Diagnostic Testing Flashcards
1
Q
Tools that provide information about clients.
A
Diagnostic and laboratory tests
2
Q
May be used for basic screening as part of a wellness check.
A
Diagnostic and laboratory tests
3
Q
One primary role of the nurse is to
A
teach the client and family or significant other how to prepare for the test and the care that may be required following the test.
4
Q
Nurses must also know the implications of the test results in order to
A
provide the most appropriate nursing care for the client.
5
Q
_ occurs in many environments.
A
Diagnostic testing
6
Q
The traditional sites of diagnostic testing include
A
hospitals, clinics, and the primary care provider’s office.
7
Q
Many test sites, however, are moving to the _. Examples, include the
A
community
home, workplace, shopping malls, and mobile units.
8
Q
The more complex diagnostic tests are performed at _ specifically built to provide those tests.
A
diagnostic centers
9
Q
Diagnostic testing involves three phases:
A
pretest, intratest, and post-test
10
Q
The major focus of the _ is client preparation.
A
pretest phase
11
Q
A thorough assessment and data collection (e.g., biologic, psychological, sociologic, cultural, and spiritual) assist the nurse in determining communication and teaching strategies.
A
Pretest
12
Q
The nurse also needs to know what equipment and supplies are needed for the specific test.
A
Pretest
13
Q
Pretest
Common questions include the following:
A
What type of sample will be needed and how will it be collected? Does the client need to stop oral intake for a certain number of hours prior to the test? Does the test include administration of dye (contrast media) and, if so, is it injected or swallowed? Are fluids restricted or forced? Are medications given or withheld? How long is the test? Is a consent form required?
14
Q
This phase focuses on specimen collection and performing or assisting with certain diagnostic testing.
A
Intratest
15
Q
The nurse uses standard precautions and sterile technique as appropriate.
A
Intratest
16
Q
During the procedure the nurse provides emotional and physical support while monitoring the client as needed (e.g., vital signs, pulse oximetry, ECG).
A
Intratest
17
Q
The nurse ensures correct labeling, storage, and transportation of the specimen to avoid invalid test results.
A
Intratest
18
Q
The focus of this phase is on nursing care of the client and follow-up activities and observations.
A
Post-test
19
Q
The nurse compares the previous and current test results and modifies nursing interventions as needed. The nurse also reports the results to appropriate health team.
A
Post-test
20
Q
Preparing for Diagnostic Testing
(7)
A
• Instruct the client and family about the procedure for the diagnostic test ordered (e.g., whether food is allowed prior to or after testing, and the length of time of the test).
• Explain the purpose of the test.
• Instruct the client and family about activity restrictions related to testing (e.g., remain supine for 1 hour after testing is completed).
• Instruct the client and family on the reaction the diagnostic test may produce (e.g., flushing if a dye is injected).
• Provide the client with detailed information about the diagnostic testing equipment.
• Inform the client and family of the time frame for when the results will be available.
• Instruct the client and family to ask any questions so that the health care provider can clarify information and allay any fears.
21
Q
Nursing Diagnoses
(3)
A
• Anxiety or Fear related to possible diagnosis of acute or chronic illness pending conclusion of diagnostic testing
• Impaired Physical Mobility related to prescribed bed rest and restricted movement of involved extremity after testing
• Deficient Knowledge (state diagnostic test) related to misperceptions received from others regarding process for test.
22
Q
_ are commonly used diagnostic tests that can provide valuable information about the hematologic system and many other body systems.
A
Blood tests
23
Q
A _ (puncture of a vein for collection of a blood specimen) can be performed by various members of the health care team.
A
venipuncture
24
Q
A _, a person from a laboratory who performs venipuncture, usually collects the blood specimen for the tests ordered by the primary care provider.
A
phlebotomist
25
In some institutions, nurses may draw blood samples.
Nurse-Phlebotomist
26
BLOOD TESTS
The nurse needs to know the _.
guidelines for drawing blood samples for the facility and also the state’s nurse practice act.
27
A _ is a blood test used to evaluate your overall health and detect a wide range of disorders, including anemia, infection and leukemia.
Complete Blood Count (CBC)
28
_ is the main intracellular protein of erythrocytes.
