Chp 34 Diagnostic Testing Study Guide Flashcards
Insertion of a need directly into the vein
venipuncture
involved removing fluid from the peritoneal cavity
paracentesis
sof tissue radiographs that allow visualization of the underlying breast tissue
mammogram
radiologic procedure in which the use of a special scanner allows cross-sectional images of an organ to be visualized
computed tomography (CT)
involves removing a larger collection of cells, as in a tumor or mass, and may be used to detect cancer in the skin, breast or liver
biopsy
involves the use of a superconducting magnet and radio frequency waves that cause hydrogen nuclei to emit signals
magnetic resonance imaging (MRI)
a procedure that provides visualization of soft tissue organs by recording and meaning the reflection of sonic waves
ultrasound
removes fluid from the pleural space
thoracentesis
contains chemically altered filter paper that change color when stool containing blood is placed on it
hemoccult
recording of the electrical current generated by the heart during depolarization and repolarization of the cardiac muscle
electrocardiogram
What are the components of a CBC
Include the RBC count, hemoglobin level, hematocrit (HCT), red cell indices, while blood cell count (WBC), and differential WBC
The nurse anticipate that testing will be done for the patient who is taking an anticoagulant. Identify at last two specific test that may be ordered to asses this patient’s status
Tests of patient on anticoagulants are platelets, bleeding time, prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time, and fibrinogen
Glucose testing is done to determine the presence of which pathologic condition
Diabetes mellitus
The patient asks about “good cholesterol” Which one of these should the nurse identify to the patient. LDL HDL
High density lipoprotein is the good cholesterol
What are expected findings for a urinalysis are
Clear to slightly hazy and negative protein
C reactive protein (CRP is used as a marker for which disorders
Has been used in the past as a marker for inflammatory and autoimmune disorders, such as rheumatoid arthritis, lupus, and inflammatory bowel syndrome. High sensitivity CRP is considered a marker for vascular inflammation. CRP is now used as a screening for coronary artery disease and as a predictor of future cardiac events
The following cardia markers may be ordered for the attitude to determine possible tissue damage
myoglobin, troponin T, total creatine kinase
the patient has stools that tare black and tarry in appearance. The nurse recognizes this finding as associated with
bleeding in the upper GI tract
Which test is performed for the patient with a suspected tapeworm and how must the sample be sent to the laboratory
A test for fecal ova and parasites is done, with the sample sen to the laboratory still warm
The patient is to have a culture and sensitivity done. How do you explain this test to the patient
For suspected infection, a specimen (urine, blood, sputum etc.) is sent to the lab, where a section is placed on a culture medium. If bacteria are found to grow, it is a positive result. After identification of the bacteria, it is exposed to different antibiotics to see which one would be most effective tin treating the infection
what disorders can be diagnosed with a chest radiograph
pulmonary disorders, such as TB, cancer, and pneumonia
The patient had a diagnostic test with contrast media. Following the test, the nurse notices that the patient has developed a rash and does not feel well. What does the nurse suspect that the patient may be experiencing
allergic reaction ,which may progress to anaphylaxis
What tests requires the patient to fast
cholesterol, low density lipoprotein
The patient is to have an MRI, What instruction would the nurse provide to the patient for this test
Contraindicated in patient with pacemakers, inner ear implants, fragments from gunshot wounds, or any other metal object in the body. All jewelry is removed before the test. Some patients experience claustrophobia because the test is sometimes performed in a tunnel like machine for 30-90 minutes. Rarely people with a tattoo have reported burning and swelling in the ear of the tattoo after MRI
What should screening for colorectal cancer for individuals older than age 50 include
Fecal occult blood test annually, Flexible sigmoidoscopy every five years or colonoscopy every 10 years (or double contrast barium enema or computed tomography (CT) colonography every five years)
What is ultrasound commonly used to determine
pregnant women, abnormal organ growth, lesions or tumors, and structural damage can also be seen with ultrasound
What is a critical question to ask young and middle adult female patients who are having diagnostic test
Chance of pregnancy? Last menstrual period?
