- Blood Loss, Anemia, Leukemia, Chronic Renal Failure

Diagnostic Test & Procedures Flashcards by Lorenz Angelo C. Sarmiento

● 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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

commonly used diagnostic tests
that can provide valuable information about
the hematologic systems and many other body
systems.

Blood Tests

How well did you know this?

Not at all

Perfectly

Puncture of the vein
for collection of a blood specimen.

Venipuncture

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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:

How well did you know this?

Not at all

Perfectly

● 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

How well did you know this?

Not at all

Perfectly

Legend: ↑ - increase ↓ - decrease

Complete Blood Count (CBC)

How well did you know this?

Not at all

Perfectly

Red Blood Cell (RBC) Count
Normal findings (Adult)

Men - 4.6 - 6.0
million/mm3
Women - 4.0 - 5.0
million/mm3

How well did you know this?

Not at all

Perfectly

↑ in RBC -

Dehydration,
Polycythemia vera,
Erythrocytosis, Cardiovascular
disease

How well did you know this?

Not at all

Perfectly

↓ in RBC

Blood Loss, Anemia,
Leukemia, Chronic Renal Failure

How well did you know this?

Not at all

Perfectly

○ 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

How well did you know this?

Not at all

Perfectly

Polycythemia,
Chronic Obstructive Pulmonary
Disease, Dehydration

↑ in Hemoglobin

How well did you know this?

Not at all

Perfectly

Blood Loss,
Anemia, Kidney Disease, Cancers

↓ in Hemoglobin

How well did you know this?

Not at all

Perfectly

Also known as packed cell volume
(Hct, PcV or crit)

Hematocrit

How well did you know this?

Not at all

Perfectly

Hematocrit
Normal Findings

Men - 40% - 54%
Women - 36% - 46%

How well did you know this?

Not at all

Perfectly

Dehydration,
Burns and Hypovolemia

↑ in Hematocrit

How well did you know this?

Not at all

Perfectly

Acute blood
loss, Pregnancy, Dietary
Deficiencies, Anemia

↓ in Hematocrit

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Nurses use knowledge from subjects
and fields.
2. Nurses deal with change in stressful
environments.
3. Nurses make important decisions.

Purposes of Critical Thinking

How well did you know this?

Not at all

Perfectly

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 -

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

1. Keep an open mind. 2. Use rationale to support opinions or decisions. 3. Reflect on thoughts before reaching a conclusion. 4. Use past clinical experiences to build knowledge. 5. Acquire an adequate knowledge base that continues to build. 6. Be aware of the interactions of others. 7. 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

1. 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

1. aids in osmotic pressure 2. renal retention and excretion of water 3. acid-base balance 4. regulation of other cations and anions in the body 5. plays a role in blood pressure regulation 6. 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 ↓

1. Hyperaldoster onism 2. Excess Insulin 3. Alkalosis 4. Diarrhea 5. Vomiting 6. Cystic Fibrosis 7. Cushing Syndrome

Hyperkalemia ↑

1. Renal Failure 2. Hypoaldostero nism 3. Addison’s Disease 4. Injury to Tissues 5. Diabetes Mellitus 6. Ketoacidosis 7. Hyperventilatio n 8. Acidosis 9. 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 ↓

1. Malnutrition 2. Cirrhosis 3. Chronic Renal Failure 4. Hyperparathyr oidism 5. Alkalosis 6. Hypomagnese mia 7. Malabsorption 8. Alcoholism 9. Osteomalacia

Hypercalcemia ↑

1. Cancers: breast, lung, and multiple myeloma 2. Hyperparathyr oidism 3. Acidosis 4. Renal Transplant 5. Sarcoidosis 6. Vitamin D Toxicity 7. 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 ↓

1. ETOH Abuse 2. Renal Failure 3. Malnutrition / Malabsorption 4. Hyperparathyr oidism 5. Hypocalcemia 6. 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 ↓

1. Congestive Heart Failure 2. Water Intoxication 3. Burns 4. Metabolic Alkalosis 5. Respiratory Acidosis 6. Addison’s Disease 7. Salt Losing Nephritis 8. Excessive sweating 9. Diarrhea 10.Vomiting

Hyperchloremia ↑

1. Dehydration 2. Acute Renal Failure 3. Cushing Disease 4. Metabolic Acidosis 5. 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 ↓

1. Malnutrition/St arvation 2. Hyperparathyr oidism 3. Hypercalcemia 4. Alcohol Abuse 5. Renal Failure

Hyperphosphatemia ↑

1. Renal Failure 2. Tumor Lysis Syndrome 3. Hypoparathyro idism 4. 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

1. Overhydration 2. Increase in Antidiuretic Hormone (ADH) 3. Increase in plasma volume 4. Severe liver failure