1 Chapter 14 Laboratory Orders and Recording Telephoned Laboratory Results

1

Chapter 14Chapter 14

Laboratory Orders and Laboratory Orders and Recording Telephoned Recording Telephoned Laboratory ResultsLaboratory Results

Slide 2Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved.

ObjectivesObjectivesObjectivesObjectives

• List the two general purposes of List the two general purposes of laboratory studies.laboratory studies.

• Name the three major laboratory Name the three major laboratory divisions, and briefly state the purpose of divisions, and briefly state the purpose of each.each.

• Name six studies performed in each of the Name six studies performed in each of the three major laboratory divisions.three major laboratory divisions.

• List five specimens that may be studied in List five specimens that may be studied in the laboratory.the laboratory.

• List the two general purposes of List the two general purposes of laboratory studies.laboratory studies.

• Name the three major laboratory Name the three major laboratory divisions, and briefly state the purpose of divisions, and briefly state the purpose of each.each.

• Name six studies performed in each of the Name six studies performed in each of the three major laboratory divisions.three major laboratory divisions.

• List five specimens that may be studied in List five specimens that may be studied in the laboratory.the laboratory.


Objectives, continuedObjectives, continuedObjectives, continuedObjectives, continued

• Describe the health unit coordinator’s Describe the health unit coordinator’s responsibilities in sending specimens to responsibilities in sending specimens to the laboratory.the laboratory.

• Name three methods of obtaining urine Name three methods of obtaining urine specimens.specimens.

• List the four tests generally performed as List the four tests generally performed as part of electrolyte studies.part of electrolyte studies.

• List five laboratory specimens that may List five laboratory specimens that may require a written consent form.require a written consent form.

• Describe the health unit coordinator’s Describe the health unit coordinator’s responsibilities in sending specimens to responsibilities in sending specimens to the laboratory.the laboratory.

• Name three methods of obtaining urine Name three methods of obtaining urine specimens.specimens.

• List the four tests generally performed as List the four tests generally performed as part of electrolyte studies.part of electrolyte studies.

• List five laboratory specimens that may List five laboratory specimens that may require a written consent form.require a written consent form.



• Describe the procedure for requisitioning Describe the procedure for requisitioning stat blood tests from the laboratory.stat blood tests from the laboratory.

• Name the procedure that must be Name the procedure that must be performed to order blood (packed cells) performed to order blood (packed cells) for transfusion.for transfusion.

• Describe the health unit coordinator’s Describe the health unit coordinator’s responsibilities in an order for a 2-hr. PP.responsibilities in an order for a 2-hr. PP.

• Explain the difference between fasting Explain the difference between fasting and NPO.and NPO.

• Describe the procedure for requisitioning Describe the procedure for requisitioning stat blood tests from the laboratory.stat blood tests from the laboratory.

• Name the procedure that must be Name the procedure that must be performed to order blood (packed cells) performed to order blood (packed cells) for transfusion.for transfusion.

• Describe the health unit coordinator’s Describe the health unit coordinator’s responsibilities in an order for a 2-hr. PP.responsibilities in an order for a 2-hr. PP.

• Explain the difference between fasting Explain the difference between fasting and NPO.and NPO.



• Identify the laboratory department that Identify the laboratory department that would perform each of the tests that are would perform each of the tests that are marked with an asterisk.marked with an asterisk.

• Explain the procedure for ordering peak Explain the procedure for ordering peak and trough drug levels.and trough drug levels.

• Name three common urine chemistry Name three common urine chemistry tests (marked with an asterisk).tests (marked with an asterisk).

• Describe how errors may be avoided in Describe how errors may be avoided in recording telephoned laboratory results.recording telephoned laboratory results.

• Identify the laboratory department that Identify the laboratory department that would perform each of the tests that are would perform each of the tests that are marked with an asterisk.marked with an asterisk.

• Explain the procedure for ordering peak Explain the procedure for ordering peak and trough drug levels.and trough drug levels.

• Name three common urine chemistry Name three common urine chemistry tests (marked with an asterisk).tests (marked with an asterisk).

• Describe how errors may be avoided in Describe how errors may be avoided in recording telephoned laboratory results.recording telephoned laboratory results.


