Diagnostic Test Nursing Considerations: Blood (Serum) Studies

Blood (Serum) Studies
Diagnostic Test Nursing Considerations
Arterial blood gases Blood draw, usually with no preparation; check to see if client should have oxygen
turned off for 20 to 30 minutes before the test
Standard ABG includes:

1) partial pressure of oxygen (PaO2)
2) partial pressure of carbon dioxide (PaCO2)
3) pH
4) bicarbonate (HCO3)
5) oxygen saturation (O2 sat or SpO2)
Basic Metabolic Panel Ordered to assess status of kidneys, blood sugar, and electrolyte and acid/base
balance
Client should be NPO 10 to 12 hours prior to the blood draw
Group of 8 specific tests: glucose, calcium, electrolytes (sodium, potassium, CO 2,
chloride), kidney tests (blood urea nitrogen [BUN], creatinine)
Comprehensive metabolic panel Gives information about the status of the client's kidneys, liver, electrolyte and
(CMP) acid/base balance, blood sugar and blood proteins
Client should be NPO 10 to 12 hours prior to the blood draw
Standard CMP includes a group of 14 tests: albumin, alkaline phosphatase, alanine

transaminase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN),
(serum) calcium, (serum) chloride, CO2, creatinine, direct bilirubin, gamma-glutamyl
transpeptidase (gamma-GT), glucose test, lactate dehydrogenase (LDH), (serum)
phosphorus, potassium, (serum) sodium, total bilirubin, total cholesterol, uric acid
Chemistry Panel Part of either the CMP or BMP (see above)
Standard chem profile includes:

1) sodium
2) potassium
3) chloride
4) bicarbonate (HCO3)
Complete blood count (CBC) Typically there are no specific pre-testing restrictions, although the client should
avoid eating a fatty meal prior to the test
Standard CBC includes:

1) white blood cells (WBC)
2) red blood cells (RBC)
3) hemoglobin content (Hgb)
4) hematocrit (Hct)
5) mean corpuscular volume (MCV)
6) mean corpuscular hemoglobin (MCH)
7) mean corpuscular hemoglobin concentration (MCHC)
8) platelet count and volume
(Serum) Enzymes/Cardiac Markers Serum enzymes typically includes:
1) (total) creatinine kinase: this enzyme is found in muscle and brain tissue; it
reflects tissue catabolism resulting from cell trauma
2) creatinine kinase isoenzymes - will increase 4 to 6 hours after injury; peaks in 12
to 24 hours; three different isoenzymes in the body: CK-MB (cardiac) - increases 4
to 6 hours after a heart attack and peaks in 12 to 20 hours; CK-MM (muscles); and
CK-BB (brain tissue)
3) lactate dehydrogenase (see BMP above)

4) lactate dehydrogenase isoenzymes: LDH1 (heart muscle & RBCs); LDH2
(concentrated in WBC); LDH3 (highest in the lung); LDH4 (highest in the kidney,
placenta, & pancreas); and LDH5 (highest in the liver & skeletal muscle)
5) myoglobin: any injury to skeletal muscle will cause a release of this oxygen-
binding protein
6) troponin: a regulatory protein found in striated muscle; troponin levels are
elevated 4 to 8 hours after a heart attack; used to diagnose a heart attack and to
assess degree of damage to heart muscle; 2 different cardiac-specific isoforms:
troponin I and troponin T
C-reactive protein (CRP) Protein produced by the liver; levels rise with inflammation throughout the body
May help determine risk of future cardiac events in clients who have had a heart
attack
Blood draw - no special prep
Lipid profile Client should be NPO 10 to 12 hours prior to the blood draw; water is permitted
Ordered to determine risk of coronary heart disease
Lipid profile typically includes

1) total cholesterol
2) high density lipoprotein cholesterol (HDL) - the "good" cholesterol
3) low density lipoprotein (LDL) - often called the "bad" cholesterol
4) triglycerides
Erythrocyte sedimentation rate Increased when inflammation is present

(ESR) Blood draw - no special prep
Drugs such as dextran, methyldopa, oral contraceptives, penicillamine
procainamide, theophylline and vitamin A can increase ESR; aspirin, cortisone, and
quinine may decrease ESR
Liver enzymes liver enzymes typically includes:

1) aspartate aminotransferase (AST)
2) alkaline phosphatase (ALP)
3) lactic dehydrogenase (LDH)
Prothrombin time (PT, INR) Measures how long (in seconds) it takes for a clot to form in a sample of blood
Prothrombin is one of the conversion factors produced by the liver
Brain natriuretic peptide (BNP) or N- Used to measure production of a hormone found in the left ventricle
terminal pro-BNP Helps diagnose and evaluate risk of future cardiac events, including heart failure,
prognosis, and to monitor therapy
Eosinophil count - absolute Measures the number of eosinophils (white blood cells)
Usually helps to confirm a diagnosis
Immunoglobulin A (IgA) Antibody testing focusing on IgA
Often used in allergy testing (and in the diagnosis of celiac disease)
IgA is usually measured as part of radioallergosorbent testing (RAST) or allergy skin

testing
Immunoglobulin E (IgE) The allergen-specific IgE antibody test

Monitors immunotherapy or to see if a child has outgrown an allergy
The level of IgE does not correlate to the severity of an allergic reaction
IgE is usually measured by radioallergosorbent testing (RAST) or allergy skin testing
Radioallergosorbent testing (RAST) Used to identify measurable allergen-specific antibodies, e.g., IgE
Tests for reaction to certain respiratory and food allergy stimulants
Blood test - no special prep is needed
Scans & X-Rays
Computed tomography Noninvasive, painless process

