Saturday, January 5, 2008

Laboratory and Other Diagnostic Procedures

Laboratory and Diagnostic examination
I. Urine Specimen
1.Clean-Catch mid-stream urine specimen for routine urinalysis, culture and sensitivity test
a. Best time to collect is in the morning, first voided urine
b. Provide sterile container
c. Do perineal care before collection of the urine
d. Discard the first flow of urine
e. Label the specimen properly
f. Send the specimen immediately to the laboratory
g. Document the time of specimen collection and transport to the lab.
h. Document the appearance, odor, and usual characteristics of the specimen.
2. 24-hour urine specimen
a. Discard the first voided urine.
b. Collect all specimen thereafter until the following day
c. Soak the specimen in a container with ice
d. Add preservative as ordered according to hospital policy
3. Second-Voided urine – required to assess glucose level and for the presence of albumen in the urine.
a. Discard the first urine
b. Give the patient a glass of water to drink
c. After few minutes, ask the patient to void
4. Catheterized urine specimen
a. Clamp the catheter for 30 min to 1 hour to allow urine to accumulate in the bladder and adequate specimen can be collected.
b. Clamping the drainage tube and emptying the urine into a container are contraindicated after a genitourinary surgery.
II. Stool Specimen
1. Fecalysis – to assess gross appearance of stool and presence of ova or parasite
a. Secure a sterile specimen container
b. Ask the pt. to defecate into a clean , dry bed pan or a portable commode.
c. Instruct client not to contaminate the specimen with urine or toilet paper( urine inhibits bacterial growth and paper towel contain bismuth which interfere with the test result.
2. Stool culture and sensitivity test
 To assess specific etiologic agent causing gastroenteritis and bacterial sensitivity to various antibiotics.
3. Fecal Occult blood test
 are valuable test for detecting occult blood (hidden) which may be present in colo-rectal cancer,
detecting melena stool
a. Hematest- (an Orthotolidin reagent tablet)
b. Hemoccult slide- (filter paper impregnated with guaiac)
Both test produces blue reaction id occult blood lost exceeds 5 ml in 24 hours.
c. Colocare – a newer test, requires no smear
a. Advise client to avoid ingestion of red meat for 3 days
b. Patient is advise on a high residue diet
c. avoid dark food and bismuth compound
d. If client is on iron therapy, inform the MD
e. Make sure the stool in not contaminated with urine, soap solution or toilet paper
f. Test sample from several portion of the stool.
a. Never collect a venous sample from the arm or a leg that is already being use d for I.V therapy or blood administration because it mat affect the result.
b. Never collect venous sample from an infectious site because it may introduce pathogens into the vascular system
c. Never collect blood from an edematous area, AV shunt, site of previous hematoma, or vascular injury.
d. Don’t wipe off the povidine-iodine with alcohol because alcohol cancels the effect of povidine iodine.
e. If the patient has a clotting disorder or is receiving anticoagulant therapy, maintain pressure on the site for at least 5 min after withdrawing the needle.
Arterial puncture for ABG test
a. Before arterial puncture, perform Allen’s test first.
b. If the patient is receiving oxygen, make sure that the patient’s therapy has been underway for at least 15 min before collecting arterial sample
c. Be sure to indicate on the laboratory request slip the amount and type pf oxygen therapy the patient is having.
d. If the patient has just receive a nebulizer treatment, wait about 20 minutes before collecting the sample.
IV. Blood specimen
a. No fasting for the following tests:
- CBC, Hgb, Hct, clotting studies, enzyme studies, serum electrolytes
b. Fasting is required:
- FBS, BUN, Creatinine, serum lipid ( cholesterol, triglyceride)
V. Sputum Specimen
1.Gross appearance of the sputum
a. Collect early in the morning
b. Use sterile container
c. Rinse the mount with plain water before collection of the specimen
d. Instruct the patient to hack-up sputum
2. Sputum culture and sensitivity test
a. Use sterile container
b. Collect specimen before the first dose of antibiotic
3. Acid-Fast Bacilli
a. To assess presence of active pulmonary tuberculosis
b. Collect sputum in three consecutive morning
4. Cytologic sputum exam-
-to assess for presence of abnormal or cancer cells.

