Chapter 23 notes

Question 1

Diagnostic Examination?

Answer 1

-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

Question 2

Nurse’s Responsibilities?

Answer 2

-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

Question 3

Patient Teaching?

Answer 3

-The nurse must be prepared to answer questions for which patient may need
Clarification

Question 4

The patient needs to know if

Answer 4

-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

Question 5

Specimen Collection?

Answer 5

-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.

Question 6

Guidelines for Specimen Collection Part 1?

Answer 6

-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

Question 7

Guidelines for Specimen Collection Part 2?

Answer 7

-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

Question 8

Specimen Labeling?

Answer 8

• 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

Question 9

Collecting Urine Specimens?

Answer 9

• Midstream
  -Sterile
  -24-hour urinary

Question 10

Measuring Blood Glucose Levels?

Answer 10

-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

Question 11

Collecting a Stool Specimen?

Answer 11

-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

Question 12

Collecting a sputum specimen ?

Answer 12

-Sputum is secretions from the lungs
-It contains mucus, cellular debris, and microorganisms and may contain blood or
Pus

Question 13

Many tests can be performed on sputum ?

Answer 13

-Culture
-Sensitivity
-Cytology
-Acid-fast bacillus

Question 14

Obtain Culture?

Answer 14

Wound
-aerobic organisms
-anaerobic organism
Thorat
-swab

Question 15

Phlebotomy can give information ?

Answer 15

-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

Question 16

Venipuncture?

Answer 16

-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

Question 17

Electrocardiogram ?

Answer 17

-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

Question 18

specimen?

Answer 18

small sample of something , intended to show the nature of the whole

Question 19

urinalysis consists of several tests, including determination?

Answer 19

-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

Question 20

A midstream urine specimen?

Answer 20

is collected to perform a culture and sensitivity

Question 21

A sterile urine specimen?

Answer 21

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

Question 22

Is it possible to measure residual?

Answer 22

urine ( urine left in the bladder after voiding ) at the time of catheterization.

Question 23

COLLECTING A 24-HOUR URINE SPECIMEN?

Answer 23

• 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

Question 24

When stool is to be examined for parasites , it must be taken immediately? .

Answer 24

to the laboratory for parasites to be examined under the microscope while they are alive

Question 25

Arrange supplies if the patient is to collect the stool?

Answer 25

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

Question 26

A sputum specimen must be obtained from deep in a bronchial tree ?

Answer 26

-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

Question 27

Many tests are possible on sputum specimen?

culture

Answer 27

such as culture( a laboratory involving cultivation of microorganisms or cells in special growth medium )

Question 28

Many tests are possible on sputum specimen

sensitivity ?

Answer 28

-sensitivity ( a laboratory method of determining the effectiveness of antibiotics , usually performed in conjunction with culture )

Question 29

Many tests are possible on sputum specimen

cytologic ?

Answer 29

-cytologic analysis ( cytology is the study of cells , including their formation , origin structure , function , biochemical activities , and pathologic processes ) ; and examination

Question 30

Many tests are possible on sputum specimen

-acid-fast bacillus ?

Answer 30

-acid-fast bacillus (the organism responsible for tuberculosis of the lung )

Question 31

Collecting a Sputum Specimen by Suction?

Answer 31

• 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 ,)

Question 32

OBTAINING A WOUND CULTURE?

Answer 32

The patient should be assessed for fever chills , malaise , and elevated WBC count , which indicate a possible systemic infection

Question 33

OBTAINING A WOUND CULTURE Aerobic organisms?

Answer 33

• 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

Question 34

OBTAINING A WOUND CULTURE anaerobic specimen?

Answer 34

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

Question 35

Venipuncture?

Answer 35

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 ,

Question 36

A special vacuum cleaner?

Answer 36

tube is used to collect multiple blood samples

Question 37

In the Vacutainer system, the tubes contain the necessary rubber stoppers that are color coded?

Answer 37

Red, lavender, blue, green, gray, and yellow are common colors

Question 38

A tourniquet ?

Answer 38

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

Question 39

Veins with the following characteristics are avoided?

Answer 39

-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

Question 40

The electrocardiogram ( ECG )?

Answer 40

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

Question 41

Chest (precordial leads)?

look picture

Answer 41

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

Question 42

BEFORE EXAMINATION Abdominal Scan ?

Answer 42

-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

Question 43

After examination Scan Abdominal Scan ?

Answer 43

-Evaluate patient for delayed reaction to dye
-Encourage oral intake of fluids.
-Report results.
-Diarrhea is possible

Question 44

Amniocentesis Explain procedure Before exaction?

Answer 44

-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 .

Question 45

Amniocentesis after ?

Answer 45

-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.

Question 46

Hematest of stools (Guaiac) Hem-occult side Test

Answer 46

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

Question 47

Colonoscopy Before

Answer 47

-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

Question 48

Colonoscopy after

Answer 48

-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.

Question 49

Parecentesis ?

Answer 49

A catheter is placed through the skin and the abdominal muscle wall into the peritoneal cavity that contains free fluid

Question 50

Parecentesis Before?

Answer 50

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.

Question 50

Colonoscopy

Answer 50

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

Question 50

The hemoccult test is a home test that’s used to detect the presence of occult blood in your stool.

Answer 50

Hematest examations

Question 51

Amniocentesis ?

Answer 51

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

Question 52

Correct Labeling information? (Important)
remember

Answer 52

1. 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

3. 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