Unit 7: Diagnostic Testing Fundamental of Nursing

Unit 7: Diagnostic Testing

Overview of noninvasive and invasive diagnostic testing.

Diagnostic tests are either noninvasive or invasive.

-Noninvasive means the body is not entered with any type of instrument.
The skin and other body tissues, organs, and cavities remain intact.

-Invasive means accessing the body’s tissue, organ, or cavity through

some type of instrumentation procedure.

Phases of Diagnostic testing

1. Pretest Phase: this phase focuses on client preparation.

2. Intra-test Phase: this phase focuses on specimen collection and

performing or assisting with certain diagnostic testing, the nurse uses
standard precautions and sterile technique as appropriate.

3. Post-test Phase: the focus of this phase is on nursing care of the client
and follow- up activities and observation. As appropriate, the nurse
compares the previous and current test results and modifies nursing
interventions as needed.

Preparing the Client for Diagnostic Testing

A: Assessment
1. Check to be sure the client is wearing an identification band.

2. Review the medical record for herbal supplements, allergies, and

previous adverse reactions to dyes and other contrast media; a signed
consent form; and the recorded findings of diagnostic tests relative to the
procedure.

1
Unit 7: Diagnostic Testing Fundamental of Nursing

3. Assess for presence, location, and characteristics of physical and

communicative limitations or preexisting conditions.

4. Monitor the client’s knowledge of why the test is being performed.

5. Monitor vital signs for clients scheduled for invasive testing to

establish baseline data.

6. Assess client outcome measures relative to the practitioner’s

preferences for pre-procedure preparations.

7. Monitor level of hydration and weakness for clients who are NPO
(nothing by mouth), especially geriatric and pediatric populations.

B: Client teaching
Discuss the following with the client and family as appropriate to
the specific test:
1. Explain reason for test and what to expect.

2. An estimation of how long the test will take.

3. NPO (if oral medication to be taken, how much water to drink).

4. Cathartics or laxative: how much, how often.

5. Sputum: cough deeply, do not clear throat.

6. Urine: voided, clean-catch specimen, time to collect.

7. No objects (jewelry or hair clips) to obscure x-ray film.

8. Barium: taste, consistency, aftereffects (stools lightly colored for 24–

72 hours, can cause obstruction or impaction).

9. Iodine: metallic taste, delayed allergic reaction (itching, rashes, hives,

wheezing and breathing difficulties).

2
Unit 7: Diagnostic Testing Fundamental of Nursing

10. Positioning during the test.

11. Positioning posttest (e.g., angiography)—immobilize limb

12. Posttest, encourage fluids if not contraindicated.

Blood Tests
Blood tests are one of the most commonly used diagnostic tests and can
provide valuable information about the hematologic system and many
other body systems. A venipuncture (puncture of a vein for collection of a
blood specimen) can be performed by various members of the health care
team.
Types of Blood Tests
1. A complete blood count (CBC).

The CBC is one of the most common blood tests. It's often done as part of
a routine checkup. CBC, include the following:

3
Unit 7: Diagnostic Testing Fundamental of Nursing

2. Blood Chemistry Tests/Basic Metabolic Panel

The basic metabolic panel (BMP) is a group of tests that measures
different chemicals in the blood. These tests usually are done on the fluid
(plasma) part of blood. The BMP includes:
Blood glucose.

Calcium.

Electrolyte: They include sodium, potassium, bicarbonate, and

chloride.

Kidney function tests: They include blood urea nitrogen (BUN) and
creatinine.

3. Blood enzyme tests

These tests include troponin and creatine kinase (CK) tests, etc…
4. Arterial Blood Gases: These tests include:

–7.45.

5. Blood clotting tests: they include:

Prothrombin time (PT) and ,

activated partial thromboplastin time (APTT).

4
Unit 7: Diagnostic Testing Fundamental of Nursing

Stool specimens
Analysis of stool specimens can provide information about a client’s
health condition. Some of the reasons for testing feces include the
following:

tary products and digestive secretion.

Urine specimens
The nurse is responsible for collecting urine specimens (clean voided-
midstream urine specimens) for a number of tests:

Types of Urine Collection Methods

Urine specimens may be collected in a variety of ways according to the
type of specimen required, the collection site and patient type.

1. Randomly Collected Specimens: are not regarded as specimens of

choice because of the potential for dilution of the specimen when
collection occurs soon after the patient has consumed fluids.

2. First Morning Specimen: is the specimen of choice for urinalysis and

microscopic analysis, since the urine is generally more concentrated.

5
Unit 7: Diagnostic Testing Fundamental of Nursing

3. Midstream Clean Catch Specimens: are strongly recommended for

microbiological culture and antibiotic susceptibility testing because of the
reduced incidence of cellular and microbial contamination.

4. Timed Collection Specimens: may be required for quantitative

measurement of certain analytes (creatinine, urea, potassium, sodium,
uric acid, cortisol, calcium, citrate, amino acids, etc..).

5. Collection from Catheters(e.g. Foley catheter): Alternatively, urine

can be drawn directly from the catheter to an evacuated tube using an
appropriate adaptor.

6. Supra-pubic Aspiration: may be necessary when a non-ambulatory

patient cannot be catheterized or where there are concerns about
obtaining a sterile specimen by conventional means.

