Chapter 29 Diagnostic Testing

29-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Noninvasive and Invasive Testing  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.

29-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Preparing the Client for Diagnostic Testing  Appropriate test selection  Correct scheduling  Confirming client’s normal baseline vital signs  Evaluating client’s knowledge of procedure

29-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Preparing the Client for Diagnostic Testing (continued)  Reporting significant information to practitioner Allergies, previous adverse reactions  Documentation of significant data  Client teaching about the procedure  Interventions NPO status Medication admin istration

29-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Care of the Client During Diagnostic Testing  Standard precautions or aseptic technique  Preparation of the room  Ongoing assessment of the client’s status  Gathering and charging for supplies  Testing the equipment to ensure it is functioning and safe  Proper containers for specimen collection  Management of procedural pain

29-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Care of the Client During 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.

29-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Care of the Client During Diagnostic Testing  The client receives written discharge instructions.  Clients may need to have follow-up appointments made for them.

29-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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

29-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Laboratory Tests  The clinical value of a test is related to: Sensitivity Specificity Incidence Predictive value  Test results are based on normal range values.

29-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Specimen Collection  Venipuncture  Arterial Puncture  Capillary Puncture  Central Lines  Implanted Port

29-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Specimen Collection  Urine Collection Random collection Timed collection Collection from a closed drainage system Clean-voided specimen  Stool Collection

29-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Hematologic System  Red Blood Cells (erythrocytes)  White Blood Cells (leukocytes)  Platelets

29-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Hematologic System  Red Cell Indices Measure the size and hemoglobin content of the RBCs -Mean Corpuscular Volume (MCV) -Mean Corpuscular Hemoglobin (MCH) -Mean Corpuscular Hemoglobin Concentration (MCHC)

29-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Hematologic System  Platelets Maintain hemostasis and blood coagulation Blood coagulation is a comprehensive, sequential process of the body’s response to injury. Prothrombin activator is the governing element in blood coagulation.

29-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Platelets  Platelet Count, Size, and Shape  Bleeding Time  Prothrombin Time (PT)  Partial Thromboplastin (PTT)  Fibrinogen Level  Thrombin Time (TT)

29-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Hematologic System  Sickle Cell Test (hemoglobin S) Sickle cell trait Sickle cell disease

29-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Hematologic System  Blood Type A. B, AB, O Determined by the presence or absence of A or B antigens. Rh factor refers to an antigen found on the RBC.

29-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Hematologic System  Blood Crossmatching Determines the compatibility of the donor’s blood with that of the recipient

29-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Hematologic System  Erythroctye Sedimentation Rate (ESR) Rate with which the RBCs settle in saline/plasma over a specified time period Diagnostic for inflammatory and chronic conditions

29-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Blood Chemistry  Blood Chemistry Analyses Sequential multiple analyzer (SMA) Performs 4 to 20 biochemical tests Ordered separately or as profile groups (SMA panels) -SMA-4 -SMA-6 -SMA-12 -SMA-20

29-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Blood Chemistry Blood Glucose Serum Electrolytes Blood Enzymes Blood Lipids Therapeutic Drug Monitoring Arterial Blood Gases

29-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Blood Chemistry  Blood Glucose Deficits in either the digestion of carbohydrates or glucose metabolism Drugs can cause elevated blood glucose values. Clients receiving intravenous fluids with a high glucose content

29-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Blood Chemistry  Serum Electrolytes An element or compound that, when dissolved, separates into ions and provides for cellular reactions -Cations -Anions

29-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Blood Chemistry  Blood Enzymes Catalyze chemical reactions within the cells by promoting oxidative reactions and synthesis of various chemicals -Lipids -Glycogen -Adenosine triphosphate (ATP) Key role in diagnosing degree of tissue damage when released into blood

29-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Blood Chemistry  Blood Lipids Total blood cholesterol Lipoproteins are blood lipids bound to proteins that transport cholesterol and other fats to and from the cells. -Low-density lipoprotein (LDL) -High-density lipoprotein (HDL) Triglycerides are the chemical form in which most fat exists in food and in the body.

29-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Therapeutic Drug Monitoring  Performed when a quantitative relationship exists between the drug concentration and drug response or toxicity is known.  Trough and peak sampling help keep the drug level below toxic value.

29-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Blood Chemistry  Arterial Blood Gases (ABG) PO2 PCO2 pH

29-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Urine Tests  Urinalysis (UA) is essential for both diagnostic and preventive purposes. Urine pH Specific gravity Urine glucose Urine ketones Urine cells and casts

29-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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

29-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Culture and Sensitivity Tests  Culture refers to the growing of microorganisms to identify the pathogen.  Sensitivity allows the practitioner to select the appropriate antibiotic therapy.

29-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Culture and Sensitivity Tests  Blood Culture  Swab (throat) Culture  Sputum Culture  Urine Culture  Stool Culture  Wound Culture  Bone Marrow

29-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Papanicolaou Test (Pap Smear)  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.