(CT) Produces two-dimensional images of organs, bones and tissues
Takes about 20 minutes
Occasionally a contrast dye is used
Although very little radiation is used, pregnant women should avoid the test
Used to detect fractures not visible on x-rays
Cisternography (also Used to detect problems with the spine and spinal nerve roots
called intrathecal Usually performed at an imaging center
contrast-enhanced CT A small sample of spinal fluid is removed via lumbar puncture; the sample is mixed with a contrast
scan) Dye and injected back into the spinal sac; CT is used to obtain two-dimensional images
May take up to an hour to complete
Clients may experience some discomfort and/or headache following the test
Magnetic Resonance Used for diagnosing heart problems

Imaging (MRI) Client may feel claustrophobic inside MRI unit
Client must remove all metal prior to test; cannot be used on client with metal implants
Nuclear scan Radioactive material is injected and flow through heart and lungs is charted
Radiographs (X-Rays) Chest x-ray to detect heart and lung physiology
Nuclear lung scanning Useful in diagnosis of conditions such as pulmonary embolus, lung infection or inflammation
Uses minute amounts of short-lived radioactive materials to depict flow of air and blood in lungs
May be done in two stages:

1) lung perfusion scan

2) lung ventilation scan
Positron emission Used when cancer is suspected

tomography (PET) This radiographic imaging technique differentiates metabolic rate differences in malignant and
benign tissues
Pulmonary artery Used to detect narrowing, blockages, vessel malformation

angiography A radiopaque dye is injected into the pulmonary artery and conventional x-rays are used to view
the dye in the lungs
Ultrasound Part of the body is exposed to high-frequency sound waves to produce pictures of inside the body
Conventional ultrasound displays images in thin, flat sections; 3-D formats are now available
Doppler ultrasound evaluates blood velocity as it flows through a blood vessel
A clear water-based gel is applied to the area of the body being studied to help the transducer
make secure contact with the body and eliminate air pockets between the transducer and the
skin
Client may need to be NPO 12 hours before the exam
Cerebrospinal fluid Removal of a small amount of fluid to detect bleeding, diagnose infection, measure intracranial
analysis pressure, or identify other neurological conditions
Appearance of fluid is normally colorless, clear, and almost entirely free of cells
Pressure is typically 50 - 180 mm H2O
Procedure
1) client is position on one side in a ball position with knees close to the chest or to lean forward
while sitting on a table or bed
2) a local anesthetic is injected in the puncture site (client will feel stinging sensation)
3) once the anesthetic has taken effect, about three teaspoons of fluid are removed; the client
may report a sensation of pressure as the needle is inserted
4) takes approximately 45 minutes
Post procedure
1) headache is a common after-effect of the procedure
2) keep client flat to minimize headache
Electroencephalograph Painless test measures brain activity through the skull

y (EEG) Client should avoid caffeine intake and prescription medications that affect the nervous system
prior to the test
A series of cup-like electrodes are attached to the client's scalp
Clients are exposed to a variety of external stimuli, i.e., bright or flashing light or noise, and are
asked to open and close the eyes or to change breathing patterns
Clients usually recline in a chair or on a bed during the test
May take up to an hour; if it is used during sleep, it can take around 3 hours
Electromyography Records electrical activity from the brain and/or spinal column to diagnose nerve and muscle
(EMG) dysfunction and spinal cord disease

Very fine electrodes are inserted into a muscle
Testing usually lasts about an hour
Most clients report it is an uncomfortable procedure
Usually done in conjunction with a nerve conduction velocity test
Electronystagmography A group of tests to diagnose involuntary eye movement, dizziness, and balance disorders
(ENG) Small electrodes are taped around the eyes to record eye movements
Painless
Evoked potentials( or Auditory evoked potentials (also called brain stem auditory evoked response)
evoked response) Painless test used to measure the electrical signals to the brain generated by hearing
Used to assess sensory nerve problems and confirm neurological conditions, e.g., multiple
sclerosis, brain tumors
Two sets of needle electrodes are used

1) one set is used to measure the electrophysiological response to stimuli and is attached to the
client's scalp using conducting paste
2) second set of electrodes is attached to the part of the body being tested
Myelography Involves injection of water or an oil-based dye into the spinal canal; used to diagnose spinal nerve
injury, herniated discs, fractures, back or leg pain and spinal tumors
Usually takes about 30 minutes
Clients may experience some pain during the spinal tap and when the dye is injected and
removed
Clients may experience headache following the spinal tap
Polysomnogram Used to measure brain and body activity during sleep

Performed over one or more nights at a sleep center
Noninvasive and painless
Other
Angiogram Dye injected through a catheter (from groin or arm) that makes coronary arteries visible on x-ray
(cardiac Client should be NPO 8 hours prior to the test
catheterization) Performed with the use of local anesthesia and intravenous sedation
Takes approximately 20 to 30 minutes
If a blockage is found during the procedure, the surgeon may perform a percutaneous coronary
intervention (PCI) to open the blockage
If the groin is used, the client will have a compression bandage on the site and must lie flat on his/her
back for several hours post procedure
Electrocardiogra 12 lead EKG takes about 10 minutes to perform at the beside

m (EKG)
With each beat, an electrical impulse (or wave) travels through the heart:
1) P wave = impulse in the atria, followed by a flat line when the electrical impulse goes to the bottom of
the chambers
2) QRS complex = impulse in the ventricles
3) T wave = represents electrical recovery or return to a resting state for the ventricles
Echocardiogram Used to diagnose and monitor heart failure, differentiating from systolic and diastolic heart failure
Uses sound waves to produce a video image of your heart

