COMMON LABORATORY AND - + signifies exposure to

DIAGNOSTIC TESTS Mycobacterium tubercle

bacilli
GENERAL PRINCIPLES IN THE CARE OF - BCG immunization will have
CLIENTS UNDERGOING DIAGNOSTIC + result
TEST - RESULTS:
 + with indurations of
 Prepare the client physically &
10 mm or more
psychosocially
 HIV, indurations of 5
 Provide privacy
mm is +
 Provide adequate information
 Chest X-ray
 Take note of NPO
- Uses a very small dose of
 Check written consent
ionizing radiation to produce
 Assess for allergy to seafood & pictures of the inside of the
iodine chest.
 Assess for history of claustrophobia - Used to evaluate the lungs,
 Increase fluid intake heart and chest wall.
 Abdomen (IAPP) - Instruct client to remove
 No abdominal Palpation if with tumor metals from chest because
(liver / kidneys) metals are radiopaque
 Examination of abdomen, flex knees
 Abdominal Sequence: RLQ, RUQ,  Bronchoscopy and
LUQ & LLQ Bronchography
 Examine chest in sitting/upright - Require insertion of
position bronchoscope
 Stand behind when examining lymph - Uses premedication:
nodes/ thyroid  Anticholinergic
 Darken room for ophthalmoscopy  Anxiolytics
 Obtain C & S specimen before 1 st  Topical Anesthetic
dose of antibiotic using sterile Spray
technique - Bronchography: uses
 In examining female clients, female iodinated contrast medium
nurse must be in attendance then radiograph
- Post procedure:
RESPIRATORY SYSTEM  NPO until reflexes
return
 Mantoux Test (Skin Test)  Side-lying position
- PPD (purified protein
derivative) is used  Sputum Examination
- Administered by intradermal - The best time to collect:
injection morning upon awakening
- Interpretation is 48-72 hrs - Rinse mouth with plain water
post injection before collection
 - AFB staining requires
collection for 3 consecutive
mornings
 Lung Biopsy
- After percutaneous needle
lung biopsy, position patient
turning toward affected side
 Arterial Blood Gas Analysis
- Assess ventilation & acid-
base balance
- Blood withdrawn from arterial
artery
- Allen’s test pre-collection
- Heparinized syringe is used
- Collected specimen is placed
in a container with ice
 Thoracentesis
- Pressure sensation is felt
during the procedure
- Pneumothorax, needle is
inserted in the 2nd & 3rd
intercostal space
- Pleural effusion, needle is
inserted in the 7th or 8th ICS
- Monitor for bleeding post
procedure
CARDIOVASCULAR AND
HEMATOLOGIC SYSTEM
 Complete Blood Count and
Erythrocyte Indices
- Erythrocyte indices (MCV,
MCH & MCHC) are best
indicators of anemia
- Increased MCV & MCH in
macrocytic anemia
- Decreased MCV & MCH in
microcytic anemia
- Decreased MCHC in severe
hypochromatic anemia
- Low RBC, hemoglobin &
hematocrit in anemia
- Polycythemia (increased
RBC & hemoglobin) indicates
hypoxia
- Elevated WBC indicates
infection
- Neutropenia/ agranulocytosis
(low neutrophil count)
indicates low resistance to
infection
- Eosinophilia (elevated
eosinophil count) indicates
allergy or parasitism
 Erythrocyte Sedimentation Rate
- It is elevated in inflammatory
conditions, e.g. Myocardial
infarction
 Blood Coagulation Studies
- Prolonged PT, PTT, APTT
indicate bleeding tendencies
- PT is valuable in evaluating
effectiveness of Coumadin
(therapeutic effect= 1.5-2)
- PTT & APTT are used to
evaluate effectiveness of
Heparin (therapeutic
effect=2-2.5)
 Blood Urea Nitrogen (BUN) and
Blood Uric Acid (BUA)
- The values are elevated
when there is low renal
tissue perfusion due to
decreased cardiac output
 Blood Lipids
- Serum cholesterol & serum
lipids
- Require NPO for 10-12 hours
- Elevated levels increase risk
of atherosclerosis