Lesson 14.1Lesson 14.1


Two Purposes of Laboratory StudiesTwo Purposes of Laboratory StudiesTwo Purposes of Laboratory StudiesTwo Purposes of Laboratory Studies

• Diagnostic evaluationDiagnostic evaluation• Evaluation of treatmentEvaluation of treatment

• Diagnostic evaluationDiagnostic evaluation• Evaluation of treatmentEvaluation of treatment


Specimens Studied by LabSpecimens Studied by LabSpecimens Studied by LabSpecimens Studied by Lab

• Blood: collected by nurse or lab techBlood: collected by nurse or lab tech• Urine: collected by CNAUrine: collected by CNA• Stool: collected by nurse or CNAStool: collected by nurse or CNA• Sputum: collected by nurse, CNA or Sputum: collected by nurse, CNA or

respiratory tech respiratory tech • Wound drainage: collected by nurse or Wound drainage: collected by nurse or

doctordoctor• N/P smear: collected by nurse or doctorN/P smear: collected by nurse or doctor• Gastric washings: collected by nurse or Gastric washings: collected by nurse or

doctordoctor• Sweat: collected by lab techSweat: collected by lab tech

• Blood: collected by nurse or lab techBlood: collected by nurse or lab tech• Urine: collected by CNAUrine: collected by CNA• Stool: collected by nurse or CNAStool: collected by nurse or CNA• Sputum: collected by nurse, CNA or Sputum: collected by nurse, CNA or

respiratory tech respiratory tech • Wound drainage: collected by nurse or Wound drainage: collected by nurse or

doctordoctor• N/P smear: collected by nurse or doctorN/P smear: collected by nurse or doctor• Gastric washings: collected by nurse or Gastric washings: collected by nurse or

doctordoctor• Sweat: collected by lab techSweat: collected by lab tech


Various Specimen ContainersVarious Specimen ContainersVarious Specimen ContainersVarious Specimen Containers


Specimens Collected by Invasive Specimens Collected by Invasive ProceduresProceduresSpecimens Collected by Invasive Specimens Collected by Invasive ProceduresProcedures

• Consent and Tray NeededConsent and Tray Needed

SpecimenSpecimen ProcedureProcedure

Bone marrow --------Bone marrow -------- Sternal puncture/Sternal puncture/

bone marrow bone marrow biopsybiopsy

Spinal fluid (CSF) ------Spinal fluid (CSF) ------ Lumbar puncture/Lumbar puncture/

spinal tapspinal tap

Thoracic cavity --------Thoracic cavity -------- ThoracentesisThoracentesis

fluidfluid



Bone marrow --------Bone marrow -------- Sternal puncture/Sternal puncture/

bone marrow bone marrow biopsybiopsy

Spinal fluid (CSF) ------Spinal fluid (CSF) ------ Lumbar puncture/Lumbar puncture/

spinal tapspinal tap

Thoracic cavity --------Thoracic cavity -------- ThoracentesisThoracentesis

fluidfluid


Specimens Collected by Invasive Specimens Collected by Invasive Procedures, continuedProcedures, continuedSpecimens Collected by Invasive Specimens Collected by Invasive Procedures, continuedProcedures, continued



Other cavity fluid-----Other cavity fluid----- ParacentesisParacentesis

Amniotic fluid----------Amniotic fluid---------- AmniocentesisAmniocentesis

Cervical smear----------Cervical smear---------- Pap smear Pap smear (no consent (no consent

needed)needed)



Other cavity fluid-----Other cavity fluid----- ParacentesisParacentesis

Amniotic fluid----------Amniotic fluid---------- AmniocentesisAmniocentesis

Cervical smear----------Cervical smear---------- Pap smear Pap smear (no consent (no consent

needed)needed)


Methods of Collecting BloodMethods of Collecting BloodMethods of Collecting BloodMethods of Collecting Blood

• Venipuncture (puncture into the vein)Venipuncture (puncture into the vein)• Finger-stick (puncture into a capillary)Finger-stick (puncture into a capillary)• Peripheral arterial draw (artery)Peripheral arterial draw (artery)

• Venipuncture (puncture into the vein)Venipuncture (puncture into the vein)• Finger-stick (puncture into a capillary)Finger-stick (puncture into a capillary)• Peripheral arterial draw (artery)Peripheral arterial draw (artery)


Three Methods of Collecting Blood Three Methods of Collecting Blood (Capillary, Venous, Arterial)(Capillary, Venous, Arterial)Three Methods of Collecting Blood Three Methods of Collecting Blood (Capillary, Venous, Arterial)(Capillary, Venous, Arterial)

From S Warekois R: Phlebotomy: Worktext and procedures manual, St. Louis, Saunders, 2001.