Hemoglobin (Hgb)
29
The _ is a measure of the total amount of hemoglobin in the blood.
hemoglobin test
30
The _ measures the percentage of RBCs in the total blood volume.
hematocrit (Hct)
31
Normal values for both hemoglobin and hematocrit vary, with _ having higher levels than _.
males
females
32
_ and _ are often ordered together and commonly referred to as “H&H” when ordering laboratory tests.
Hemoglobin and hematocrit
33
_ are responsible for transporting oxygen from your lungs to your body's tissues.
Red blood cells (RBC)
34
_, which is the number of RBCs per cubic millimeter of whole blood.
red blood cell (RBC) count
35
Low RBC counts are indicative of _.
anemia
36
Clients with chronic hypoxia may develop higher than normal counts, a condition known as _.
polycythemia
37
_ may be performed as part of the CBC to evaluate the size, weight, and hemoglobin concentration of RBCs.
Red blood cell (RBC) indices
38
A cellular component of the blood that lacks hemoglobin, has a nucleus, is capable of motility, and defends the body against infection and disease by ingesting foreign materials and cellular debris, by destroying infectious agents and cancer cells, or by producing antibodies.
White blood cell (WBC) "leukocyte or white corpuscle"
39
_ are often routinely ordered for any client admitted to a hospital as a screening test for electrolyte and acid–base imbalances.
Serum electrolytes
40
_ is a blood test that measures levels of the body's main electrolytes.
Serum Electrolytes
41
The most commonly ordered serum tests are for _, _, _, and _.
sodium, potassium, chloride, and bicarbonate ions
42
Components of Serum Electrolytes
Sodium
Chloride
Potassium
Bicarbonate
43
Components of Serum Electrolytes
_, which helps control the amount of fluid in the body. It also helps your nerves and muscles work properly.
Sodium
44
Components of Serum Electrolytes
_, which also helps control the amount of fluid in the body. In addition, it helps maintain healthy blood volume and blood pressure.
Chloride
45
Components of Serum Electrolytes
_, which helps your heart and muscles work properly.
Potassium
46
Components of Serum Electrolytes
_ which helps maintain the body's acid and base balance. It also plays an important role in moving carbon dioxide through the bloodstream.
Bicarbonate
47
The _ is a measure of the different solutes in plasma.
serum or plasma osmolality
48
It is primarily determined by sodium and its corresponding anions (chloride and bicarbonate), glucose, and urea.
Serum Osmolality
49
Serum osmolality values are used primarily to _.
evaluate fluid balance
50
Serum Osmolality
Normal values are _ to _.
280 to 300 mOsm/kg
51
_ is often conducted when a client is taking a medication with a narrow therapeutic range (e.g., digoxin, theophylline, aminoglycosides).
Therapeutic drug monitoring
52
This monitoring includes drawing blood samples for peak and trough levels to determine if the blood serum levels of a specific drug are at a therapeutic level and not a subtherapeutic or toxic level.
Drug Monitoring
53
Drug Monitoring
The _ indicates the highest concentration of the drug in the blood serum, and the _ represents the lowest concentration.
peak level
trough level
54
_ is a blood test that requires a sample from an artery in your body to measure the levels of oxygen and carbon dioxide in your blood.
Arterial Blood Gas (ABG) Test
55
Arterial Blood Gas:
O2CT
pH
PaCO2
PaO2
HCO3
O2Sat
Normal Range: ?
O2CT - 15-23% per 100 mL of blood
pH - 7.35-7.45
PaCO2 - 35-45 mmHg
PaO2 - 80-100 mmHg
HCO3 - 22-26 mEq/L
O2Sat - 95-100%
56
Blood Chemistry
Enzymes/acids:
Uric acid
SGOT/SGPT
Rheumatoid factor
Anti-DNA antibody
CK-MB, LDH and Troponin
Purpose: ?
Uric acid - Gout detection
SGOT/SGPT - Liver function test
Rheumatoid factor - For Rheumatoid arthritis
Anti-DNA antibody - SLE diagnosis
CK-MB, LDH and Troponin - Identifies cardiac damage or muscle damage
57
A test done on a sample of blood to measure the amount of certain substances in the body.