  CENTRAL VENOUS PRESSURE
 Tropinin (CVP) MONITORING
- Elevated Troponin I & T are - Place 0 level/ base of the
best indicators of Myocardial water manometer at the right
infarction mid-axillary, 4th ICS
- Elevated CVP readings
 Electrocardiography (ECG) indicate hypervolemia or right
- Elevated Troponin I & T are sided congestive heart failure
best indicators of Myocardial
infarction  ECHOCARDIOGRAPHY
- MI: elevated ST, inverted T - Uses ultrasound to assess
wave, pathologic/ enlarged Q cardiac structures & mobility
wave
- Hypokalemia: prolonged  DOPPLER ULTRASONOGRAPHY
QRS, elevated ST, short T - Permits assessment of
wave arterial and venous flow in
- Hyperkalemia: Prolonged the lower extremities with the
QRS, elevated ST, peaked T use of a probe moved over a
wave skin surface
- ECG machine
o Detects the patterns  ULTRASONIC DUPLEX
of electrical impulse SCANNING
generation and - Localizes site of vascular
conduction through obstruction
the heart - Evaluates degree of
o translates that narrowing & the amount of
information into vascular reflux
recorded patterns - Detects deep vein
(waveform on cardiac thrombosis
monitor or calibrated
paper)  PLETHYSMOGRAPHY
- Evaluates venous
 Holter Monitoring insufficiency
- Continuous ECG monitoring,
24-H period  ARTERIOGRAPHY AND
- Instruct to record activities & VENOGRAPHY
any unusual sensation - Assess for allergy to seafood
experienced & iodine before the
- May remove device only procedure
during bathing
- Continued even during  TRENDELENBURG TEST
asleep - Done to detect leg
varicosities
GASTROINTESTINAL SYSTEM
 CARCINOEMBRYONIC ANTIGEN
(CEA)
- Elevated levels indicate
presence of colorectal cancer
 D-XYLOSE ABSORPTION TEST
- Indicates presence of
malabsorption disorders
 FECAL ANALYSIS
- Guaiac stool exam (Fecal
occult blood test/ FOBT)
 No red meats, poultry
for 3 days
 Withhold iron,
steriods, NSAID’s for
48 hours
- For detection of ova &
parasites, send fresh, warm
stool specimen to laboratory
 UPPER GI SERIES/ BARIUM
SWALLOW
- NPO for 6 to 8 hours
- Barium Sulfate is
administered orally
- X-rays are taken in standing
& supine position
- Laxatives & fluids are given
after procedure
 LOWER GI SERIES / BARIUM
ENEMA
- Preparation for the test
includes:
 NPO for 6 to 8 hours
 Laxative the night
before the procedure
 Cleansing enema in
the morning of the
test
- Care post procedure is the
same as post upper GI series
 UPPER GI ENDOSCOPY
- NPO for 6 to 8 hours
- Remove dentures
- Gag reflex is depressed with
local anesthetic
- Post procedure, side lying
position & NPO until gag
reflex returns
 LOWER GI ENDOSCOPY
 PROCTOSIGMOIDOSCOPY
o NPO for 6-8 hours
o Laxative the night
before the test
o Placed in knee
chest/lateral position
during the procedure
o Post procedure,
assess for perforation
& vagal stimulation
 COLONOSCOPY
o Preparation is the
same as
proctosigmoidoscopy
o Place in side-lying
position with knees
flexed
o Post procedure, same
as
proctosigmoidoscopy
 ULTRASOUND OF THE
ABDOMEN, LIVER, GALL
BLADDER & PANCREAS
- NPO for 8-12 hours
- Laxative the night before the
test
HEPATO-BILIARY AND PANCREATIC
SYSTEM
  LIVER BIOPSY  GLYCOSYLATED HEMOGLOBIN /
- Vitamin K injection prior the HGBA1C
procedure if PT is prolonged - The most accurate indicator
- During procedure: left lateral of diabetes mellitus
position - Reflects glucose levels for
- Instruct to exhale deeply, the past 3-4 months
hold breath for 5 – 10
seconds during needle  Thyroid Function test:T3, T4 and
insertion RAIU(Radioactive Iodine Uptake)
- Post procedure: right side - Increased in hyperthyroidism
lying for 4 hours - Decreased in hypothyroidism

