Common Laboratory Common Laboratory procedures:procedures:
Nursing Responsibilities and Nursing Responsibilities and ImplicationsImplications
3 Phases of Diagnostic testing3 Phases of Diagnostic testing
PretestPretestClient preparationClient preparation
Intra-testIntra-testspecimen collection and VS specimen collection and VS
monitoringmonitoring Post-testPost-test
Monitoring and follow-up Monitoring and follow-up nursing carenursing care
Related Nursing Related Nursing DiagnosesDiagnoses AnxietyAnxiety FearFear Impaired physical Impaired physical
mobilitymobility Deficient knowledgeDeficient knowledge
BLOOD TESTSBLOOD TESTS
CBCCBCHemoglobin, Hematocrit, Hemoglobin, Hematocrit,
WBC, RBC and plateletWBC, RBC and platelet Serum ElectrolytesSerum Electrolytes Arterial blood gasesArterial blood gases Blood ChemistryBlood Chemistry Drug and Hormone AssayDrug and Hormone Assay
Complete Blood CountComplete Blood Count
Specimen: Venous bloodSpecimen: Venous blood PretestPretest: obtain syringe, : obtain syringe,
tourniquet, vial with appropriate tourniquet, vial with appropriate anticoagulantanticoagulant
Intratest:Intratest: Cubital vein commonly Cubital vein commonly used for venipunctureused for venipuncture
Post-testPost-test: direct pressure and : direct pressure and observe for bleeding, label vialobserve for bleeding, label vial
Normal values for CBCNormal values for CBC
RBC (M) 4.7-6.1/ (F) 4.2-5.4RBC (M) 4.7-6.1/ (F) 4.2-5.4 Hgb (M) 14-18/ (F) 12-16 mg/dLHgb (M) 14-18/ (F) 12-16 mg/dL Hct (M) 42-52/ (F) 33-47 %Hct (M) 42-52/ (F) 33-47 % WBC 5-10,000 cells/cubic cmWBC 5-10,000 cells/cubic cm
Differential countDifferential count Neutrophils- 55- 70%Neutrophils- 55- 70% Lymphocytes- 20-40%Lymphocytes- 20-40% Monocytes- 2-5%Monocytes- 2-5% Eosinophils- 1-4%Eosinophils- 1-4%
Platelets 150,000-400,000Platelets 150,000-400,000
Table. 11.2Table. 11.2
CBCCBC
Normal WBC countNormal WBC count 5-10,000 cell/cm35-10,000 cell/cm3
Increased WBCIncreased WBC
(Leukocytosis)(Leukocytosis)More than 10, 000More than 10, 000
Increased Increased NeutrophilsNeutrophils
ACUTE bacterial ACUTE bacterial infectioninfection
Increased Increased LymphocytesLymphocytes
CHRONIC bacterial CHRONIC bacterial infectioninfection
VIRAL infectionVIRAL infection
Increased Increased EosinophilsEosinophils
PARASITIC PARASITIC infection infection
Serum ElectrolytesSerum Electrolytes
Specimen: venous bloodSpecimen: venous blood Pretest/Intratest/Post-test- samePretest/Intratest/Post-test- same
Commonly ordered:Commonly ordered: Sodium- 135-145 mEq/LSodium- 135-145 mEq/L Potassium- 3.5-5.0 mEq/LPotassium- 3.5-5.0 mEq/L Chloride- 95-105 mEq/LChloride- 95-105 mEq/L Magnesium- Magnesium- 1.3 to 2.1 mEq/L1.3 to 2.1 mEq/L Calcium- Calcium- 8 to 10 mg/dL8 to 10 mg/dL
Serum ElectrolytesSerum Electrolytes
Problems can beProblems can be HyperHyper if increased if increased HypoHypo if decreased if decreased
Blood ChemistryBlood Chemistry
Specimen: Venous blood, serumSpecimen: Venous blood, serum Pretest/Intratrest/Post-test-samePretest/Intratrest/Post-test-same Examined are enzymes, Examined are enzymes,
hormones, lipid profile BUN , hormones, lipid profile BUN , Creatinine, etc…Creatinine, etc…
Place Place patient on NPO for 8 hpatient on NPO for 8 h **CreatinineCreatinine is produced relatively is produced relatively
constant by muscles, excreted by constant by muscles, excreted by the kidneys and is thethe kidneys and is the RELIABLE RELIABLE Reflection of Renal StatusReflection of Renal Status
Blood ChemistryBlood Chemistry
Normal values for :Normal values for :Creatinine: 0.7 to 1.4 mg/dLCreatinine: 0.7 to 1.4 mg/dLBUN: 10-20 mg/dLBUN: 10-20 mg/dLCreatinine clearance: 1.67 to 2.5 mL/sCreatinine clearance: 1.67 to 2.5 mL/sSerum uric acid: 2.5 to 8 mg/dLSerum uric acid: 2.5 to 8 mg/dLBlood osmolality= 250 to 290 mOsm/LBlood osmolality= 250 to 290 mOsm/L
Blood ChemistryBlood Chemistry
Enzymes/acidsEnzymes/acids PurposePurpose
Uric acidUric acid Gout detectionGout detection
SGOT/SGPTSGOT/SGPT Liver function testLiver function test
Rheumatoid factorRheumatoid factor For Rheumatoid For Rheumatoid arthritisarthritis
Anti-DNA antibodyAnti-DNA antibody SLE diagnosisSLE diagnosis
CK-MB, LDH and CK-MB, LDH and TroponinTroponin
Identifies Cardiac Identifies Cardiac damage or muscle damage or muscle damagedamage
Blood ChemistryBlood ChemistryCoagulation Coagulation studiesstudies
PurposePurpose
PTPT12-16 seconds12-16 seconds
Measures the Measures the effectiveness of effectiveness of WarfarinWarfarin
PTTPTT60-70 seconds60-70 seconds
The BEST single The BEST single screening test for screening test for coagulation disorderscoagulation disorders
aPTTaPTT30-40 seconds30-40 seconds
Same as PTT, Same as PTT, measures measures effectiveness of effectiveness of HEPARINHEPARIN
(more specific than (more specific than PTT)PTT)