1) painless procedure that usually takes less than an hour to perform
2) the client may be asked to change positions or hold his/her breath at times during the procedure
3) sometimes, the client will receive an injection of either saline or dye to better highlight the heart
Image can be used to determine ejection fraction

Usually an EKG is performed at the same time
Other types of echocardiography

1) stress echocardiography: an exercise stress test using echocardiography prior to and after exercise
(see ECST)
2) transesophageal echocardiography (TEE): used for more detailed images of the heart
Exercise cardiac Measures how heart and blood vessels respond to exertion
stress test Client may walk on a treadmill or pedal a stationary bicycle with continuous EKG monitoring
(ECST)
Radionuclide Injection of a radioactive isotope (typically thallium or cardiolite) and then taking nuclear images of the
stress testing client's heart, first during rest and then following exercise
Blockage in a coronary artery results in diminished blood flow, which shows up as a "cold" spot on the
scan
Antinuclear Used to screen for certain autoimmune disorders, such as systemic lupus erythematosus (SLE),
antibodies (ANA) Sjogren's syndrome, scleroderma
Blood draw - no prep needed
May be ordered along with ESR and CRP
ANA tests are performed using different assays (indirect immunofluorescence microscopy or by
enzyme-linked immunosorbent assay-ELISA) and results are reported as a titer
Alkaline Measurement is used in the management of Paget's disease and osteoporosis

phosphatase Blood draw - fasting is preferred but not required
Usually is part of a routine liver panel
Rheumatoid Detects the level of rheumatoid factor (RF) antibody

arthritis (RA) Blood draw - no special prep
factor Related tests: ANA
Bone scans Used to detect fractures not visible on x-rays; also to detect bone infection or metastasis
Involves the use of radioactive substance (technetium-99m-labelled pyrophosphate) that is absorbed by

any healing bone
1) administered IV
2) creates image that can be viewed on computer screen
Dual-energy X- Used for screening for or diagnosing osteoporosis

Ray Low-dose x-rays are used to examine bone density at the lower spine, hip, wrist
Absorptiometry
(DXA)
Arthroscopy Fiberoptic scope is inserted into a joint space

Image is projected on a television screen
Either a local, spinal, or general anesthetic is used, depending on joint location
Tissue is removed for biopsy
Usually same-day surgery
Joint aspiration Synovial fluid is examined (for bacteria or crystals)

and analysis Can be performed in a doctor's office
Usually quick, easy, relatively painless
Minimal risk of joint infection
Nerve conduction Measures the speed impulses travel through a nerve

studies Nerve conduction studies help indicate whether the problem is with the muscles (muscular dystrophy),
the nervous system (stroke) or with the neuromuscular junction (myasthenia gravis)
Clients may be startled by the suddenness of the stimulation, but it is not painful (sensation may be
similar to one received when one touches a doorknob after walking across carpeting)
(Normal Adult) Laboratory Values for Urine Tests
Category Normal Values
Acetone negative
Bacteria none or less than 1000/mL
Bilirubin none
(granular) Casts none to few
Chloride 110 - 250 mEq/24 hour
Color pale yellow
Creatinine clearance men: 90 - 140 mL/min women: 85 - 125 mL/min
Crystals none
Glucose less than 0.5 grams/day
Ketones none/negative
Category Normal Values
Magnesium 7.4 - 12.2 HPF
Odor specific aromatic odor, similar to ammonia
Osmolality 500 - 800 mOsm/L
pH 4.5 - 7.8
Phenylketonuria negative
Potassium 25 - 125 mEq/24 hour
Protein negative
Red blood cells less than 3 cells/high-powered field
Sodium 40 - 220 mEq/24 hour
Specific gravity 1.016 - 1.022
White blood cells less than or equal to 4 cells/high-powered field
Uric Acid 3 - 7 mg/dL (or 250 - 750 mg/24 hour)
Urobilinogen 0.5 - 1 mg/dL
GI SYSTEM
Specific Test Nursing Considerations
Alpha-fetoprotein (AFP) tumor To help diagnose and monitor therapy for some cancers of the liver
markers Related test: CEA
Blood sample - no special prep
Amylase Ordered with lipase test to help diagnose and monitor acute chronic pancreatitis
Ammonia Related test: liver panel (LFT)

Used primarily to investigate the cause of changes in behavior and
consciousness, severe liver disease; used to support diagnosis of Reye's
syndrome
Blood draw - client should not be smoking prior to collection of the sample
Bilirubin To screen for or monitor liver disorders

Related test: liver panel (LFT)
Sampling
1) adult: usually a blood draw - no special prep
2) newborn: heel stick
Complete blood count (CBC) Typically there are no specific pre-testing restrictions, although the client should
avoid eating a fatty meal prior to the test
The standard CBC includes:

