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54 Cards in this Set
- Front
- Back
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pretest
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client preparation, thorough assessment, data collection, ask female if pregnant for precautions, nurse needs to know what supplies and equipment is needed for test
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intratest
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focuses on specimen collection and performing or assisting with certain diagnostic testing, nurse uses precautions and sterile techniques as appropriate, emotional and physical support, responsible for specimen
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post test
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nursing care of the client and follow up activities and observations, compares results, modifies interventions as needed
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complete blood count (CBC)
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includes hemoglobin and hematocrit measurements, erythrocyte (RBC) count, leukocyte (WBC), basic screening tests and one of the most ordered
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red blood cell count (RBC)
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normal / m:4.5-5.3, f:4.1-5.1
increased: polycythemia, caused by oxygen need decreased: loss of erythrocytes, lack of needed elements and hormones for erythrocyte production, bone marrow suppression |
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hemoglobin (Hgb)
(contains iron and a protein) |
*carries oxygen and removes carbon dioxide from rbc's
normal/ m:13.8-18, f:12-16 increased: polycythemia decreased:blood loss, hemolytic anemia, bone marrow suppression, sickle cell anemia |
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hematocrit (Hct)
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*fast way to determine the percentage of rbc's in the plasma
normal/ m:37-49, f:36-46 incresed:polycythemia, dehydration, burns decreased:blood loss, overhydration, dietary deficiency, anemia |
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red blood cell indices (RBC indices)
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normal/m:78-100, f:78-102
increased: liver disease, alcoholism, pernicious anemia decreased: iron deficiency anemia, lead poisining |
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white blood cell count (WBC)
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normal: 4500 - 11,000
increased: leukocytosis, infection decreased: leukopenia, autoimmune disease |
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differential count (proportion of 5 types of wbc's in a sample)
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*neutrophils, normal: 55-70, increased: stress, acute infection, decreased: viral disease, some drugs, radiation therapy
*lymphocytes, normal: 20-40, increased: viral infection, mononucleosis, tuberculosis, chronic bacterial infections, leukemia, decreased: autoimmune disease (lupus), severe malnutrition |
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differential count (proportion of 5 types of wbc's in a sample)
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*eosinophils, normal: 1-4, increased: allergic reactions, parasitic infections, decreased: corticosteroid therapy
*basophils, normal: 0-2, increased: leukemia, decreased: acute allergic reaction, corticosteroids, acute infections |
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platelet count
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*coagulation
normal: 150,000 - 350,000 increased: malignant tumors, polycythemia vera decreased: idiopathic, viral infections, aids, lupus, chemotherapy drugs, some types of anemias |
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hemoglobin and hematocrit
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-increase with dehydration as blood becomes more concentrated
-decrease with hypovolemia and resulting hemodilution -often ordered together, referred as "H&H" |
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high white blood cell count
low blood cell count |
-bacterial infection
-viral infection |
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serum electrolytes
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-screening test for electrolyte and acid-base imbalances
-also for clients being treated with a diuretic for hypertension or heart failure -most commonly ordered serum tests are for sodium, potassium, chloride, and bicarbonate ions -may be ordered as Chem 7 or BMP |
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blood urea nitrogen (BUN)
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- blood levels of 2 metabotically produced substances (urea and creatinine)
-used to evaluate renal function -urea: the end product of protein metabolism, creatinine: produced in constant quantities by muscles and excreted by kidneys |
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serum osmolality
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-measure of the solute concentration of clood
-used to evaluate fluid balance -normal:280-300 -an increase indicates a fluid volume deficit, a decrease indicates fluid volume excess |
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drug monitoring
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-includes drawing blood samples for peak and trough levels to determine if blood serum levels are @ therapeutic levels
-peak level: highest concentration of the drug, trough level: lowest concentration of the blood |
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arterial blood gases
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-normally take specimens from radial, brachial, or femoral arteries
-apply pressure 5-10 min after removing needle to prevent hemorrhaging |
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normal electrolyte values for adults
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-sodium: 135-145