Bleeding timeBleeding time1-9 minutes1-9 minutes
Measures Platelet Measures Platelet functionfunction
Blood ChemistryBlood ChemistryOthersOthers PurposePurposeESR (erythrocyte ESR (erythrocyte sedimentation rate)sedimentation rate)
10-20 mm/hour10-20 mm/hour
Measures the rate at Measures the rate at which the RBCs settle which the RBCs settle out of the anti-out of the anti-coagulated bloodcoagulated blood
Elevates in Elevates in inflammation auto inflammation auto immune diseases immune diseases
Blood lipidsBlood lipids
Cholesterol= 150-200 Cholesterol= 150-200 mg/dLmg/dL
Triglycerides= 140-200 Triglycerides= 140-200 mg/dLmg/dL
To detect To detect hyperlipidemiahyperlipidemia
Diabetes MellitusDiabetes Mellitus
DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA
FBS equal to or greater FBS equal to or greater than 126 mg/dL than 126 mg/dL (7.0mmol/L) (7.0mmol/L) (Normal 8 hour FBS- (Normal 8 hour FBS- 80-109 mg/dL)80-109 mg/dL)
Diabetes MellitusDiabetes Mellitus
DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA
OGTT value 1 and 2 hours OGTT value 1 and 2 hours post-prandial equal to or post-prandial equal to or greater than 200 mg/dLgreater than 200 mg/dL
Normal OGTT 1 and 2 Normal OGTT 1 and 2 hours post-prandial- ishours post-prandial- is140 mg/dL140 mg/dL
Diabetes MellitusDiabetes Mellitus
DIAGNOSTIC DIAGNOSTIC CRITERIACRITERIA
RBS of equal to or RBS of equal to or greater than 200 greater than 200
mg/dL mg/dL PLUS the 3 PLUS the 3 P’sP’s
Diabetes MellitusDiabetes Mellitus
DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA
Glycosylated hemoglobinGlycosylated hemoglobin
(HbA1c) is a monitoring (HbA1c) is a monitoring test to assess the test to assess the adherence to diabetic adherence to diabetic medicationmedication
Arterial Blood GasesArterial Blood Gases Specimen: arterial bloodSpecimen: arterial blood PretestPretest: obtain syringe with : obtain syringe with
heparin, rubber stopper, heparin, rubber stopper, container with icecontainer with ice
IntratestIntratest:: usual site-radial usual site-radial artery, perform artery, perform Allen’s testAllen’s test
Post-testPost-test: Apply direct : Apply direct pressure on site for 5-10 pressure on site for 5-10 minutes, send specimen with minutes, send specimen with occluded needle on iceoccluded needle on ice
Normal ABG valuesNormal ABG values
pH 7.35-7.45pH 7.35-7.45 pCO2 35-45 mmHgpCO2 35-45 mmHg paO2 80-100 mmHgpaO2 80-100 mmHg HCO3 22-26 mEq/LHCO3 22-26 mEq/L Base excess -2 to +2Base excess -2 to +2 O2 satO2 sat 95-98% 95-98%
ABG interpretationABG interpretationValueValue NormalNormal AcidosisAcidosis AlkalosiAlkalosi
sspH 7.35-7.45 Below
7.35Above 7.45
paO2paO2 95-100 95-100 mmHgmmHg
SaO2SaO2 95-98%95-98%paCO2 35-45
mmHgRespiratory >45
Respiratory<35
HCO3 22-26 mEq/L
Metabolic<22
Metabolic>26
Urine AnalysisUrine Analysis
SpecimensSpecimens Clean-voided urine for Clean-voided urine for
routine urinalysisroutine urinalysis Clean-catch or midstream Clean-catch or midstream
urine for urine cultureurine for urine culture Suprapubic and Suprapubic and
catheterized urine for urine catheterized urine for urine cultureculture
Routine UrinalysisRoutine Urinalysis
Specimen: Clean voidedSpecimen: Clean voided PretestPretest: give clean vial and : give clean vial and
instruct to void directly into the instruct to void directly into the specimen bottlespecimen bottle
Intratest:Intratest: Allow a 10 ml collection Allow a 10 ml collection Post-testPost-test: prompt delivery to : prompt delivery to
laboratorylaboratory **First voided urine in a.m. is highly First voided urine in a.m. is highly
concentrated, more uniform concentrated, more uniform concentration and with more concentration and with more acidic pHacidic pH
Urine Culture: Normal is <100,000 Urine Culture: Normal is <100,000
Specimen: clean catch, midstream Specimen: clean catch, midstream or catheterized urineor catheterized urine
PretestPretest: Instruct to wash and dry : Instruct to wash and dry genitalia/perineum with soap and genitalia/perineum with soap and water. (M)- circular motion, (F)-water. (M)- circular motion, (F)-front to back directionfront to back direction
Intratest:Intratest: Midstream urineMidstream urine, 30-60 , 30-60 mlml
Post-test:Post-test: Cap and label, prompt Cap and label, prompt delivery and documentationdelivery and documentation
Special Urine CollectionSpecial Urine Collection
InfantsInfants Special urine bagSpecial urine bag Or cut a hole of the diaper (front for Or cut a hole of the diaper (front for
the boy, middle for the girl) pulling the boy, middle for the girl) pulling out through the hole the special bagout through the hole the special bag
ChildrenChildren May use potty chair or bedpanMay use potty chair or bedpan Give another vial to play with, allow Give another vial to play with, allow