1) number of white blood cells (WBC)
2) number of red blood cells (RBC)
3) total amount of hemoglobin content (Hgb)
4) hematocrit (Hct) - fraction of the blood composed of RBCs
5) mean corpuscular volume (MCV) - the size of RBCs
6) mean corpuscular hemoglobin (MCH)
7) mean corpuscular hemoglobin concentration (MCHC)
8) platelet count and volume
Basic metabolic panel (BMP or Standard BMP includes (8 specific tests):

chemistry panel) 1) glucose
2) calcium
3) electrolytes (sodium, potassium, carbon dioxide (CO2), chloride, bicarbonate)
4) kidney tests (blood urea nitrogen [BUN], creatinine)
Blood draw - may be collected on a random basis or drawn after fasting 10 to 12

hours prior to the blood draw
When more information is needed, a complete metabolic panel (CMP) may be
ordered
Electrolytes See also BMP
Enzyme-linked immunosorbent assay An assay that uses an enzyme-bound antibody to detect antigen
(ELISA) Note: also known as enzyme
immunoassay (EIA) The enzyme catalyzes a color reaction when exposed to substrate
1) specific color changes indicate specific diseases
2) the greater the density of color, the more advanced the disease
Most types of biological samples can be used, e.g., plasma, serum, urine, cell
extracts
One of the tests used to diagnose human immunodeficiency virus (HIV)
Glucose See also BMP
Lipase Usually ordered with serum amylase
Liver enzyme tests (formerly called Standard liver tests include:

liver function tests) 1) albumin
2) alkaline phosphatase
3) alanine transaminase (ALT)
4) aspartate aminotransferase (AST)
5) bilirubin
6) gamma-glutamyl transpeptidase (GGT)
Prothrombin time ([PT] also known as Determine how well anticoagulants are working
pro time or international normalized Diagnose bleeding disorders
ratio) Blood draw (or may be fingerstick) - no special prep unless client is taking
anticoagulants, when the specimen should be collected prior to receiving daily
dose
Partial thromboplastin time (aPTT or Used to

APTT) 1) investigate a bleeding or thrombotic episode

2) monitor unfractionate (standard) heparin anticoagulant therapy
Blood draw - no special prep needed
Triglycerides Typically used to assess the risk of developing heart disease

Usually part of a lipid profile
Blood draw after a 9 to 12 hour fast prior to testing; water is permitted but no
alcohol should be consumed for 24 hours before the test
Possibly: carcinoembryonic antigen Used to help determine whether cancer is present in the body and to help in
(CEA), cancer antigen (CA) staging of cancer
White blood cell count differential Used to assess the ability of the body to respond to and eliminate infection
Typically run as part of the CBC
White blood cell components: neutrophils, eosinophils, basophils, lymphocytes,
monocytes
Stool Studies
Stool cultures Primarily used to identify pathogenic bacteria in the GI tract, e.g., salmonella, shigella,
campylobacter, E coli 0157:H7, usually when there is prolonged or severe diarrhea
May also be checked for

1) white blood cells, which may be caused by diseases like inflammatory bowel disease
2) toxins
3) pH
4) O&P (see below)
5) blood (see below)
A fresh stool sample is need - no special prep

Related tests: O&P
Fecal occult blood (also Used to screen for lower GI bleeding, which may indicate colon cancer
known as Guaiac smear Part of routine examination to begin at age 50, unless family history of colon cancer exists
test) Usually involves taking samples of 3 different stool samples on three different days
Clients should avoid

1) eating red meat, turnips, cauliflower, broccoli, bananas, cantaloupe, beets
2) drinking alcohol
3) taking NSAIDs
4) taking vitamin C
Females should not collect a stool sample during their menstrual period and wait until after their
period has stopped
Ova & parasite Used to determine if stool sample contains parasites or ova that are associated with intestinal
infections, e.g., amebiasis, giardiasis
Stool sample - no special prep
Qualitative fecal fat test Check for poor absorption of nutrients by the digestive tract (malabsorption syndrome)
Stool is collected over a 72-hour period and checked for fat and meat fibers
Client may need to stop taking medications such as antacids, antidiarrheal medications, anti-
parasite medications, antibiotics, enemas, laxatives or NSAIDs for 1 to 2 weeks prior to the test
Stool-reducing Used to measure unabsorbed sugars in stool

substances Related test: lactose intolerance
measurement Stool sample needed - no special prep but client may need to avoid certain medications
(antibiotics, antidiarrheals, iron) or treatments prior to the exam
Urine Studies
Urea nitrogen A 24-hour urine sample is needed
Excretion of urea can reflect kidney function

1) low levels usually indicate malnutrition (inadequate protein in diet)
2) high levels may indicate too much protein intake or increased protein breakdown
Osmolality Test for urine concentration (particles/kg water)

Clean-catch (midstream) urine sample is needed
Frequently ordered along with plasma osmolality
Related tests: urine sodium and creatinine
pH A clean-catch (midstream) urine sample is needed
Urine Group of tests on the urine, including potassium, sodium, chloride, calcium
electrolytes 1) potassium
2) sodium
3) chloride
4) calcium
Typically a 24-hour urine test is ordered (although a random urine sample could be used to determine
urine sodium levels)
Urobilinogen Used to detect possible liver disease

