Diagnostic Test & Procedures Flashcards
● Tools that provide information about the
clients
● As healthcare has become more
complex and technological, nurses have
been increasingly expected to integrate
laboratory data into their practice.
● Laboratory data can be used in
formulating nursing diagnosis.
● Nurses must also determine if the
results of a test need to be reported
immediately to a physician or if the
report is not urgent. Nurses may also
need to alert other healthcare workers
or the client and family about symptoms
to watch for or precautions to take.
● Technological advances have now
made it possible for nurses to
perform many tests at the point of
care.
● Emphasis is given to the many
factors that influence test results,
such as physiology, drug
interference, and the statistical
methods used to determine normal
ranges.
Laboratory Tests
Early diagnosis and treatment
● If a patient routinely submits to
laboratory testing, this may allow
doctors to respond swiftly with
preventive treatment, which could
save the patient’s time, money, and
possible sickness in the future.
Importance of Laboratory Tests
commonly used diagnostic tests
that can provide valuable information about
the hematologic systems and many other body
systems.
Blood Tests
Puncture of the vein
for collection of a blood specimen.
Venipuncture
- A person from a laboratory who
performs venipuncture. - Collects the blood specimen for the
test - Nurses who may draw blood samples
should know the guidelines for drawing
blood samples.
Phlebotomist
- Skin to wet with antiseptic
- Moisture in the syringe or collection
tube - Prolong use of a tourniquet or clenching
of fist - Use of small gauge needle to withdraw
a large volume of blood - Use of suction in the syringe
- Vigorous shaking of the blood specimen
- Not removing the needle from the
syringe before expelling the blood into
the collection tube - Vigorous expulsion of blood from the
syringe into the collection tube - Drawing blood from an arm in which
there is an intravenous catheter is highly
not advised because values are changed
by the solution being infused - Blood samples may be obtained by
vascular access devices or central
venous catheters when peripheral draws
are not possible
11.Complete filling of the tube is important
for some tests
Avoid the following to prevent hemolysis of
blood samples:
● Providing client comfort, privacy and
safety
● Explaining the purpose of a procedure
for the specimen collection
● Using correct procedure for obtaining
the specimen
● Noting relevant information on
laboratory requisition slip
● Transporting the specimen promptly
● Reporting abnormal findings
Nursing Responsibilities associated with
Specimen Collection
Legend: ↑ - increase ↓ - decrease
Complete Blood Count (CBC)
Red Blood Cell (RBC) Count
Normal findings (Adult)
- Men - 4.6 - 6.0
million/mm3 - Women - 4.0 - 5.0
million/mm3
↑ in RBC -
Dehydration,
Polycythemia vera,
Erythrocytosis, Cardiovascular
disease
↓ in RBC
- Blood Loss, Anemia,
Leukemia, Chronic Renal Failure
○ Composed of a pigment (heme)
which contains iron, and a
protein (globin)
○ Normal Findings
- Men - 13.5 - 18 g/dL
- Women - 12-15 g/dL
- Polycythemia,
Chronic Obstructive Pulmonary
Disease, Dehydration
↑ in Hemoglobin
- Blood Loss,
Anemia, Kidney Disease, Cancers
↓ in Hemoglobin
Also known as packed cell volume
(Hct, PcV or crit)
Hematocrit
Hematocrit
Normal Findings
- Men - 40% - 54%
- Women - 36% - 46%
- Dehydration,
Burns and Hypovolemia
↑ in Hematocrit
- Acute blood
loss, Pregnancy, Dietary
Deficiencies, Anemia
↓ in Hematocrit
The process of intentional higher level of
thinking to define a client’s problem, examine
the evidence-based practice in caring for the
client, and make choices in the delivery of
care. (Kozier 10th edition page 170)
“…reasonable reflective thinking that is
focused on deciding what to believe or do”
(Ennis, 2000)
Process through which nurses analyze and
make sense of situations in order to make
sound clinical decisions.
“the art of thinking about your thinking
while you are thinking in order to make your
thinking better…” (Paul, 1988)
The way in which the nurse processes
information using knowledge, past
experiences, intuition, and cognitive abilities to
formulate conclusions or diagnoses.
Critical Thinking
The cognitive process that uses thinking
strategies to gather and analyze client
information, evaluate the relevance of the
information, and decide on possible nursing
actions to improve the client’s physiological and
psychological outcomes. (Kozier 10th edition,
page 170)
Clinical Reasoning
Nurses use knowledge from subjects
and fields.
2. Nurses deal with change in stressful
environments.