parent to assistparent to assist ElderlyElderly
Assistance may be requiredAssistance may be required
Timed-urine collectionTimed-urine collection Collection of Collection of ALL urineALL urine voided over a voided over a
specified timespecified time RefrigeratedRefrigerated or with preservative or with preservative Pretest:Pretest: Specimen container with Specimen container with
preservative, receptacle for collection, a preservative, receptacle for collection, a post signpost sign
Intratest: Intratest: AAt the start of collection, have t the start of collection, have patient void and patient void and discard the urinediscard the urine
At the end of collection period, At the end of collection period, instruct to completely void and instruct to completely void and save the save the urineurine
Post test: Post test: Documentation Documentation
Catheter specimen Catheter specimen
Sterile urineSterile urine Insert needle of the syringe through a Insert needle of the syringe through a
drainage portdrainage port Only done with the rubber catheter not Only done with the rubber catheter not
the plastic, silastic or silicone catheter.the plastic, silastic or silicone catheter. IntratestIntratest: Clamp catheter x 30 mins if no : Clamp catheter x 30 mins if no
urineurine Wipe area where needle will be Wipe area where needle will be
insertedinserted 30-4530-45° angle, 3 ml for culture° angle, 3 ml for culture
Post-testPost-test : Unclamp catheter after : Unclamp catheter after collectioncollection
Stool AnalysisStool Analysis
Occult BloodOccult Blood GUAIAC test GUAIAC test SteatorrheaSteatorrhea Ova/ParasitesOva/Parasites BacteriaBacteria VirusesViruses
General Nursing consideration General Nursing consideration for stool collectionfor stool collection
PretestPretest: Determine purpose/s, obtain : Determine purpose/s, obtain gloves, container and tongue bladegloves, container and tongue blade
Intratest:Intratest: Instruct to defecate in clean bed panInstruct to defecate in clean bed pan Void before collectionVoid before collection Do not discard tissue in bedpanDo not discard tissue in bedpan Obtain 2.5 (1 inch) formed stoolObtain 2.5 (1 inch) formed stool 15-30 ml of liquid stool15-30 ml of liquid stool
Post-testPost-test: prompt delivery: prompt delivery
Occult Blood: Guaiac TestOccult Blood: Guaiac Test Detect the presence of enzyme: Detect the presence of enzyme:
PeroxidasePeroxidase (+) blue color(+) blue color positive guaiac positive guaiac Restrict intake of red meats, some Restrict intake of red meats, some
medications and Vitamin C for 3-7 daysmedications and Vitamin C for 3-7 days FALSE (+):FALSE (+): red meatred meat, raw fruits and , raw fruits and
vegetables especially radish, turnip, vegetables especially radish, turnip, melon and horseradish; meds like aspirin, melon and horseradish; meds like aspirin, NSAIDS, iron and anticoagulantsNSAIDS, iron and anticoagulants
FALSE (-): Vitamin C, ingested 250 mg FALSE (-): Vitamin C, ingested 250 mg per day from any sourceper day from any source
Sputum AnalysisSputum Analysis
For Culture and sensitivityFor Culture and sensitivity For sputum cytologyFor sputum cytology For sputum AFBFor sputum AFB For monitoring of the For monitoring of the
effectiveness of therapyeffectiveness of therapy
Sputum examinationSputum examination
Pretest:Pretest: Morning specimen is Morning specimen is collectedcollected
Intratest:Intratest: Mouthwash with Mouthwash with plain waterplain water Deeply inhale x 2 then coughDeeply inhale x 2 then cough Wear gloves in collecting Wear gloves in collecting
specimenspecimen Expectorate needed- 1-2 Tbsp or Expectorate needed- 1-2 Tbsp or
15-30 ml15-30 ml Post-testPost-test: oral care and prompt : oral care and prompt
delivery to labdelivery to lab
VISUALIZATION VISUALIZATION PROCEDURESPROCEDURES
InvasiveInvasive procedures are procedures are direct direct methods and need methods and need CONSENTCONSENT
Non-invasiveNon-invasive procedures procedures are are indirectindirect methods and methods and may need written consent may need written consent in some instancesin some instances
Visualization proceduresVisualization procedures
They can be:They can be:
Radiographic proceduresRadiographic procedures
““Scopic”Scopic” procedures procedures
GIT VisualizationGIT Visualization Barium Swallow- UGISBarium Swallow- UGIS Pretest: written consent, NPO Pretest: written consent, NPO
the nightthe night Intratest: administer barium Intratest: administer barium
orally, then orally, then followed by X-rayfollowed by X-ray Post-test: Laxative for Post-test: Laxative for
constipation, increased fluids, constipation, increased fluids, assess for intestinal obstruction assess for intestinal obstruction , warn that stool is light colored!, warn that stool is light colored!