Diagnostic Test
1. PPD test
a. read result 48 – 72 hours after injection.
b. For HIV positive clients, induration of 5 mm is considered positive
2. Bronchography
a. Secure consent
b. Check for allergies to seafood or iodine or anesthesia
c. NPO 6-8 hours before the test
d. NPO until gag reflex return to prevent aspiration
3. Thoracentesis – aspiration of fluid in the pleural space.
a. Secure consent, take V/S
b. Position upright leaning on overbed table
c. Avoid cough during insertion to prevent pleural perforation
d. Turn to unaffected side after the procedure to prevent leakage of fluid in the thoracic cavity
e. Check for expectoration of blood. This indicate trauma and should be reported to MD immediately.
4.Holter Monitor
a. it is continuous ECG monitoring, over 24 hours period
b. The portable monitoring is called telemetry unit
5. Echocardiogram –
a. ultrasound to assess cardiac structure and mobility
b. Client should remain still, in supine position slightly turned to the left side, with HOB elevated
15-20 degrees
6. Electrocardiography-
a. If the patient’s skin is oily, scaly, or diaphoretic, rub the electrode with a dry 4x4 gauze to enhance electrode contact.
b. If the area is excessively hairy, clip it
c. Remove client`s jewelry, coins, belt or any metal
d. Tell client to remain still during the procedure
7. Cardiac Catheterization
a. Secure consent
b. Assess allergy to iodine, shelfish
c. V/S, weight for baseline information
d. Have client void before the procedure
e. Monitor PT, PTT, ECG prior to test
f. NPO for 4-6 hours before the test
g. Shave the groin or brachial area
h. After the procedure: bed rest to prevent bleeding on the site, do not flex extremity
i. Elevate the affected extremities on extended position to promote blood supply back to the heart and prevent thrombplebities
j. Monitor V/S especially peripheral pulses
k. Apply pressure dressing over the puncture site
l. Monitor extremity for color, temperature, tingling to assess for impaired circulation.
8. MRI
m. secure consent,
n. the procedure will last 45-60 minute
o. Assess client for claustrophobia
p. Remove all metal items
q. Client should remain still
r. Tell client that he will feel nothing but may hear noises
s. Client with pacemaker, prosthetic valves, implanted clips, wires are not eligible for MRI.
t. Client with cardiac and respiratory complication may be excluded
u. Instruct client on feeling of warmth or shortness of breath if contrast medium is used during the procedure
9.UGIS – Barium Swallow
a. instruct client on low-residue diet 1-3 days before the procedure
b. administer laxative evening before the procedure
c. NPO after midnight
d. instruct client to drink a cup of flavored barium
e. x-rays are taken every 30 minutes until barium advances through the small bowel
f. film can be taken as long as 24 hours later
g. force fluid after the test to prevent constipation/barium impaction
10.LGIS – Barium Enema
a. instruct client on low-residue diet 1-3 days before the procedure
b. administer laxative evening before the procedure
c. NPO after midnight
d. administer suppository in AM
e. Enema until clear
f. force fluid after the test to prevent constipation/barium impaction
11. Liver Biopsy
a. Secure consent,
b. NPO 2-4 hrs before the test
c. Monitor PT, Vit K at bedside
d. Place the client in supine at the right side of the bed
e. Instruct client to inhale and exhale deeply for several times and then exhale and hold breath while the MD insert the needle
f. Right lateral post procedure for 4 hours to apply pressure and prevent bleeding
g. Bed rest for 24 hours
h. Observe for S/S of peritonitis
12. Paracentesis
a. Secure consent, check V/S
b. Let the patient void before the procedure to prevent puncture of the bladder
c. Check for serum protein. excessive loss of plasma protein may lead to hypovolemic shock.
13. Lumbar Puncture
a. obtain consent
b. instruct client to empty the bladder and bowel
c. position the client in lateral recumbemt with back at the edge of the examining table
d. instruct client to remain still
e. obtain specimen per MDs order

