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Health Assessment (MIDTERMS) > Theory: Diagnostic Testing > Flashcards

Theory: Diagnostic Testing Flashcards

1
Q

What are the Nurse’s Responsibilities?

A
  1. Prepare patient mentally, explain procedure.
  2. Collaborate with laboratory personnel in proper collection and transport of samples.
  3. Proper labeling and documentation.
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2
Q

What are the 2 types of Diagnostic testing? define them

A

Invasive - accessing the body’s tissue, organ, or cavity through
some type of instrumentation procedure.
E.g. Most of Laboratory Exams, Biopsy (Excisional and Incisional), lumbar puncture
Visualization Procedures: Endoscopic Procedures like Arthroscopy, Bronchoscopy, Colonoscopy, Cystourethroscopy, Laparoscopy
Non- invasive - body is not entered with any type of instrument. E.g. EEG, ECG, Stress Test, Holter ECG (24 hrs), Chest X-ray, Sputum exam, Urine and Stool examinations

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3
Q

What are the 3 phases of Diagnostic Testing?

A
  1. PRE TEST PHASE - Client Preparation
  2. INTRA TEST PHASE - specimen collection, standard precautions and aseptic technique in collection of samples.
  3. POST-TEST PHASE: nursing care of the client and follow- up activities and observation. (comparison of previous and current test results and modifies nursing interventions as needed)
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4
Q

How do doctors Reach a diagnosis?

A
  1. Initial Diagnostic Assessment – Patient history, physical exam, evaluation of the patient’s chief complaint and symptoms.
  2. DIFFERENTIAL DIAGNOSIS, AND ORDERING OF DIAGNOSTIC TESTS.
    WE CONFIRM OR RULE OUT the initial diagnosis. WE SEAL THE CASE!
  3. Referral, Consultation, Treatment & Follow-Up
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5
Q

what are the steps in preparing a client for a diagnostic testing?

A

Assessment- Verify clients identity, check medical history, etc.
Client Teaching- Explaining of reason of test, etc.
Documentation- Recording of Data

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6
Q

What are the Factors that can affect the results?

A

• Time of day
• Fasting
• Postprandial
• Supine, upright position
• Age
• Gender
• Climate
• Effects of drugs
• Effects of diet

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7
Q

What is the order of draw of the tube?

A

Light blue (Citrate Tube)
Yellow (Blood cultures)
Lavender (EDTA tube)
Gray ( Fluoride Tube)

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8
Q

Give atleast 3 guidelines for Specimen collection

A

• Consider the patient’s need and ability to participate in specimen collection procedures.
• Recognize that the collection of a specimen may provoke anxiety, embarrassment, or discomfort.
• Provide support for patients who are fearful about the results of a specimen examination.

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9
Q

-information about the types and numbers of cells in the blood.
- OBTAINED: Capillary prick, Venipuncture, Arterial sampling.

A

Complete Blood Count

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10
Q

What are the components and their types of CBC?

A

RBC HEMOGLOBIN HEMATOCRIT:
•BLOOD INDICES
•MCV
•MCH
•MCHC

WBC DIFFERENTIAL COUNT:
• NEUTROPHILS
• LYMPHOCYTES
• MONOCYTES
• EOSINOPHILS
• BASOPHILS

PLATELETS:
• OTHER TESTS:
• ESR
• BLOOD TYPING
• BLOOD DONATION

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11
Q

What are the 3 purpose of CBC?

A

PURPOSE:
1. PREOPERATIVE.
>determine oxygen carrying capacity of the blood and hemostasis (Blood disorders)
2. INFECTION.
ANEMIA and monitor progress of treatment.
3. CHRONIC ILLNESS or blood disorders.
4. Monitor effects of CHEMOTHERAPHY

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12
Q

What are the blood components, decreased and increased indication?

