Lecture 1: Diagnostic and Therapeutic Techniques Flashcards
What is step 1 of diagnosing?
Recognizing the S/S of an infection.
What are some general symptoms of infection?
Fatigue
Fever
Chills
What are some skin/wound symptoms of infection?
Redness
Swelling
Tenderness
Discharge
What are some lower respiratory tract symptoms of infection?
Productive cough
SOB
Pleuritic chest pain
What are some upper respiratory tract symptoms of infection?
Congestion
Discharge/drainage
HA/pain/pressure
What are some abdominal symptoms of infection?
Abd pain
N/V/D
What are some GU symptoms of infection?
Pain/burning upon urination
Vaginal/urethral discharge
What are some neuro symptoms of infection?
HA
Confusion
AMS
What are some MSK symptoms of infection?
Arthralgia
Edema
Erythema
Warmth
What are some general signs of infection?
Fever
Tachycardia
What are some skin/wound signs of infection?
Erythema
Edema
Discharge
Lesions
What are some lower respiratory tract signs of infection?
Wheezing/rhonchi/rales
Dullness to percussion
Hypoxia
What are some upper respiratory tract signs of infection?
Ears: bulging, erythematous TMs
Nose: Edematous, eythematous nasal mucosa/turbinates, sinus tenderness.
Throat: Erythematous oropharyngeal mucosa, tonsillar hypertrophy, exudates.
What are some GI signs of infection?
Abd tenderness
Increased bowel sounds
What are some GU signs of infection?
Cloudy/dark urine
Vaginal/urethral discharge
Lesions/sores
What are some neuro signs of infection?
Papilledema
Meningeal signs
Focal neurologic deficits
What are some MSK signs of infection?
Tenderness
Joint effusion
Decreased ROM
What is step 2 of diagnosing an infection?
Confirming the presence of an infection.
What is the category we are concerned with in a CBC regarding infection?
Leukocytes, which are typically ELEVATED in the presence of an infection.
What are the granulocytes and agranulocytes?
Granulocytes: Neutrophils, Eosinophils, Basophils
Agranulocytes: Lymphocytes, monocytes
What is the general proportion of leukocytes in the blood?
Neutrophils: 60-70%
Lymphocytes: 20-30%
Monocytes: 1-6%
Eosinophils: 1-3%
Basophils: <1%
Never Let Monkeys Eat Bananas
When are neutrophils typically elevated?
Bacterial infections
Sometimes fungal infections and general physiological stress.
What is a left shift and what does it indicate?
Increased presence of IMMATURE neutrophils.
Suggests Acute/early bacterial infection.
When do I see lymphocytosis?
Mainly in viral infections.
Leukemias and lymphomas as well.
What is the most common WBC in lymph?
Lymphocytes
What is the largest WBC?
Monocytes
When are monocytes typically elevated?
Late/chronic infection.
When are eosinophil counts elevated?
Allergic
Parasitic
Chronic skin conditions
When are basophil counts elevated?
Hypersensitivity reactions
Note:
Least common cause of leukocytosis.
What is a clean catch?
Collecting a clean urine sample that has typically only been in the bladder for 2-3 hours max.
What does getting a clean catch require?
Women must clean the labia.
Men must clean the head of the penis.
Children must be potty trained. If not, catherization will be used.
Describe the clean catch process.
Clean GU area.
Pee a little into the toilet.
Stop and then pee the cup to the marker.
Close the cup with the lid, never touching the inside of the cup.
Note:
If at home, refrigerate in a plastic bag afterwards.
What does a cloudy/turbid urine suggest?
Pyuria. (color)
What does a strong/fishy odor urine suggest?
Infection. (odor)
What main things are we testing for in a dipstick test of urine?
Leukocyte esterase
Nitrites
Blood
What are we looking for in a microscopic examination of urine?
WBCs
RBCs
Microorganisms
Casts
What does elevated leukocyte esterase suggest?
Increased WBC count and therefore infection.
Note:
Enzyme made by WBCs.
What does elevated nitrites suggest?
Presence of G- bacteria.
What does presence of casts indicate?
Kidney infection
When is a wet mount/KOH prep used?
Primary indication for vaginal/cervical/urethral discharge.
What is a wet mount used to observe?
Looking for microorganisms.
Clue cells indicate bacterial vaginosis.
Protozoans indicate Trichomonas
What is a KOH prep used to observe?
Fungal cells.
Note:
KOH degrades skin cells.
Can a wet mount be used to identify bacteria?
NO.
What does a clue cell look like?
Stippled appearance, covered in bacteria.
See slide 32 for visual
What is the purpose of an LP?
Obtain CSF for analysis
Therapeutic:
Relieve ICP
Administer intrathecal medications.
When are LPs indicated?
Sudden/severe HA and/or stiff neck.
Fever
Confusion, hallucinations, seizures, difficulty with speech, light sensitivity, dizziness, lethargy, and muscle weakness.
What positions are used for an LP?
Lateral decubitus is used when opening pressure is needed.
Upright, hunched over position is used when opening pressure is not needed.
What are the two pops I will feel on an LP?
Pop 1 will be the ligamentum flavum.
Pop 2 will be the dura mater.
Where is an LP performed?
Around L4-L5 vertebral level.
How many tubes do I get when collecting CSF? Why?
4
- Cell count and Diff
- Glucose and protein levels
- Gram stain, C&S
- Other
If my CSF looks yellowy, what is that called and what is it indicative of?
Xanthochromic.
Bleeding!!
What is the normal viscosity of CSF?
Same as water.
Thicker would imply an infection or malignancy.
What does presence of RBCs in tube 1 indicate?
CNS bleed
OR
Traumatic tap