ACTUAL DIAGNOSTIC TEST

DATE BASIC TEST WITH NORMAL VALUES RATIONALE RESULT CLINICAL SIGNIFICANCE NURSING INTERVENTIONS BEFORE AND AFTER EXAMS 1. Explain to the patient that the test requires blood sample and he may experience slight discomfort from the tourniquet and needle puncture. 2. Tell to the patient that this test determines the blood group and may also be used to determine the donors blood type. 3. Instruct the patient that need not restrict food or fluids. 4. Inform the patient that the procedure usually takes less than 5 minutes. 5. Apply direct pressure to the venipuncture site until the bleeding stops.

A U G U S T 17 2 0 1 0

ABO blood tying

To establish a patients blood group according to the ABO system. To check the compatibility of donor and recipient blood before transfusion.

HEMATOLOGY (Blood typing) A ABO type Rh positive (+) Rh type Cross match Compatability

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Glucose 3.9- 6.1 m mol/ L

Creatinine 61-133 m mol/l A U G U S T 17,

LABORATORY RESULT 4.7 m mol/l Increase: It is used to Normal diagnose and Acromegaly manage Chronic pancreatitis patients with Cushing syndrome diabetes Diabetes mellitus mellitus. Hyperthyroidism It is obtained as Hyperosmolar coma a supportive Stress data in many diagnoses, Decrease: because Addisons disease metabolic Advanced liver factors will disease influence Alcohol intake when glucose use fasting and storage. Excessive exogenous insulin Islet cell adenoma Malnutrition 100 m mol/l Increase: Creatinine, a Normal by- product of Acute and chronc renal muscle failure catabolism, is Systemic lupus derived from erythematosus the breakdown Cancer of muscle Acute myocardial creatinine infarction phosphate. Diabetic neuropathy Serum Congestive heart creatinine is failure considered a 46

1. Explain the procedure to the client. 2. Instruct the patient not to eat or drink fluids except water for 12 hours before the blood is drawn. 3. Collect 5 to 10 ml. of venous blood in a redtop tube. 4. Send blood to the lab, because it needs to be centrifuged within 30 minutes for serum and plasma levels. 5. The nurse ensures that the patient receives food and medications that were withheld.

2 0 1 0 Cholesterol 3.90- 6.50 m mol/l

more sensitive and specific indicator of renal disease than BUN. Serum cholesterol levels can be used as indicator of liver function since it is synthesized by the liver, but serum cholesterol can also be used as an indicator of atherosclerosi s and coronary artery disease. 3.2 m mol/l Low Increase: Acute myocardial infarction Atherosclerosis Biliary obstruction Biliary cirrhosis Hypercholesterolemia Nephritic syndrome Pancreatectomy Decrease: Hyperthyroidism Cushings syndrome Starvation Acute infection Malabsorption 0.6g/l Normal Increased: Anemia Renal disease Heart disease Liver disease Levels >1000mmol/l are associated with

Triglyceride

To detect hyperlipidemia and eleveated risk for Cardio vascular disease

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Normal value: Adult: <1.7mmol/l

pancreatits Decreased: cerebral infarction familial plasma lecithin and cholesterol acyltransferase deficiency hyperparathyroidism hyperthyroidism

Direct HDL

It's also sometimes called "good" cholesterol. Lipoproteins are made of fat and protein. It is a protection against CAD. Normal value: Adult: >1.40mmol/l 1. LDL levels are a better predictor of

1.3mmol/L Low

Abnormal values may be a sign that you are at increased risk for atherosclerosis and related disorders, including: Heart disease Kidney disease Poor blood supply to the legs Stroke High levels may be associated with a higher risk for heart

LDL

1.53mmol/L Normal

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heart disease (CAD), and they determine how high cholesterol should be treated. Normal value: <2.56mmo/l 2. VLDL is considered a type of bad cholesterol, because it helps cholesterol build up on the walls of arteries. Normal value: 2 - 38 mg/dL 3. The alanine aminotransfera se (ALT) blood test is typically used to detect liver injury.

disease and stroke.