29-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Papanicolaou Test (Pap Smear)  Cervical pap smear testing is recommended every 2 to 3 years after the onset of sexual activity.  Annual testing is indicated for women: Over 40 years of age With a family history of cervical cancer With a previously positive test

29-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

29-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Radiologic Studies  Contrast Media Radiopaque substances that facilitate roentnen imaging of the internal structures -Barium -Iodine Clients with a history of allergies to any foods or drugs (particularly fish or iodine) may be predisposed to allergic reactions to contrast media.

29-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Radiologic Studies  Chest X-ray  Kidney-Ureter-Bladder (KUB)  Mammography  Skeletal X-rays  Computed Tomography (CT)

29-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Computed Tomography (CT)

29-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Barium Studies  Barium is a chalky, white contrast medium.  Allow for visualization of the internal structures of the digestive tract.  Fluids are forced to help with excretion.  If not completely excreted, barium can cause an intestinal obstruction.

29-39 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Barium Studies  Barium Swallow (esophography) Upper gastrointestinal study (UGI) Fluoroscopic visualization of the esophagus  Barium Enema (rectal infusion of barium sulfate Roentgenographic study of the lower intestinal tract

29-40 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Angiography  Visualization of the vascular structures through the use of fluoroscopy with a contrast medium  Reveals blood flow to heart, lungs, brain, kidneys, and lower extremities  Useful in diagnosing an aneurysm

29-41 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Angiography  Arteriography  Cardiac Catheterization  Digital Subtraction Angiography  Lymphangiography  Venography

29-42 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Dye Injection Studies  Iodine is a common dye used in radiographic studies.  May cause temporary symptoms of shortness of breath, nausea, and a warm, hot-flushed sensation.  Most dye injection studies are invasive, requiring written consent.

29-43 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cholangiography  The roentgenographic procedure visualizing the integrity of the biliary system by a radiopaque contrast medium Intravenous Cholangiography Percutaneous Cholangiography T-Tube Cholangiography

29-44 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Oral Cholecystography  Visualization of the gall-bladder and presence of stones  Administration of radiopaque iodine tablets  The evening before the test the client eats a fatty meal and takes the iodine tablets 5 minutes apart with 8 ounces of water.

29-45 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cystography  Radiographic study that uses an aqueous iodine contrast agent instilled into the bladder through a urinary catheter  Used to visualize the bladder, urethra, ureteral openings

29-46 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Intravenous Pyelogram (IVP)  A series of x-ray films of the kidneys, ureters, and bladder  An intravenous iodine preparation is administered.

29-47 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Bronchography  Radiographic study of the trachea and bronchi  A contrast agent is injected through a catheter.

29-48 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Myelography  Study of the spinal cord and its surrounding subarachnoid spaces through the use of radiography and Pantopaque (contrast agent)  The Pantopaque dye is injected by performing a lumbar puncture.

29-49 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

29-50 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Ultrasonography  Brain  Thyroid  Heart  Vascular Structure  Abdominal Aorta

29-51 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Ultrasonography  Spleen  Liver  Gallbladder  Pancreas  Pelvis

29-52 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Ultrasonography  Echocardiogram  Doppler Ultrasonography

29-53 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Magnetic Resonance Imaging (MRI)  Noninvasive procedure that places the client in a magnetic field instead of ionizing radiation  Provides contrast between normal tissue and pathologic tissue  Evaluates lesions and changes in the body’s organs, tissues, vascular, and skeletal structures

29-54 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Radioactive Studies  Use radionuclides (nuclear scanning) to image the morphologic and functional changes in the body’s structure  Reveal congenital abnormalities, lesions, skeletal changes, infections, gland, and organ enlargement

29-55 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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

29-56 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Endoscopy  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.

29-57 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

29-58 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Aspiration/Biopsy  Amniocentesis Withdrawal of amniotic fluid to obtain a sample for specimen examination

29-59 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Bone Marrow Aspiration/Biopsy  Common sites are the sternum and iliac crest.  A fluid specimen (aspiration) or a core of marrow cells (biopsy) is obtained.

29-60 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Paracentesis  Aspriation of fluid from the abdominal cavity  Diagnostic or therapeutic  A trocar (a large-bored abdominal paracentesis needle) is advanced into the peritoneal cavity.  An inner catheter drains the fluid.

29-61 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Thoracentesis  Aspiration of fluids from the pleural cavity  The client is monitored for symptoms of a pneumothorax (collection of air or gas in the pleural space causing the lungs to collapse).

29-62 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cerebrospinal Fluid (CSF) Aspiration  Lumbar puncture (spinal tap) is the aspiration of CSF from the subarachnoid space. To obtain a pressure measurement when blockage is suspected During a myelogram To instill anesthesia, antibiotics, or chemotherapy

29-63 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Lumbar Puncture