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

post-procedure
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

xray
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

Barium
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

Iodine-based
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

fluids
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

neutrophils
first line of defense

segs
mature neutrophils

bans
immature neutrophils

hematocrit
% of the volume of blood that is RBCs

hemoglobin
mass of RBCs

men
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

platelets
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______

sodium
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___________

potassium
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

creatinine
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______

peak
when a drug is at its highest concentration`

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

kidneys
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 _____

1.5-2.0
therapeutic INR range for DVT prophylaxis

2.0-3.0
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_

mice, rats, hamster, guinea pig, anesthesia, diagnostic, disease

What animal can you not do a cervical dislocation for euthanasia?
hamsters

What agency has a book on how to euthanasia each rodent?
USDA

what inhaled anesthesia can be used on mice, rats, and hamsters?
halothane and isoflurane

what injectable anesthesia can be used on mice, rats, and hamsters?
ketamine/xylazine

What is the most common blood collection sight in mice and rats?
lateral tail vein

how do you collect blood from large rats?
Cranial vena cava

For terminal rats, mice how would you collect blood?
Cardiac puncture

What is another way of collecting blood from mice and rats besides lateral tail vein?
retro – orbital bleeding (capillary)

What are the different venipuncture sights for mice and rats?
SQ, IV, IP

How do you do an IP venipuncture?
draw an imaginary line across the abdomen, just above the knees, insert needle at 30* angle into the abdomen on the animals right side (because the kidney is higher on that side), close to the midline, aspirate and inject if safe to do so.

What do you use to give oral medication to rats and mice?
blunt tipped catheter or gavage needle (metal).

What injections are used in guinea pigs?
SQ, IM

what is the most common blood collection site in guinea pigs?
lateral saphenous and cephalic veins

What blood collection site for guinea pigs can be stressful?
jugular

what blood draw sights in guinea pigs do they need to be anesthetized?
cranial vena cava, retro – orbital

What are some of the biggest cause of diseases in rodents?
poor husbandry, nutrition, housing, temperature, sanitation, handling stress.

What is the most common upper respiratory infection for rodents?
Mycoplasma spp.

What is the most common disease in rats?
neoplasia

What is the most common disease in hamsters?
Proliferative ileitis (wet tail)

What rodents/animals get malocclusions?
Guinea pig, rabbits

Slobbers happens in what animals/rodents?
rabbits and guinea pig

What animal do you have to worry about vitamin C deficiency?
guinea pigs

what are the clinical findings of vitamin C deficiency?
rough coat, anorexia, diarrhea, teeth grinding, vocalizing, delayed wound healing, lameness, pathologic fractures.

what animals cant have penicillin’s, erythromycin, lincomycin?
rodents and rabbits

What are signs that rodents and rabbits have been given penicillin’s, erythromycin, lincomycin?
diarrhea, gastrointestinal system upset and death

What does streptomycin cause in rodents and rabbits?
neurotoxic.

Report on diagnostic medical sonographer

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One of the key components in this career is the ability to explain clear procedures to your patient so that they know what is going on at all times. Along with clear procedures comes comforting them because most times a patient may be new to the surroundings. How you present yourself to the patient will play a big part in determining how relaxed they will be; although, this does not always go as planned. You will most likely get a few frantic patients either because of their current medical situation or simply because they are unfamiliar and nervous, so you must be mentally prepared to handle that situation with ease by being compassionate and always feeling empathetic for your patient. I also learned that being extremely observant by noticing the small details is another essential part in being a Diagnostic Sonographer. As soon as you notice an abnormality, it is important that you document it, remain calm, and let the physician know. That being said, knowing how to properly communicate to your colleagues will be very crucial in this setting in order to keep the workplace running smoothly and fast. Lastly, your mental health will be challenged at one point in this career setting but you cannot let it distract you from noticing the small, vital details. You must always try to clear your mind from any discomfort, and think positively in order to get the job done right.

Other than having your brain extremely sharp as a Diagnostic Medical Sonographer, you will also need to have a certain set of skills to make sure you are being efficient in your workplace. To my surprise, I learned that a tricky part of being a Diagnostic Sonographer is the hand-eye coordination technique. You must be able to move your hand on the patient’s body while watching the screen to find the best quality images needed. Along with skills that are needed, comes your technical abilities. Always being educated and keeping up to date on the new technology in the medical field is a must, especially for a career relying so much on technical devices. I have also learned that after completing an ultrasound, you are supposed to complete a hand-written report and doing so, you must obtain the correct medical terminology and correct writing format in order to clearly state the diagnosis to the physician. Lastly, time management is a keen skill that will help you as a medical sonographer. You will need to plan ahead to ensure that the scheduled appointments for your patients are going smoothly and you must be ready for any situation thrown your way.

In my opinion, the most important part about my research for Diagnostic Sonography, was the academic side of it. Your knowledge to handle any situation is essential in a setting where you do not always know what the results may be. Personally, I love math and science so when finding out if either were involved, I was so pleased to find out that they were and are definitely the most crucial subjects in learning Diagnostic Sonography. I learned that algebra plays a key role in sonography; for example, you might have to scale an abdominal circumference to calculate the weight of a fetus or compare a patient’s data over a certain time period. “Learning algebra enhances the power to think through problems, and that is critical for sonographers”. (UTC p1) The basis understanding of algebra will keep you ready for any circumstance. I learned that the science involved is mostly anatomy and physiology which makes complete sense because you are dealing with organ systems and knowing how they function properly. An example showing that anatomy and physiology are crucial in Diagnostic Sonography is how the ultrasound produces images of internal organs meanwhile combines information such as the movement and velocity of tissue or blood.

One factor I have made sure that I am well aware of, is the typical day of a Diagnostic Medical Sonographer. If I want to make this a career I made sure to know what an average day may look like. After doing the research, I have learned that at first you may need to adjust equipment and make sure everything is ready to be put to use and will not malfunction. Next, would be to greet the patient and examine their body and facial signals to ensure that they are comfortable and aware of the procedures. Then would be to follow procedure and find the best positions to make sure that you are getting the most accurate images of the motion and shape. Lastly, you should report your findings from the sonogram to the physician. After repeating the same process to each of your patients, you will find that throughout the work day, you are mostly standing and walking around for the majority of time. I am now aware that your physical shape is important in order to keep you at your best. On top of being on your feet most of the day, you may also need to help patients position themselves so being strong and in shape is a great skill to have to get you through the day successfully.