} Fourth intercostal space (ICS ) at right sternal border
V_{2} Fourth ICS at left sternal border
V_{3} Midway between and V_{2}; V_{4};
V_{4} Fifth ICS at midclavicular line
V_{5} Left anterior axillary line at level of V_{4} horizontally
V 6 : Left midaxillary line at level of V_{4} horizontally
BEFORE EXAMINATION Abdominal Scan ?
-Order prescribed test per facility policy
-Explain procedure.
-Obtain informed consent , if required by facility
-Assess laboratory results for kidney function
-If contrast medium is to be used, instruct patient to maintain NPO status for 4 h before examination .
-Assess patient for allergies to dye or shellfishit is possible to perform the abdominal scan with or without the dye.
-Assess patient for claustrophobia. Patients who are mildly claustrophobic often benefit from premedication with antianxiety drugs.
-Some patients experience mild nausea from the contrast medium; provide emesis basin.
- Advise patient that he or she may experience a salty taste flushing, and a sensation of warmth when dye is injected
After examination Scan Abdominal Scan ?
-Evaluate patient for delayed reaction to dye
-Encourage oral intake of fluids.
-Report results.
-Diarrhea is possible
Amniocentesis Explain procedure Before exaction?
-Encourage patient’s verbalization of concerns
-Obtain written consent from patient
-Monitor fetal heart tones No fluid or food restrictions are necessary .
- Monitor mother’s blood pressure .
-Follow instructions regarding emptying the bladder , which depend on gestational age .
-Before 20 wk of gestation , it is necessary to keep the bladder full to support the uterus .
-After 20 wk , the bladder typically is emptied to minimize the chance of puncture .
-After 20 wk gestation , the health care provider may order external fetal monitoring for 30-60 min before and after the procedure .
-NOTE : The location of the placenta is determined by ultrasonography before the study to enable selection of a site that will help prevent placental puncture .
Amniocentesis after ?
-Monitor fetal heart tones .
-If patient complains of vertigo or nausea , allow her to rest on her left side for several minutes before leaving examination room ; assess her vital signs .
- If any fluid loss or temperature elevation, abdominal pain or cramping, or fetal hyperactivity or unusual fetal lethargy occurs
-instruct patient to notify her health care provider. Instruct patient to contact her health care provider to obtain results ( usually after 2 wk ).
-For women who have Rh-negative blood and are not sensitized , administer RhoGAM because of the risk of immunization from the fetal blood
-Observe puncture site for bleeding.
Hematest of stools (Guaiac) Hem-occult side Test
Explain procedure .
-Assist patient in obtaining specimens .
-There are many options for type of procedural materials ( cards , tissue home with cards ( Hemoccult ) that can be mailed when the wipes , test paper ) .
-Document specimens as sent to laboratory
-Instruct patients not to eat foods that may affect the test for at least 3 days before the test . Foods include red meat cantaloupe , uncooked broccoli , and turnips
- Medications that can affect the test results include vitamin C aspirin , and NSAID medications and should be held in the days preceding the test if approved of by the health care Instruct patient not to mix urine with the stool specimen
Colonoscopy Before
-Explain procedure .
-Instruct patient to lie still during the procedure . Obtain written consent .
-Administer enemas as ordered , and record results . If local anesthesia is used , liquid breakfast is sometimes allowed .
-If general anesthesia is used , keep patient on NPO status after midnight on day of test . –Administer premedications as ordered . Insert a Foley catheter if ordered . Showing a picture of the x -ray machine (used for patients who are
Colonoscopy after
-For at least 24 h after procedure , assess patient’s ability to void; urinary retention sometimes occurs secondary to edema caused by instrumentation .
-Record urine color; if it is bright red, report to health care provider . Suggest warm sitz baths for relaxation Encourage fluid intake to maintain a constant flow of urine .
-Observe vital signs ; watch for decrease in blood pressure and increase in pulse , which indicate possible hemorrhage.
Parecentesis ?
A catheter is placed through the skin and the abdominal muscle wall into the peritoneal cavity that contains free fluid
Parecentesis Before?
Explain procedure.
Obtain written consent.
Provide emotional support.
Obtain equipment .
Assist health care provider.
No fasting or sedation is necessary.
Have patient urinate before the test (helps prevent accidental bladder trauma ) .
Measure abdominal girth. Measure patient’s weight .
Measure baseline vital signs.
Although local anesthetics eliminate pain at insertion site, tell patient that he or she will feel a pressure -like pain as the needle is inserted.
Colonoscopy
Colonoscopy or coloscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anu
The hemoccult test is a home test that’s used to detect the presence of occult blood in your stool.
Hematest examations
Amniocentesis ?
is a procedure in which amniotic fluid is removed from the uterus for testing or treatment. Amniotic fluid is the fluid that surrounds and protects a baby during pregnancy. This fluid contains fetal cells and various proteins
Correct Labeling information? (Important)
remember
- Patient’s full name ( last name , first name , and middle name or initial )
2.Patient’s identification number , bed number , room number , and medical record number
- Patient’s age , sex (male or female )
4.Health care provider’s name
5.Date and time of specimen collection
6.Collector’s name or initials
7.Test ordered
8.Most facilities have an electronic health record (EHR) label containing necessary informatio
