DIAGNOSITC TESTING

BY: JERVY P. BERANRDINO, RN, MSN

DIAGNOSTIC TESTING
Also known as laboratory Testing Are tools that provide information about the cleint PURPOSE: Used for basic screening as part of wellness check Used to help confirm a diagnosis Monitor an illness Provide valuable information about the clients response to the treatment

DIAGNOSTIC TESTING PHASES

PRETEST The major focus is the client preparation A thorough assessment and data collection assist the nurse in determining communication and teaching strategies The nurse needs to know what equipment and supplies are needed for the specific test

DIAGNOSTIC TESTING PHASES

INTRATEST This phase focuses on specimen collection and performing or assisting with certain diagnostic testing The nurse uses standard precautions and sterile technique as appropriate During the procedure the nurse provides emotional and physical support while monitoring the client as needed The nurse ensures correct labeling, storage, and transportation of the specimen to avoid invalid test

DIAGNOSTIC TESTING PHASES

POST-TEST The focus of this phase is on nursing care of the client and follow-up activities and observations The nurse compares the previous and current test results and modifies nursing interventions as needed.

BLOOD TESTS

Provide valuable information about the hematologic system and many other body system A VENIPUNCTURE (puncture of a vein for collection of a blood specimen) can be performed by various members of the healthcare team A PHLEBOTOMIST, a person from a laboratory who performs venipuncture, usually collects the blood specimen for the test ordered by the primary care provider

BLOOD TESTS

COMPLETE BLOOD COUNT (CBC) SERUM ELECTROLYTES BLOOD CHEMISTRY SERUM OSMOLALITY DRUG MONITORING ARTERIAL BLOOD GASES CAPILLARY BLOOD GLUCOSE

COMPLETE BLOOD COUNT

COMPONENT Red Blood Cell (RBC) count The number of RBCs per cubic millimeter (mm3) NORMAL FINDINGS Men: 4.6-6.0 million/mm3 Women: 4.0-5.0 million/mm3

COMPLETE BLOOD COUNT

COMPONENT NORMAL FINDINGS Hemoglobin (Hgb) Men: Composed of a pigment (heme), which 13.5-18 g/dL contains iron, and a protein (globin) Women: 12-15 g/dL Anemia is classified when the hemoglobin level falss below 10.5 g/dL

COMPLETE BLOOD COUNT

COMPONENT Hematocrit (Hct) The hematocrit or packed cell volume (Hct, PCV, or crit) is a fast way to determine the percentage of RBCs in the plasma The Hct is reported as a percentage because it is the proportion of RBCs to the plasma Men: 40-54% Women: 36-46% NORMAL FINDINGS

COMPLETE BLOOD COUNT

COMPONENT RBC INDICES NORMAL FINDINGS

Mean Corpuscular Volume (MCV) The mean or average size of the individual RBC

Men: 80-90 Women: 78-102

25-35 pg

Mean Corpuscular Hemoglobin (MCH) Amount of Hgb present in one cell

31-37% Mean Corpuscular Hemoglobin Concentration The proportion of each cell occupied by hgb.

COMPLETE BLOOD COUNT

COMPONENT White Blood Cell (WBC) Count Count of the total number of WBCs in a cubic millimeter of blood NORMAL FINDINGS 4,500 11,000/mm3

COMPLETE BLOOD COUNT

COMPONENT WBC DIFFERENTIAL COUNT: The proportion of each of the five types of WBCs in a sample of 100 WBCs Neutrophils Lymphocytes Monocytes Eosinophils Basophils 50-70% 25-45% 4-6% 1-3% 0.4-1.0% NORMAL FINDINGS

COMPLETE BLOOD COUNT

COMPONENT Platelet Count Platelets are fragments of cytoplasm that function in blood coagulation NORMAL FINDINGS 150,000-350,000/mm3

SERUM ELECTROLYTES
COMPONENT SODIUM NORMAL FINDINGS 135-145 meq/L

POTASSIUM
CHLORIDE CALCIUM MAGNESIUM PHOSPHATE

3.5-5.3 meq/L
95-105 meq/L 4.5-5.5 meq/L 1.5-2.5 meq/L 1.8-2.6 meq/L or 8.5-10.5 mg/dL

BLOOD CHEMISTRY
TEST LIVER FUNCTION TESTS ALT (Alanine Amino Transferase) AST (Aspartate Amino Transferase) Men: 10-55 unit/L Women: 7-20 unit/L Men: 10-40 unit/L Women: 9-25 unit/L Marker of hepatic injury More specific of liver damage than AST Found in heart, liver, and skeletal muscle. Can also be used to indicate liver injury Is a protein produced by the liver Found in the tissues of the liver, bone, intestine, kidney, and placenta NORMAL FINDINGS SIGNIFICANCE

Albumin

3.5-4.8 g/dl or 35-48 g/L 25-100 unit/L

Alkaline Phosphatase

BLOOD CHEMISTRY
TEST LIVER FUNCTION TESTS Ammonia 15-45 mcg/dl The liver coverts ammonia, a by-product of protein metabolism, into urea which is excreted by the kidneys Results from the breakdown of hemoglobin in the red blood cells; removed from the body by the liver, which excretes it into the bile NORMAL FINDINGS SIGNIFICANCE