GIT VisualizationGIT Visualization Barium Enema- LGISBarium Enema- LGIS Pretest: Informed consent, NPO Pretest: Informed consent, NPO
the night, Enema the morningthe night, Enema the morning Intratest: Position on Intratest: Position on LEFT side, LEFT side,
administer enema, then X-ray administer enema, then X-ray followfollow
Post-test: Cleansing enema , Post-test: Cleansing enema , Laxative for constipation, assess Laxative for constipation, assess for intestinal obstruction for intestinal obstruction
GIT VisualizationGIT Visualization
EsophagogastroscopyEsophagogastroscopy Pretest: Informed consent, Pretest: Informed consent,
NPO for 8 hours, warn that NPO for 8 hours, warn that gag reflex is abolishedgag reflex is abolished
Intratest: Position on Intratest: Position on LEFT LEFT side during scope insertionside during scope insertion
Post-test: NPO until gag Post-test: NPO until gag returns. Monitor for returns. Monitor for complicationscomplications
GIT VisualizationGIT Visualization Anoscopy, proctoscopy, Anoscopy, proctoscopy,
proctosigmoidoscopy, proctosigmoidoscopy, colonoscopycolonoscopy
Pretest: Consent, NPO, and enema Pretest: Consent, NPO, and enema administration the morningadministration the morning
Intratest: Position on the Intratest: Position on the LEFT LEFT side during scope insertionside during scope insertion
Post-test: Monitor for Post-test: Monitor for complicationscomplications
GallbladderGallbladder
Oral cholescystogramOral cholescystogram PTCPTC ERCPERCP UltrasoundUltrasound
IV CholecystogramIV Cholecystogram
X-ray visualization of the X-ray visualization of the gallbladder after administration of gallbladder after administration of contrast media intravenously contrast media intravenously
Pre-test: Allergy to iodine and sea-Pre-test: Allergy to iodine and sea-foodsfoods
Intra-test: ensure patent IV lineIntra-test: ensure patent IV line Post-test: increase fluid intake to Post-test: increase fluid intake to
flush out the dye, Assess for flush out the dye, Assess for delayed hypersensitivity reaction delayed hypersensitivity reaction to the dye like chills and N/Vto the dye like chills and N/V
Oral CholecystogramOral Cholecystogram
X-ray visualization of the X-ray visualization of the gallbladder after gallbladder after administration of contrast administration of contrast mediamedia
Done 10 hours after ingestion Done 10 hours after ingestion of contrast tabletsof contrast tablets
Done to determine the Done to determine the patency of biliary ductpatency of biliary duct
Endoscopic retrograde Endoscopic retrograde cholangiopancreatographycholangiopancreatography
Examination where a flexible Examination where a flexible endoscope is inserted into the endoscope is inserted into the mouth and via the common bile mouth and via the common bile duct and pancreatic duct to duct and pancreatic duct to visualize the structuresvisualize the structures
Iodinated dye can also be Iodinated dye can also be injected after for the x-ray injected after for the x-ray procedureprocedure
Endoscopic retrograde Endoscopic retrograde cholangiopancreatographycholangiopancreatography Pre-test: consent, NPO for 12 Pre-test: consent, NPO for 12
hours, Allergy to sea-foods, hours, Allergy to sea-foods, Atropine sulfateAtropine sulfate
Intra-test: Gag reflex is Intra-test: Gag reflex is abolished, Position on LEFT abolished, Position on LEFT sideside
Post-test: NPO until gag reflex Post-test: NPO until gag reflex returns, Position side lying returns, Position side lying and monitor for perforation and monitor for perforation and hemorrhageand hemorrhage
Percutaneous Transhepatic Percutaneous Transhepatic CholangiogramCholangiogram Under fluoroscopy, the bile duct Under fluoroscopy, the bile duct
is entered percutaneously and is entered percutaneously and injected with a dye to observe injected with a dye to observe filling of hepatic and biliary ductsfilling of hepatic and biliary ducts
Ultrasound of the liver, Ultrasound of the liver, gallbladder and pancreasgallbladder and pancreas
Consent MAY be neededConsent MAY be needed Place patient on NPO!!!Place patient on NPO!!! Laxative may be given to Laxative may be given to
decrease the bowel gasdecrease the bowel gas
Urinary VisualizationUrinary Visualization
Non-invasive: KUB, IVP, Non-invasive: KUB, IVP, UltrasoundUltrasound
Pretest: Elicit allergy to iodine Pretest: Elicit allergy to iodine and seafood, NPO after and seafood, NPO after midnightmidnight
Intra-test: IV iodinated Dye is Intra-test: IV iodinated Dye is administered then X-ray is administered then X-ray is takentaken
Post-test: Increase fluids to Post-test: Increase fluids to flush the dye. Documentation, flush the dye. Documentation, VS monitoringVS monitoring