3. Nurses make important decisions.
Purposes of Critical Thinking
thinking that results in the
development of new ideas and products.
Creativity in problem solving and decision
making is the ability to develop and implement
new and better solutions for health care
outcomes
Creativity -
application of a set
of questions to a particular situation or
idea to determine essential information
and ideas and discard unimportant
information and ideas.
Critical Analysis
a technique
one can use to look beneath the
surface, recognize and examine
assumptions, search for inconsistencies,
examine multiple points of view, and
differentiate what one knows from what
one merely believes.
Socratic Questioning
generalizations
are formed from a set of facts or
observations
Inductive Reasoning
from general
premise to the specific conclusion.
Deductive Reasoning
● Contextual Awareness
● Inquiry
● Considering Alternatives
● Examining Assumptions
● Reflecting Critically
Major Categories of Critical Thinking
a systematic,
rational method of planning and
providing individualized nursing care. It
begins with assessment of the client and
use of clinical reasoning to identify client
problems. The phases of the nursing
process are: Assessment, Diagnosis,
Planning, Implementing and Evaluating.
Nursing Process
a mental activity in
which a problem is identified that
represents an unsteady state. It requires
the nurse to obtain information that
clarifies the nature of the problem and
suggests possible solutions. Throughout
the problem solving process the
implementation of critical thought may
or may not be required in working
towards a solution (Wilkinson, 2012).
Problem Solving -
number of
approaches are tried until a solution is
found
● Trial and Error
problem solving approach
that relies on a nurse’s inner sense
Intuition
a formalized,
logical, systematic approach to problem
solving.
Research Process
Nurses use critical thinking skills when
making decisions about client care.
Integration of Critical Thinking and Clinical
Reasoning
● Facts
● Inferences
● Opinions
● Judgments
Differentiating Types of Statement
- Keep an open mind.
- Use rationale to support opinions or
decisions. - Reflect on thoughts before reaching a
conclusion. - Use past clinical experiences to build
knowledge. - Acquire an adequate knowledge base
that continues to build. - Be aware of the interactions of others.
- Be aware of the environment.
Seven Essential Critical Thinking Characteristics
often referred to as the
diagnostic phase or clinical reasoning
phase because the end result or
purpose is identification of a nursing diagnosis, collaborative problem, or
need for referral to another health care
professional.
Data analysis
is the way in which the
nurse processes information using
knowledge, past experiences, intuition
and cognitive abilities to formulate
conclusions or diagnoses.
Critical Thinking
The purpose of assessing a client’s
health status is to
analyze the subjective
and objective data collected.
Health Promotion Diagnosis
● Risk Diagnosis
● Actual Diagnosis
● Collaborative Problems
● Referrals to health care providers for
possible medical problem
Analysis of Data Section
- a form of critical
thinking. Due to the complex nature of nursing
as both a science and an art, the nurse must
think critically in a rational, self-directed,
intelligent, and purposeful manner
Diagnostic Reasoning
This phase consists of the following
essential components: grouping and
organizing data, validating data and
comparing the data with the norms,
clustering data to make inferences,
generating possible hypotheses
regarding the client’s problems,
formulating professional clinical judgment and validating the judgment
with the client.
● These basic components have been
organized in various of ways to break
the process of diagnostic reasoning into
easily understood steps.
Diagnostic Phase
Steps of Essential Components of Diagnostic
Phase
Step 1: Identify Strengths and Abnormal
Data
Step 2: Cluster Data
Step 3: Draw Inferences
Step 4: Propose Possible Nursing
Diagnoses
Step 5: Check for Defining
Characteristics
Step 6: Confirm or Rule out Diagnosis
Step 7: Document Conclusions
○ Problem
○ Etiology
○ Joined by the words “related to”
PE format
○ Problem
○ Etiology
○ Signs and Symptoms
PES Format
One-part statement
● Health promotion diagnoses beginning
with
“READINESS FOR ENHANCED”
reasoning process
Diagnosing
statement or conclusion regarding
the nature of a
phenomenon
Diagnosis
Standardized NANDA
names for diagnoses
Diagnostic labels
Causal relationship between
problems and its related factors
Etiology
Problem statement
consisting of diagnostic label plus
etiology
Nursing diagnosis
○ Currently experiencing the stated
problem
○ Problem present at the time of
assessment
○ Presence of associated signs and
symptoms
○ (for problem) + related to (r/t) +
etiology + as manifested by
(AMB) + defining characteristics
Ex. Fatigue r/t an increase in job
demands and personal stress AMB
client’s statements of feeling exhausted
all of the time and inability to perform
usual work and home responsibilities.