1. Steam Inhalation
a. It is dependent nursing function.
b. Heat application requires physician’s order.
c. Place the spout 12-18 inches away from the client’s nose or adjust the distance as necessary.
2. Suctioning
a. Assess the lungs before the procedure for baseline information.
b. Position: conscious – semi-Fowler’s
c. Unconscious – lateral position
d. Size of suction catheter- adult- fr 12-18
e. Hyper oxygenate before and after procedure
f. Observe sterile technique
g. Apply suction during withdrawal of the catheter
h. Maximum time per suctioning –15 sec
3. Nasogastric Feeding (gastric gavage)
a. Fowler’s position
b. Tip of the nose to tip of the earlobe to the xyphoid
Tube Feeding
a. Semi-Fowler’s position
b. Assess tube placement
c. Assess residual feeding
d. Height of feeding is 12 inches above the tube’s point of insertion
e. Ask client to remain upright position for at least 30 min.
f. Most common problem of tube feeding is Diarrhea due to lactose intolerance
4. Enema
a. Check MD’s order
b. Provide privacy
c. Position left lateral
d. Size of tube Fr. 22-32
e. Insert 3-4 inches of rectal tube
f. If abdominal cramps occur, temporarily stop the flow until cramps are gone.
g. Height of enema can – 18 inches
5. Urinary Catheterization
a. Verify MD’s order
b. Practice strict asepsis
c. Perineal care before the procedure
d. Catheter size: male-14-16 , female – 12 – 14
e. Length of catheter insertion
male – 6-9 inches ,female – 3-4 inches
For retention catheter:
Male –anchor laterally or upward over the lower abdomen to prevent penoscrotal pressure
Female- inner aspect of the thigh
6. Bed Bath
a. Provide privacy
b. Expose, wash and dry one body part a time
c. Use warm water (110-115 F)
d. Wash from cleanest to dirtiest
e. Wash, rinse, and dry the arms and leg using Long, firm strokes from distal to proximal area – to increase venous return.
7. Foot Care
a. Soaking the feet of diabetic client is no longer recommended
b. Cut nail straight across
8. Mouth Care
a. Eat coarse, fibrous foods (cleansing foods) such as fresh fruits and raw vegetables
b. Dental check every 6 mounts
9. Oral care for unconscious client
a. Place in side lying position
b. Have the suction apparatus readily available
10. Hair Shampoo
c. Place client diagonally in bed
d. Cover the eyes with wash cloth
e. Plug the ears with cotton balls
f. Massage the scalp with the fatpads of the fingers to promote circulation in the scalp.
11. Restraints
g. Secure MD’s order for each episode of restraints application.
h. Check circulation every 15 min
i. Remove restraints at least every 2 hours for 30 minutes

Normal Values
Bleeding time 1-9 min
Prothrombin time 10-13 sec
Hematocrit Male 42-52%
Female 36-48%
Hemoglobin male 13.5-16 g/dl
female 12-16 g/dl
Platelet 150,00- 400,000
RBC male 4.5-6.2 million/L
female 4.2-5.4 million/L
Amylase 80-180 IU/L
Bilirubin(serum) direct 0-0.4 mg/dl
indirect 0.2-0.8 mg/dl
total 0.3-1.0 mg/dl
pH 7.35- 7.45
PaCo2 35-45
HCO3 22-26 mEq/L
Pa O2 80-100 mmHg
SaO2 94-100%
Sodium 135- 145 mEq/L
Potassium 3.5- 5.0 mEq/L
Calcium 4.2- 5.5 mg/dL
Chloride 98-108 mEq/L
Magnesium 1.5-2.5 mg/dl
BUN 1 0-20 mg/dl
Creatinine 0.4- 1.2
CPK-MB male 50 –325 mu/ml
female 50-250 mu/ml
Fibrinogen 200-400 mg/dl
FBS 80-120 mg/dl
Glycosylated Hgb 4.0-7.0%
Uric Acid 2.5 –8 mg/dl
ESR male 15-20 mm/hr
Female 20-30 mm/hr
Cholesterol 150- 200 mg/dl
Triglyceride 140-200 mg/dl

Lactic Dehydrogenase 100-225 mu/ml
Alkaline phospokinase 32-92 U/L
Albumin 3.2- 5.5 mg/dl

1 comment:

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