VLDL

0.33mmol/L Normal

ALT

80U/L High

Decreased ALT in combination with increased cholesterol levels is seen in cases of a congested liver. Increased levels in mononucleosis, alcoholism, liver

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Normal value: 10 - 35 U/L

damage, kidney infection, chemical pollutants or myocardial infarction 1. Explain the procedure to the client. 2. Inform the patient that a blood sample will be taken. 3. Explain to the patient that he/she may feel slight discomfort from the needle puncture and the tourniquet. 4. Apply pressure to the puncture site. 5. Assess for signs of bleeding. 6. Observe for signs and symptoms of infection. 7. Provide adequate rest. 8. Encourage patient to have adequate balance

A U G U S T 17, 2 0 1 0

Hemoglobin Male: 140- 180 g/dl Female: 120-160 g/dl

Erythrocyte Male: 4.5- 5.0 10^12 L Female: 4.0-5.0 10^12 L

HEMATOLOGY (Complete blood count) 42 Increase: It is a test that Low measures the total amount of Erythrocytosis Hemoglobin in Congenital Heart the blood. disease It is used as a Severe Chronic rapid indirect Obstructive measurement Pulmonary disease of the RBC Polycythemia vera count. It also Decrease: determines the oxygen Anemia capacity of the Hemoglobinopathy blood. Hemorrhage Leukemia Hodgkin disease Rhematoid/ collagen vascular disease 1.39 Increase: This test is a 10^12 L count of the Low number of Erythrocytosis circulating Congenital Heart RBCs in disease 1mm^3 of Severe Chronic peripheral Obstructive 50

venous blood.

Pulmonary disease Severe dehydration Decrease: Anemia Hemoglobinopathy Hemorrhage Leukemia Hodgkin disease

diet and eat iron- rich foods. 9. Arrange for prompt transport of the specimen. If there is an anticipated delay, refrigerate specimen.

MCH 27- 33

It is a measure of the average amount/ weight of hemoglobin within an RBC.

30.2 Normal

Increase: Macrolytic anemia Decrease: Microlytic anemia Hypochronic anemia

MCV 80- 96

It is a measure of the average volume, or size, of a single RBC and is therefore used in classifying anemias.

96.1 Normal

Increase: Pernicious anemia Folic acid deficiency Decrease: Iron deficiency anemia Thalassemia

MCHC 32-36

It is a measure of the average

31.4 Low 51

Increase:

concentration or percentage of Hemoglobin within a single RBC.

Intravscular hemolysis Cold agglutins

Decrease: Iron- deficiency anemia Thalassemia Leukocyte 5.0-10.0 10^9L It measures the bodys capacity to defend against foreign bodies and to transport, produce and distribute defensive elements. To determine infection or inflammation Increase: 2.9 10^9L Low Infection Abscess Meningitis Appendicitis Tonsillitis Leukemia Decrease: Bone marrow depression Viral infections Typhoid fever Influenza Measles Infectious hepatitis Rubella Increase:

Neutrophils

To determine the need for further tests such as

0.53 52

0.55- 0.65

the WBC different or bone marrow biopsy. To monitor response to chemotherapy or radiation therapy.

Low Infections Metabolic disorder Stress response Inflammatory disease Decrease: Bone marrow depression Infections Folic or Vit. B12 deficiency 0.38 High Increase: Infections Lymphocytic leukemia Infectious mononucleosis Ulcerative colitis Decrease: Severe debilitating illnesses: heart failure renal failure, advanced TB Defective lymphatic circulation, high levels of adrenal corticosteroids, immunodeficiency due to 53

Lymphocytes 0.20-0.35%

Monocytes 0.02-0.06%

0.07 High

immunosuppressives. Increase: Infections Carcinomas Monocytic leukemia Lymphomas Chronic Inflammatory diseases Chronic ulcerative colitis Decrease: Stress Bone marrow depression Viral infections Increase: Allergic disorders Parasitic infections Neoplastic disease Decrease: Stress response Cushings syndrome

Eosinophils 0.02-0.04%

0.02 Normal

Basophils 0.000-0.005%

0.00 Normal

Increase: Hodgkins disease Ulcerative colitis Chronic hypersensitivity states

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 Certain skin disease Decrease: Hyperthyroidism Stress Severe infection Adrenocortical stimulation Hematocrit Male: 0.40-0.48 Female: 0.77-0.40 It is a measure of the percentage of the total blood volume that is made up by the RBCs. 0.13 Low Increase: Erythrocytosis Congenital Heart disease Severe Chronic Obstructive Pulmonary disease Severe dehydration Decrease: Anemia Hemoglobinopathy Hemorrhage Leukemia Hodgkin disease Rhematoid/ collagen vascular disease Increase: Malignant disorders Hodgkins disease Lymphomas

Thrombocytes 150.0-450.0 10^g/dl

It is an actual count of the number of platelets

172 Normal

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(thrombocytes) per cubic millimeter of blood.

