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CA 1- Diagnostics

When looking at deviations from normal, it is important to remember that laboratory tests are
not always positive or negative in its absence. The results of many tests may be affected by
non-disease-associated influences such as diet, physical activity, drugs and genetic factors.
Therefore, the nurse must be aware of the fact that it is often difficult to make the transition
from a test result to a clinical picture of the patient and related nursing care. Thus, the nurse
must look at the results of the lab test with reference to the total patient.

Collection of Specimens
Type of Exam Preparation of Patient Method of Collection
1. Blood Exam - inform patient about what, why Venipuncture, skin puncture or
and how of the specimen collection blood culture
2. Serial blood Requires large amount of blood to From the IV line, blood is drawn
Sampling be drawn for lab studies from the stopcock proximal to the
insertion site
3. Arterial blood gas Inform patient that ABG arterial Allens test is done prior to getting
sampling puncture usually causes blood, blood is placed in a syringe
momentary deep throbbing or tightly capped and placed in a
cramping pain container with ice and send to lab
4. Bone Marrow Informed consent signed; patient is Aseptic technique is used to
Exam positioned on his back or side lying collect bone marrow specimen
and the area is anesthesized
5. Urine Exam No special prep, but must be First voided morning urine is best,
instructed how to collect the urine midstream urine or clean voided
for different types of urine exam urine
6. CSF exam Informed consent signed, empty Patient is in side lying with knees
the bladder and bowel; patient is flexed up to the abdomen and the
placed to assume flexed body head flexed down to the chest,
position during the procedure puncture site is cleansed with
antiseptic and anesthesia is
injected before the CSF is
withdrawn from the spinal needle
7. Sputum Patient is instructed how to collect Sputum should be collected in a
Collection the sputum and not the saliva clean or sterile container with
tight fitting cap
8. Fecal Studies Patient is told about the reason Stool specimen is placed in a
and how the stool is collected container and properly labeled
9. Throat Culture Patient is told about the reason Patients tongue is depressed with
and how the specimen will be a depressor and the throat is
obtained swabbed. It should not touch the
tongue or lips. The swab is placed
in a test tube and send to lab
Laboratory Tests of Hematological Function
Lab. test Preparation Causes of Deviations Nursing Implications
Complete Blood Decrease level in: massive Assess specific area that
Count or prolonged blood loss, should be included in the
1. Hematocrit a No food or fluid anemia, leukemia, excessive NP and decide what
measurement of restrictions IVF administration nursing management is
the % of RBC in prior to test Elevated in: hemo- needed to address the
the total volume concentration caused by problem related to the
of blood burns, surgery, shock, cause
severe DHN
2. Hemoglobin is Decrease level in: anemia,
the major No food or fluid dec. blood prod.; massive or Assess specific area that
component of restrictions prolonged blood loss, hemo- should be included in the
RBC; carries O2 prior to test lytic reaction, last trimester NP and decide what
of pregnancy nursing management is
Elevated in: needed to address the
hemo- concentration caused problem related to the
by burns, surgery, shock, cause
severe DHN

3. Red blood cell Decrease level in: anemia,


Count is the No food or fluid hemorrhage, disease of Nursing care is directed
number of RBCs restrictions bone marrow, endocrine to the management of
in 1 cm of whole prior to test disorders, LE and RF symptoms and causes of
blood Elevated in: polycythemia the abnormal levels
vera and secondary poly-
cythemia
4. White blood cell Differential WBC count is
count is the No food or fluid divided into 2 main groups Differential count must
absolute restrictions 1. granulocytes be monitored and
number of WBCs prior to test 2. agranulocytes nursing interventions are
circulating in 1 ( pls. refer to separate table directed to the
cm of blood for more discussions) management of the
cause of abnormal levels
5. Mean Corpuscular Decrease level in: pernicious
Volume describes No food or fluid anemia, iron def. anemia, Specific interventions
individual red cell restrictions thalassemia and anemia directed to management
size; the ratio of prior to test asso. with chronic blood loss of anemia causing the
the vol. of packed Elevated level in: liver abnormal results
cell to RBC count disease, alcoholism , folate
or Vit. B12 def. or sprue
6. Mean Corpuscular
Hgb measures the No food or fluid Abnormal values are related Specific interventions
wt.of Hgb in an restrictions to severe anemic conditions directed to management
average RBC; it is prior to test of anemia causing the
related to MCV abnormal results
Decrease in level may be The nursing care of a
7. Platelet count ; No food or fluid seen in newborn or in patient with an abnormal
responsible for restrictions women 2 wks prior to platelet count should
coagulation prior to test menstruation. Disorders in focus on the possibility of
process the count can have several spontaneous and
causes prolonged bleeding