Three Methods of Collecting UrineThree Methods of Collecting UrineThree Methods of Collecting UrineThree Methods of Collecting Urine

• VoidedVoided• Clean catch – mid-streamClean catch – mid-stream• CatheterizedCatheterized

(Clean catch and catheter specimens (Clean catch and catheter specimens are sterile specimens)are sterile specimens)

• VoidedVoided• Clean catch – mid-streamClean catch – mid-stream• CatheterizedCatheterized

(Clean catch and catheter specimens (Clean catch and catheter specimens are sterile specimens)are sterile specimens)


Point-of-Care TestingPoint-of-Care TestingPoint-of-Care TestingPoint-of-Care Testing

• Laboratory tests that are collected and Laboratory tests that are collected and analyzed on the hospital nursing unit by analyzed on the hospital nursing unit by nursing personnel include:nursing personnel include: ElectrolytesElectrolytes Blood glucoseBlood glucose Hemoglobin, hematocritHemoglobin, hematocrit Coagulation studies (stat for PT)Coagulation studies (stat for PT)

• ABGs may also be performed on the ABGs may also be performed on the nursing unit nursing unit

• Laboratory tests that are collected and Laboratory tests that are collected and analyzed on the hospital nursing unit by analyzed on the hospital nursing unit by nursing personnel include:nursing personnel include: ElectrolytesElectrolytes Blood glucoseBlood glucose Hemoglobin, hematocritHemoglobin, hematocrit Coagulation studies (stat for PT)Coagulation studies (stat for PT)

• ABGs may also be performed on the ABGs may also be performed on the nursing unit nursing unit


Point-of-Care Testing, continuedPoint-of-Care Testing, continuedPoint-of-Care Testing, continuedPoint-of-Care Testing, continued

Reagent-based tests may include:Reagent-based tests may include:

• HCG (pregnancy test)HCG (pregnancy test)• ACT (activated clotting time)ACT (activated clotting time)• CLO test (uses a biopsy specimen obtained CLO test (uses a biopsy specimen obtained

in the endoscopy department to detect in the endoscopy department to detect Helicobacter pyloriHelicobacter pylori (a bacterium indicated (a bacterium indicated in ulcers of the gastrointestinal system)in ulcers of the gastrointestinal system)

Reagent-based tests may include:Reagent-based tests may include:

• HCG (pregnancy test)HCG (pregnancy test)• ACT (activated clotting time)ACT (activated clotting time)• CLO test (uses a biopsy specimen obtained CLO test (uses a biopsy specimen obtained

in the endoscopy department to detect in the endoscopy department to detect Helicobacter pyloriHelicobacter pylori (a bacterium indicated (a bacterium indicated in ulcers of the gastrointestinal system)in ulcers of the gastrointestinal system)


Point-of-Care Testing, continuedPoint-of-Care Testing, continuedPoint-of-Care Testing, continuedPoint-of-Care Testing, continued

• Urine and blood for the presence of ketones Urine and blood for the presence of ketones and levels of glucoseand levels of glucose

• Guaiacs, gastroccults, or hemoccults to Guaiacs, gastroccults, or hemoccults to detect occult (hidden) blooddetect occult (hidden) blood

• Urine and blood for the presence of ketones Urine and blood for the presence of ketones and levels of glucoseand levels of glucose

• Guaiacs, gastroccults, or hemoccults to Guaiacs, gastroccults, or hemoccults to detect occult (hidden) blooddetect occult (hidden) blood


Divisions Of LaboratoryDivisions Of LaboratoryDivisions Of LaboratoryDivisions Of Laboratory


A Downtime Requisition A Downtime Requisition A Downtime Requisition A Downtime Requisition


HematologyHematologyHematologyHematology

• Study of physical properties of blood Study of physical properties of blood including blood cells and their including blood cells and their appearance—tests related to clotting and appearance—tests related to clotting and bleeding disorders, and coagulation bleeding disorders, and coagulation (clotting) studies to monitor patients on (clotting) studies to monitor patients on anticoagulant therapyanticoagulant therapy

• Bone marrow and spinal fluid also may Bone marrow and spinal fluid also may be studied in hematologybe studied in hematology