Urinary VisualizationUrinary Visualization Invasive: retrograde Invasive: retrograde
cystourethrogramcystourethrogram Pretest: Elicit allergy to iodine Pretest: Elicit allergy to iodine
and seafoodand seafood Intra-test: catheter is inserted Intra-test: catheter is inserted
with dye is administered then with dye is administered then X-ray is taken as patient X-ray is taken as patient voidsvoids
Post-test: Increase fluids to Post-test: Increase fluids to flush the dye. Documentation, flush the dye. Documentation, VS monitoringVS monitoring
Pulmonary visualizationPulmonary visualization
Invasive: Bronchoscopy, Invasive: Bronchoscopy, laryngoscopylaryngoscopy
Non-invasive: CXR and ScanNon-invasive: CXR and Scan
BronchoscopyBronchoscopy Purpose: Diagnostic and Purpose: Diagnostic and
therapeutictherapeutic Pretest:Pretest: Consent, NPO, client Consent, NPO, client
teaching, anti-anxiety drugsteaching, anti-anxiety drugs IntratestIntratest: gag reflex is abolished, : gag reflex is abolished,
instruct to remain still during instruct to remain still during procedure, FOWLER or procedure, FOWLER or SUPINESUPINE
Post-testPost-test: NPO until gag reflex : NPO until gag reflex returns, monitor patient for returns, monitor patient for complication like perforation/bleedcomplication like perforation/bleed
Pulmonary function testPulmonary function test
Test to determine lung volumes Test to determine lung volumes and capacitiesand capacities
LUNG VOLUMESLUNG VOLUMES
1. Tidal volume – TV1. Tidal volume – TV 2. Inspiratory Reserve Volume- 2. Inspiratory Reserve Volume-
IRVIRV 3. Expiratory Reserve Volume- 3. Expiratory Reserve Volume-
ERVERV 4. Residual volume- RV4. Residual volume- RV
LUNG CAPACITIESLUNG CAPACITIES
Lung volume + another lung volumeLung volume + another lung volume 1. Inspiratory Capacity- IC1. Inspiratory Capacity- IC 2. Functional Residual Capacity- 2. Functional Residual Capacity-
FRCFRC 3. Vital capacity- VC3. Vital capacity- VC 4. Total Lung capacity- TLC4. Total Lung capacity- TLC
Pulmonary "Volumes”Pulmonary "Volumes”
1. 1. Tidal Volume:Tidal Volume: -volume of air inspired or -volume of air inspired or
expired with each normal expired with each normal breath, about 500mlbreath, about 500ml
2. 2. Inspiratory Reserve VolumeInspiratory Reserve Volume -extra volume of air than can -extra volume of air than can
be inspired over & beyond the be inspired over & beyond the normal tidal volume, about normal tidal volume, about 3000ml3000ml
Pulmonary "Volumes”Pulmonary "Volumes”
3. 3. Expiratory Reserve VolumeExpiratory Reserve Volume -amount of air that can still be -amount of air that can still be
expired by forceful expiration after expired by forceful expiration after the end of a normal tidal the end of a normal tidal expirationexpiration
-about 1100ml-about 1100ml4. Residual Volume4. Residual Volume -volume of air still remaining in -volume of air still remaining in
the lungs after the most forceful the lungs after the most forceful expiration, averages about 1200mlexpiration, averages about 1200ml
Pulmonary "Capacities:"Pulmonary "Capacities:"
1. Inspiratory Capacity1. Inspiratory Capacity -equals TV + IRV, about 3500ml-equals TV + IRV, about 3500ml -amount of air that a person can -amount of air that a person can
breathe beginning at the normal breathe beginning at the normal expiratory level & distending his expiratory level & distending his lungs to maximum amountlungs to maximum amount
2. Functional Residual Capacity2. Functional Residual Capacity -equals ERV + RV-equals ERV + RV -about amount of air remaining in -about amount of air remaining in
the lungs at the end of normal the lungs at the end of normal expiration, about 2300mlexpiration, about 2300ml
Pulmonary "Capacities:"Pulmonary "Capacities:"
3. 3. Vital CapacityVital Capacity -equals IRV + TV + ERV or 1C + ERV, -equals IRV + TV + ERV or 1C + ERV,
about 4600mlabout 4600ml -maximum amount of air that a person -maximum amount of air that a person
can expel from the lungs after filling the can expel from the lungs after filling the lungs to their maximum extent & lungs to their maximum extent & expiring to the maximum extentexpiring to the maximum extent
4. Total Lung Capacity4. Total Lung Capacity -maximum volume to which the lungs -maximum volume to which the lungs
can be expanded with the greatest can be expanded with the greatest possible effortpossible effort
-volume of air in the lungs at this level is -volume of air in the lungs at this level is equal to FRC (2300ml) in young adultequal to FRC (2300ml) in young adult
Cardiac VisualizationCardiac Visualization
