Medical Laboratory

Quality clinical laboratory testing is evidenced by: performing the correct test, on the right person, at the right time, producing accurate test results, with the best outcome, in the most cost- effective manner. This is accomplished by: Ensuring that appropriate clinical laboratory tests are ordered; Procuring clinical laboratory test samples in an efficient, timely manner; Producing accurate clinical laboratory test results; Correlating and interpreting clinical laboratory test data; Disseminating clinical laboratory test information to clinicians and patients in a timely manner; Evaluating the outcome of clinical laboratory testing for each individual patient and the entire health care system; Utilizing qualified medical laboratory personnel.

Obtaining Blood Glucose Record & Report Fasting BS: Before the patient has had anything to eat/drink. PPBS: 2 hr postprandial blood sugar is collected exactly 2 hrs after the patient finishes eating. The patients BS should return to normal within 2 hrs. Specimens that are not collected at the proper time can cause misinterpretation of the results. (report all results to the RN) STAT BS: BS must be checked immediately.

Obtaining Blood Glucose Record & Report Fingerstick Blood Sugar: FSBS is checked by collecting a sample of capillary blood with a lancet. This is transferred to a reagent strip or other test strip.

Obtaining Blood Glucose Record & Report Important observations of diabetic patients Inadequate food intake Eating food not allowed on diet Refusal of meals, supplements, or snacks Inadequate fluid intake Excessive activity Complaints of dizziness, shakiness, racing heart Blood sugar values outside of normal reporting range for your facility

Hyperglycemia Nausea, vomiting Weakness Headache Full, bounding pulse Fruity smell to breath Hot, dry, flushed skin Labored respirations Drowsiness Mental confusion Unconsciousness Sugar in the urine High blood sugar as measured by FSBS

Hypoglycemia Complaints of hunger, weakness, dizziness Shakiness Skin cold, moist, clammy, pale Rapid, shallow respirations Nervousness and excitement Rapid pulse Unconsciousness No sugar in urine Low blood sugar as measured by FSBS

FSBS Need: Gloves Alcohol sponge Lancet Blood glucose meter Reagent strip or test strip Sharps container Plastic bag for used supplies Wipe patients finger with alcohol, allow to dry Pierce the side of the middle or ring finger using lancet Discard lancet Squeeze finger gently to obtain drop of blood Hold site directly over test strip Wipe patients finger with alcohol and apply pressure

A1C Measurement of glucose levels in the blood over a prolonged period of time. It differs from the fingerstick blood sugar because it provides a snapshot of the patient’s diabetic control over the past 2 to 3 mths. The % of A1C in whole blood is 50% from the most recent 30 days 25% from the previous days 25% from the previous days Normal (non-diabetic) A1C = 5% ADA recommended goal < 7% In some facilities, a value above 6.5% is further addressed

A1C

Urine Physical testing of urine includes: Color Odor Transparency Specific gravity Physical characteristics normal/abnormal

Collecting a Urine Sample (documentation) Urine Specimen used for a variety of laboratory tests such as urinalysis. Usually collect the first urine voided in the morning because this urine is more concentrated and may reveal more abnormalities. Also usually has an acidic pH which helps preserve any cells. Specimen can be collected in: Bedpan, urinal, specimen hat, specimen cup Usually 120mL is sufficient (if unable to produce that amount send what is collected to lab anyway)

Collecting a Urine Sample (documentation) Midstream (clean-catch) Specimen: a urine specimen that is free from contamination. Because microorganisms are present on the genital area and on the specimen containers, special precaution are used to obtain a specimen. Genital area will be cleansed thoroughly Female: front to back motion, external lip, internal lip, then center. Male: Circular motion from meatus down

Midstream specimen

Obtaining a Sterile Specimen

24 Hr Urine Sample The first urine voided in a 24-hr specimen is discarded because it was produced before the start of the test. Preserving a 24-hr specimen can be done by cold storage or chemicals.

Collecting a Stool Sample (Documentation) It is important to send a sample being examined for ova and parasites to the lab immediately because it is most accurate within 30 minutes and it should stay at body temperature. When an occult blood test is positive it indicates there is blood present in the stool. All urine and stool specimens should be placed in a biohazard bag when transported to avoid contamination from spills.

Proper Procedure for Capillary Blood Test

Basic Technique for Venipuncture