• Study of physical properties of blood Study of physical properties of blood including blood cells and their including blood cells and their appearance—tests related to clotting and appearance—tests related to clotting and bleeding disorders, and coagulation bleeding disorders, and coagulation (clotting) studies to monitor patients on (clotting) studies to monitor patients on anticoagulant therapyanticoagulant therapy

• Bone marrow and spinal fluid also may Bone marrow and spinal fluid also may be studied in hematologybe studied in hematology


Common Tests Ordered From Common Tests Ordered From HematologyHematologyCommon Tests Ordered From Common Tests Ordered From HematologyHematology

• CBC (complete blood cell count)CBC (complete blood cell count) WBC c diff WBC c diff RBCRBC Hemoglobin and hematocrit (H & H)Hemoglobin and hematocrit (H & H)

• Erythrocyte sedimentation rate (ESR)Erythrocyte sedimentation rate (ESR)• Platelet count (plt ct)Platelet count (plt ct)• PT and PTTPT and PTT• Bleeding timeBleeding time

• CBC (complete blood cell count)CBC (complete blood cell count) WBC c diff WBC c diff RBCRBC Hemoglobin and hematocrit (H & H)Hemoglobin and hematocrit (H & H)

• Erythrocyte sedimentation rate (ESR)Erythrocyte sedimentation rate (ESR)• Platelet count (plt ct)Platelet count (plt ct)• PT and PTTPT and PTT• Bleeding timeBleeding time


Lesson 14.2Lesson 14.2


ChemistryChemistryChemistryChemistry

• Study of chemical reactions occurring in Study of chemical reactions occurring in living organismsliving organisms

• When a disease process occurs, the When a disease process occurs, the chemicals within the body fluids vary from chemicals within the body fluids vary from the normalthe normal

• Specimens studied include blood, urine, Specimens studied include blood, urine, and CSFand CSF

• Study of chemical reactions occurring in Study of chemical reactions occurring in living organismsliving organisms

• When a disease process occurs, the When a disease process occurs, the chemicals within the body fluids vary from chemicals within the body fluids vary from the normalthe normal

• Specimens studied include blood, urine, Specimens studied include blood, urine, and CSFand CSF


Common Tests Ordered From ChemistryCommon Tests Ordered From ChemistryCommon Tests Ordered From ChemistryCommon Tests Ordered From Chemistry

• Chemistry panels (CMP, BMP)Chemistry panels (CMP, BMP)• Blood sugars (glucose) FBS, RBS, 2hr PPBlood sugars (glucose) FBS, RBS, 2hr PP• GTT (glucose tolerance test) 2 hr or 6 hrGTT (glucose tolerance test) 2 hr or 6 hr• Electrolytes (lytes)Electrolytes (lytes)

Sodium (Na)Sodium (Na) Potassium (K)Potassium (K) Chloride (Cl)Chloride (Cl) Carbon dioxide (COCarbon dioxide (CO22))

• Chemistry panels (CMP, BMP)Chemistry panels (CMP, BMP)• Blood sugars (glucose) FBS, RBS, 2hr PPBlood sugars (glucose) FBS, RBS, 2hr PP• GTT (glucose tolerance test) 2 hr or 6 hrGTT (glucose tolerance test) 2 hr or 6 hr• Electrolytes (lytes)Electrolytes (lytes)

Sodium (Na)Sodium (Na) Potassium (K)Potassium (K) Chloride (Cl)Chloride (Cl) Carbon dioxide (COCarbon dioxide (CO22))


Common Tests Ordered From Common Tests Ordered From Chemistry, continuedChemistry, continuedCommon Tests Ordered From Common Tests Ordered From Chemistry, continuedChemistry, continued

CholesterolCholesterol• TriglyceridesTriglycerides• Cardiac enzymesCardiac enzymes

CK (CPK) and CK-MBCK (CPK) and CK-MB LDHLDH AST (SGOT)AST (SGOT) TroponinTroponin

• BilirubinBilirubin• CreatinineCreatinine• Blood urea nitrogen (BUN)Blood urea nitrogen (BUN)

CholesterolCholesterol• TriglyceridesTriglycerides• Cardiac enzymesCardiac enzymes

CK (CPK) and CK-MBCK (CPK) and CK-MB LDHLDH AST (SGOT)AST (SGOT) TroponinTroponin

