Module 11: Testing and Laboratory Procedures Flashcards
most commonly tested specimen in ambulatory care setting
urine
random urine
- pt urinates in clean and nonsterile container
- used for screening purposes
first morning specimen
- pt collects first specimen of the morning in clean container
- more concentrated
- pregnancy testing, analytes (protein, nitrites) evaluations
clean catch midstream
- perineal cleaning
- begins urinating and collects midstream in sterile urine container
- used for cultures, when noncontaminated specimen is desired
24-hour urine sample
- container with preservatives
- discards first morning specimen
- collects all specimens for next 24 hr, including first of second day
- qualitative analysis of components like protein when analyzing kidney function
catheterized urine collection
- when sterile urine sample needed
- if pt can’t provide specimen on their own
- insertion of sterile catheter through urethra into bladder
fecal occult blood test
- stool sample
- screen for blood in stool
- pt must avoid some medications and foods for 3 days prior
- collects three separate specimens
tape test
- detects pinworms
- typically in small children
- tape placed over anus before getting up in the morning
- brought to provider for analysis
ova and parasite testing (O&P)
- detects presence of parasites and their eggs
obtaining sputum specimen
- sterile container
- pt produces deep and productive cough for specimen from deep within lungs
- best collected early in the morning before eating or drinking
- pt should avoid mouthwash before collection
what are specimens for cultures collected in
sterile containers
reminders for specimen collection
- collect at appropriate time
- collect from site of suspected infection
- minimize transport time to lab
- collect appropriate quantity
- use appropriate containers and label correctly
what federal agency determines the complexity of tests performed in the lab
food and drug administration (FDA)
CLIA waived testing
- clinical laboratories improvement amendments
- simplest lab procedures
pregnancy testing
- urine screened for human chorionic gonadotropin (hCG) antibodies
rapid streptococcus testing
- throat swabs screen for group A streptococcus
dipstick, tablet, or multi-stick urinalysis
- urine screened for analytes excreted in urine
hemoglobin
- machine screens for hemoglobin in blood
- capillary puncture
spun hematocrit
- fingerstick
- centrifuged and evaluated for percentage of RBC
blood glucose
- blood analyzed in glucometer for glucose level
- screening for diabetes
- capillary puncture
hemoglobin A1c
- capillary blood test
- shows diabetes control over approx 3 months
cholesterol testing
- lipids evaluated
- capillary blood
helicobacter pylori
- blood sample
- screens for H. pylori
mononucleosis screening
- capillary blood
- screens for Epstein-Barr virus in blood
nasal smear for influenza types A and B
- qualitative test for influenza antigens using nasal swab
drug testing
- substances detected in urine and blood
when was CLIA established
1988
moderate and high complexity tests
- nonwaived
- must have CLIA certificate and undergo inspections
- typically performed in reference or hospital laboratory
provider performed microscopy procedures
- form of moderate complexity testing
- approved for screening of some specimens (urine or body excretions)
COLA
- commission on office laboratory accreditation
- independent accreditor for labs
- focuses on meeting CLIA regulations and providing best care
quality assurance
- comprehensive
- relates to policies and procedures that must be implemented for reliability of test results
- ex: policies related to rotating stock to put newest container in the back of the storage area, policy of checking lab fridge temperature
quality control
- included in quality assurance but more specific
- test reliability and accuracy while uncovering and eliminating errors
- ex: reviewing expiration of urine multi-sticks, checking temp of lab fridge and documenting on log
controls
- quality control samples
- known results used to compare results of pt sample and confirm validity of test
- ex: blue strip on fecal occult test
what does incorrect specimen labeling contribute to
lab error
medicare access and CHIP reinforcement act of 2015 (MACRA)
- payment for healthcare under direction of the CMS
- control credentialing for computerized provider order entry
information required in lab requisition form
- pt demographics
- providers signature
- specific tests needed
- source of specimen
- date and time of specimen collection
panel
- groups of tests that are connected to one body system
- aka profile
information required when labeling lab specimens
- pts name
- date and time of collection
information that MAY be required when labeling lab specimens
- pt date of birth
- provider name
- initials of person collecting specimen
where should you label a specimen container
the actual container and not the lid
department running culture and sensitivity
microbiology
what lab test looks for nitrite
urinalysis
department running fasting blood sugar test
chemistry
