MedicalSurgical Nursing An Integrated Approach 2 E Chapter

Medical-Surgical Nursing: An Integrated Approach, 2 E Chapter 13 DIAGNOSTIC TESTS

Types of Diagnostic Tests Noninvasive: The body is not entered with any type of instrument. n Invasive: The body’s tissues, organs, or cavities are accessed through some type of procedure making use of instruments. n Most invasive procedures require informed consent of the client. n

Preparing the Client for Diagnostic Testing Nurses prepare clients by ensuring client understanding and compliance with preprocedural requirements. n Clients, families, and significant others must be involved in the testing process and should be advised as to the estimated time required to perform the test. n

Preparing the Client for Diagnostic Testing Nursing interventions used during diagnostic testing include: Evaluating the client’s anxiety level. n Teaching relaxation techniques, such as deep breathing and imagery. n Evaluating the client’s level of safety and comfort. n

Role of the Nurse in Diagnostic Testing To facilitate the scheduling of tests. n To perform client teaching. n To perform or assist with procedures. n To assess clients for adverse responses to procedures. n

Further Nursing Responsibilities During Diagnostic Testing Preparing the procedure room (e. g. ensuring adequate lighting). n Gathering and charging for supplies to be used during the procedure. n Testing the equipment to ensure it is functional and safe. n Securing proper containers for specimen collection. n

Conscious Sedation n A minimally depressed level of consciousness during which the client retains the ability to maintain a continuously patent airway and respond appropriately to physical stimulation or verbal commands.

Care of the Client After Diagnostic Testing Directed toward restoring the client’s prediagnostic level of functioning. n Client is monitored for signs of respiratory distress and bleeding. n With some diagnostic tests, the client’s intake and output (I & O) is monitored for 24 hours. n Clients received written instructions upon discharge. n

Reasons for Laboratory Tests n n n To detect and quantify the risk of future disease. To establish or exclude diagnoses. To assess the severity of the disease process and formulate a prognosis. n n n To guide the selection of interventions. To monitor the progress of the disorder. To monitor the effectiveness of the treatment.

Accuracy in Laboratory Testing The following are required n n n The practitioner’s order must be transcribed onto the correct requisition form. All information must be written on form. Pertinent data that could influence the test’s results must be included. Collection of the specimen from the correct client must be confirmed by checking the identification band. Laboratory results must be placed in the correct medical record.

Concerns of Nurses Regarding Diagnostic Testing n Nurses should schedule diagnostic testing to promote: n Client comfort. n Cost containment.

Types of Specimen Collection n n n Venipuncture: the use of a needle to puncture a vein to aspirate blood. Arterial puncture. Capillary puncture. Central Lines: refers to a venous catheter inserted into the superior vena cava through the subclavian or internal or external jugular vein. Implanted port: a port that has been implanted under the skin. Urine collection.

Types of Urine Collection Random (routine analysis) n Timed (24 -hour urine) n Collection from a closed urinary drainage system. n Sterile specimen (catheterized) n Clean-voided specimen. n

Procedures for Stool Collection n Explain to client the reason for collection. n Refrigerate stools if collected for a prolonged period of time. n Label container with client’s name, date and time, and test to be performed on the specimen. n Place stool specimens in biohazard bag before transport to laboratory.

Type and Crossmatch n Identifies the client’s blood type and determines the compatibility to blood between a potential donor and recipient (client).

Blood Chemistry Blood Glucose. n Serum Electrolytes. n Blood Enzymes. n Blood Lipids. n

Types of Urine Tests Urine p. H. n Specific Gravity. n Urine Glucose. n Urine Ketones. n Urine Cells and Casts. n

Types of Stool Tests Urobilinogen. n Occult blood (blood in the stool detected only with a microscope or by chemical means). n Parasites. n

Culture and Sensitivity Tests Culture refers to the growing of microorganisms to identify the pathogen. n Sensitivity tests are performed to identify both the nature of the invading organism and its susceptibility to commonly used antibiotics. n

Types of Culture and Sensitivity Tests Blood Culture. n Throat (Swab) Culture. n Sputum Culture. n Urine Culture. n Stool Culture. n

Papanicolaou Test n A smear method of examining stained exfoliative cells, commonly called a Pap smear.

Radiography The study of film exposed to x-rays or gamma rays through the action of ionizing radiation. n Used by the practitioner to study internal organ structure. n

Fluoroscopy Immediate, serial images of the body’s structure and function. n Reveals the motion of organs. n

Chest X-Ray The most common radiological study. n Noninvasive, noncontrasted. n

Computed Tomography The radiological scanning of the body. n X-ray beams and radiation detectors transmit data to a computer that transcribes the data into quantitative measurement and multidimensional images of the internal structures. n

Barium Studies n The use of barium, a chalky white contrast medium, in a preparation that permits roentgengraphic visualizations of the internal structures of the digestive tract.

Angiography n Visualization of the vascular structures through the use of fluoroscopy in conjunction with a contrast medium.

Arteriography n The radiographic study of the vascular system following injection of a radiopaque dye through a catheter.

Ultrasound A noninvasive procedure that uses highfrequency sound waves to visualize deep body structures. n Also called echogram or sonogram. n

Magnetic Resonance Imaging n The MRI use of radiowaves and a strong magnetic field to make continuous crosssectional images of the body.

Electrocardiogram n A graphic recording of the heart’s electrical activity.

Stress Test A measure of the client’s cardiovascular fitness. n It demonstrates the ability of the myocardium to respond to increased oxygen requirements by increasing the blood flow to the coronary arteries. n

Thalium Test Thalium 201 is a radioactive isotope that emits gamma rays and closely resembles potassium. n Often performed in conjunction with ECG. n

Electroencephologram (EEG) n The graphic recording of the brain’s electrical activity.

Endoscopy n The visualization of a body organ or cavity through a scope.

Aspiration n A procedure that is performed to withdraw fluid that has abnormally collected or to obtain a specimen.

Biopsy n The excision of a small amount of tissue, obtained during aspiration or in conjunction with other diagnostic tests.

Amniocentesis The withdrawal of amniotic fluid to obtain a sample for examination. n Indicated when client is: n Over 35. n Has had a spontaneous abortion with a previous pregnancy. n Has a family history of genetic, chromosomal, or neural tube defects. n

Paracentesis n The aspiration of fluid from the abdominal cavity.

Thoracentesis n The aspiration of fluid from the pleural cavity.

Lumbar Puncture The aspiration of cerebrospinal fluid (CSF) from the subarachnoid space. n Also called spinal tap. n