• BilirubinBilirubin• CreatinineCreatinine• Blood urea nitrogen (BUN)Blood urea nitrogen (BUN)


Common Panels Ordered From ChemistryCommon Panels Ordered From ChemistryCommon Panels Ordered From ChemistryCommon Panels Ordered From Chemistry

• ElectrolytesElectrolytes• Basic metabolic panel (BMP)Basic metabolic panel (BMP)• Comprehensive metabolic panel (CMP)Comprehensive metabolic panel (CMP)• Lipid panelLipid panel• Hepatic function panelHepatic function panel

• ElectrolytesElectrolytes• Basic metabolic panel (BMP)Basic metabolic panel (BMP)• Comprehensive metabolic panel (CMP)Comprehensive metabolic panel (CMP)• Lipid panelLipid panel• Hepatic function panelHepatic function panel


Common Laboratory PanelsCommon Laboratory PanelsCommon Laboratory PanelsCommon Laboratory Panels


Tests that Require FastingTests that Require Fasting(Unless Ordered Otherwise by Doctor)(Unless Ordered Otherwise by Doctor)Tests that Require FastingTests that Require Fasting(Unless Ordered Otherwise by Doctor)(Unless Ordered Otherwise by Doctor)

• FBSFBS• GTTGTT• Some chem profiles/panelsSome chem profiles/panels• CholesterolCholesterol• TriglyceridesTriglycerides• Fe c TIBCFe c TIBC

• FBSFBS• GTTGTT• Some chem profiles/panelsSome chem profiles/panels• CholesterolCholesterol• TriglyceridesTriglycerides• Fe c TIBCFe c TIBC


ToxicologyToxicologyToxicologyToxicology

• Scientific study of poisons, their detection, Scientific study of poisons, their detection, their effects, and methods of treatment their effects, and methods of treatment for conditions they producefor conditions they produce

• Tests for detecting drug abuse and for Tests for detecting drug abuse and for monitoring drug usage also are performed monitoring drug usage also are performed in toxicologyin toxicology

• Special consents, handling, and labeling Special consents, handling, and labeling may be requiredmay be required

• Scientific study of poisons, their detection, Scientific study of poisons, their detection, their effects, and methods of treatment their effects, and methods of treatment for conditions they producefor conditions they produce

• Tests for detecting drug abuse and for Tests for detecting drug abuse and for monitoring drug usage also are performed monitoring drug usage also are performed in toxicologyin toxicology

• Special consents, handling, and labeling Special consents, handling, and labeling may be requiredmay be required


Common Tests Ordered From ToxicologyCommon Tests Ordered From ToxicologyCommon Tests Ordered From ToxicologyCommon Tests Ordered From Toxicology

• Levels of certain medications the patient is Levels of certain medications the patient is receiving may be monitored by doing a peak receiving may be monitored by doing a peak and troughand trough Peak levels are useful when testing for Peak levels are useful when testing for

toxicity toxicity Trough levels are useful for demonstrating a Trough levels are useful for demonstrating a

satisfactory therapeutic levelsatisfactory therapeutic level

• Levels of certain medications the patient is Levels of certain medications the patient is receiving may be monitored by doing a peak receiving may be monitored by doing a peak and troughand trough Peak levels are useful when testing for Peak levels are useful when testing for

toxicity toxicity Trough levels are useful for demonstrating a Trough levels are useful for demonstrating a

satisfactory therapeutic levelsatisfactory therapeutic level


Peak and Trough Levels of a MedicationPeak and Trough Levels of a MedicationPeak and Trough Levels of a MedicationPeak and Trough Levels of a Medication


Common Medications for Peak and/or Common Medications for Peak and/or Trough Levels from ToxicologyTrough Levels from ToxicologyCommon Medications for Peak and/or Common Medications for Peak and/or Trough Levels from ToxicologyTrough Levels from Toxicology

• Antibiotics that may be monitored Antibiotics that may be monitored include:include: AmikacinAmikacin GentamicinGentamicin KanamycinKanamycin TobramycinTobramycin

• Other medication levels may include:Other medication levels may include: Dilantin (random)Dilantin (random) Digoxin (random)Digoxin (random) Prograf (trough level)Prograf (trough level)

• Antibiotics that may be monitored Antibiotics that may be monitored include:include: AmikacinAmikacin GentamicinGentamicin KanamycinKanamycin TobramycinTobramycin

• Other medication levels may include:Other medication levels may include: Dilantin (random)Dilantin (random) Digoxin (random)Digoxin (random) Prograf (trough level)Prograf (trough level)


MicrobiologyMicrobiologyMicrobiologyMicrobiology

• Study of the organisms that cause diseaseStudy of the organisms that cause disease• Includes bacteriology, mycology, virology Includes bacteriology, mycology, virology

and parasitologyand parasitology• Specimens may include urine, stool, Specimens may include urine, stool,

sputum, wound drainage, eye/ear sputum, wound drainage, eye/ear drainage, etc.drainage, etc.

