1. Chapter 28 Diagnostic Testing Fundamentals of Nursing: Standards & Practices, 2E

2.  Copyright 2002 by Delmar, a division of Thomson Learning 28-2 Understanding Diagnostic Testing  Diagnostic tests are either noninvasive or invasive.  Noninvasive means the body is not entered with any type of instrument.  Invasive means accessing the body’s tissue, organ or cavity through some type of instrumentation procedure.

3.  Copyright 2002 by Delmar, a division of Thomson Learning 28-3 Nursing Care of the Client  Preparing a client for diagnostic testing Identification and assessment of client  Establish baseline vital signs  Identify known allergies Client teaching about the procedure Interventions  NPO status  Medication administration

4.  Copyright 2002 by Delmar, a division of Thomson Learning 28-4 Evaluation of client’s knowledge, anxiety level, comfort and safety level Reporting significant information to practitioner - allergies, previous adverse reactions Documentation of significant data

5.  Copyright 2002 by Delmar, a division of Thomson Learning 28-5  Care of the client during diagnostic testing Ongoing assessment of the client’s status Preparing the room Gathering and charging for supplies Testing the equipment to ensure it is functioning and safe Securing proper containers for specimen collection

6.  Copyright 2002 by Delmar, a division of Thomson Learning 28-6  Care of the client after diagnostic testing Nursing assessment and interventions are based on the nature of the test and whether or not anesthesia was administered. The client is monitored for respiratory distress, bleeding.

7.  Copyright 2002 by Delmar, a division of Thomson Learning 28-7 The client receives written discharge instructions. Clients may need to have follow-up appointments made for them.

8.  Copyright 2002 by Delmar, a division of Thomson Learning 28-8 Laboratory Tests  Detect and quantify the risk of future disease  Establish and exclude diagnoses  Assess the severity of the disease process and determine the prognosis  Guide the selection of interventions  Monitor the progress of the disorder  Monitor the effectiveness of the treatment

9.  Copyright 2002 by Delmar, a division of Thomson Learning 28-9 Specimen Collection  Point of care testing (POCT)  Venipuncture  Arterial puncture  Capillary puncture  Central lines  Implanted port

10.  Copyright 2002 by Delmar, a division of Thomson Learning 28-10  Urine collection Random collection Timed collection Collection from a closed drainage system Clean-voided specimen  Stool collection

11.  Copyright 2002 by Delmar, a division of Thomson Learning 28-11 Blood Tests  Point of care testing (POCT) is a common nursing practice requiring minimal blood loss and provides prompt client diagnosis, treatment, and monitoring by decreasing turnaround time.  A phlebotomist is an individual who performs venipuncture. Nurses routinely perform venipuncture.

12.  Copyright 2002 by Delmar, a division of Thomson Learning 28-12 Analytes  Red blood cell count  Hemoglobin  Hematocrit  Red blood cell indices  White blood cell total count  White blood cell differential

13.  Copyright 2002 by Delmar, a division of Thomson Learning 28-13 Sickle cell test Type and crossmatch

14.  Copyright 2002 by Delmar, a division of Thomson Learning 28-14 Blood chemistry  Blood glucose  Serum electrolytes  Blood enzymes  Blood lipids  Therapeutic drug monitoring  Arterial blood gases

15.  Copyright 2002 by Delmar, a division of Thomson Learning 28-15 Urine Tests  Although laboratories provide a wide range of urine tests, some types of tablet, tapes, and dipstick tests for UA can be performed outside the laboratory setting.  On comparison, the results are similar for both dipstick and microscopic components of urinalysis.

16.  Copyright 2002 by Delmar, a division of Thomson Learning 28-16 Urine pH Specific gravity Urine glucose Urine ketones Urine cells and casts

17.  Copyright 2002 by Delmar, a division of Thomson Learning 28-17 Stool Tests  Stool analysis is used to determine the various constituents of the stool for diagnostic purposes such as diseases of the gastrointestinal tract, the liver. and the pancreas. Urobilinogen Occult blood Parasites

18.  Copyright 2002 by Delmar, a division of Thomson Learning 28-18 Culture and Sensitivity Tests  Culture refers to the growing of microorganisms to identify the pathogen.  Culture and sensitivity (C&S) tests are performed to identify both the nature of the invading organisms and their susceptibility to commonly used antibiotics.

