Lab & Diagnostic Tests

medical purposes for lab and diagnostic tests
to confirm wellness, detect deviations from wellness, make medical diagnosis, and make treatment decisions

pre-procedure preparations
nurse will be making PT ready, teaching what to expect and what will be required of him/her during and after, explaining length of procedure

during procedure
nurse will assist physician and collect samples properly

nurse will make assessments, carry out special care, notify the ordering MD of lab or diagnostic test results (required if abnormal)

microbiology studies
tests done if an infection is suspected. Culture and sensitivity, get specimin prior to starting antibiotic, final results may take 2-3 days

sputum for culture and sensitivity
AM awakening is the best collection time, PT should produce sample into sterile cup and call nurse immediately afterward. Can be induced by catheter insertion nasally to bronchus

stool for C&S or O&P
test usually done for diarrhea of unexplained origin, used when testing for organisms, immediate transport to the lab is important

clean catch collection
test that avoids skin organism contamination, must clean peri-area, begin voiding, pass specimen container into stream, then take to lab or keep cold.

catheter urine specimen
could be taken from an “In and Out”, specimen port, but never from drainage bag

timed urine collection
1st void is discarded, last void is kept, all urine must be saved and kept cold during the collection period. This test is a measurre of kidney function

most common medical imaging. There is always some risk of injury but shielding, minimal exposure and distance minimizes risk.

contrast media
Some xray studies produce better results if the PT is given a dye or ________that shows up on the xray

used for dynamic swallowing studies, upper GI lumen images, enemas for the inner colon profile

constipation, laxative
Barium studies can cause __________. Afterward, Pts may be given a _____. Stools will be lightly colored

used for GI or vascular studies.

dangers of iodine based studies
shellfish allergies, fasting, potential nephrotoxicity in renal compromised pts, elevated BUN/creatinine before test indicates kidney trouble

What should be given to PTs after iodine tests?

computerized tomography CT
specialized xray that gives a cross-sectional analysis with or without contrast

Magnetic resonance imaging MRI
non-invasive test, most sensitive technique for differentiating between normal and pathological studies

dangers of MRI
cardiac pacemakers, intracranial aneurysm clips and metal are contraindicated in this test.

CBC-complete blood count
includes WBC count and WBC differential, RBC count, hematocrit and hemoglobin

first line of defense

mature neutrophils

immature neutrophils

% of the volume of blood that is RBCs

mass of RBCs

men or women have higher hemoglobin, hematocrit and RBCs?

low RBCs
low or high RBCs is more common?

fatigue and activity intolerance
Common responses to low RBCs, H&H are _________. It may also cause exacerbations of other illnesses

reasons for high RBCs H&H
dehydration, chronic hypoxia response, severe chronic lung disease mechanism of compensation

normal value 150,000-400,000

dyspnea, chest pain, confusion, increased leg pain with walking
O2 sat may be okay but each PT has symptoms of poor oxygenation due to anemia. PT has asthma..anemia causes_______ PT has coronary artery disease…anemia causes_______ PT has cerebral vascular disease….anemia causes_______PT has peripheral vascular disease…anemia causes______

normal value 135-145 mEQ/L

sodium, confusion, neurologic abnormalities, conduction of electrical impulses
the most common particle in the blood is the _____ion, very high or very low concentrations causes____and______, it is a major determinant of extracellular osmolality, and is necessary for___________

normal value 3.5-5.3 mEQ/L

cardiac dysrhythmias, dig toxicity, lower, higher, increase the action of digoxin
Low or high concentrations of potassium contribute to ___________, low concentrations + high digoxin concentration =______________, Thiazide and loop diuretics cause ________levels, potassium sparing diruetics and potassium supplements cause ________levels. There is an interaction between low potassium + digoxin which is to ______________

potassium, loop, thiazide, K-sparing diuretics or digoxin
Nurse needs to check Potassium levels before giving_____

extended release, immediate
K supplements are often given in __________form: do not crush but may be broken in half. Liquid K is in_____________form and needs to be diluted in >4 oz liquid. Taking with food minimizes GI discomfort

normal value 0.5-1.5 mEQ/L

creatinine, kidney dysfunction, Basic Metabolic Panel
_______varies with muscle mass, it is the most specific blood test for kidney function, elevation above normal indicates______________ This test is part of the most commonly ordered chemistry test:________________

serum proteins, total protein, bilirubin, GGT
The liver is where __________are synthesized. A liver panel includes albumin, _________, ALT, _________, AST and _______

dose adjustment, toxicity, therapeutic margin (digoxin-0.5-2.0 ng/ml)
The purpose of therapeutic drug monitoring is to guide___________, gather information when the drug is not having the expected effect, where s/s of _______appear despite dose being in the normal range and when a drug has a narrow______

when a drug is at its highest concentration`

when a drug is at its lowest concentration, just before the next dose is due

if the trough level is too high, ______can ebe damaged

PT prothrombin time
measures vit K factor-dependent coagulation

coumadin, coagulation or bleeding issues
ProThrombin Time is measured when effectiveness of the drug_____is being monitored or if a Patient has__________

INR, 1.0
PT is expressed as an _______value. The mean value for a person with normal coagulation is _____

therapeutic INR range for DVT prophylaxis

therapeutic INR range for stroke prophylaxis in PTs with atrial fibrillation

Monitor for s/s of infection and v.s q 4 h, if very low may need protective isolation
with abnormal WBCs, Neutrophils, polys and bands…the nursing implications will be_

monitor nutritional status, protect form sources of infection
with abnormal lymphocytes…the nursing implications will be_

monitor for fatigue, activity inotlerace, dyspnea, v.s. q4h, monitor for s/s of volume deficit and check RR
with abnormally low hct, hgb and RBCs…the nursing implications will be_

monitor for s/s of bleeding
with abnormally low platelets…the nursing implications will be_

monitor neuro status, muscular weakness, volume status
with abnormal NA…the nursing implications will be_

monitor for irregular heart rhythm
with abnormal K and Mg…the nursing implications will be_

monitor for s/s of volume excess, serum K, increased effect of drugs cleared by the kidneys
with abnormal BUN and Cr…the nursing implications will be_

monitor for s/s of volume deficit
with abnormal BUN but not Cr….the nursing implications will be_

if non-diabetic, assess for cause of stress, albumin and total albumin
with abnormal glucose…the nursing implications will be____

monitor LOC, increased effect of drugs cleared by the liver, s/s of bleeding
with abnormal protein, bili, AST/SGOT, GGT/GGTP and liver function tests…the nursing implications will be_

monitor nutritional status
with low albumin and total protein…the nursing implications will be_

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