Diagnostic tests
Colonoscopy Bowel prep: all solids must be emptied from the GI tract prior to procedure
Procedure
1) usually performed in clinic
2) clients lie on their left side on an examination table
3) light sedative and pain medication administered IV
4) long, flexible, lighted tube inserted into the anus and slowing guided through
rectum into the lower colon; the scope inflates the entire large intestine with
carbon dioxide gas
5) polyps can be removed during procedure and are biopsied
6) takes about 30 to 60 minutes
Recovery
1) client may have cramping or bloating following the procedure
2) client remains in clinic 1 to 2 hours after the procedure; driving is not permitted
for 24 hours after procedure
Endoscopic retrograde Used to diagnose problems in the liver, gallbladder, bile ducts, pancreas
cholangiopancreatography (ERCP) NPO 6 - 8 hours prior to test
Check allergies
Procedure
1) clients lies on left side on examination table
2) medication to numb back of throat prior to swallowing the endoscope; sedative
and pain medication administered
3) air is blown into duodenum and dye is injected into the ducts for visualization
using x-rays
4) treatment can be performed, e.g., removing gallstone
5) takes 30 minutes to 2 hours
Flexible sigmoidoscopy Used to detect inflamed tissue, abnormal growths, and ulcers of the sigmoid colon
and rectum
Unlike colonoscopy, which visualizes the entire colon, this is for the sigmoid colon
only
Preparation
1) usually one or more enemas are performed about 2 hours before the procedure
to remove all solids
2) sometimes the entire GI tract must be emptied; prep will be similar to
colonoscopy
Procedure is similar to colonoscopy
Lower GI series (also called a barium X-rays are used to help diagnose problems of the large intestine
enema) Prep includes emptying all solids from GI tract
Procedure
1) client lies on x-ray table
2) large intestine is filled with barium liquid (client may experience some
discomfort and will feel urge to have BM); leakage is prevented by an inflated
balloon on end of insertion tube
3) the client is asked to change positions several times at first so the large
intestine is evenly coated with barium liquid
4) client must hold still when x-ray pictures (and/or video) is taken
5) when imaging is complete, balloon on the tube is deflated and most of the
barium liquid drains through the tube; the client can expel the remaining barium
liquid in a bed pan or toilet
6) an enema may be used to flush out remaining barium liquid
7) takes about 30 to 60 minutes
After the procedure

1) clients may may experience bloating, fatigue and anal soreness
2) traces of barium liquid may cause stools to be white or light-colored for a few
days
3) may resume regular diet following procedure
4) mild constipation is to be expected
Possible risks include mild constipation, bowel obstruction, electrolyte imbalances,

an allergic reaction to barium, and cell or tissue damage from radiation exposure
Report complaints of severe abdominal pain, rectal bleeding, failure to have a BM

2 days post-procedure, inability to pass gas, fever
Liver biopsy Three types of liver biopsies, all involving the insertion of a needle into the liver to
remove tissue
1) percutaneous
2) transvenous
3) laparoscopic
Medications that affect blood clotting or interact with sedative may be stopped at
least 1 week prior to
Hct and/or Hgb may be drawn prior to procedure to identify any clotting problems;
major risk of liver biopsy is hemorrhage
Upper GI series Used to help diagnose problems of the upper GI tract, including the esophagus,
stomach and duodenum
The upper GI tract must be empty prior to the series; client is NPO 8 hours before
the procedure, with no smoking or chewing gum allowed
Client drinks barium liquid and x-ray pictures (and video) are taken
Clients may experience bloating and nausea and fatigue post-procedure
Possible risks include mild constipation, bowel obstruction, an allergic reaction to
barium, and cell or tissue damage from radiation exposure
Report complaints of severe abdominal pain, rectal bleeding, failure to have a BM
2 days post-procedure, inability to pass gas, fever
Upper GI endoscopy A lighted, flexible endoscope is used to see inside the upper GI tract
Prep includes NPO 4 to 8 hours before the procedure; no smoking or chewing
gum
Client receives local anesthetic to numb throat and IV sedative
Client may feel bloated, nauseated and may have a sore throat following the
procedure
Possible risks include abnormal reaction to sedatives, bleeding from biopsy,
accidental puncture of the upper GI tract
Report swallowing difficulties; increasing throat, chest, and abdominal pain;
vomiting; bloody or very dark stool; and fever
Virtual colonoscopy Used to look for signs of polyps (pre-cancerous growths) and other diseases of
the large intestine
All solids must be emptied from the GI tract, followed by a clear liquid diet 1 to 3
days before procedure
During the procedure, a tube is inserted into the rectum to expand the large
intestine with gas or liquid
This procedure does NOT allow for removal of samples or polyps
Lung
Acid-fast bacillus (AFB) Used to identify causative agent for tuberculosis and monitor the effectiveness of treatment
smear and culture Usually three sputum samples are collected, early in the morning
Client can rinse mouth with plain water (no mouthwash)
The difference between sputum and spit should be emphasized
Collected on three different days
Bronchoscopy Direct visual examination of the larynx and airways using a bronchoscope
Usually used to investigate source of bleeding in the lungs
Is also used to treat certain conditions, i.e., remove secretions, blood, pus and foreign bodies;
to place drugs in specific areas of the lung
Client should be NPO at least 4 hours before the procedure
Usually a sedative is given as well as a local anesthetic
Needle Biopsy This is the next step when a thoracentesis does not uncover the cause of a pleural effusion
The health care provider uses a cutting needle to take a small sample of the pleura for biopsy;
often a CT is used for guidance
Pulmonary Function Measure the lungs' capacity to hold air, move air in and out, to exchange oxygen and carbon
Testing (PFT) dioxide
Includes:
1) lung volume and flow rate measurements
2) flow volume testing
3) muscle strength assessment
4) diffusing capacity measurement
5) maximal voluntary ventilation (MVV)
Thoracentesis Fluid from pleural space is removed for diagnostic testing or to relieve shortness of breath
Procedure:
1) client sits and leans forward
2) local anesthetic is used prior to needle insertion
3) client may feel some pain as the lung fills with air and expands against the chest wall, the
need to cough, light-headed and short of breath
Post-procedure CXR may be ordered if complications are suspected