Blood Chemistry
58
Blood Chemistry
These substances include electrolytes (such as sodium, potassium, and chloride), fats, proteins, glucose (sugar), and enzymes (including _), serum glucose, hormones such as _ and other substances such as _ and _.
lactic dehydrogenase [LDH],
creatine kinase [CK],
aspartate aminotransferase [AST], and alanine aminotransferase [ALT]
thyroid hormone
cholesterol
triglycerides
59
_ is a special test used to test your baby for certain serious medical conditions.
The Newborn Metabolic Screen
60
The goal of the screen is to identify babies who have these disorders before they ever get sick, and to help them get treatment as soon as possible.
The Newborn Metabolic Screen
61
The Adult Metabolic Screen
The screening measures five things:
- If three or more factors are outside the normal range, you have _
1. waistline
2. blood pressure
3. HDL cholesterol
4. triglycerides level
5. fasting blood sugar
metabolic syndrome
62
A _ is taken to measure the current blood glucose level when frequent tests are required or when a venipuncture cannot be performed.
capillary blood specimen
63
Capillary Blood Glucose
Timing:
Fasting
Pre-meal
1 hr after a meal
2 hrs after a meal
Target in mg/dl: ?
Fasting - 70-90 mg/dl
Pre-meal - 90-100 mg/dl
1 hr after a meal - <130 mg/dl
2 hrs after a meal - <120 mg/dl
64
Specimen Collection & Testing
Nurse's Role:
(6)
• Provide client comfort, privacy, and safety.
(The nurse needs to be nonjudgmental and sensitive to possible sociocultural beliefs that may affect the client’s willingness to participate in the specimen collection procedure.)
• Explain the purpose of the specimen collection and the procedure for obtaining the specimen.
(A clear explanation will facilitate the client’s cooperation in the collection of the specimen. With proper instruction, many clients are able to collect their own specimen, which promotes independence and reduces or avoids embarrassment.)
• Use the correct procedure for obtaining a specimen or ensure that the client or staff follows the correct procedure.
(A nursing procedure or laboratory manual is often available if the nurse is unfamiliar with the procedure.)
• Note relevant information on the laboratory requisition slip, for example, medications the client is taking that may affect the results.
• Transport the specimen to the laboratory promptly. Fresh specimens provide more accurate results.
• Report abnormal laboratory findings to the health care provider in a timely manner consistent with the severity of the abnormal results.
65
STOOL SPECIMEN
Stool Sample Collection and Transport:
(3)
1. Collect on plastic wrap and transfer to vial until liquid reaches fill line.
2. Remove spoon from lid and discard.
3. Replace cap on vial tightly and shake for a minute. Place a vial in refrigerator until ready to ship.
66
A stool test may also be referred to as a _, a _, or _ .
"stool sample"
"stool culture"
"fecal sample"
67
This type of test looks at fecal matter for evidence of a medical condition.
Stool Test
68
The test may look for evidence of infection, allergy, blood or digestive problems.
Stool Test
69
Stool Specimen
Purpose:
(4)
• To determine the presence of occult (hidden) blood.
• To analyze for dietary products and digestive secretions.
• To detect the presence of ova and parasites.
• To detect the presence of bacteria or viruses.
70
Stool Specimen
Purpose:
• To determine the presence of occult (hidden) blood.
- _ can occur as a result of gastrointestinal ulcers, inflammatory disease, or tumors.
Bleeding
71
Stool Specimen
Purpose:
• To determine the presence of occult (hidden) blood.
- The test for occult blood, often referred to as the _, can be readily performed by the nurse in the clinical area or by the client at home.
guaiac test
72
Stool Specimen
Purpose:
• To determine the presence of occult (hidden) blood.
- _ used in the test is sensitive to fecal blood content.
Guaiac paper
73
Stool Specimen
Purpose:
• To analyze for dietary products and digestive secretions.
- For example, an excessive amount of fat in the stool (_) can indicate faulty absorption of fat from the small intestine.
steatorrhea
74
Stool Specimen
Purpose:
• To analyze for dietary products and digestive secretions.
- The nurse needs to _.
collect and send the total quantity of stool expelled at one time instead of a small sample
75
Stool Specimen
Purpose:
• To detect the presence of ova and parasites.
