Chapter 29 Diagnostic Testing Copyright 2004 by Delmar

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 2

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

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 administration Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 4

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 5

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 6

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

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

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

Specimen Collection § § § Venipuncture Arterial Puncture Capillary Puncture Central Lines Implanted Port

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

Hematologic System § Red Blood Cells (erythrocytes) § White Blood Cells (leukocytes) § Platelets

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) Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 13

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 14

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

Hematologic System § Sickle Cell Test (hemoglobin S) • Sickle cell trait • Sickle

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 17

Hematologic System § Blood Crossmatching • Determines the compatibility of the donor’s blood with

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 19

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 20

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

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 22

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

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 24

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 25

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 26

Blood Chemistry § Arterial Blood Gases (ABG) • PO 2 • PCO 2 •

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

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 30

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 32

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 33

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 35

Radiologic Studies § § § Chest X-ray Kidney-Ureter-Bladder (KUB) Mammography Skeletal X-rays Computed Tomography

Computed Tomography (CT) 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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 38

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 39

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 40

Angiography § § § Arteriography Cardiac Catheterization Digital Subtraction Angiography Lymphangiography Venography Copyright 2004

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 42

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 44

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 45

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

Bronchography § Radiographic study of the trachea and bronchi § A contrast agent is

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 48

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

Ultrasonography § § § Brain Thyroid Heart Vascular Structure Abdominal Aorta Copyright 2004 by

Ultrasonography § § § Spleen Liver Gallbladder Pancreas Pelvis Copyright 2004 by Delmar Learning,

Ultrasonography § Echocardiogram § Doppler Ultrasonography Copyright 2004 by Delmar Learning, a division of

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 53

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 54

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 56

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

Aspiration/Biopsy § Amniocentesis • Withdrawal of amniotic fluid to obtain a sample for specimen

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 59

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 60

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). Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 61

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 62