Iron- deficiency anemia Inflammation Decrease: Hemorrhage Immune Thrombocytopenia Leukemia Pernicious anemia Hemolytic anemia DIC Systemic lupus erythematous Cancer Chemotherapy Hypersplenism Infection

Normal: Compatible (Negative crossmatch)

HEMATOLOGY (BLOOD CROSSMATCHING) DATE: Positive Crossmatch: AUGUST 17, -Incompatibility between It determines the 2010 the donors blood and major blood the recipients blood. groups, to Serial No.: screen for Negative Crossmatch: antibodies, and 2009-167663 Compatible to determine Probable compatibility the between the donors compatibility of Serial No.: blood and the the blood of the 2009-167663 recipients blood. The Compatible recipient and donor unit of blood is that of the considered safe for 56

Before: 1. Ask the intended recipient about a history of blood transfusion in the past 3 months because antibodies from a previous transfusion may be present. Additional laboratory testing is needed when the antibody screen is

potential donor.

DATE: AUGUST 18, 2010 Serial No.: 2009-193354 Compatible Serial No.: 2009-193354 Compatible DATE: AUGUST 19, 2010 Serial No.: 2009-167676 Compatible Serial No.: 2009-1677676 Compatible

transfusion to the recipient.

positive. During: 1. When blood is to be withdrawn, the intended recipient must be identified with absolute certainty by the person who draws the blood using the following steps: 2. The intended recipient states his or her name and the hospital wristband is compared with the verbal identification. 3. A transfusion wristband is also applied to the recipients wrist. This wristband contains the recipients name and hospital identification number and the date and initials of the phlebotomist. 4. The specimen tubes and the requisition form also are labeled with the

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same identification information. 5. The requisition form is signed by the phlebotomist, indicating that all identification information has been verified on the 2 wristbands and by the intended recipient. After: 1. Once the type and crossmatch is completed, the donor blood units are available for the recipient. Donor blood that has been crossmatched is usually held for no more than 24 hours. 2. Use the same careful identification procedure when the blood is to be administered. The consequences of an error in identification are profound. When error occurs, it can result in the death of the patient.

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POSSIBLE DIAGNOSTIC EXAM BASIC TEST WITH NORMAL VALUES Normal Values: 20-130 Unit/L at 37C CLINICAL SIGNIFICANCE ALKALINE PHOSPHATE Abnormal Findings To indicate liver diseases and bone Increase: diseases. Infection Evaluates liver function. Cirrhosis To determine Infiltrating liver increased activity of disease the liver from liver Bone metastases diseases. Biliary obstruction .Determines the cause Cholestasis of increased AST Myelofibrosis and ALT levels. RATIONALE NURSING INTERVENTIONS BEFORE AND AFTER EXAMS 1. Explain the procedure to the Patient. 2. Instruct that a venipuncture is performed to collect a blood sample. 3. Instruct the patient to discontinue food intake for 12 hours before the test. 4. Explain that general and fatty foods can elevate the test result in some individuals. 5. Label all specimens with the 59

DATE

patients name, room number, and the date and time of collection. 6. Deliver all specimens immediately to the laboratory or refrigerate the specimen. 7. Handle the specimen(s) with extreme care. Aseptic technique should be used. Prevent contamination of the specimen(s) or transmission of the organism to other people. 8. Keep lids on sterile specimen containers.

DIRECT ANTIGLOBULIN TEST Normal Findings: NEGATIVE Direct antiglobulin test detect red blood cell incompatibility between donor and recipient. It helps diagnose hemolytic diseases. Confirms hemolytic anemia Determines antigenAbnormal Findings: Positive: Autoimmune hemolytic anemia Hemolytic transfusion reaction Sensitivity to particular medications 60 1. Explain the procedure to the client. 2. Hold antibiotics or sulfonamides until after the specimen has been collected. These drugs could cause false negative results. If these drugs have been given, they should be listed to the laboratory slip and recorded on the patients

antibody reaction.

chart. 3. include all the following information on the requisition form: recent history of blood transfusion or plasma expanders and pertinent medications taken by the patient. 4. Label all specimens with the patients name, room number, and the date and time of collection. 5. Deliver all specimens immediately to the laboratory or refrigerate the specimen. 6. Handle the specimen(s) with extreme care. Aseptic technique should be used. Prevent contamination of the specimen(s) or transmission of the organism to other people. 7. Keep lids on sterile specimen containers.