department running type and cross match test
blood bank
department running pap smear
cytology
department running WBC test
hematology
most effective means of preventing spread of infection
hand washing
chain of custody
- when collecting and handling specimens for drug testing for employment or a court subpoena
- ensures security and accuracy
- signature of everyone who has contact with specimen is requried
how to handle urine specimen testing for bilirubin
- protection from light
- dark container
processing nonblood specimens
- may need to be processed prior to transport to maintain specimen integrity
- making sure swabbed specimen is moist, proper storage
how to process urine sample for microscopic analysis
- can require centrifuging before transport with supernatant fluid removed
storing nonblood specimens
- some require refrigeration (urine)
- refrigeration to avoid chemical changes or biological breakdown of specimen
- some require body temp storage (swabs for STDs)
- cooling of this specimen can kill organism
transporting nonblood specimens
- appropriate packaging
- if container could break add padding and protection from leakage
- wrap in absorbent material and put in biohazard bag
- biohazard identification on outside to alert handlers of infectious material
disposal of nonblood specimens
- red biohazard waste bags
- sharps container for anything that would break or splinter
- designated sink for urine specimens
what to do if getting critical value call from lab
- ensure accuracy by repeating test results back to lab personnel
- notify provider immediately
- document communication and actions taken
hyperopia
- difficulty seeing things up close
- farsightedness
myopia
- difficulty seeing things far away
- nearsightedness
presbyopia
- gradual age-related loss of eyes’ ability to focus actively on nearby objects
near vision testing
- screens for presbyopia or hyperopia
- uses near vision acuity chart
- pt reads material of various sizes 14 to 16 inches away
- no corrective lenses
- test each eye separately and then both together
distance vision testing
- screens for myopia
- pt stands 20 ft from chart
- test eyes separately and together
- pt wear corrective lenses
- pt can miss one item and still pass line
- recorded as fraction, 20/20 is normal
who is more commonly affected by color blindness
males
most common type of color blindness
red-green deficiency
color vision testing
- 11 plates within ishihara book
- pt misses four or more then they may have a color deficiency
- further testing to warrant diagnosis
visual field testing
- aka perimetry testing
- detects eye diseases like glaucoma
- pt looks straight ahead and responds when they see light flash or hand or fingers in their peripheral vision
tympanometry
- records movement of tympanic membrane (affected by pressure in middle ear)
- changing air pressure measured
- determines presence of fluid and infection in middle ear
- normal tympanogram produces peak on graph and abnormal produces flat line
audiometry
- raise hand when various tones are heard through headphones
normal adult hearing level
25 decibels
normal child hearing level
15 decibels
tuning fork
- determines pt ability to hear tones transmitted through air and bone conduction
- placed on top of head or on mastoid process
scratch testing
- diluted allergen applied to scratch or prick on surface of skin
- wheal in first 15 mins can be possible allergen and warrant intradermal testing
- the larger the wheal, the more significant the allergy
intradermal testing
- diluted allergen injected intradermally
- initial wheal is expected
- inflamed with with induration (raised, hard area) can be identified as allergen
RAST testing
- radioallergosorbent testing
- checks blood for antibodies that could indicate allergy
- more invasive than skin testing
- safer by avoiding potential allergic reation
challenge testing
- detects specific allergies (food)
- prescribed if scratch or intradermal tests are positive and pt (usually child) has suspected life-threatening food allergies
- receives increasing amount of suspected food allergen
- conducted in controlled environment where treatment is available for acute allergic reactions
peak flow testing
- monitor lung function in the home
- especially for pts with chronic respiratory diseases (asthma)
- measures forced expiratory volume, indicates effectiveness of airflow out of lungs
pt instructions for peak flow testing
- wear nonrestrictive clothing
- begin with marker at bottom of scale on mete
- upright sitting or standing postibio
- take deep breath and forcefully blow out of mouth secure around mouthpiece of machine
- record number where marker is located at end of test
- repeat two or three times
spirometry
- automated test that produces graphic result
- similar to peak flow test
- apply clip to pts nose to avoid nose-breathing
- lift chin and extend neck to reduce breathing resistant
pt preparation for spirometry
- no large meals 2 hr before test
- no smoking 1 hr before test
- discontinue use of bronchodilators or breathing therapies (inhaler, nebulizer) for at least 6 hr before test