• Study of the organisms that cause diseaseStudy of the organisms that cause disease• Includes bacteriology, mycology, virology Includes bacteriology, mycology, virology

and parasitologyand parasitology• Specimens may include urine, stool, Specimens may include urine, stool,

sputum, wound drainage, eye/ear sputum, wound drainage, eye/ear drainage, etc.drainage, etc.


Common Tests Ordered From MicrobiologyCommon Tests Ordered From MicrobiologyCommon Tests Ordered From MicrobiologyCommon Tests Ordered From Microbiology

• Cultures (viral, fungal)Cultures (viral, fungal)• Culture and sensitivity (C & S)Culture and sensitivity (C & S)

AerobicAerobic AnaerobicAnaerobic

• AFB cultureAFB culture• C. diffC. diff culture culture

Cultures may be done on blood, urine, stool, Cultures may be done on blood, urine, stool, sputum, wound drainage, and ear, nose, sputum, wound drainage, and ear, nose, throat drainagethroat drainage

• Cultures (viral, fungal)Cultures (viral, fungal)• Culture and sensitivity (C & S)Culture and sensitivity (C & S)

AerobicAerobic AnaerobicAnaerobic

• AFB cultureAFB culture• C. diffC. diff culture culture

Cultures may be done on blood, urine, stool, Cultures may be done on blood, urine, stool, sputum, wound drainage, and ear, nose, sputum, wound drainage, and ear, nose, throat drainagethroat drainage


SerologySerologySerologySerology

• Study of antibodies and antigens in body fluids Study of antibodies and antigens in body fluids to detect the presence and intensity of a current to detect the presence and intensity of a current infectioninfection

• Also may be used to detect a previous infection Also may be used to detect a previous infection or exposure to an organismor exposure to an organism

• Study of autoimmune diseasesStudy of autoimmune diseases

• Study of antibodies and antigens in body fluids Study of antibodies and antigens in body fluids to detect the presence and intensity of a current to detect the presence and intensity of a current infectioninfection

• Also may be used to detect a previous infection Also may be used to detect a previous infection or exposure to an organismor exposure to an organism

• Study of autoimmune diseasesStudy of autoimmune diseases


Common Tests Ordered From SerologyCommon Tests Ordered From SerologyCommon Tests Ordered From SerologyCommon Tests Ordered From Serology

• RPRRPR - dx of syphilis- dx of syphilis• CEACEA - dx and tx of types of cancer- dx and tx of types of cancer• CMVCMV - dx of cytomegalovirus- dx of cytomegalovirus• HIVHIV - dx of AIDS virus- dx of AIDS virus• RSVRSV - respiratory syncytial virus- respiratory syncytial virus• MonospotMonospot - dx of mononucleosis- dx of mononucleosis• RA factorRA factor - dx of rheumatoid arthritis- dx of rheumatoid arthritis• HBAgHBAg - dx of hepatitis B- dx of hepatitis B

• RPRRPR - dx of syphilis- dx of syphilis• CEACEA - dx and tx of types of cancer- dx and tx of types of cancer• CMVCMV - dx of cytomegalovirus- dx of cytomegalovirus• HIVHIV - dx of AIDS virus- dx of AIDS virus• RSVRSV - respiratory syncytial virus- respiratory syncytial virus• MonospotMonospot - dx of mononucleosis- dx of mononucleosis• RA factorRA factor - dx of rheumatoid arthritis- dx of rheumatoid arthritis• HBAgHBAg - dx of hepatitis B- dx of hepatitis B


Blood BankBlood BankBlood BankBlood Bank

• Stores, types, and cross-matches blood Stores, types, and cross-matches blood and blood products for transfusionand blood products for transfusion

• Permission or refusal for transfusion Permission or refusal for transfusion signed by patientsigned by patient