Normal values: Total Bilirubin: 0.1-1.2 mg/dL Direct bilirubin:

BILIRUBIN, SERUM Evaluate liver function Increase: Diagnose jaundice and Total bilirubin monitor its Hepatocellular progression damage Identify underlying cause of the elevated Jaundice 61

1. Explain the procedure to the client. 2. Inform the patient that a blood sample will be taken.

<0.3 mg/dL Indirect Bilirubin: 0.1-1.0 mg/dL

bilirubin level

Hemolytic disease Familial hyperbilirubinemia Reaction to some medications Direct Bilirubin: Hepatotoxins Hepatitis Cirrhosis Cancer Acute pancreatitis Indirect Bilirubin: Inherited defects of RBCs Inherited enzymes disorders Reaction to some medications Malaria Physiologic jaundice Rh ABO incompatibility BT reaction due to incompatibilty

3. Inform the patient to fast from food for 8-12 hours (overnight) because serum lipids will alter the result. 4. Take baseline vital signs and record. 5. Explain to the patient that he/she may feel slight discomfort from the needle puncture and the tourniquet. 6. Apply pressure to the puncture site. 7. Assess for signs of bleeding. 8.Observe for signs and symptoms of infection. 9. Provide adequate rest. 10. Arrange for prompt transport of the specimen. If there is an anticipated delay, refrigerate specimen. 11. Label all the specimen containers and slide the patients name and the tissue source. 1. Explain the procedure to the

Normal Findings:

Evaluate

BIOPSY, BONE MARROW Abnormal Findings: 62

 Normal bone marrow

hematopoiesis Diagnoses malignancy of primary and metastatic origin of an infection Evaluate the progression of hematologic diseases

patient. Iron deficiency anemia Infection Hemolytic anemia Anemia of chronic disease Megaloblastic anemia Macroalbuminemia myelofibrosis 2. A consent form should be signed by the patient or an appropriate member of the family. 3. The patient should be NPO for 8 hours before the test. 4. Inform patient that he or she will most likely to feel pressure with the insertion of the needle. 6. Record Baseline vital signs 7. Administer premedications as prescribed. 8. Position the patient according to the site that will be biopsied. 9. Caution the patient to remain immobile as the biopsy needle is inserted. 10. Label all the slide used. 11. once the needle is removed, apply pressure to the site using small sterile gauze. 12. after bleeding has stopped, place a small sterile dressing over 63

the puncture site. 13. arrange prompt transport of the specimens and slides to the laboratory. 14. reassure the patient that for few days, mild discomfort at the biopsy site is expected. 15. POSTTEST: take vital signs and record q15-30mins until the patient is active, alert and stable Normal Values: The liver cells are normal, with no evidence of inflammation, scarring, degeneration, infection, tumor, or other pathologic change. LIVER BIOPSY Abnormal Findings: Deternine cause of abnormal liver function, jaundice Cirrhosis and enlarged liver. Hepatitis B or C Use to identify the Cancer of the Liver cause and extent of Military tubercolosis disease. Amyloidsosis Wilsons disease 1. Explain the procedure to the patient. 2. A consent form should be signed by the patient or an appropriate member of the family. 3. The patient should be NPO for 8 hours before the test. 4. Inform patient that he or she will most likely to feel pressure with the insertion of the needle. 6. Record Baseline vital signs 7. Administer premedications as prescribed.

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8. Obtain the patients clotting ability prior to procedure; should not be >3sec. 9. take the baseline data and record. 10. Position the patient on the left side or supine with the arm under the head. 11. Cleanse the skin and drape with sterile cloth. 12. Ask the patient to remain immobile while the needle is inserted. 13. The nurse assists in placing the specimen and label all slides and the container properly. 14. Cover the biopsy site with sterile bandage. 15. Instruct the patient to remain in his position for 1-2 hours with a pillow on the right side pressing the waist area. 16. Take vital signs q15-1 hour, q4 hours for 4 hours and q4 hours thereafter until the patient is stable. 65

Normal Values

CERUPLASMIN Abnormal Findings: Used to evaluate chronic active Elevated: hepatitis, cirrhosis, and other liver Leukemia diseases. Hodgkins disease Inflammation Tissue necrosis Trauma Decreased: Wilsons disease Hepatocellular disease Malabsorption syndrome Nephritic syndrome

1. Explain the procedure to the client. 2. Inform the patient that a blood sample will be taken. 3. Inform the patient to fast from food for 8-12 hours (overnight) because serum lipids will alter the result. 4. Take baseline vital signs and record. 5. Explain to the patient that he/she may feel slight discomfort from the needle puncture and the tourniquet. 6. Apply pressure to the puncture site. 7. Assess for signs of bleeding. 8. Observe for signs and symptoms of infection. 9. Provide adequate rest. 10. Arrange for prompt transport of the specimen.