 PARACENTESIS  THYROID SCAN

- Check vital signs - Helps determine whether the
- Empty bladder prior to tumor is benign or malignant
procedure
- Place in upright or sitting  FINE NEEDLE BIOPSY
position - Is done to confirm
- Post procedure: monitor for malignancy
hypovolemic shock &
peritonitis  VANILLYLMANDELIC ACID (VMA)
TEST
 ENDOSCOPIC RETROGRADE - Done to detect
CHOLANGIOPANCREATOGRAPH pheochromocytoma
Y (ERCP) - VMA is the metabolite of
- ERCP is a procedure that epinephrine
enables your physician to - 24-hour urine specimen
examine the pancreatic and - Avoid in 24H: coffee, tea,
bile ducts.  chocolate, banana, vanilla &
- Involves upper GI endoscopy aspirin
for contrast medium - Elevated:
- Assess allergy to seafood & pheochromocytoma – a
iodine tumor in the adrenal medulla
- Post procedure: NPO until
gag reflex returns & turn to GENITO-UNRINARY SYSTEM
sides
 ROUTINE URINALYSIS
- Collect in the morning upon
 ULTRASOUND OF THE GALL
awakening
BLADDER
- Cleanse external genitals
- The most Definitive test to
with soap & water
detect gallstones.
- Discard the first flow of urine,
ENDOCRINE SYSTEM collect the midstream, then
discard the last flow
 - Label properly & send  Permits better
immediately to labs transmission of high
frequency sound
 24 – HOUR URINE COLLECTION (ultrasound)
- Discard the first voided urine
- Collect specimen thereafter  RENAL BIOPSY
- Include the last voided - Check coagulation studies
specimen - Placed in prone position
- If a specimen was discarded, - Post procedure: placed in
restart the collection the supine with small pillow or
following day rolled towel under the
posterior lumbar area
 CREATININE CLEARANCE
- Best indicator of glomerular NERVOUS SYSTEM
function
 CAT SCAN
- Requires 24-H urine
- Assess for allergy to seafood
specimen collection
& iodine (if done with
- Low: renal function
contrast medium)
impairment
- Assess for claustrophobia
- Remove metallic items from
 KUB
hair
- Plain Xray of the kidneys,
Ureters & bladder
 ELECTROENCEPHALOGRAPHY
- Laxative is administered the
(EEG)
night before
- Provide hair shampoo prior
to procedure
 INTRAVENOUS PYELOGRAM - Avoid caffeine,
(IVP) / EXCRETORY UROGRAM anticonvulsants, & stimulants
- An x-ray examination of the for at least 24 hours prior to
kidneys, ureters and urinary procedure
bladder that uses iodinated
contrast material injected into
 ELECTROMYOGRAPHY (EMG) &
veins. 
NERVE CONDUCTION VELOCITY
- Assess allergy to seafood
(NCV)
and iodine
- Done to diagnose
- Administer laxative
neuromuscular disorders
- Dangerous Complication:
- Electrode needles will be
Anaphylactic Shock
inserted into the muscle with
mild discomfort
 ULTRASOUND OF THE KIDNEYS,
URETERS, BLADDER
 LUMBAR PUNCTURE
- Distend the bladder by giving
- Placed in lateral, knee-chest
2 glasses of water
position
- Instruct to withhold voiding
 - Label specimen - Denominator indicates
- Post procedure: placed in flat distance at which the normal
position for 6-8 hours to eye can read letters
prevent spinal headache - 20/200 means legal
- Spinal headache is due to blindness
leakage of CSF thru the dural - 20/30 or greater means
hole. myopia/nearsightedness
- 20/15 or less means
 MYELOGRAPHY hyperopia /farsightedness
- Detects vertebral disk
diseases & spinal cord  TONOMETRY
tumors - Indirectly measures
- Contrast medium is intraocular pressure (IOP)
administered thru lumbar - 25 mmHg & above means
puncture glaucoma

 MAGNETIC RESONANCE  OPTHALMOSCOPY

IMAGING (MRI) - Examines the fundus, interior
- Obtain history of metal of the eyes
implants & artificial cardiac - May diagnose retinal
pacemaker detachment & papilledema /
- Assess for claustrophobia choked disk
- Drum-like or knocking sound
 TUNING FORK TESTS
MUSCULOSKELETAL SYSTEM  RINNE’S TEST
 BONE X-RAY o Compares air
- To detect bone fracture conduction from bone
conduction
 BONE SCAN o Vibrating tuning fork
- Instruct client to void is placed against the
immediately prior to mastoid process
procedure to prevent irritation (behind the ear) then
of the bladder by 2 inches from the
radioisotope opening of the ear
canal
EYES AND EARS o Valuable in the
diagnosis of
 SNELLEN’S TEST otosclerosis,
- Tests visual acuity conductive hearing
- Normal result 20/20 loss
- Numerator indicates distance  RINNE’S TEST FINDINGS
of the client from the chart - Normal: air
conduction is better
than bone conduction
 -
Conductive hearing
loss: bone conduction
is better than air
conduction
- Sensorineural hearing
loss: result is the
same as normal
result
 WEBER TEST
- The rounded tip of the
handle of vibrating
tuning fork is placed
in the center of the
client’s head
- Valuable in the
diagnosis of
Meniere’s Disease,
sensorineural hearing
loss
 WEBER TEST FINDINGS
- Normal: tone is
perceived in the
center of the clent’s
head or equally in
both ears
- Conductive Hearing
loss: tone is heard
better in the poor ear
- Sensorineural hearing
loss: tone is heard
better in the good ear

 AUDIOMETRY
- Single most important
diagnostic test in detecting
hearing loss
- May be pure tone or speech
audiometry
- Critical level of loudness is
30 decibels