Invasive: angiography. Invasive: angiography. Cardiac catheterizationCardiac catheterization
Non-invasive: ECG, Non-invasive: ECG, Echocardiography, Echocardiography, Stress ECGStress ECG
The Cardiovascular SystemThe Cardiovascular SystemLABORATORY PROCEDURESLABORATORY PROCEDURES
ECHOCARDIOGRAMECHOCARDIOGRAM Non-invasive test that Non-invasive test that
studies the structural and studies the structural and functional changes of the functional changes of the heart with the use of heart with the use of ultrasoundultrasound
No special preparation is No special preparation is neededneeded
2 D-echocardiogram2 D-echocardiogram
AngiographyAngiography
Pretest: informed consent, Pretest: informed consent, allergy to dyes, seafood and allergy to dyes, seafood and iodineiodine
Intratest: Monitor VSIntratest: Monitor VS Post-test: maintain pressure Post-test: maintain pressure
dressing over puncture sitedressing over puncture site Immobilize for 6 hours Immobilize for 6 hours
Cardiac CatheterizationCardiac Catheterization
Introduction of catheter into heart Introduction of catheter into heart chamberschambers
Pretest: informed consent, allergy Pretest: informed consent, allergy to dyes, seafood and iodine, NPO to dyes, seafood and iodine, NPO 8-12 hours8-12 hours
Intra-test: Empty bladder, Monitor Intra-test: Empty bladder, Monitor VS, explain palpitationsVS, explain palpitations
Post-test: maintain pressure Post-test: maintain pressure dressing over puncture sitedressing over puncture site
Immobilize for 6-8 hours with Immobilize for 6-8 hours with extremity straightextremity straight
MyelographyMyelography
Radiographic examination of the Radiographic examination of the spinal column and sub-spinal column and sub-arachnoid space to help arachnoid space to help diagnose back pain causesdiagnose back pain causes
Pre-test: Consent, NPO, allergy Pre-test: Consent, NPO, allergy to seafoodsto seafoods
Intra-test: like LTIntra-test: like LT Post-test: supine for 12 hoursPost-test: supine for 12 hours
ArthroscopyArthroscopy
Insertion of fiber optic scope into Insertion of fiber optic scope into the joint to visualize it, perform the joint to visualize it, perform biopsy biopsy
Performed under OR conditionPerformed under OR condition After care: Dressing over the After care: Dressing over the
puncture site for 24 hours to puncture site for 24 hours to prevent bleedingprevent bleeding
Limit activity for several days (7 Limit activity for several days (7 usually)usually)
ArthrogramArthrogram
X-ray visualization of the joint X-ray visualization of the joint after introduction of contrast after introduction of contrast mediummedium
Pre-test: consent, allergy to Pre-test: consent, allergy to seafoodsseafoods
Post-test: Dressing over Post-test: Dressing over puncture site and limit joint puncture site and limit joint activity activity
ElectromyelographyElectromyelography
Records the electrical activity in Records the electrical activity in muscles at rest and during muscles at rest and during involuntary and involuntary and electrical electrical stimulationstimulation
Detects disorders such as MG, MS Detects disorders such as MG, MS and Parkinson’sand Parkinson’s
Explain the use of electrode inserted Explain the use of electrode inserted into the musclesinto the muscles
Mild discomfort may be experiencedMild discomfort may be experienced About 45 minutes for one muscleAbout 45 minutes for one muscle
CT scanCT scan
Painless, non-invasive, Painless, non-invasive, x-ray procedurex-ray procedure
Mechanism: distinguish Mechanism: distinguish density of tissuesdensity of tissues
MRIMRI Painless, non-invasive, no radiationPainless, non-invasive, no radiation Creates a magnetic fieldCreates a magnetic field Contraindications:Contraindications:
(+) pacemaker(+) pacemaker (+) metal prosthesis(+) metal prosthesis
Client teaching:Client teaching: Lie still during the procedure for 60-90 Lie still during the procedure for 60-90
minutesminutes Earplugs to reduce noise discomfortEarplugs to reduce noise discomfort ClaustrophobiaClaustrophobia No radiation No radiation
ASPIRATION AND BIOSPYASPIRATION AND BIOSPY
AspirationAspiration: withdrawal of : withdrawal of fluidfluid
BiopsyBiopsy: removal and exam : removal and exam of tissueof tissue
Invasive procedure needs Invasive procedure needs INFORMED CONSENTINFORMED CONSENT
Lumbar PunctureLumbar Puncture
Withdrawal of CSF from the Withdrawal of CSF from the arachnoid spacearachnoid space
Purpose: diagnostic and Purpose: diagnostic and therapeutictherapeutic
To obtain specimen, relieve To obtain specimen, relieve pressure and inject pressure and inject medication medication