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11. Ensure that the vial of blood is placed on ice and sent to the laboratory immediately. 12. Label all the specimen containers and slide the patients name and the tissue source. HEPATITIS B VIRUS DNA ASSAY Abnormal Findings: Helps diagnose the chronic carrier state of hepatitis B in those Positive Values: areas of mild to Hepatitis B infection severe chronic liver disease.

Normal Values: Hepatitis B Virus: Negative

1. Explain the procedure to the client. 2. Inform the patient that a blood sample will be taken. 3. Inform the patient to fast from food for 8-12 hours (overnight) because serum lipids will alter the result. 4. Take baseline vital signs and record. 5. Explain to the patient that he/she may feel slight discomfort from the needle puncture and the tourniquet. 6. Apply pressure to the puncture site. 7. Assess for signs of bleeding.

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8. Observe for signs and symptoms of infection. 9. Provide adequate rest. 10. Arrange for prompt transport of the specimen. 11. Label all the specimen containers and slide the patients name and the tissue source. Normal Values: Normal cell shape and structure RED BLOOD CELL MORPHOLOGY Abnormal Findings: The cells of the blood are examined to help (SIZE) identify causes of anemia and to Macrocytic evaluate the function -Marrow disorder with of the bone marrow. defective DNA that affects cell development during erythropoiesis Microlytic -defficiency of heme, lack of iron, or impaired hemoglobin synthesis (SHAPE) Elliptocyte -cytoplasm and cholesterol in the cell 68 1. Explain the procedure to the client. 2. Inform the patient that a blood sample will be taken. 3. Inform the patient to fast from food for 8-12 hours (overnight) because serum lipids will alter the result. 4. Take baseline vital signs and record. 5. Explain to the patient that he/she may feel slight discomfort from the needle puncture and the tourniquet. 6. Apply pressure to the puncture

membrane are polarized in areas of convexity; increased hemolysis can occur Spherocyte -genetic disease of the bone marrow; the abnormal cells have a shorter life span Target cell -deficient hemoglobin for normal cell size Sickle cell -the hemoglobin S becomes elongated and rigid; cell membranes also become sickle shaped Poikolocytosis -irreversible alteration of cell membrane from rapid erythropoiesis or extra medullary erythropoiesis (COLOR) Hyperchromic -increase in hemoglobin within the 69

site. 7. Assess for signs of bleeding. 8. Observe for signs and symptoms of infection. 9. Provide adequate rest. 10. Arrange for prompt transport of the specimen. 11. Label all the specimen containers and slide the patients name and the tissue source.

erythrocyte that has a small diameter and small cell membrane; the cell is spherical Hypochromic -iron deficiency in proportion to erythropoiesis; defective hemoglobin synthesis (STRUCTURE) Basophilic stippling -abnormal hemoglobin synthesis and increased erythropoiesis Howell-jolly bodies -abnormal erythropoiesis Heinz bodies -genetic abnormality of hemoglobin formation; hemoglobin is oxidezed and nonfunctional Normal Values: UROBILINOGEN, URINARY Abnormal Values: Used to detect hemolytic anemia 70 1. Explain the procedure to the patient.

Male: 0.3-2.1 mg/2 hr Female: 0.1-1.1 mg/2 hr

and confirm the diagnosis of liver diseases, including hepatitis and cirrhosis.

Increased: Moderate hepatocellular damage Hepatitis Hepatotoxicity Hepatic anoxia Portal hypertension Hemolysis of erythrocytes Intravascular hemolysis Hemolytic anemia Decreased: Biliary tract obstruction Massive hepatocellular damage Renal insufficiency

2. Instruct the patient to collect sample of urine, preferably on arising in the morning. The specimen must not be contaminated by toilet paper, toilet water, feces, or secretions. 3. Teach the patient how to cleanse the urinary meatus and how to collect the urine (midstream clean- catch). 4. Label the container with the patients name, the time and the date of the voiding. 5. Arrange for transport of the specimen to the laboratory as soon as possible. 6. If the specimen cannot be processed immediately, refrigerate it.

71