A

Type of Cell, Reference Range, Decreased Ind., Increased Ind.
• WBC, 3.4 - 9.6 billion cells/L, (Infection, Liver or Spleen condition, Cancer), (Infection, Allergic Reaction, Autoimmune Conditions)

•RBC, 3.92 - 5.65 Trillion cells/L, ( Hemorrhage, Anemia, Cancer, Malnutrition), (Dehydration, Lung Disease, Heart Disease, Polycythemia vera)

• Hemoglobin (HgB), 11.6-16.6 g/dL, Any abnormalities in HgB can indicate concern in the blood’s oxygen-carrying Capacity

• Hematocrit (Hct), 35.5% -48.6 %, (Low levels of iron, Anemia, Heavy menses), (Polycythemia Vera, dehydration, shock)
• Platelet Counts, 135-371 billion/L, Higher Risk for bleeding, Higher risk for blood clots

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13
Q

What are the different types of WBC?

A

Neutrophils - First to respond in a bacteria or a virus
Lymphocytes - fight infection y producing antibodies
Basophils - known for their role in asthma
Eosinophils- known for their role in allergy symptoms
Monocytes - Clean up dead cells

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14
Q

how many RBCs are there in one drop of blood?

A

250M

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15
Q

What are the drugs that may increase and decrease RBCs?

A

Drugs that may INCREASE RBC count: Methyldopa, Gentamycin
Drugs that may DECREASE RBC count: Quinidine, hydantoins, chloramphenicol, chemotherapeutic drugs

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16
Q

What are the drugs that increase and decreased Hemoglobin?

A

Drugs that may increase hemoglobin:

Erythropoietin, iron supplements.

Drugs that may decrease hemoglobin:

Aspirin, antibiotics, sulfonamides,
trimethadione, anti-neoplastic drugs, indomethacin, doxapram, rifampin, and primaquine.

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17
Q

What are the drugs that may increase and decrease WBC?

A

Drugs that may increase white blood cells:

Corticosteroids, heparin, beta-
adrenergic agonists, epinephrine, granulocyte colony-stimulating factor, lithium.

Drugs that may decrease white blood cells:

Diuretics, chemotherapeutic drugs, histamine-2 blockers, captopril, anticonvulsants, antibiotics, antithyroid drugs, quinidine, chlorpromazine, terbinafine, clozapine, sulfonamides, ticlopidine.

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18
Q

What are the differential count of the types of WBC?

A

Neutrophils - 55-70
Basophils- 0.5-1
Lymphocytes- 20-40
Monocytes- 2-8
Eosinophils- 1-4

19
Q

What are the drugs that may increase and decrease platelets?

A

Drugs that may increase platelets:

Romiplostim, steroids, human IgG, immunosuppressants.

Drugs that may decrease platelet:

Aspirin, hydroxyurea, anagrelide,
chemotherapeutic drugs, statins, ranitidine, quinidine, tetracycline, vancomycin,
valproic acid, sulfonamides, phenytoin, piperacillin, penicillin, pentoxifylline, omeprazole, nitroglycerin.

20
Q

Determines the concentration of various chemical substances found in the blood that provide clues to the functioning of the major body systems.
*SERUM is the sample of choice in most of the tests.
*Common tests require no special preparation. However, some blood chemistry tests will have specific requirements such as dietary restrictions or medication restrictions.

A

blood chemistry

21
Q

What are the electrolytes?

A

Sodium- Main extracellular ion.
Monitor the effectiveness of diuretics.

Potassium - Major intracellular cation that regulate acid-base equilibrium, control cellular water balance, and transmit electrical impulses in skeletal and cardiac muscles.

Chloride- acts as buffer during oxygen and carbon dioxide exchange in red blood cells (RBCs). Aids in digestion and maintaining osmotic pressure and water balance

Magnesium- needed in the blood-clotting mechanisms, regulates neuromuscular activity, acts as a cofactor that modifies the activity of many enzymes, and has an effect on the metabolism of calcium

Phosphorus - important in bone formation, energy storage and release, urinary acid-base buffering, and carbohydrate metabolism. It is absorbed from food and is excreted by the kidneys. High concentrations of phosphorus are stored in bone and skeletal muscle.

