prep of patient

• Diagnostic test


  A chemical, microscopic, bacteriologic or biopsy study of secretions, discharges, blood or tissue to identify nature of a disease
• Diagnostic test


  Commonly called lab test / laboratory test
• Purposes/uses of diagnostic tests


  • Provide information about the client
  • Basic screening as part of a wellness check
  • Confirm a diagnosis
  • Monitor an illness
  • Provide valuable information about the client's response to treatment
• Role of nurses


  • Teach the client and family or significant other how to prepare for the test
  • Do the care that may be required following the test
  • Know the implications of the test results in order to provide the most appropriate nursing care for the client
• Diagnostic testing phases and the nurses' role

  1. Pre-test - major focus is on client preparation

  2. Intra test - focuses on specimen collection and performing or assisting with certain diagnostic testing

  3. Post-Test - focus on nursing care of the client and follow up activities and observations
• Pre-test phase


  • Assessment and data collection (biologic, psychological, sociologic, cultural, spiritual)
  • Know the equipment and supplies needed for specific test
  • Instruct the client about the test (fasting, administration of dye/contrast medium, restriction or forcing of fluids, medication, duration of test, secure consent)
• Intra test phase


  • Use standard precautions and sterile technique as appropriate
  • Provide emotional and physical support while monitoring the client as needed
  • Ensures correct labeling, storage, transportation of the specimen to avoid invalid test results
• Post-Test phase


  • Compare previous and current test results and modifies nursing interventions as needed
  • Report the results to appropriate health team members
• Specimen collection and testing

  Laboratory examination of urine, blood, stool, sputum, and wound drainage providing important adjunct information for diagnosing health problems and providing measure of the responses to therapy
• Nursing responsibilities to specimen collection

  • Provide client comfort, privacy and safety
  • Explain the purpose of the specimen collection and procedure to obtain the specimen
  • Use the correct procedure for obtaining a specimen
  • Note relevant information on the laboratory request slip
  • Transport the specimen to the laboratory promptly
  • Report abnormal laboratory findings to the health care provider in a timely manner consistent with the severity of abnormal results
• Venipuncture


  Puncture of vein for collection of a blood specimen
• Phlebotomist


  A person from a laboratory who performs venipuncture
• Blood specimen testing


  • Complete Blood Count
  • Coagulation Studies
  • Serum Electrolytes
  • Serum Osmolality
  • Drug Monitoring
  • Arterial Blood Gases
  • Blood Chemistry
  • Metabolic Screening
  • Blood Culture and Sensitivity
• Complete Blood Count


  Basic screening test and one of the most frequently ordered blood tests, includes hemoglobin, hematocrit measurements, erythrocyte (RBC) count, RBC cell indices, leukocytes (WBC) count and a differential white cell count
• Coagulation studies


  • Platelet count
  • Bleeding time
  • Clotting time
  • Prothrombin time
  • Activated partial thromboplastin time
• Serum electrolytes


  • Serum Sodium (Na+)
  • Potassium(K+)
  • Chloride(Cl-)
  • Magnesium (Mg)
  • Serum Bicarbonate(HCO3-)
  • Phosphorus(P)
  • Total Calcium(Ca+)
  • Ionized Calcium
• Serum osmolality


  A measure of solute concentration of the blood, the particles included are sodium ions, glucose and urea (BUN)
• Drug monitoring


  Often conducted when client is taking medications with narrow therapeutic changes (e.g. digoxin, theophylline, amino glycosides)
• Arterial blood gases


  A blood test that requires a sample from an artery in the body to measure the levels of oxygen and carbon dioxide as well as the pH balance in the blood
• Blood chemistry


  • LDH – Lactic Dehydroginase
  • Cardiac Markers (CK – Creatine Kinase, Myoglobin, Troponin I, Troponin T)
  • BNP Test (BRAIN NATRIURETIC PEPTIDE, OR B-TYPE NATRIURETIC PEPTIDE)
  • Liver Function Test (Alt – Alanine Aminotransferase, AST – Aspartate Aminotransferase, Albumin, Alkaline Phosphatase, Ammonia, Bilirubin, GGT – Gamma-glutamyl Transferase, Prothrombin)
  • Thyroid Hormone (T3T4)
  • Glucose Studies
  • Lipoprotein Profile (cholesterol, HDL-C, LDL, Triglycerides)
  • HIV and AIDS Testing
  • Hepatitis Screening
• Glucose studies