Bilirubin

0.3-1.0 mg/dl

GGT (Gamma-Glutamyl Transferase

Men: 1-94 unit/L Women: 1-70 unit/L

Found primarily in the liver, kidney prostate and spleen. Is more specific

BLOOD CHEMISTRY
TEST CARDIAC MARKERS CK (Creatinine Kinase) Men: 38-174 unit/L Women: 26-140 unit/L ISOENZYMES: MM (CK3): 96-100% MN (CK2): 0-6% BB (CK1): 0% An enzyme found in the heart and skeletal muscles. Has three isoenzymes: MM (CK3) MN (CK2) BB (CK1) NORMAL FINDINGS SIGNIFICANCE

Myoglobin

5-70 ng/ml

After an MI, serum levels of myoglobin rise in 2-4 hours making it an early marker for muscle damage in MI Cardiac troponin is highly concentrated in the heart muscle. This test is used

Troponin I Troponin T

<0.34 ng/mL <0.2 ng/mL

BLOOD CHEMISTRY
TEST BNP (Brain Natriuretic Peptide, or B-Type Natriuretic Peptide) NORMAL FINDINGS <100 pg/mL or <100 ng/L SIGNIFICANCE A hormone produced by the ventricles of the heart Is a marker of ventricular systolic and diastolic function This test is useful in diagnosing and guiding treatment of heart failure

BLOOD CHEMISTRY
TEST LIPOPROTEIN PROFILE Cholesterol <200 mg/dL This test is an important screening test for heart disease A class of lipoproteins produced by the liver and intestines the good cholesterol NORMAL FINDINGS SIGNIFICANCE

HDL-C (High-Density Lipoprotein Cholesterol)

Men: 35-65 mg/dL Women: 35-80 mg/dL

LDL (Low Density Lipoprotein)

130 mg/dL

Up to 70% of the total serum cholesterol is present in LDL The bad cholesterol
This test evaluates suspected atherosclerosis and measures the bodys

Triglycerides

<150 mg/dL

SERUM OSMOLALITY

Is a measure of the solute concentration of the blood The particles included are sodium ions, glucose , and urea. Are used primarily to evaluate fluid balance Normal Values: 280-300 mOsm/kg An increase in serum osmolality indicates a fluid volume deficit A decrease in serum osmolality indicates a fluid volume excess

DRUG MONITORING

Is conducted when a client is taking a medication with a narrow therapeutic range

ARTERIAL BLOOD GASES

CAPILLARY BLOOD GLUCOSE

Used to measure blood glucose

SPECIMEN COLLECTION AND TESTING

STOOL SPECIMEN URINE SPECIMEN SPUTUM SPECIMEN

STOOL SPECIMEN

To determine the presence of occult (hidden) blood. To analyze for dietary products and digestive.
Ex.

An excessive amount of fat in the stool (steatorrhea) can indicate faulty absorption of fat from the small intestine.

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

To detect the presence of bacteria or viruses.

FECAL OCCULT BLOOD TESTING

Is the test for occult blood Guaiac Test (Hemoccult). Uses a chemical reagent that detects the presence of the enzyme peroxidase in the hemoglobin molecule

URINE SPECIMENS

TYPES: Clean voided urine specimen Clean-Catch or Midstream Urine Specimen Timed Urine Specimen Indwelling Catheter Specimen

Clean Voided Urine Specimen

Is used for routine examination First voided specimen in the morning is used because it tends to have a higher, more uniform concentration and more acidic pH 10 mL of urine is used The specimen must be free of fecal contamination The nurse must make sure that the specimen label and laboratory requisition carry the correct information

Clean-Catch or Midstream Urine Specimen

Are collected when a urine culture is ordered to identify microorganisms causing UTI. Clean-Catch specimens are collected in a sterile specimen container with a lid.

Timed Urine Specimen

Require collection of all urine produced and voided over a specified period of time, ranging from 1 to 2 hours to 24 hours Timed specimens generally either are refrigerated or contain a preservative to prevent bacterial growth Each voiding of urine is collected in a small. Clean container and then emptied immediately into the large refrigerated bottle.

Indwelling Catheter Specimen

Sterile urine specimens can be obtained from closed drainage system by inserting a sterile needle attached to a syringe through a drainage port in the tubing Aspiration of urine from catheters can be done only with self-sealing rubber catheters

COMPONENTS OF URINE TESTING

TEST Specific Gravity NORMAL FINDINGS 1.010-1.025 SIGNIFICANCE Is the indicator of urine concentration or the amount of solutes (metabolic wastes and electrolytes present in the urine Determines the relative acidity or alkalinity of urine and assess the clients acid-base status To screen clients for Diabetes Mellitus Ketone bodies are products of the breakdown of fatty acids Found in the urine of clients with poorly controlled diabetes

Urinary pH Glucose Ketones

pH of 6 negligible Absent

Protein

Absent

Protein molecules normally are too large to escape from glomerular capillaries into the filtrate
When blood is present, it may be clearly visible or not visible (occult)

Occult Blood

Absent