Total Calcium- cation absorbed into the bloodstream from dietary sources and functions in bone formation, nerve impulse transmission, and contraction of myocardial and skeletal muscles. Calcium aids in blood clotting by converting prothrombin to thrombin.

22
Q

What is Serum Osmolality and their normal values ?

A

measure of solute concentration of blood. (sodium ions, glucose, urea); usually estimated by doubling the serum sodium because sodium is a major determinant of serum osmolality.

Normal Values:
SI UNITS / CONVENTIONAL
A- 285-295 mmol/ko / mOsm/kg H2O
C- 275-290 mmol/ko / mOsm/kg H2O
CV- <265 or >320 mmol/kg / mOsm/kg H2O

23
Q

What is Serum Bicarbonate and their normal values)

A

Part of the bicarbonate-carbonic acid buffering system and mainly responsible for regulating the pH of body fluids.
Ingestion of acidic or alkaline solutions may affect results.

Normal values:
SI Units/ Conventional)
Adult: 23–30 mmol/L / mEq/L
Child: 20–28 mmol/L / mEq/L
Infant: 20–28 mmol/L / mEq/L
Newborn: 13-22 mmol/L / mEg/L
Critical values: <10 or >40 mmol/L / mEq/L

24
Q

What are the Renal Function Tests?

A
  1. SERUM CREATININE -measures the amount of creatinine in the blood. Increased in kidney disease. Usually a creatinine level more than 1.2 for women and more than 1.4 for men may be a sign that the kidneys are not working like they should.
  2. GLOMERULAR FILTRATION RATE (GFR)- measure of excretory function of kidneys.
    a. GFR of 60 or more together with a normal urine albumin test is normal. b. GFR less than 60, indicates kidney disease.
    c. GFR less than 15, indicates kidney failure. (Candidate for dialysis or
    transplant.
    d. GFR level consistently less than 20 over a 6- 12month period need
    transplant.
  3. BLOOD UREA NITROGEN (BUN): measures the amount of urea nitrogen in the blood (by product of protein metabolism). NV ranges from 7 to 20. Levels will increase as disease progresses.
25
Q

What are the Liver function tests?

A

Conditions affecting the GIT can be easily evaluated by studying the normal laboratory values of the following:
1. ALT (Alanine aminotransferase or SGPT)
2. AST (Aspartate aminotransferase or SGOT) 3. BILIRUBIN
4. ALBUMIN
5. Ammonia, amylase, lipase, protein, and lipids.

26
Q

What is Lipoprotein Profile?

A

Lipid assessment or lipid profile includes: 1. Total cholesterol
2. High-density lipoprotein (HDL)
3. Low-density lipoprotein (LDL)
4. Triglycerides

27
Q

present in all body tissues and is a major component of LDL, brain, and nerve cells, cell membranes, and some gallbladder stones.

A

cholesterol

28
Q

the stored fats in our body; constitute a major part of very-low- density lipoproteins and a small part of LDLs.

A

triglycerides

29
Q

What are the normal and critical values for lipid profile?

A

Cholesterol:
A- <5.20 mmol/L
C-
F-
M-
In -

30
Q

released into the circulation normally
following a myocardial injury as seen in
acute myocardial infarction (MI) or other
conditions such as heart failure.
• CK,
• CK-MB
• Myoglobin
• Troponin I, Troponin II

A

CARDIAC MARKERS &
SERUM ENZYMES

31
Q

enzyme found in muscle and brain tissue that
reflects tissue catabolism resulting from cell
trauma.

A

Creatine Kinase (CK)

32
Q

Isoenzymes includes?

A

CK-MB (cardiac)- cardiac muscles
CK-BB (brain)- brain tissue
CK-MM (muscles)- skeletal muscles

33
Q

an oxygen-binding protein that is found in striated (cardiac and skeletal) muscle, releases oxygen at very low tensions. Any injury to skeletal muscle will cause a release of myoglobin into the blood. Myoglobin rise in 2-4 hours after an MI making it an early marker for determining cardiac damage.
Normal lab: 5-70 ng/mL

A

Myoglobin

34
Q

regulatory protein found in striated muscle (myocardial and skeletal). released into the bloodstream when an infarction causes damage to the myocardium.