  • Fasting Blood Glucose
  • Glucose Tolerance Test (GTT)
  • Capillary Blood Glucose Test
  • HBA1C - glycosylated hemoglobin
• HBA1C


  Measurement of blood glucose that is bound to hemoglobin, reflection of how well blood glucose levels have been controlled during the prior 3-4 months, normal range is 4-5.5 (elevation reflects hyperglycemia)
• Metabolic screening


  Routine screening for newborns to detect congenital metabolic conditions, tests for PKU (Phenyl ketonuria), congenital hypothyroidism, sickle cell disease and galactosemia
• Blood culture and sensitivity


  Done to help figure out what kind of infection is in the bloodstream that is affecting the entire body and detect specific bacteria or yeast causing the systemic infection
• Stool specimen


  Analysis of stool providing information about clients' health condition
• Reasons for stool testing

  • Determine presence of occult (hidden) blood / guaiac test
  • Analyze for dietary products and digestive secretion
  • To detect presence of ova and parasites
  • To detect presence of bacteria and viruses
• Nursing responsibilities before stool specimen collection

  • Assess patient's level of comfort
  • Encourage the patient to urinate
  • Avoid laxatives
  • Instruct a red-meat free and high-residue diet
• Instructions in stool specimen collections

  1. Defecate in a clean bedpan or commode

  2. If possible, do not contaminate the specimen with urine or menstrual discharge

  3. Do not place toilet tissue in the bedpan after defecation

  4. Notify the nurse as soon as possible after defecation for immediate sending of specimen to the laboratory
• After stool specimen collection

  • Instruct patient to do handwashing
  • Resume activities
  • Recommend regular screening
• Ways of taking urine specimen


  • Clean voided urine specimen
  • Clean catch or midstream urine specimen
  • Indwelling catheter specimen
• Urine testing


  • Specific Gravity
  • Urinary pH
  • Glucose
  • Ketones
  • Protein
  • Occult Blood
  • Osmolality
• Specific gravity


  Indicator of urine concentration and amount of solute present, normal value is 1.010-1.025
• Urinary pH


  Determine the relative acidity or alkalinity of urine and asses the client's acid-based balance status, normal pH is 6-7.5
• Sputum specimen


  Mucous secretion from the lungs, bronchi, and trachea (usually taken in early morning for 3 days)
• Purposes of sputum specimen

  • For culture and sensitivity
  • For cytology to identify origin structure, function and pathology of cell
  • For AFB (Acid-Fast Bacillus)
  • To assess effectiveness of therapy
• Steps in collecting sputum specimen

  1. Offer mouth care so that specimen will not be contaminated with microorganism from the mouth

  2. Ask the client to breathe deeply and then cough by 1-3 step (4-10ml) of sputum

  3. Wear gloves and protective equipment to avoid direct contract of the sputum

  4. Ask client to expectorate (cough up) the sputum to the specimen container

  5. After collection offer mouthwash to remove unpleasant taste

  6. Label and transport the specimen

  7. Document the sputum collection
• Throat culture


  A throat culture sample is collected from the mucosa of the oropharynx and tonsillar region using a culture swab
• Wound drainage culture


  A test that finds germs such as bacteria, fungi, or viruses in the wound
• Visualization procedures


  • Gastrointestinal alterations (anoscopy, proctoscopy, proctosigmoidoscopy, colonoscopy)
  • Urinary alterations (X-rays of the kidney, ureter, bladder, ultrasound of kidney, ureter, bladder, intravenous pyelography, retrograde pyelography)
• Nursing responsibilities for colonoscopy

  • Secure informed consent
  • Obtain medical history of the patient
  • Provide information about the procedure
  • Ensure that the patient has complied with the bowel preparation
  • Establish an IV line
  • Provide reassurance
  • Explain to the patient that air may be introduced through the colonoscope
  • Instruct patient to empty bladder prior to the procedure
  • Instruct patient to remove all metallic objects from the area to be examined
  • Instruct patient to cooperate and follow directions