• Must be labeled properlyMust be labeled properly• Blood types include:Blood types include:

A: may receive types A or OA: may receive types A or O B: may receive types B or OB: may receive types B or O AB: may receive types A, B, AB, or OAB: may receive types A, B, AB, or O O: may only receive type OO: may only receive type O

• Stores, types, and cross-matches blood Stores, types, and cross-matches blood and blood products for transfusionand blood products for transfusion

• Permission or refusal for transfusion Permission or refusal for transfusion signed by patientsigned by patient

• Must be labeled properlyMust be labeled properly• Blood types include:Blood types include:

A: may receive types A or OA: may receive types A or O B: may receive types B or OB: may receive types B or O AB: may receive types A, B, AB, or OAB: may receive types A, B, AB, or O O: may only receive type OO: may only receive type O


Common Orders for Blood BankCommon Orders for Blood BankCommon Orders for Blood BankCommon Orders for Blood Bank

• Type and screen Type and screen • Type and crossmatch for packed cellsType and crossmatch for packed cells• PlateletsPlatelets• PlasmaPlasma• Washed cellsWashed cells• CryoprecipitatesCryoprecipitates• Other tests include Coombs test to Other tests include Coombs test to

determine anti-Rh antibodies in serum of determine anti-Rh antibodies in serum of pregnant women before deliverypregnant women before delivery

• Type and screen Type and screen • Type and crossmatch for packed cellsType and crossmatch for packed cells• PlateletsPlatelets• PlasmaPlasma• Washed cellsWashed cells• CryoprecipitatesCryoprecipitates• Other tests include Coombs test to Other tests include Coombs test to

determine anti-Rh antibodies in serum of determine anti-Rh antibodies in serum of pregnant women before deliverypregnant women before delivery


UrinalysisUrinalysisUrinalysisUrinalysis

• The physical, chemical, and microscopic The physical, chemical, and microscopic examination of the urineexamination of the urine

• May be a voided, clean catch, or cath May be a voided, clean catch, or cath specimenspecimen

• The physical, chemical, and microscopic The physical, chemical, and microscopic examination of the urineexamination of the urine

• May be a voided, clean catch, or cath May be a voided, clean catch, or cath specimenspecimen


Common Tests Ordered From UrinalysisCommon Tests Ordered From UrinalysisCommon Tests Ordered From UrinalysisCommon Tests Ordered From Urinalysis

• UAUA Study of urine for color, clarity, pH (degree of acidity or Study of urine for color, clarity, pH (degree of acidity or

alkalinity), specific gravity (degree of concentration), protein alkalinity), specific gravity (degree of concentration), protein (albumin), glucose, blood, bilirubin, and urobilinogen; viewed (albumin), glucose, blood, bilirubin, and urobilinogen; viewed microscopically for organisms, intact cells, and crystalsmicroscopically for organisms, intact cells, and crystals

• Urine reflexUrine reflex Urine is tested; if certain parameters met, a culture will be Urine is tested; if certain parameters met, a culture will be

performedperformed

• UAUA Study of urine for color, clarity, pH (degree of acidity or Study of urine for color, clarity, pH (degree of acidity or

alkalinity), specific gravity (degree of concentration), protein alkalinity), specific gravity (degree of concentration), protein (albumin), glucose, blood, bilirubin, and urobilinogen; viewed (albumin), glucose, blood, bilirubin, and urobilinogen; viewed microscopically for organisms, intact cells, and crystalsmicroscopically for organisms, intact cells, and crystals

• Urine reflexUrine reflex Urine is tested; if certain parameters met, a culture will be Urine is tested; if certain parameters met, a culture will be

performedperformed


Pathology DepartmentPathology DepartmentPathology DepartmentPathology Department

• Under direction of a pathologistUnder direction of a pathologist• Study of biopsies, tissue, and other Study of biopsies, tissue, and other

specimens to determine disease and specimens to determine disease and changes in the bodychanges in the body

• Under direction of a pathologistUnder direction of a pathologist• Study of biopsies, tissue, and other Study of biopsies, tissue, and other

specimens to determine disease and specimens to determine disease and changes in the bodychanges in the body


Common Tests Ordered From PathologyCommon Tests Ordered From PathologyCommon Tests Ordered From PathologyCommon Tests Ordered From Pathology