A

Troponin

35
Q

Normal Values of Troponin?

A

Troponin - <0.4 ng/mL
Cardiac troponin T- <0.1 ng/mL
Cardiac troponin I - <0.03 ng/mL

36
Q

What are the different HIV and AIDS Testing

A
  1. ELISA - A single reactive ELISA test by itself is not conclusive; should be repeated in duplicate with the same blood sample; if the result is repeatedly reactive, follow-up tests using Western blot or IFA.
  2. WESTERN BLOT- A positive Western blot or IFA results is considered confirmatory for HIV.
  3. IMMUNOFLUORESCENCE ASSAY (IFA).
    Note: A positive ELISA but not confirmed by Western blot or IFA should be repeated after 3 to 6 months.
37
Q

What is CD4+ T-CELL COUNTS?

A

-help monitor progression of HIV.
Number of CD4+ T-cells decreases as the disease progresses, with a resultant decrease in immunity.

38
Q

What are the normal values for HIV/ AIDS testing?

A

T cells - 800–2,500 cells/uL
T-helper cells (CD4) - 600–1,500 cells/uL
T-suppressor cells (CD8)- 300-1,000 cells/uL
B cells -100-450 cells/uL
Natural killer cells- 75-500 cells/uL
CD4 CD8 ratio- >1

39
Q

What are the 3 parts of Urine Examination?

A

Physical - Color, Volume, Odor, Transparency

Chemical Strip- Glucose, Protein, pH, sp. gr , Ketones, Bilirubin, Nitrite, Ascorbic acid

MICROSCOPIC
FORMED SEDIMENTS- RBC, WBC, Bacteria, Casts, Crystals, Epithelial cells, Mucus, Yeast

40
Q

What are the indications of Urine Color?

A

•CLEAR TO DARK YELLOW – normal •AMBER TO HONEY YELLOW – dehydration
•ORANGE – dehydration, intake of rifampicin, consumption of orange food dye
•BROWN ALE – severe dehydration, liver
disease
•PINK TO REDDISH – consumption of
bSeervtsi,crehOubnaerborblueberries,mercury Service Two
poisoning, tumors, kidney diseases,
prostate problems, UTI
to discuss.
•BLUE OR GREEN – consumption of
asparagus, genetic disorders, excess
calcium, heartburn medications,

41
Q

What are the factors that interfere with urine results?

A
  1. Medications and supplements (metronidazole and vitamin C)
  2. Contamination- blood, mucus, unsterile collection bottle
42
Q

What are the steps in Stool Sample collection?

A
  1. Collect on plastic wrap and transfer to vial until liquid reaches fill line.
  2. Remove spoon from lid and discard.
  3. Replace cap on vial tightly and shake for a minute. Place vial in refiaerator until readv to shio
43
Q

What are the nurses role in the collection of stool sample?

A

• Guide patient on proper specimen collection. Ask patient to urinate first to avoid contaminating stool with urine.
• Provide accurate sample identification
• Ensure all supplies are appropriate for collection
• Timely transport of specimen to the laboratory.

44
Q

What is the Visualization Procedures?

A

INDIRECT (non-invasive)- X-ray, Ultrasonography, EEG, ECG, 2D/3D echo, lung scan
MEDICAL IMAGING- CT (Computed Tomography), MRI uses magnetic field, Nuclear imaging uses radioactive isotope, PET (Positron Emission Tomography) inhalation or ingestion of radioisotope
DIRECT (invasive)- Colonoscopy, Angiography
Used to visualize body organs and system functions. E.g.
ANOSCOPY (anal canal)
PROCTOSCOPY (rectum)
PROCTOSIGMOIDOSCOPY (rectum and sigmoid colon) COLONOSCOPY (large intestine)
KUB (Kidney, ureters, bladder)
LARYNGOSCOPY and BRONCHOSCOPY

Health Assessment (MIDTERMS) (6 decks)

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