What is the most critical area to monitor during bronchoscopy
Respiratory status
Thoracentesis nursing care
Position the patient to the unaffected side for at last an hour
Monitor vital signs until stable
Check the dressing frequently
Assess the puncture site for bleeding or crepitus
Assess respiratory status, including breath sounds and symmetry during respiration, and monitor for signs of distress
Lumbar puncture nursing care
Instruct the patient to lie flat for 4-8 hours Encourage fluids Perform neurologic assessment as ordered Assess the puncture site for drainage Administer analgesics PRN
The nurse is going to perform a venipuncture and asks the UAP to get a collection tubes for the blood chemistry and blood culture. The UAP is told to get the tubes with what color stoppers
Blood culture - yellow
Blood chemistry - red, red/black, green (stat chemistry)
National Patient Safety Goals
Identifying patients correctly continues to be a top National Patient Safety Goal
Two patient identifiers are used when collecting blood samples and other specimens for clinical testing
The patient’s room number or physical location is NOT used as an identifier
Containers used for blood and other specimens are labeled in the presence of the patient
Standard precautions for venipuncture
hand washing is done before and after, gloves are worn throughout the procedure, and sharps are disposed of immediately after specimen collection
Standard precautions for urine collection
hand washing is done before and after, gloves are worn during the procedure, and the specimen is store din a plastic bah or biohazard container for transport to the lab
While the patient is going through a procedure what can the nurse do to provide support and comfort
maintain a necessary position, pad bony prominences, explain what is happening, and offer emotion support, like holding the patients hand
How does the nurse carefully manage collection and transfer of specimen
placed in appropriate container, correctly identified, handled with aseptic technique, and sent to the lab in a timely manner
For timed urine collection, what should be done with the initial voiding? What should be done if a voiding is not collected during the time period?
The first riding is discarded for the timed urine collection
If a coding is discarded, the timed collection needs to be restarted
Sputum collection is usually ordered when what disease processes are suspected
Respiratory disease, such as pneumonia or T, It can also be done to evaluate the effectiveness of antibiotic/antiviral therapy or identify the presence of abnormal cells (tumors)
The correct procedures for sputum collection are
Samples should be collected first thing in the morning, clean containers are used, specimen of 2-10mL is needed, the patient expectorates directly into the container
The patient starts to gag during the throat culture. The nurse should?
instruct them to sit upright and say AHHH place the swab off center and swab quickly
After most procedures, the nurse should minor the patients
vital signs, airway, oxygenation status, and site of the procedure, if bleeding may occur
Results female patient RBC 3.7 cells/mm3
RBC decreased - anemia, bone marrow suppression, chronic infection, hemorrhage, renal disease, vitamin B or folic acid deficiency. Normal value 4.2-5.4
Results for 8 year old child, WBC 8000cells/mm3
WBC increased - acute leukemia, infections, surgery, trauma. Normal value 5000-10000
Lab results Platelets 75,000 cells/mm3
Platelets decreased - anemias, transfusions of packed cells, HIV infection, chemo/radiation therapy. Normal value 150,000-400,000
Lab value BUN 30 mg/dL
BUN increased - acute glomerulonephritis, congestive heart failure, drabbest mellitus, high protein diet, nephrotic syndrome, renal disease, severe dehydration, secure infections shock. Normal value 10-20
CT of scan can be used to diagnose
abscesses, cerebral infarctions (strokes), aneurysms, hemorrhage hydrocephalus, and tumors
To verify the presence of Crohn disease, the nurse anticipates that there will be an order for which test