Actual Diagnosis
○ Does not currently have the
problem but is vulnerable to
developing it
○ Problem does not exist
○ Presence of risk factors Risk for +
diagnostic label + related to (r/t)
+ etiology
Ex. Risk for Infection r/t presence of
dirty knife wound, leukopenia, and lack
of client knowledge of how to
adequately care for the wound
Risk Nursing Diagnosis
○ Indicates that the client has the
motivation to increase well-being
and enhance health behaviors
○ Preparedness to implement
behaviors to improve their health
condition
ex: readiness for enhanced self care
Health promotion diagnosis or
Wellness Diagnosis
Cluster of nursing diagnoses that
have similar interventions
Syndrome Diagnosis
Count of the total number of
WBCs in a cubic millimeter of
blood
○ Normal Findings
- 4,500 - 11,000 / mm3
↑ in WBC -
- Acute infection
↓ in WBC -
- Viral infection
Neutrophils -
- 50 - 70%
Lymphocytes
25 - 35%
body’s first defense against
bacterial infection and severe stress
Neutrophils
↓Neutrophils -
Viral diseases such as
hepatitis, influenza,
measles, mumps,
and Rubella
Chemotherapy drugs,
antibiotics,
psychotropic drugs
↑Neutrophils
Bacterial infections,
Inflammatory
processes, Physical
stress, Emotional
Stress
↓Lymphocyte
AIDS, Autoimmune
diseases, severe
malnutrition
↑
Viral Infections,
Pertussis, Infectious
Mononucleosis,
Tuberculosis, Chronic
Bacterial Infections,
Lymphocytic
leukemia
↓Monocyte 4-6%
Anything that
decreases the overall
↑Monocyte 4-6%
Tuberculosis,
Protozoan Infections
↓Eosinophil 1-3%
Stress (burns shock),
corticosteroid therapy
↑Eosinophil 1-3%
Allergic reactions,
parasitic infestations,
neoplasms
purpose in the blood
stream is not well understood, few conditions
seem to increase this relatively rare type of
WBC
Basophil 6.4-10%
↓ Basophil 6.4-10%
Allergic reactions,
acute infections,
stress
↑ Basophil 6.4-10%
Leukemia, Other
Pathologic Alterations
in Bone Marrow
Production,
Inflammatory process
Produced in the bone marrow and play a
role in hemostasis
● Basic elements in the blood that
promote coagulation
Platelet
↓ Platelet -
- Thrombocytopenia
↑ Platelet
Thrombocytosis
↓ Platelet
Idiopathic (unknown
cause),
Thrombocytopenic
purpura, Systemic
lupers erythematosus
(SLE)
↑ Platelet
Infections,
Polycythemia Vera,
Acute blood loss,
Splenectomy
● Screening test for electrolyte and acid
base imbalance
● Urea and Creatinine are routinely used
to evaluate renal function
● Urea, the end product of protein
metabolism, is measured as blood urea
nitrogen (BUN)
● Creatinine is produced in relatively
constant quantities by the muscles and
is created by the kidneys
● The amount of creatinine in the blood is
related to renal excretory function.
Serum Electrolytes
A measure of the solute concentration
of the blood
● Sodium and its associated ions are the
major determinants
● Values are used to evaluate fluid
balance.
○ ↑ - Fluid Volume Deficit
○ ↓ - Fluid Volume Excess
Serum Osmolality
Minerals that carry an electric charge
when they dissolve in a liquid, such as
blood
● Are important because they help
balance the amount of water in the
body and the body’s acid base or the pH
level.
● They also help regulate nerve and
muscle function.
● We get electrolytes from food we eat
and fluids we drink.
Electrolytes
The most abundant extracellular
cation
Sodium (Na+)
Normal value -Sodium (Na+)
- 135 - 145 mEq/L
- aids in osmotic pressure
- renal retention and
excretion of water - acid-base balance
- regulation of other cations
and anions in the body - plays a role in blood
pressure regulation - stimulation of
neuromuscular reactions
functions of sodium
Hyponatremia ↓
Actual (loss of Na):
1. Sweating
2. Wound
drainage
3. Low Na Diet
Relative (Inc. in fluid)
1. SIADH
2. Water
3. Freshwater
submersion
4. Water
Intoxication
Hypernatremia ↑
Actual (loss of Na):
1. Steroid
2. Hypertonic
Solution
3. Cushing’s
Syndrome
Relative (Inc. in fluid)
1. NPO
2. Fever
3. Hyperventilatio
n
○ The most abundant intracellular
cation
○ Plays a vital role in the
transmission of electrical
impulses in cardiac and skeletal
muscle.