- When collecting specimens for parasites, it is important that _.
the sample be transported immediately to the laboratory while it is still warm
76
Stool Specimen
Purpose:
• To detect the presence of ova and parasites.
- Usually _, over a period of days, are evaluated to confirm the presence of and to identify the organism so that appropriate treatment can be ordered.
three stool specimens
77
Stool Specimen
Purpose:
• To detect the presence of bacteria or viruses.
- Only a _ of feces is required because the specimen will be cultured.
- Collection containers or tubes must be _ and _ used during collection.
- Stools need to be sent - to the laboratory
small amount
sterile and aseptic technique
immediately
77
Stool Specimen
Purpose:
• To detect the presence of bacteria or viruses.
- The nurse needs to _.
note on the laboratory requisition if the client is receiving any antibiotics
78
URINE SPECIMEN
3 Types of Urinalysis
1. Complete Urinalysis
2. Rapid Urinalysis
3. 24-hour Urine Collection
79
URINE SPECIMEN
3 Types of Urinalysis
- Performed in lab
- Looks at urine composition
Complete Urinalysis
80
URINE SPECIMEN
3 Types of Urinalysis
- Performed at doctor's office using test strips.
- Checks for common renal abnormalities
Rapid Urinalysis
81
URINE SPECIMEN
3 Types of Urinalysis
- Performed at home near over 24 hours
- Gives clearer picture of renal function
24 - hour Urine Collection
82
_ is one type of specimen that can be easily collected from a patient.
_ can give the doctor valuable information about many body systems especially kidney function.
The physician uses the information from _ to diagnose and treat many disease states.
Urine
Urinalysis testing
urine testing
83
The nurse is responsible for collecting urine specimens for a number of tests: _ for routine urinalysis, _ for urine culture, and _ for a variety of tests that depend on the client’s specific health problem.
clean voided urine specimens
clean-catch or midstream urine specimens
timed urine specimens
84
TYPES of Urine Specimen:
(7)
1. First morning specimen
2. Single random specimen
3. Timed short-term specimens
4. Timed long-term specimens: 12 or 24 hours
5. Catheterized specimen or specimen from an indwelling catheter
6. Double voided specimen (test for sugar and acetone)
7. Clean-catch (midstream) specimen for urine culture and cytological analysis
85
Reference values for normal urinalysis
(it is important to check with _)
your agency's laboratory for normal reference values
86
Urine Specimen
General characteristics and measurements:
(5)
Color
Clarity
Specific gravity (sp gr)
pH
Volume
87
Urine Specimen
General characteristics and measurements:
Color: _ to _ is mainly determined by the concentration of the pigments urochrome, urobilin, and uroerythrin.
pale yellow to dark amber
88
Urine Specimen
General characteristics and measurements:
Clarity: _ to _ due to leukocytes, bacteria, epithelials or precipitation of phosphates
clear to cloudy
89
Urine Specimen
General characteristics and measurements:
Specific gravity (sp gr): may range between _ and _
1.001 and 1.025
90
Urine Specimen
General characteristics and measurements:
pH: _-_ (average pH around _)
4.5-8
6
91
Urine Specimen
General characteristics and measurements:
Volume: _-_ cc/24 hours (adult)
1000-2500
92
Urine Specimen
Microscopic exam of sediment:
(5)
Casts: negative (occasional hyaline casts)
Red Blood Cells (RBCs): negative or rare
White Blood Cells (WBCs): negative or rare
Crystals: negative
Epithelial cells: few
93
SPUTUM SPECIMEN
How?
(3)
1. Clear your mouth
2. Breath in and out 3 times
3. Give a sputum sample
94
_ is the mucous secretion from the lungs, bronchi, and trachea.
Sputum
95
SPUTUM SPECIMEN
Purpose:
(4)
• For culture and sensitivity to identify a specific microorganism and its drug sensitivities.
• For cytology to identify the origin, structure, function, and pathology of cells.
• For acid-fast bacillus (AFB), which also requires serial collection, often for 3 consecutive days, to identify the presence of tuberculosis (TB).
• To assess the effectiveness of therapy.
96
SPUTUM SPECIMEN
Purpose:
• For cytology to identify the origin, structure, function, and pathology of cells.