sigmoidoscopy or colonoscopy
Diabetes mellitus under control
hgb A 1c 7% to 11%
The nurse is teaching the UAP how to collect a specimen for blood glucose monitoring. The patient demonstrates correct technique when
calibrating the meter to the strip
When obtain a urine specimen for a urinalysis from a patient with an indwelling catheter the nurse should
clamp the drainage tubing for 30-60 minutes before specimen collection begins
The patient is going to have a cystoscopy tomorrow. The nurse is aware that a possible complication of this procedure is
hematuria
Neutrophils percentage and function
55-70%. First defenders against bacterial and fungal infections, foreign antigens, and cell debris
Lymphocytes (T and B cells) % and function
20-35%. Recognize foreign antigens; create memory cells; produce antibodies
Monocytes percent and function
3-8%. Involved in phagocytosis; become macrophages
Eosinophils percentage and function
1-3%. Destroy parasites; involved in allergic reactions
Basophils percentage and function
less than 1%. Involved in the inflammatory response to injury; release histamine
electrolytes
Sodium (Na+), potassium (K+), calcium (Ca++), magnesium (Mg++), chloride (CI-), bicarbonate (HCO3-) and phosphate (HPO4-)
fluid portion of blood
plasma
the major plasma protein, maintains fluid balance by providing colloidal osmotic pressure in the blood
albumin
fibrinogen facilitates coagulation by converting into fibrin threads in the presence of ionized ? Essential component of blood clots
(Ca++) calcium
classified as alpha, beta, and gamma
globulins
Normal structures of blood plasma
Electrolytes, proteins (albumin, fibrinogen, globlins), nutrients (glucose, amino acids, fatty acids, vitamins), hormones, and waste products
used for arterial blood gases
arterial sample
information on oxygen and carbon dioxide transport and immune/inflammatory response
CBC
CBC components
RBC count, RBC indices (mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC)), hemoglobin level and hematocrit, WBC count, and differential WBC count
Blood vessel injury activates
Vascular spasm
Plug formation
Blood clotting
Five clotting tests
Platelets Bleeding time Prothrombin time (PT/INR) APTT Fibrinogen
RBC value adult male and female
4.7-6.1 and 4.2-5.4
RBC count newborn and child 8-12
N - 4.8-7.1. C - 4.0-5.5
Hemoglobin value
Male - 14-8. Female - 12-16
Hematocrit %
Male - 42-52. Female 37-48
WBC (cells/MM2)
Adult - 5000-10,000. Child less than 2 - same as above. Newborn - 9000-30000
Hemoglobin A1c (Hgb A1c) is
glycosylated hemoglobin
Patients without diabetes have what percent of hemoglobin(HGB, A1c)
3-5%
Diabetics under control have what percentage of hemoglobin
7-11%
Diabetics with poor control have what percentage of hemoglobin
greater than 11%
a steroid found in cell membranes; a precursor for other steroids in the body
cholesterol
transporters of cholesterol from the liver to the body. “bad cholesterol” because of its role in atherosclerotic disease
Low density lipoproteins
transports excess cholesterol from the tissues back to the liver, where it is broken down and excreted in bile “good cholesterol”
high density lipoprotein
composed of fatty acids, proteins, and glucose
triglycerides
LDL formula
LDL= total cholesterol-HDL-(0.20x total triglycerides)
levels controlled by glucagon and insulin
glucose
Liver function tests
Albumin - plasma protein synthesized by liver
Prealbumin - plasma protein synthesized by liver
Bilirubin - component of bile, byproduct of hemolysis
Alanine aminotransferase (ALT) 0 enzyme found primarily in the liver and also in kidneys, heart and skeletal muscle
Alkaline phosphatase (ALP) - enzyme found primarily in the liver
Aspartate aminotransferase (AST) 0 enzyme found primary in the heart, liver and muscle
Gamma-glutamyltransferase (GGT) - enzyme found primarily in the liver and biliary tract
Urea is a byproduct of protein metabolism, it is excreted by the kidneys and is measured as?
BUN
normal ration of BUN to creatinine should be?