○ It also plays a role in acid base
equilibrium, in states of acidosis,
Hydrogen will enter the cell and
as this happens it will force
Potassium out of the cell.
Potassium
Potassium - Normal value
2.5 - 5.0 mEq/L
Hypokalemia ↓
- Hyperaldoster
onism - Excess Insulin
- Alkalosis
- Diarrhea
- Vomiting
- Cystic Fibrosis
- Cushing
Syndrome
Hyperkalemia ↑
- Renal Failure
- Hypoaldostero
nism - Addison’s
Disease - Injury to
Tissues - Diabetes
Mellitus - Ketoacidosis
- Hyperventilatio
n - Acidosis
- Infection
10.Dehydration
11.Burns
A positive ion in the body
○ Necessary for neuromuscular
processes, bone mineralization,
and hormonal secretion.
○ It is regulated by the parathyroid
gland and vitamin D.
○ When albumin levels are low,
calcium levels will appear lower.
○ Has an important relationship
with Phosphorus because they
are inversely proportional.
Calcium
Calcium normal value
- 8.4 - 10.2 mg/dL
Hypocalcemia ↓
- Malnutrition
- Cirrhosis
- Chronic Renal
Failure - Hyperparathyr
oidism - Alkalosis
- Hypomagnese
mia - Malabsorption
- Alcoholism
- Osteomalacia
Hypercalcemia ↑
- Cancers:
breast, lung,
and multiple
myeloma - Hyperparathyr
oidism - Acidosis
- Renal
Transplant - Sarcoidosis
- Vitamin D
Toxicity - Dehydration
Plays an important role in the
body in terms of enzyme
activities, brain neuron activities,
the contraction of skeletal
muscles and the relaxation of
respiratory smooth muscles.
○ Normal Value -
Magnesium
Magnesium Normal Value
1.6 - 2.6 mg/dL
Hypomagnesemia ↓
- ETOH Abuse
- Renal Failure
- Malnutrition /
Malabsorption - Hyperparathyr
oidism - Hypocalcemia
- Diarrhea
Hypermagnesemia ↑
Excess intake
of Magnesium-co
ntaining
medications
2. Overcorrection
with
Magnesium
supplementati
on, IV or PO
3. Renal Failure
(fairly
uncommon)
○ Most abundant extracellular anion
○ Works together with Sodium to
help maintain oncotic pressure
and water balance in the body
○ Directly related to Sodium and
Potassium
Chloride
Hypochloremia ↓
- Congestive
Heart Failure - Water
Intoxication - Burns
- Metabolic
Alkalosis - Respiratory
Acidosis - Addison’s
Disease - Salt Losing
Nephritis - Excessive
sweating - Diarrhea
10.Vomiting
Hyperchloremia ↑
- Dehydration
- Acute Renal
Failure - Cushing
Disease - Metabolic
Acidosis - Respiratory
Alkalosis
Responsible for cellular
metabolism and energy
production
○ Can be seen in the phospholipid
bilayer of our cell membranes
○ Has inverse relationship with
Calcium
Phosphorus
phosphorus normal value:
3.0-4.5 mg/dL
Hypophosphatemia ↓
- Malnutrition/St
arvation - Hyperparathyr
oidism - Hypercalcemia
- Alcohol Abuse
- Renal Failure
Hyperphosphatemia ↑
- Renal Failure
- Tumor Lysis
Syndrome - Hypoparathyro
idism - Hypocalcemia
Kidneys
● Important functional unit of the kidneys
are the nephrons.
● Nephrons are the structures that
actually produce urine in the process of
removing waste from the blood.
● There are millions of nephrons in each
human kidney
Renal Function Tests
Measures the amount of urea nitrogen
in the blood or serum
● Urea is a waste product of protein
metabolism and is formed by the liver
and carried in the blood of the kidneys
or in the blood to the kidneys for
excretion because Urea is cleared from
the bloodstream by the kidneys, the
BUN can be used as a test of renal
function.
Blood Urea Nitrogen (BUN / Serum Urea
Nitrogen
Blood Urea Nitrogen (BUN / Serum Urea
Nitrogen Normal Value (Adult) -
8 - 25 mg/dL, Values may be slightly higher in men
than in women
↓ Blood Urea Nitrogen (BUN / Serum Urea
Nitrogen
- Overhydration
- Increase in
Antidiuretic
Hormone
(ADH) - Increase in
plasma volume - Severe liver
failure