• Study of tissue and organs to determine Study of tissue and organs to determine changes caused by disease; determination changes caused by disease; determination of cancerof cancer

• Study of tissue and organs to determine Study of tissue and organs to determine changes caused by disease; determination changes caused by disease; determination of cancerof cancer


CytologyCytologyCytologyCytology

• Study of cells obtained from body tissues Study of cells obtained from body tissues and body fluids to determine cell type and and body fluids to determine cell type and to detect cancer or a precancerous to detect cancer or a precancerous conditioncondition

• Study of cells obtained from body tissues Study of cells obtained from body tissues and body fluids to determine cell type and and body fluids to determine cell type and to detect cancer or a precancerous to detect cancer or a precancerous conditioncondition


Common Tests Ordered From CytologyCommon Tests Ordered From CytologyCommon Tests Ordered From CytologyCommon Tests Ordered From Cytology

• Biopsy specimensBiopsy specimens• Pap smearPap smear• To determine the presence of cancerTo determine the presence of cancer

• Biopsy specimensBiopsy specimens• Pap smearPap smear• To determine the presence of cancerTo determine the presence of cancer


Recording Laboratory ResultsRecording Laboratory ResultsRecording Laboratory ResultsRecording Laboratory Results

• The HUC records laboratory results The HUC records laboratory results received via telephone on a received via telephone on a telephone laboratory report sheet.telephone laboratory report sheet.

• Laboratory results may also be sent Laboratory results may also be sent to the unit via the computer. HUC to the unit via the computer. HUC may print them on the unit printer.may print them on the unit printer.

• Results from an outside laboratory Results from an outside laboratory may be faxed to the nursing unit.may be faxed to the nursing unit.

• The HUC records laboratory results The HUC records laboratory results received via telephone on a received via telephone on a telephone laboratory report sheet.telephone laboratory report sheet.

• Laboratory results may also be sent Laboratory results may also be sent to the unit via the computer. HUC to the unit via the computer. HUC may print them on the unit printer.may print them on the unit printer.

• Results from an outside laboratory Results from an outside laboratory may be faxed to the nursing unit.may be faxed to the nursing unit.


Recording Laboratory Results, Recording Laboratory Results, continuedcontinuedRecording Laboratory Results, Recording Laboratory Results, continuedcontinued

• The HUC should report the values to the The HUC should report the values to the patient’s nurse, who may request the patient’s nurse, who may request the results to be called in to the doctor’s office. results to be called in to the doctor’s office.

• Stat and/or abnormal laboratory test results Stat and/or abnormal laboratory test results are communicated verbally or by telephone are communicated verbally or by telephone to the doctor by the HUC or nurse.to the doctor by the HUC or nurse.

• The HUC should report the values to the The HUC should report the values to the patient’s nurse, who may request the patient’s nurse, who may request the results to be called in to the doctor’s office. results to be called in to the doctor’s office.

• Stat and/or abnormal laboratory test results Stat and/or abnormal laboratory test results are communicated verbally or by telephone are communicated verbally or by telephone to the doctor by the HUC or nurse.to the doctor by the HUC or nurse.


Recording Laboratory Results, Recording Laboratory Results, continuedcontinuedRecording Laboratory Results, Recording Laboratory Results, continuedcontinued

To avoid errorsTo avoid errors::• Always read the laboratory values you Always read the laboratory values you

have recorded back to the person in the have recorded back to the person in the laboratory.laboratory.

• Always have the person you are Always have the person you are communicating to in the doctor’s office communicating to in the doctor’s office repeat his or her recorded values back to repeat his or her recorded values back to you.you.

• Place the written report on the patient’s Place the written report on the patient’s chart in a timely manner. chart in a timely manner.

To avoid errorsTo avoid errors::• Always read the laboratory values you Always read the laboratory values you

have recorded back to the person in the have recorded back to the person in the laboratory.laboratory.

• Always have the person you are Always have the person you are communicating to in the doctor’s office communicating to in the doctor’s office repeat his or her recorded values back to repeat his or her recorded values back to you.you.

• Place the written report on the patient’s Place the written report on the patient’s chart in a timely manner. chart in a timely manner.


Telephoned Laboratory Results FormTelephoned Laboratory Results FormTelephoned Laboratory Results FormTelephoned Laboratory Results Form

Documents

1 Chapter 14 Laboratory Orders and Recording Telephoned Laboratory Results