Skin
Mantoux test (purified protein derivative Used to determine exposure to and infection with Mycobacterium
standard [PPD] or tuberculin skin test ) tuberculosis
Intradermal injection of a small amount of purified protein derivative (PPD)
solution
Readings of a reaction, if any, is done 48 to 72 hours after the injection
A positive result is when the injection site is red and swollen
Positive results may occur in individuals who have received a BCG (Bacille
Calmette-Guerin) vaccination
Radioallergosorbent test (RAST): allergy Used to identify measurable allergen-specific antibodies, e.g., IgE
skin test Tests for reaction to certain respiratory and food allergy stimulants
Blood test - no special prep is needed
Urine
Casts Urinary casts are tiny tube-shaped particles composed of white blood cells, red blood cells, or kidney
cells
No special prep is needed for a clean-catch (midstream) urine specimen
Culture and Used to diagnose a urinary tract infection (UTI)

sensitivity No special prep is needed for a clean-catch (midstream) urine specimen
Urinalysis A physical, chemical, and microscopic examination of urine

No special prep is needed for a clean-catch (midstream) urine specimen
Other
Sleep studies Used to detect sleep apnea

Usually combined with electroencephalogram (EEG) and pulse oximetry
(EEG) + (pulse oximetry) + (sleep study) = polysomnography
Skin/wound Studies
Cultures Used to detect a bacterial wound infection and to determine and isolate the specific type of bacteria
A sterile swab is used to collect cells or pus; an aspiration of fluid from deeper wounds may be indicated
Patch testing Indicated when allergic contact dermatitis (ADC) is suspected and does not respond to treatment
Procedure
1) standard contact allergens are applied to the upper back using adhesive-mounted patches or plastic
(Finn) chambers containing minute amounts of allergen
2) skin under the patches is evaluated 48 to 96 hours after application
Skin scrapings Used to diagnose fungal infections and scabies
Scales are taken from the border of the lesion and placed onto a microscope slide
Skin biopsy Types

1) punch biopsy: a tubular punch (4 mm diameter) is inserted into deep dermal or subcutaneous tissue to
obtain a specimen
2) skin shaving: superficial lesions are biopsied using a skin scalpel or razor blade
Bleeding is controlled by medication, electrodesiccation; large incisions are closed by sutures
Tzanck testing Used to diagnose viral infection, e.g., herpes simplex and herpes zoster (but does not differentiate
between the two)
Performed when active intact vesicles are present
Uses a scraping from the vesicle, which is transferred to a slide, stained, and examined microscopically
Wood's light Used to distinguish hypopigmentation from depigmentation

(black light)
Fluorescence color changes seen under the black light:
1) erythrasma fluoresces bright orange-red
2) tinea capitis (caused by microsporum canis and microsporum audouinii) fluoresces a light, bright green
3) pseudomonas infection may be green fluorescence
ENDOCRINE LAB STUDIES
fasting ACTH (adrenocorticotropic ACTH is used to detect, diagnose and monitor conditions associated with cortisol in
hormone) the body, e.g., Cushing's disease (excess ACTH), Addison's disease, ectopic tumor
producing ACTH, pituitary insufficiency
Clients usually fast the night before and blood sample is usually drawn by or before 8
in the morning
Clients may need to stop taking steroids prior to test
Special handling of blood sample is required
ACTH (cosyntropin) stimulation test Measures how well the adrenal glands respond to ACTH, which is produced in the
(also called test of adrenal reserve) pituitary gland: ACTH stimulates the adrenal gland to release cortisol - it is useful for
determining if there are pituitary tumors, low pituitary function, Addison's disease,
acute adrenal crisis
Blood draw measuring cortisol levels in the blood 60 minutes after an ACTH injection
Client should limit activities prior to test and eat a high-carbohydrate diet 12 to 24
hours before the test; the Client may be asked to fast for 6 hours before the test
aldosterone Aldosterone is a hormone released by the adrenal glands
This test is often used to with other tests to diagnose over- or under-production of
aldosterone:
1)ACTH infusion test
2) Captopril test
3) Intravenous saline infusion test
4) Plasma renin activity (see below)
Blood draw
catecholamines test - blood: Used to diagnose or rule out and/or to evaluate treatment for a pheochromocytoma or
dopamine, norepinephrine and neuroblastoma
epinephrine (adrenalin) Blood draw
Client should avoid stressful situations and foods that can increase catecholamine
levels prior to the test
cortisol Cushing's disease or Addison's disease can affect cortisol levels

Blood sample is usually drawn at 8 in the morning (cortisol levels are highest in the
morning)
Estrogen and synthetic glucocorticoids (predniSONE) can affect cortisol levels
C-peptide suppression test Used to measure the amount of C-peptide in the blood, particularly with a tumor of
the pancreas is suspected
Insulin is injected into a vein to lower the client's blood sugar, which should decrease
the amount of insulin in the blood in clients (unless there is a tumor present)
CRP (C-reactive protein) CPR is produced by the liver; levels rise with inflammation throughout the body
(oral) glucose tolerance test (GTT) Fasting: NPO after midnight or 12 hours prior to the test
For the test:

1) blood draw
2) the client drinks a liquid containing glucose
3) more blood tests, every 30 to 60 minutes
4) the test takes up to 3 hours
Test results may be affected by medications, acute stress and/or vigorous exercise
glucose test - blood Used to diagnose diabetes mellitus, hypo/hyperthyroidism, hypopituitarism, Cushing
syndrome, acute adrenal crisis
May be fasting or random
Fasting: no eating or drinking 6 hours before the test
DHEA-sulfate Used to help evaluate adrenal gland function; increased DHEA-sulfate may indicate
(dehydroepiandrosterone sulfate) adrenal carcinoma, congenital adrenal hyperplasia, polycystic ovary syndrome,
adrenal tumor
Blood draw - no special prep for men; women may need to have the sample collected
a week before or after their menstrual period
electrolytes (calcium, chloride, Blood draw - typically no special prep

magnesium, phosphorus, sodium) Frequently ordered as part of routine physical, by itself or as a component of a basic
metabolic panel or comprehensive panel
estrogens: estrone (E1), estradiol Blood draw - no special prep

(E2), estriol (E3) and others Blood and urine results are not interchangeable
Illnesses such as hypertension, anemia, and impaired liver and kidney function can
affect estrogen levels
Many medications affect estrogen levels
FSH (follicle-stimulating hormone) Used to determine reason for loss of menstrual period, loss of sex drive, infertility
Blood draw
Often ordered with tests for LH, testosterone, estradiol, progesterone
Results can be affected by medications and the radioisotopes used in a nuclear scan
GH (growth hormone) Ordered on those with symptoms of growth hormone abnormalities, e.g., precocious
puberty, Kallman syndrome; and to evaluate pituitary function
Blood sample
1) drawn at timed intervals, or
2) a single sample of blood is drawn following a fast or after a period of strenuous
exercise
Timed intervals testing: either a GH suppression or stimulation test is done

1) suppression: client drinks standard glucose solution; blood samples are then
drawn at timed intervals
2) stimulation: the client is given an IV solution of insulin or arginine; blood samples
are then drawn at timed intervals
hCG (human chorionic hCG levels rise rapidly during the first trimester of pregnancy and then slightly
gonadotropin) decline; increased levels may indicate cancer (in both males and females), more than
one fetus; decreased levels may indicate fetal death and miscarriage, ectopic
pregnancy
HbA1c Measures the amount of glycated hemoglobin in the blood

Provides a good estimate of how well diabetes has been managed the past 2 to 3
months
No special prep is needed
HbA1c of 6% or less is normal; diabetics should try to keep their HbA1c at or below
7%
IGF-1 (insulin-like growth factor - 1 Used to help diagnose the cause of growth abnormalities, e.g., slowed growth rate
or somatomedin G) and short stature, and to evaluate pituitary function; it is not diagnostic of GH
deficiency
Related tests: GH, glucose, glucose tolerance test
May be ordered with other pituitary hormone tests (ACTH)
LH (luteinizing hormone) Used to help determine the reason for loss of menstrual period, loss of sex drive,
infertility
Blood draw
For women of childbearing age, the test may need to be done on mid-way through
the menstrual cycle (when LH levels peak)
plasma aldosterone concentration This adrenal hormone helps regulate blood pressure; abnormal levels may indicate
(PAC) secondary hyperaldosteronism (from heart or kidney disease); congenital adrenal
hyperplasia
The client will be asked to remain upright or lying down for a period of time (usually
15 to 30 minutes) prior to the blood draw
Usually combined with ACTH infusion test, plasma renin activity, intravenous saline
infusion test
Factors that can affect aldosterone measurements: stress, dietary salt intake,
strenuous exercise and medications
progesterone Used to diagnose infertility, ectopic pregnancy, cancer, multiple pregnancies

Multiple (serial) measurements are taken to diagnose infertility
Other associated tests: FSH, LH, hCG, and thyroid tests
Taking estrogen and progesterone supplements can affect results
plasma renin activity (PRA) Renin is a protein (enzyme); it plays a role in the release of aldosterone; abnormal
levels are associated with Addison's disease, cirrhosis, dehydration, hypokalemia,
malignant hypertension, renin-producing renal tumors
Blood draw
Client should eat a normal, balanced diet with low-sodium content (about 3 gm/day)
for 3 days before the test
Renin measurements are affected by salt intake, pregnancy, time of day, and body
position)
Aldosterone test may also be ordered if the client has essential hypertension
prolactin Usually measured to check for pituitary tumors and the cause of impotence, infertility,
irregular or absent menstrual periods, breast milk
Production not related to childbirth
PTH (parathyroid hormone) Parathyroid is used to diagnose the reason for low or high calcium levels and to help
distinguish between parathyroid-related and non-parathyroid-related causes
Blood draw
PTH is composed of 84 amino acids (sometimes called PTH 1 - 84); tests for PTH
may measure one or more of the fragments
PTH levels vary during the day, peaking at about 2 am; specimens are usually drawn
around 8 in the morning
Medications affect PTH levels: steroids, isoniazid, lithium, rifampin, anticonvulsants,
phosphates
Related tests: calcium, phosphate, magnesium
testosterone Used to diagnose several conditions in boys (delayed or precocious puberty); men
(change in sex drive, infertility, tumors, erectile dysfunction); and women (hirsutism,
infertility, decreased sex drive)
In males, the test is ordered with FSH and LH
thyroid levels: TSH, T3 TSH is produced by the pituitary gland and tells the thyroid gland to make and
(triiodothyronine); T4 (thyroxine) release the hormones thyroxine and triiodothyronine TSH can be used to diagnose
and/or Free T4 (FT4) or Free T4 hyper/hypothyroidism, TSH deficiency, use of certain medications
index (FT4I) T3 can be used to diagnose hyper/hypothyroidism (Hashimoto's disease), starvation
T4 and Free T4 can also be used to diagnose hyper/hypothyroidism, early
Hashimoto's disease, Graves disease, tumors, goiters, malnutrition (or fasting)
Some medications can affect the tests; the health care provider may discontinue the
medications prior to the test
Pregnancy and liver disease will falsely raise T3 levels - the free T3 level or T3RU
should be ordered if client is pregnant
Urine
aldosterone Requires a 24-hour urine sample