6:1 to 20:1
why is serum creatinine used to test renal impairment
it is a waste product of skeletal muscle metabolism and is excreted via the kidneys. Because creatinine is exerted at a more consistent rate than BUN, serum level values tend to be more sensitive in detecting renal impairment
troponin I and troponin T are found exclusively in
cardiac muscle
used to detect mycardial damage resulting from coronary artery occlusion
cardiac markers (creatine kinase, hemocysteine, brain natriuretic peptide, C-reactive protein, arterial blood gas and myglobin)
an enzyme found primarily in skeletal muscles, cardiac muscle, and brain tissue
creatine kinase
an oxygen transporting and storage protein found in cardia and skeletal muscle
myoglobin
hight levels are associated with an increased risk of cardiovascular disease (one of the cardiac markers)
hemocysteine
Elevated levels are often found in patients with heart failure and can be used to assess severity
Brain natriuretic peptide (BNP)
Appears in blood in response to inflammation, tissue damage, and infection; used as a screening for coronary artery disease and as a predictor of future cardiac events
C-reactive protein (CRP)
used to assess oxygenation status and acid base balance
ABG Arterial blood gas
detects very small amounts of blood in stool
occult blood
steatorrhea
fecal fat
urobilinogen levels
breakdown of bilirubin
common sites of cultures
blood, throat, sputum, stool ,urine, and wounds
noncontrast studies
chest x ray, bones, mammogram
use of x-rays to visualize bones, organs, and soft tissues of abnormalities. X rays are electromagnetic vibrations that travel in a straight line
radiography
Upper GI series includes
esophagus, stomach, duodenum, and upper portion of jejunum
Lower GI series includes
ascending, transverse, descending, and sigmoid colon and rectum
radiologic procedure in which the use of a special scanner allows cross sectional images of an organ to be visualized
CT
a recording of the electrical current generated by the heart during depolarization and depolarization of the cardiac muscle
Electrocardiogram ECG
general term used to describe the examination of the interior of an organ or cavity by means fiberoptic scope
endoscopy
colorectal cancer guidelines for people of average risk who are asymptomatic
fecal occult test starting at age 50 (if positive, colonoscopy is performed), flexible sigmoidoscopy every five year starting at age 50 (if positive, same as above), OR colonoscopy every 10 years starting at ave 50
OR double contrast barium enema every 5 years
OR CT colonography every 5 years
Patients considered at greater risk have tests more often
Nurses responsibilities
Monitor patient and assist HCP Monitor VS and oxygenation Provide supportive interventions Assist in positioning Provide emotional support Answer any questions Maintain precautions Assist maintaining sterile field Ensure specimens are labeled correctly
collecting blood through venipuncture accesses it through
a vein
collecting blood through arterial puncture accesses
an artery
a fingerstick collects
capillary samples
Venipuncture Considerations
Invasive and can potentially expose the nurse to blood borne organisms and contaminated needles
WEAR GLOVES throughout procedure and property dispose of the collection immediately after specimen is obtained
When venipuncture is required, the timing of the test may be important
an increased concentration of RBCs compared with plasma volume
hemoconcentration
the breakdown of RBSc and the subsequent release of hemoglobin
hemolysis
Venipuncture Safe Practice Alert
Assess the site in patients who are on anticoagulant therapy (Coumadin, heparin, Lovenox) or take aspirin on a daily basis.
Collaboration and Delegation
Blood glucose testing MAY be delegated to UAP with nurse assistance.
UAP should report: completion, timely notification of results, difficulties
UAP should be instructed: timing of procedure (freq. before meals and bedtime), Avoidance of cuts or bruises, preferred site (fingers and forearms depending on testing meter)
When a urine sample is needed for culture and sensitivity what is needed?
clean catch or midstream collection
When patients are being tested for occult blood with a guaiac based fecal occult blood test, it is important that patients
adhere to 72 hour diet free of meat, poultry, fish, and leafy green veggies before testing.
Medications such last aspirin and anti-inflammatory agents, iron, and oxidizing drugs and potassium preparation may cause fast positive results and ascorbic acid ay result in false NEGATIVE results
sputum mucus is found
lungs, bronchial tubes, and trachea when inflammation or infection is present
a sputum sample is often ordered when?
infectious disease such as pneumonia or TB is suspected.
Sputum can be used to evaluate medication therapy
It can identify abnormal cells that may indicate presence of tumor or malignancy
Can sputum specimen be delegated?
Only if suctioning techniques are NOT used
Can delegation of throat culture be delegated to UAP
Nope