-potassium:3.5-5.0 -chloride:95-105 -calcium:4.5-5.5 meq or 8.5-10.5 mg -magnesium:1.5-2.5 meq or 1.6-2.5 mg -phophate:1.8-2.6 -serum osmolality:280-300 |
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hemoglobin A1c
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-measurement of blood glucose that is bound to hemoglobin
-reflects how well glucose levels have been controlled during the prior 3-4 months -normal: 4.0-5.5 -elevated, reflects hyperglycemia in diabetics |
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liver function test
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*ALT: normal: 10-30, increased:hepatitis, mononucleosis, pancreatitis, MI, heart failure
*AST, normal:9-25, increased:liver disease, MI, anemia, skeletal muscle disease, decreased: renal dyalisis, vit b6 deficiency *albumin, normal:3.5-4.8, increase:dehydration, decrease:AIDS, burns, malnutrition, renal disease, acute & chronic infections |
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liver function test
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*alkaline phosphate, normal:25-100, increased:bone disease, hyperparathyroidism, MI, renal & heart failure
*ammonia, normal:35-65, increased:cirrhosis, reye's syndrome, GI hemorrhage, decreased:renal failure *bilirubin, normal:0.3-1.0, increased: hepatitis, pernicious anemia, sickle cell anemia |
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metabolic screening
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-tests for PKU and congenital hypothyroidism are required in all states on newborns
-involves collecting peripheral venous blood |
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cardiac makers
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*CK (creatine kinase), normal:26-174, increased:MI, muscle dystrophy, chronic alcoholism
*myoglobin, normal:5-70, increased: MI, angina, trauma, renal failure, decreased: rheumatoid arthritis, myasthenia gravis *troponin I&T, increased: small infaract, myocardial injury/acute MI, angina,myocarditis |
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lipoproteins
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*cholesterol, normal: less than 200
*HDL-C (good)), normal:35-80 *LDL (bad), normal:less than 130 *triglycerides, normal: less than 150 |
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capillary blood glucose
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-measures blood glucose
-commonly obtained from the lateral aspect or side of the finger -earlobe may be used if client is in shock or fingers are edematous |
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measuring blood glucose
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-calibrate meter
-wrap finger first in a warm cloth -clean site w/antiseptic swab or soap and water -do not smear the blood |
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specimen collection
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-nurse assumes responsibility, may be able to delegate to UAP under supervision of nurse
-aseptic technique, to prevent contamination that can cause inaccurate results -medication client takes may affect results -transport specimen to lab promptly -report abnormal findings to PCP - |
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stool specimens
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-to determine presence of occult blood
-to analyze for dietary products and digestive secretions, (steatorrhea) amount of fat -to detect presence of ova & parasites -to dectect presence of bacteria or viruses |
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testing feces
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-certain foods, medications, and vit c can produce inaccurate results
-false positive: red meat, raw vegetables, medications (asa, iron, anticoagulants) |
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urine specimens
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-clean voided specimens for routine urinalysis
-clean catch or midstream urine specimens for urine culture -timed urine specimens for a variety of test, are either refrigerated or contain a preservative/ post signs in clients chart, room, bathroom alerting personnel to save all urine/at end of collection period, instruct client to completely empty bladder and save this voiding as part of this specimen |
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indwelling catheter specimen
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-put disposable gloves
-if no urine in catheter, clamp drainage at least 3 in. for 30 min, to allow fresh urine to collect in catheter -wipe area where needle will be inserted, site should be distal to tube leading to the balloon to avoid puncturing -insert needle 30-45 degress -unclamp catheter -withdraw required amt. of urine -3ml for a urine culture, 30 ml for urine urinalysis -transfer urine to container |
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reasons to collect sputum specimens
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-to identify a specific microrganism & its drug sensitivities
-for cytology to identify the origin, structure, function, & pathology of cells -for acid-fast bacillus -to assess the effectiveness of therapy |
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throat culture
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-collected from the mucosa of the oropharynx & tonsillar regions using a culture swab
-clean gloves, runs the swab along the tonsils and areas on the pharynx that are reddened or contain exudate |
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gastrointestinal system visualization (direct)
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*anoscopy: viewing of anal canal
*proctoscopy: viewing of rectum *proctosigmoidoscopy: viewing of rectum & sigmoid colon *colonoscopy: viewing of LI |
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gastrointestinal system visualization (indirect)
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x-rays: can be enhanced by introduction of a radiopaque substance such as barium through swallowing or enema, include fluoroscopic examination