19.  Copyright 2002 by Delmar, a division of Thomson Learning 28-19 Blood culture Swab culture Sputum culture Urine culture Stool culture Wound culture Bone marrow

20.  Copyright 2002 by Delmar, a division of Thomson Learning 28-20 Papanicolaou Test  Evaluates the cell maturity, metabolic activity, and morphologic variations of the cervical tissue.  Papanicolaou testing can also be used for tissue specimens from other organs, such as bronchial aspirations and gastric secretions.

21.  Copyright 2002 by Delmar, a division of Thomson Learning 28-21 Radiologic Studies  Radiography is the study of x-rays or gamma ray-exposed film and is used to study internal organ structure.  Fluoroscopy is used to demonstrate the motion of organs when used with contrast medium.

22.  Copyright 2002 by Delmar, a division of Thomson Learning 28-22 Chest x-ray Kidney-ureter-bladder (KUB) Mammography Skeletal x-rays Computed tomography (CT)

23.  Copyright 2002 by Delmar, a division of Thomson Learning 28-23 Barium studies  Barium swallow  Upper gastrointestinal study  Barium enema

24.  Copyright 2002 by Delmar, a division of Thomson Learning 28-24 Angiography  Arteriography  Cardiac catheterization  Digital subtraction angiography  Lymphangiography  Venography

25.  Copyright 2002 by Delmar, a division of Thomson Learning 28-25 Dye injection studies  Cholangiography  Intravenous cholangiography  Percutaneous cholangiography  T-tube cholangiography

26.  Copyright 2002 by Delmar, a division of Thomson Learning 28-26  Oral cholecystography  Cystography  Intravenous pyelogram  Bronchography  Myelography

27.  Copyright 2002 by Delmar, a division of Thomson Learning 28-27 Ultrasonography  Ultrasound (echogram) is a noninvasive study that uses high-frequency sound waves to visualize deep body structures.  A transducer emits waves that travel through the body tissue and are reflected back to the transducer and recorded.  The varying density of body tissues deflects the waves into a differentiated pattern on an oscilloscope.

28.  Copyright 2002 by Delmar, a division of Thomson Learning 28-28 Echocardiogram Doppler ultrasonography

29.  Copyright 2002 by Delmar, a division of Thomson Learning 28-29 Magnetic Resonance Imaging  Magnetic resonance imaging (MRI) is an imaging technique that uses radiowaves and a strong magnetic field to make continuous cross-section images of the body.  The study reveals lesions and changes in the body’s organs, tissues, vascular, and skeletal structures.

30.  Copyright 2002 by Delmar, a division of Thomson Learning 28-30 Radioactive Studies  Radionuclide imaging (nuclear scanning) uses radiopharmaceuticals to image the morphologic and functional changes in the body’s structure.  The results reveal congenital abnormalities, lesions, skeletal changes, infections, gland and organ enlargement.

31.  Copyright 2002 by Delmar, a division of Thomson Learning 28-31 Electrodiagnostic Studies  These diagnostic tests use devices to measure the electrical activity of the heart, brain, and skeletal muscles. Electrocardiography Signal-averaged electrocardiography Stress test Thallium test Electroencephalography

32.  Copyright 2002 by Delmar, a division of Thomson Learning 28-32 Endoscopy  Endoscopy is the visualization of a body organ or cavity through a scope.  A light at the end of the scope allows the practitioner to assess for lesions and structural problems.  Several areas of the body can be visualized using the endoscope.

33.  Copyright 2002 by Delmar, a division of Thomson Learning 28-33 Aspiration/Biopsy  Aspiration is performed to withdraw fluid that has abnormally collected, or to obtain a specimen.  A tissue biopsy (excision of a small amount of tissue) can be obtained during aspiration or with other diagnostic tests.

34.  Copyright 2002 by Delmar, a division of Thomson Learning 28-34 Amniocentesis Bone marrow aspiration/biopsy Paracentesis Thoracentesis Cerebrospinal fluid aspiration