- Specimens for cytology often require serial collection of _ and are tested to _.
three early-morning specimens
identify cancer in the lung and its specific cell type
97
SPUTUM SPECIMEN
Purpose:
• For _, which also requires serial collection, often for 3 consecutive days, to identify the presence of tuberculosis (TB).
- Some agencies use a special glass container when the presence of _ is suspected.
acid-fast bacillus (AFB)
98
VISUALIZATION PROCEDURES
Visualization procedures include _ and _ techniques for visualizing body organ and system functions.
indirect visualization (noninvasive) and
direct visualization (invasive)
99
Clients with Gastrointestinal Alterations
_ (the viewing of the anal canal)
_ (the viewing of the rectum)
_ (the viewing of the rectum and sigmoid colon)
_ (the viewing of the large intestine)
anoscopy
proctoscopy
proctosigmoidoscopy
colonoscopy
100
Clients with Urinary Alterations
- _ also may be used to evaluate urinary function.
- _ may be performed to assess the abdominal area for causes of abdominal pain, or to assess the organs and structures of the urinary and/or gastrointestinal (GI) system.
Visualization procedures
A kidney, ureter, and bladder (KUB) X-ray
101
Clients with Urinary Alterations
- _ and _ are also radiographic studies used to evaluate the urinary tract.
Intravenous pyelography (IVP) and retrograde pyelography
102
Clients with Urinary Alterations
- In an _, contrast medium is injected intravenously, during _, the contrast medium is instilled directly into the kidney pelvis via the urethra, bladder and ureters.
IVP
retrograde pyelography
103
Clients with Urinary Alterations
- What to Expect During an Intravenous Pyelogram
(6)
1. Stop eating and drinking the night before test.
2. IV is started
3. You're given an antihistamine
4. X-rays taken
5. Contrast medium administered through IV
6. More x-rays taken
104
Clients with Urinary Alterations
- _ is a noninvasive test that uses reflected sound waves to visualize the kidneys.
Renal ultrasonography
105
Clients with Urinary Alterations
- During a _, the bladder, ureteral orifices, and urethra can be directly visualized using a _, a lighted instrument inserted through the urethra.
cystoscopy
cystoscope
106
Clients with Cardiopulmonary Alterations
- A number of _ can be done to examine the cardiovascular system and respiratory tract.
visualization procedures
107
Clients with Cardiopulmonary Alterations
- _ provides a graphic recording of the heart’s electrical activity.
- _ placed on the skin transmit the electrical impulses to an oscilloscope or graphic recorder
Electrocardiography
Electrodes
108
Clients with Cardiopulmonary Alterations
- With the wave forms recorded, the _ can then be examined to detect dysrhythmias and alterations in conduction indicative of myocardial damage, enlargement of the heart, or drug effects.
electrocardiogram (ECG)
109
Clients with Cardiopulmonary Alterations
- _ uses ECGs to assess the client’s response to an increased cardiac workload during exercise
Stress electrocardiography
110
Clients with Cardiopulmonary Alterations
- _ is an invasive procedure requiring informed consent of the client.
- _ is performed to evaluate the extent of coronary artery disease; pulmonary angiography may be performed to assess the pulmonary vascular system, particularly if pulmonary emboli are suspected.
Angiography
Coronary angiography
111
Clients with Cardiopulmonary Alterations
- An _ is a noninvasive test that uses ultrasound to visualize structures of the heart and evaluate left ventricular function.
echocardiogram
112
Clients with Cardiopulmonary Alterations
- What to Expect During an Echocardiogram
(4)
1. Gel is placed on chest.
2. Transducer sends sound waves through chest to heart.
3. Sound waves bounce back from heart to transducer.
4. Computer processes sound waves to make visual of beating heart.
113
Clients with Cardiopulmonary Alterations
- A _, also known as a _, records the emissions from radioisotopes that indicate how well gas and blood are traveling through the lungs.
lung scan
V/Q (ventilation/perfusion) scan
114
Computed tomography (CT)
- also called _, _, or _
CT scanning
computerized tomography
computerized axial tomography (CAT)
115
_ is a painless, noninvasive x-ray procedure that has the unique capability of distinguishing minor differences in the density of tissues.