8. Erythrocyte This test is non-specific and May be useful to assess


Sedimentation No food or fluid cannot be used to confirm progression of an
Rate is a test to restrictions presence of a specific inflammatory diseases; a
determine the rate prior to test disease process. The ESR decrease in ESR indicates
at which RBCs may be useful in ff. the some improvements
settle out of progress of diagnosed while an increase may
unclotted blood in inflammatory diseases such mean that condition is
1 hour as RA, RF, MI and respiratory worsening or that a new
infections inflammatory process
has begun

9. Blood Typing may No food or fluid A persons blood type


be done for a restrictions generally does not change; Not applicable
variety of reasons: prior to test however, some bone
blood donation, marrow transplant patients
transfusion to undergo blood-type changes
determine when the donors blood type
compatibility of is different
blood

10. Crossmatch is a No food or fluid Incompatibility occurs when Assess for transfusion
test done before restrictions antibodies are present that reactions which may
blood transfusion prior to test causes hemolysis of either include chest pain,
to determine the donors or recipients cyanosis, dyspnea,
compatibility of blood headache, chills,
recipients and hematuria, oliguria;
donors blood follow protocol andthe
procedure in blood
administration; if TR
occurs, stop the
transfusion
11. Rh Antibody Titer A person with Rh-negative
is performed No food or fluid blood will have a positive There are no clinical
when it appears restrictions antibody titer if an manifestations the first
that a person with prior to test incompatible transfusion of time a person with Rh-
Rh-negative blood whole blood, packed cells, negative blood receives
may be producing platelets or granulocytes Rh-positive antigens.
antibodies against have been given or a child However, subsequent
the Rh factor have been conceived whose exposures result in
father is Rh-positive and a prompt destruction of
fetal-maternal hemorrhage red cells.
has occurred
12. Bone marrow
Exam involves No food or fluid Increases and decreases of Nursing interventions are
evaluation and restrictions RBCs and WBCs are directed to the provision
classification of prior to test associated with specific of support to patient
the material pathologies; Inc. or Dec. in with abnormal findings;
obtained from WBCs may indicate leukemia assist the patient in
bone marrow Decrease in RBCs may adapting or coping with
tissue by indicate anemia; cancerous the condition
aspiration or cells can also be
biopsy demonstrated in this exam
TYPES OF WHITE BLOOD CELLS
Granulocytes Comprise half or more of the white cells. Granules are present in their
cytoplasm. They arise from the bone marrow.
Neutrophil Also called polymorphonuclear leukocytes (PMNs, pols). Their name reflects
the lobular nuclear bound in the mature cell. The mature cell develops by
progressing through th e following stages: 1) myeloblast; 2) promyelocyte:
3)myelocyte: 4) Metamyelocyte: 5) band neutrophil; 6) segmented
neutrophil.
The protective function of the neutrophils includes phagocytosis. Foreign
particles are degraded, and pyrogens are released that produce fever by
acting on the hypothalamus to set the bodys thermostat at a higher level.

Eosinophils Their protective function is not fully understood. They play a role in allergic,
reactions, possibly inactivating histamine.
Basophils Their protective function is not fully understood. They contain histamine and
heparin and appear to be involved in immediate hypersensitivity reactions.
Agranulocytes Also called munonuclear leukocytes; they comprise the rest of the white cells.
Their cytoplasm does not contain granules and they originate in bone marrow
and lymphoid tissue.
Lymphocytes Their protective function is in antibody production and humoral immunity.
Monocytes Their protective function is phagocytosis against bacteria and large protozoa
such as fungi and parasites.