Pretest:Pretest: consent, empty consent, empty bladderbladder
Lumbar PunctureLumbar Puncture
Intra-test:Intra-test: Site used-between Site used-between L4/L5L4/L5Position- flexion of the trunkPosition- flexion of the trunk
Post-test:Post-test: Flat on bed (8-12 Flat on bed (8-12 hours)hours)Offer fluids to 3 LitersOffer fluids to 3 LitersOral analgesic for headacheOral analgesic for headacheMonitor bleeding, swelling and Monitor bleeding, swelling and
changes in neurologic statuschanges in neurologic status
Abdominal ParacentesisAbdominal Paracentesis
Withdrawal of fluid from the Withdrawal of fluid from the peritoneal spaceperitoneal space
Purpose: diagnostic and Purpose: diagnostic and therapeutictherapeutic
Pretest:Pretest: consent, empty consent, empty bladderbladder Position: sittingPosition: sitting Site: midway between the Site: midway between the
umbilicus and symphysisumbilicus and symphysis
Abdominal ParacentesisAbdominal Paracentesis
Intratest:Intratest: 1,500 ml maximum 1,500 ml maximum amount collected at one time, amount collected at one time, Monitor VSMonitor VS
Post-testPost-test: monitor VS, : monitor VS, bleeding complicationbleeding complication Measure abdominal girth and Measure abdominal girth and
weightweight
ThoracentesisThoracentesis
Removal of fluid from the Removal of fluid from the pleural spacepleural space
Purpose: Diagnostic and Purpose: Diagnostic and therapeutictherapeutic
Pretest:Pretest: Consent, teach to Consent, teach to avoid coughingavoid coughingPosition: sitting with arms Position: sitting with arms
above headabove head
ThoracentesisThoracentesis
Intra-test:Intra-test: Support and Support and observationobservation
Post-test:Post-test: Assess VS Assess VSPosition Post-procedure: lie Position Post-procedure: lie
on the on the UNAFFECTED SIDEUNAFFECTED SIDE with head elevated 30with head elevated 30° x 30 ° x 30 minutes to facilitate minutes to facilitate expansion of the affected expansion of the affected lungslungs
Bone marrow BiopsyBone marrow Biopsy
Removal of specimen of bone Removal of specimen of bone marrowmarrow
Purpose: diagnosticPurpose: diagnostic PretestPretest: consent, teach that : consent, teach that
procedure is painfulprocedure is painful Site: POSTERIOR SUPERIOR Site: POSTERIOR SUPERIOR
ILIAC CREST (adult); ILIAC CREST (adult); PROXIMAL TIBIA (pedia)PROXIMAL TIBIA (pedia)
Position: prone or lateralPosition: prone or lateral
Bone marrow BiopsyBone marrow Biopsy
Intratest:Intratest: Monitor, maintain Monitor, maintain pressure dressing over pressure dressing over punctured site X 10 mins punctured site X 10 mins
Post-test:Post-test: Asses for Asses for discomfort, administer discomfort, administer prescribed pain medsprescribed pain meds
Liver BiopsyLiver Biopsy Liver tissue obtained for Liver tissue obtained for
diagnostic purposediagnostic purpose Pretest:Pretest: consent, consent,
administer Vitamin K, administer Vitamin K, monitor bleeding monitor bleeding parameters, NPO 2 hours parameters, NPO 2 hours before procedurebefore procedurePosition: Supine or Position: Supine or
semi-fowlers with upper semi-fowlers with upper right quadrant of right quadrant of abdomen exposedabdomen exposed
Liver BiopsyLiver Biopsy Intra-testIntra-test: Monitor VS: Monitor VS
Take few deep inhalation Take few deep inhalation and exhalation and hold and exhalation and hold final breath in exhalation x final breath in exhalation x 10 seconds as needle is 10 seconds as needle is injectedinjected
Post-test:Post-test: monitor VS, monitor VS, bleedingbleedingPosition post-procedure: Position post-procedure:
RIGHT side-lying with RIGHT side-lying with folded towel/pillow under folded towel/pillow under biopsy site for 4-6 hoursbiopsy site for 4-6 hours
Papanicolau SmearPapanicolau Smear
Done as screening test for Done as screening test for cervical cancer, for culturecervical cancer, for culture
Pre-test: no coitus for 2-3 Pre-test: no coitus for 2-3 days, no menstrual bleedingdays, no menstrual bleeding
Intra-test: Lithotomy, Intra-test: Lithotomy, speculum with speculum with water for water for lubrication, lubrication, specimen specimen obtained for cervix and vaginaobtained for cervix and vagina
Post-test: monitor for Post-test: monitor for bleedingbleeding
The Cardiovascular SystemThe Cardiovascular SystemLABORATORY PROCEDURESLABORATORY PROCEDURES
ELECTROCARDIOGRAM ELECTROCARDIOGRAM (ECG)(ECG)
A non-invasive A non-invasive procedure that evaluates procedure that evaluates the electrical activity of the electrical activity of the heartthe heart
Electrodes and wires are Electrodes and wires are attached to the patient attached to the patient
What the waves represent?What the waves represent?