7. Pediatric Specimens: For infants and small children, a special urine

collection bag can be adhered to the skin surrounding the urethral area.
Sputum specimens
Sputum is the mucus secretion from the lung, bronchi, and trachea. It is
important to differentiate it from saliva, the clear liquid secreted by the
salivary glands in the mouth, sometimes referred to as (spit). Healthy
individuals do not produce sputum.
Sputum specimens are usually collected for one or more of the following
reasons:

drug sensitivities.

cells.

(TB).

6
Unit 7: Diagnostic Testing Fundamental of Nursing

Throat culture.
Nursing responsibilities during Specimen collection
1. Provide client comfort, privacy, and safety.

2. Explain the purpose of the specimen collection and the procedure for
obtaining the specimen.

3. Use the correct procedure for obtaining a specimen or ensure that the
client or staff follows the correct procedure.

4. Note relevant information on the laboratory requisition slip, for

example, medications the client is taking that may affect the results.

5. Transport the specimen to the laboratory promptly.

6. Report abnormal laboratory findings to the health care provider in a

timely manner consistent with the severity of the abnormal results.
Visualization procedures
Visualization procedures include indirect visualization (noninvasive) and
direct visualization (invasive) techniques for visualizing body organ and
system functions.
Non-invasive Diagnostic Methods
They are include:
1. Laboratory Exams
Such exams can evidence abnormal blood values, such as an infarct
enzyme, or changes in the blood electrolyte.
2. Electrocardiogram (ECG)
This test evidences the characteristics and duration of the heart's electrical
activity.
3. Stress ECG
4.Electroencephalography ( EEG)
7
Unit 7: Diagnostic Testing Fundamental of Nursing

It is a test to measure the electrical activity of the brain.

5. Holter ECG
A portable recording device monitors the time of occurrence of the extra-
systoles over twenty-four hours.
6. Chest X-Ray
This test determines the heart's size and position, and whether the lungs
are functioning properly. 7. Cardiac Ultrasonography
(Echocardiography)
This test checks both the heart valves and the movement and thickness of
the heart walls.
Invasive Diagnostic Tests
A: Endoscopic Procedures, include the followings:
1. Arthroscopy: examines joint structures, primarily the knee.

2. Bronchoscopy: examines the bronchus and bronchial tree.

3. Colonoscopy: examines the large intestine.

4. Colposcopy: examines the cervix and vagina following a positive Pap

smear.

5. Cystourethroscopy: uses two instruments:

a. Cystoscope: to examine the bladder and ureter openings, and

b. Urethroscope: to examine the bladder neck and the urethra

6. Esophagogastroduodenoscopy (EGD): examines the esophagus,
stomach, and upper duodenum.

7. Laparoscopy: examines the peritoneal cavity: pelvis and abdomen.

8. Proctoscope: to examine the lower rectum and anal canal.

8
Unit 7: Diagnostic Testing Fundamental of Nursing

9. Arthroscopy: It is a surgical procedure use to visualize, diagnose, and

treat problems inside a joints.

B: Biopsy procedures
There are various kinds of biopsy procedure, including:
1. Bone marrow biopsy: a small sample of bone marrow (usually from
the hip) is removed via a slender needle. This type of biopsy helps to
diagnose diseases such as leukemia.

2. Colposcopy-directed biopsy: a colposcope is a small microscope used

to examine a woman’s cervix while a tissue sample is taken. This biopsy
is usually performed to investigate the reasons for an abnormal Pap test
result.

3. Endoscopic biopsy: the endoscope is a flexible tube that can be

inserted into an orifice (such as the mouth or anus) or through a small
skin incision. Once the lump is reached, cutting tools are threaded
through the endoscope so that a sample of tissue can be taken.

4. Excisional biopsy: This type of biopsy may be used for breast lumps.

5. Incisional biopsy: This type of biopsy may be used for lumps located
in connective tissue such as muscle.

6. Needle biopsy:. This type of biopsy may be used to diagnose

conditions of the liver or thyroid.

7. Punch biopsy: This type of biopsy can help diagnose various skin
conditions.

8. Stereotactic biopsy: This type of biopsy is usually performed

whenever the lump is hard to see or feel.

9
Unit 7: Diagnostic Testing Fundamental of Nursing

9. Lumbar Puncture: CSF is withdrawn through a needle inserted in to

the subarachnoid space of the spinal canal between the third and fourth
lumbar vertebrae or between the fourth and fifth lumbar vertebrae.
Some diagnostic procedures that may require analgesia or sedation
1. Bone marrow aspiration or biopsy.

2. Endoscopy.

3. Lumbar puncture.

4. Placement of catheters, tubing.

5. Radiologic procedures (CT and MRI).

6. Tissue biopsies.

Documentation of diagnostic Procedures

Record in the client’s medical record:
1. Who performed the procedure.

2. Reason for the procedure.

3. Type of anesthesia, dye, or other medications administered.

4. Type of specimen obtained and where it was delivered.

5. Vital signs and other assessment data, such as client’s tolerance of the
procedure or pain and discomfort level.

6. Any symptoms of complications.

7. Who transported the client to another area (designate the names of

persons who provided transport and place of destination).

11