Computed Tomography
116
The _ produces a three-dimensional image of the organ or structure, making it more sensitive than the x-ray machine.
Computer Tomography (CT)
117
_ is a noninvasive diagnostic scanning technique in which the client is placed in a magnetic field.
Magnetic resonance imaging (MRI)
118
Magnetic Resonance Imaging (MRI)
- Clients with _ (e.g., _, _) cannot undergo an MRI because of the strong magnetic field.
implanted metal devices
pacemaker
metal hip prosthesis
119
Magnetic Resonance Imaging (MRI)
- There is no exposure to _.
radiation
120
_ involve the therapeutic use of radioactive isotopes for diagnostic purposes.
Nuclear imaging studies
121
Nuclear Imaging Studies
- A _, a pharmaceutical (targeted to a specific organ) with an embedded radioisotope, is administered through various routes for the test.
radiopharmaceutical
122
Nuclear Imaging Studies
_ is a noninvasive radiologic study that involves the injection or inhalation of a radioisotope.
Positron emission tomography (PET)
123
Nuclear Imaging Studies
- _
• _ are created as the radioisotope is distributed in the body.
• This allows study of various aspects of organ function and may include evaluation of blood flow and tumor growth, for example.
Positron emission tomography (PET)
Images
124
_ is the withdrawal of fluid that has abnormally collected (e.g., pleural cavity, abdominal cavity) or the obtaining of a specimen (e.g., cerebrospinal fluid).
Aspiration
125
A _ is the removal and examination of tissue.
biopsy
126
_ is a procedure in which a thin needle called spinal needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give drugs.
Lumbar Puncture
127
Lumbar Puncture
- A _ is withdrawn through a needle inserted into the subarachnoid space of the spinal canal between the third and fourth lumbar vertebrae or between the fourth and fifth lumbar vertebrae.
cerebrospinal fluid (CSF)
128
Lumbar Puncture
Lifespan Considerations
CHILDREN:
(2)
• Briefly demonstrate the procedure on a doll or stuffed animal. Allow time to answer questions.
• One member of the health care team should stay in close physical contact with the child, maintain eye contact, and talk to and reassure the child during the procedure.
129
Lumbar Puncture
Lifespan Considerations
OLDER ADULTS:
(3)
• Some clients need help maintaining the flexed position due to arthritis, weakness, or tremors.
• Provide an extra blanket to keep the client warm during the procedure. Older adults have a decreased metabolism and less subcutaneous fat.
• If the client has a hearing loss, speak slowly, distinctly, and loud enough, especially when unable to make eye contact.
130
Abdominal Paracentesis
- In some disease processes, a large amount of fluid accumulates in the abdominal cavity; this condition is called _.
ascites
131
An _ is carried out to obtain a fluid specimen for laboratory study and to relieve pressure on the abdominal organs due to the presence of excess fluid.
abdominal paracentesis
132
Abdominal Paracentesis
- The primary care provider makes a small incision with a scalpel, inserts the _ (a sharp, pointed instrument) and _ (tube), and then withdraws the trocar, which is inside the cannula.
trocar
cannula
133
_ to remove the excess fluid or air to ease breathing.
Thoracentesis
134
_ is also performed to introduce chemotherapeutic drugs intrapleurally.
Thoracentesis
135
A _ is the removal of a specimen of bone marrow for laboratory study.
bone marrow biopsy
136
The _ is used to detect specific diseases of the blood, such as pernicious anemia and leukemia.
Bone marrow biopsy
137
Bone Marrow Biopsy
- The bones of the body commonly used for a bone marrow biopsy are the _, _, _ or _, and _ in children. The _ is the preferred site with the client placed prone or on the side.
sternum, iliac crests, anterior or posterior iliac spines, and proximal tibia
posterior superior iliac crest
138
A _ is a short procedure, generally performed at the client’s bedside, in which a sample of liver tissue is aspirated.
liver biopsy
139
The client exhales and is instructed to hold his or her breath while the primary care provider inserts the biopsy needle, injects a small amount of sterile normal saline to clear the needle of blood or particles of tissue picked up during insertion, and aspirates liver tissue by drawing back on the plunger of the syringe.
Liver Biopsy