P wave= Atrial DepolarizationP wave= Atrial Depolarization
QRS= Ventricular Depolarization QRS= Ventricular Depolarization
T wave= Ventricular REPOLARIZATIONT wave= Ventricular REPOLARIZATION
LABORATORY PROCEDURESLABORATORY PROCEDURES
CVPCVP The CVP is the pressure The CVP is the pressure
within the SVCwithin the SVC Reflects the pressure Reflects the pressure
under which blood is under which blood is returned to the SVC and returned to the SVC and right atriumright atrium
LABORATORY PROCEDURESLABORATORY PROCEDURES
CVPCVP Normal CVP is 0 to 8 Normal CVP is 0 to 8
mmHg/ mmHg/ 4-10 cm H2O4-10 cm H2O
LABORATORY PROCEDURESLABORATORY PROCEDURES
Measuring CVPMeasuring CVP 1. Position the client supine with 1. Position the client supine with
bed elevated at bed elevated at 45 degrees (CBQ)45 degrees (CBQ) 2. Position the zero point of the 2. Position the zero point of the
CVP line at the level of the right CVP line at the level of the right atrium. Usually this is at the atrium. Usually this is at the MAL, MAL, 44thth ICS ICS
3. Instruct the client to be relaxed 3. Instruct the client to be relaxed and avoid coughing and straining.and avoid coughing and straining.
TubesTubes
LevineLevine Salem Sump tubeSalem Sump tube Gastrostomy tubeGastrostomy tube Jejunostomy tubeJejunostomy tube
DrainageDrainage
Penrose DrainPenrose Drain HemovacHemovac PleuravacPleuravac Jackson-PrattJackson-Pratt
Asked in the local Asked in the local boardsboards
DREDRESnellen’s chartSnellen’s chartWeber’s testWeber’s testRinnes’ testRinnes’ test
DREDRE
Position: Left Lateral or Sim’s Position: Left Lateral or Sim’s position with upper leg position with upper leg acutely flexed. Females can acutely flexed. Females can also be examined in lithotomyalso be examined in lithotomy
Ask client to Ask client to BEAR DOWNBEAR DOWN To accentuate rectal To accentuate rectal
fissure, prolapse ,polypsfissure, prolapse ,polyps To relax the anal sphincterTo relax the anal sphincter
Snellen’s Chart: test for Snellen’s Chart: test for visual acuity visual acuity
20 ft or 6 m distance20 ft or 6 m distance 3 readings: L, R and Both 3 readings: L, R and Both
eyeseyes Report: 20/ xxxReport: 20/ xxx
Numerator: denotes the Numerator: denotes the distance from the chartdistance from the chart
Snellen’s Chart: test for Snellen’s Chart: test for visual acuity visual acuity
Denominator denotes the Denominator denotes the distance from which the distance from which the normal eye can read the normal eye can read the chartchart
20/60: the person can see 20/60: the person can see at 20 feet, what a normal at 20 feet, what a normal person can see at 60 feet.person can see at 60 feet.
Weber’s testWeber’s test
Test for lateralization and Test for lateralization and bone conductionbone conduction
Tuning fork is placed on top Tuning fork is placed on top of headof head
NORMAL: sound is heard in NORMAL: sound is heard in BOTH ears, localized at the BOTH ears, localized at the center of the head: center of the head: WEBER WEBER NEGATIVENEGATIVE
Weber’s testWeber’s test
Sound is heard BETTER in the Sound is heard BETTER in the affected ear: Bone conductive affected ear: Bone conductive hearing losshearing loss
Sound is heard only or better Sound is heard only or better on the NORMAL ear: on the NORMAL ear: Sensorineural heating lossSensorineural heating loss
ABNORMAL: ABNORMAL: WEBER WEBER POSITIVEPOSITIVE
Rinne’s TestRinne’s Test
Test for Test for AIR and BONE AIR and BONE conductionconduction
Tuning fork is initially placed Tuning fork is initially placed on the mastoid process until on the mastoid process until no vibration is heardno vibration is heard
Tuning fork is now placed in Tuning fork is now placed in front of the ear until sound front of the ear until sound disappearsdisappears
Rinne’s TestRinne’s Test
Air conduction is Air conduction is LONGER than bone LONGER than bone conductionconduction
Normal is POSITIVE Normal is POSITIVE Rinne’sRinne’s
Rinne’s TestRinne’s Test
CONDUCTIVE HEARING CONDUCTIVE HEARING LOSS:LOSS:Bone conduction is Bone conduction is
GREATER GREATER than or equal to than or equal to the AIR conductionthe AIR conduction
Abnormal is NEGATIVE Abnormal is NEGATIVE RINNEsRINNEs
Rinne’s TestRinne’s Test
SENSORINEURAL SENSORINEURAL HEARING LOSS:HEARING LOSS:No bone conduction and No bone conduction and
air conduction vibration air conduction vibration can be assessedcan be assessed
NEGATIVE RINNEsNEGATIVE RINNEs
WeberWeber
Rinne’sRinne’s
Rinne’sRinne’s
FAILING TO PREPARE IS
PREPARING TO FAIL…