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cardiopulmonary system visualization (noninvasive)
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*ECG:graphic recording of the hearts electrical activity; detects dysrhythmias, MI damage, enlargement of drugs, drug effects
*stress ECG:assess the clients response to an increased cardiac workload during exercise *echocardiogram:uses ultrasound to visualize structures of heart & evaluate left ventricular function |
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cardiopulmonary system visualization (invasive)
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angiography: radiopaque dye injected into vessels and are assesed & areas of blockage can be observed
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computed tomography (CT)
(noninvasive) |
painless xray procedure that has unique capability of distinguishing minor differences in the density of tissues, 3 dimensional image
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magnetic resonance imaging (MRI)
(noninvasive) |
-clients with implanted devices (pacemaker, hip prosthesis) , tatoo, transdermal patches(can apply new patch after)cannot have procedure
-no exposure to radiation -lasts between 60-90 min -magnetic field -provides a better contrast than MRI |
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Positron emission tomography /PET
(noninvasive) |
-radiologic study that invloves the injection or inhalation of a radioscope
-allows study of various aspects of organ function -may include evaluation of blood flow and tumor growth |
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*aspiration
*biopsy |
*withdrawal of fluid that has abnormally collected
-to obtain specimen *removal and examination of tissue |
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lumbar puncture
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-withdrawal of cerobrospinal fluid between 4th and 5th lumbar vertebra
-client must lie still for 15 min as procedure is performed -support clients behind neck & knees -place sterile dressing over puncture site -assist client into dorsal recumbent position with 1 pillow for 1-12 hours -offer oral fluids frequently |
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things to monitor after after lumbar puncture
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-swelling or bleeding at the puncture site
-changes in neurologic status -numbness, tingling, or pain radiating down the legs |
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abdominal paracentisis
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-carried out to obtain fluid and to relieve pressure on the abdominal organs due to excess fluid
-must remain still -observe for color, pulse, bp, signs of hypovolemic shock(1500ml max drained to avoid)/after:vital signs, urine output scrotal edema, drainage -measure the abdominal girth @ level of umbilicus |
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thoracentesis
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-to remove excess fluid or air to ease breathing as in pneumothorax
-discomfort, avoid coughing, sitting position w/arms above head -observe for signs of distress during (dyspnea, pallor, coughing) -monitor pulse, respirations, skin color after -remove no more than 1000ml within first 30 min -note complaints of chest pain |
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collecting stool specimens
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-client to defecate in clean bedpan or bedside commode
-do not contaminate the specimen with urine or menstrual discharge, void before -do not place toilet tissue in bedpan after defecation -notify nurse as soon after defecating -usually about 1 in. of formed stool, 15-30 ml of liquid is adequate -stool culture: sterile technique |
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liver biopsy
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-assist supine w/upper right quadrant of abdomen exposed
-hold breath as needle is inserted -assist client to right side lying position after procedure -place small pillow under biopsy site |
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nuclear imaging studies
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-study physiology & function of organ
-uses a radiopharmaceutical labeled with a radioscope -administered through various routes -retain radiostope for short period of time -gamma camera converts emission to form of detailed image -darker spots (hot spots) indicate hyperfunction -lighter areas (cold spots) indicate hypofunction |
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bone marrow biopsy
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-removal of specimin of bone marrow
-posterior superior iliac crest is preferred site with client placed prone or on side -small incision may be made with scapel to avoid tearing skin -crunching sound may be heard as needle punctures cortex of bone -observe for pallor, diaphoresis, and faintness -apply direct pressure 5-10 min after procedure |
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liver function test
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*GGT, normal:1-94, increased: liver disease, alcohol abuse
*prothrombin, normal:11-13 sec, increased: liver disease, vit k deficiency, obstruction of common bile duct, deficiency of factors 2,5,7,10, decreased: thrombophlebitis, malignant tumor |
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liver biopsy
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-short procedure, performed @ client bedside, sample of liver aspirated
-give vit k several days prior -client remain NPO for 2 hrs prior |
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differential count (proportion of 5 types of wbc's in a sample)
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*monocytes, normal: 2-8, increased: chronic inflammatory disorders, tuberculosis,potozoan infections,chronic colitis decreased: drug therapy: prednisone
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