prep of patient

• 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
• 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
• 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
• 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)
• 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
• 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)
• 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
• 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
• Urine testing


  • Specific Gravity
  • Urinary pH
  • Glucose
  • Ketones
  • Protein
  • Occult Blood
  • Osmolality
• 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
• 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
• 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
• Nursing responsibilities during colonoscopy

  • Assist with patient positioning as necessary
  • Administer medication as ordered
  • Instruct patient to bear down
  • Change the position of the patient
  • Encourage the patient to take slow deep breaths
• Nursing responsibilities after colonoscopy

  • Observe the patient closely for signs of bowel perforation
  • Obtain and record the patient's vital signs
  • Instruct patient to resume a normal diet, fluids, and activity as advised by the health care provider
  • Provide privacy while the patient rest after the procedure
  • Monitor for any rectal bleeding
  • Encouraged increase fluid intake
• Urinary visualization procedures


  • X-rays of the kidney, ureter, bladder (KUB)
  • Ultrasound of kidney, ureter, bladder (KUB Ultrasound)
  • Intravenous Pyelography
  • Retrograde Pyelography
• Indirect - non-invasive


  Achieved by roentgenography (x-ray)
• Clients with Urinary Alterations


  • X-rays of the kidney, ureter, bladder (KUB)
  • Ultrasound of kidney, ureter, bladder (KUB Ultrasound)
  • Intravenous Pyelography - the roentgenogram of the kidney, pelvis and ureter wherein the radiologist injects a contrast dye into the vein
  • Retrograde Pyelography - done to visualize the ureters and collecting system of the kidneys through the introduction of contrast into the urinary system in a retrograde fashion with simultaneous imaging using dynamic fluoroscopy and done with cystoscopy
  • Cystoscopy - direct visualization of bladder, ureteral orifices and urethra using a cystoscope
• Nursing Responsibilities Before the Procedure

  1. Signed and informed consent, procedure should be well-understood by the patient

  2. Withhold blood thinning medications

  3. Provide instruction for fasting and non-fasting preparation

  4. Establish an IV line

  5. Prepare the patient

  6. Administer sedative and other medication as ordered
• After the Procedure


  1. Monitor and record vital signs

  2. Assess the patient's ability to void at least 24 hours after the procedure

  3. Observe the color of the urine

  4. Encourage increase fluid intake if not contraindicated

  5. Encourage deep breathing exercises

  6. Provide warm sitz bath and administer mild analgesics as ordered

  7. Watch out for signs of serious complications
• Nursing Responsibilities Before the Bronchoscopy Procedure


  1. Signed and informed consent

  2. Obtain medical history (allergy)

  3. NPO for 6-12 hours prior to the procedures

  4. Monitor vital signs

  5. Provide oral hygiene

  6. Administer pre-op medication as ordered

  7. Prepare for local anesthesia

  8. Relieve anxiety

  9. Prepare emergency resuscitation equipment at the bedside
• During the Bronchoscopy Procedure

  1. Position the client

  2. Provide assistance with the diagnostic procedure

  3. Secure specimen
• After the Bronchoscopy Procedure

  1. Assess bleeding episodes

  2. Assess respiratory status

  3. Monitor vital signs

  4. Position the patient

  5. Reinforce diet

  6. Prevent aspiration

  7. Relieve anxiety and provide comfort measures
• Computed Tomography (CTScan)


  Non-invasive X-ray producing 3 dimensional images of the organ or structure making it more sensitive than the x-ray machine so it is capable of distinguishing minor differences in the density of tissues
• Magnetic Resonance Imaging (MRI)


  Non-invasive diagnostic scanning technique in which the client is placed in a magnetic field for about 60 – 90 min to visualize brain, spine, limbs and joints, heart, blood vessels and pelvis in great detail and produces images of organs and vessels in motion
• Nursing Responsibilities Before the MRI Procedure

  1. Signed an informed consent

  2. Explain to the patient the purpose of the test and the procedure

  3. For MRI of urinary tract, advise the patient to avoid alcohol, caffeine-containing beverages and smoking for at least two hours and food for at least 1 hour before the test

  4. If contrast media is to be used, obtain a history of allergy or hypersensitivity to these agents

  5. Instruct patient to remove all metallic objects (jewelry, hairpins, watches)

  6. Ask patient for any metallic implants

  7. Administer prescribed sedative if ordered

  8. Have the patient urinate and recheck once again
• During the MRI Procedure


  1. Remind patient to remain still throughout the procedure

  2. Assess how patient responds to the enclosed environment

  3. Monitor for cardiac functions

  4. If patient is unstable, make sure an IV line with no metal component is in place
• After the MRI Procedure

  1. Tell the patient to resume usual activities as ordered

  2. If the test took a long time and the patient was lying for extended hours, observe for orthostatic hypotension

  3. Provide comfort measures and pain medications as needed

  4. Monitor patient for the adverse reaction to the contrast medium
• Lumbar Puncture/ Spinal Tap


  Invasive procedure wherein the cerebrospinal fluid is withdrawn through an insertion of fine needle into the subarachnoid space of the spinal canal between the third and fourth lumbar vertebrae or between the fourth and fifth lumbar vertebrae to measure CSF, to instill medications or introduce a contrast medium