This may be preferred by health care providers since plasma aldosterone levels vary
throughout the day and are affected by position
catecholamines (see blood Used to diagnose or assess treatment for neuroblastoma and pheochromocytoma (an adrenal
test above) gland tumor)
Urine sample
Blood and urine results are not interchangeable
glucose test - urine Glucose is not normally found in the urine; greater than normal levels may indicate diabetes
mellitus, pregnancy
Urine sample (clean catch)
Blood and urine results are not interchangeable
osmolality To determine concentration of particles in urine (particles/kg water)

Urine sample (clean catch)
Drugs that interfere with specific gravity measurements include dextran and sucrose
Client should eat a normal, balanced diet for several days before the test
17-hydroxycorticosteroids An inactive product formed when the liver and other body tissues break down the steroid
(17-OHCS) hormone, cortisol
Greater-than-normal levels may indicate Cushing syndrome; lower-than-normal levels may

indicate adrenal insufficiency or hypopituitarism
24-hour urine sample is needed
17-beta hydroxysteroid Used to detect congenital adrenal hyperplasia (CAH), a group of inherited disorders caused by
specific gene mutations, resulting in ambiguous genitalia, virilization, acne, or pubic hair
Ordered as part of a newborn screen
May be used to rule out CAH in older people, particularly girls and women with symptoms
such as hirsutism and irregular periods
Scans
Computed Noninvasive, painless process

tomography (CT) Produces two-dimensional images of endocrine glands
Takes about 20 minutes
Occasionally a contrast dye is used
Although very little radiation is used, pregnant women should avoid the test
Magnetic Used for imaging thyroid and other glands

resonance imaging Client may feel claustrophobic inside MRI unit
(MRI) Client must remove all metal prior to test; cannot be used on client with metal implants
Radioisotope scans Used to detect fractures not visible on x-rays; also to detect bone infection or metastasis
Involves the use of radioactive substance

1) typically administered intravenously
2) flow of radioactive substance through the blood stream creates an image that can be viewed on
computer screen
Example of specific test: radioactive iodine uptake (RAIU) tests for thyroid function, measuring how
much radioactive iodine is taken up the the thyroid gland in a given time period
Radioactive iodine Tests for thyroid function, measuring how much radioactive iodine is taken up the the thyroid gland in
uptake (RAIU) a given time period
Client swallows a liquid or capsule containing radioactive iodine and 6 to 24 hours later a gamma
probe is placed over the thyroid gland
Test takes about 30 minutes
Ultrasound Part of the body is exposed to high-frequency sound waves to produce pictures of inside the body
1) conventional ultrasound displays images in thin, flat sections; 3-D formats are now available
2) doppler ultrasound evaluates blood velocity as it flows through a blood vessel
A clear water-based gel is applied to the area of the body being studied to help the transducer make
secure contact with the body and eliminate air pockets between the transducer and the skin
Client may need to be NPO 12 hours before the exam

Other
Fluid deprivation Used to help diagnose and distinguish the type of diabetes insipidus
study Sometimes serum ADH is done with this test
Karyotyping A test used to examine chromosomes in a sample of cells

Identifies genetic abnormalities
Almost any tissue can be used, including: amniotic fluid (amniocentesis); bone marrow (biopsy); blood
(venipuncture)

Diagnostic Test Nursing Considerations: Blood (Serum) Studies

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Diagnostic Test Nursing Considerations: Blood (Serum) Studies

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Blood (Serum) Studies

Diagnostic Test Nursing Considerations

Standard ABG includes:

Standard CMP includes a group of 14 tests: albumin, alkaline phosphatase, alanine

Chemistry Panel Part of either the CMP or BMP (see above)

Standard chem profile includes:

Standard CBC includes:

(Serum) Enzymes/Cardiac Markers Serum enzymes typically includes:

3) lactate dehydrogenase (see BMP above)

Lipid profile typically includes

Erythrocyte sedimentation rate Increased when inflammation is present

Liver enzymes liver enzymes typically includes:

Usually helps to confirm a diagnosis

Immunoglobulin A (IgA) Antibody testing focusing on IgA

Often used in allergy testing (and in the diagnosis of celiac disease)

IgA is usually measured as part of radioallergosorbent testing (RAST) or allergy skin

Immunoglobulin E (IgE) The allergen-specific IgE antibody test

Monitors immunotherapy or to see if a child has outgrown an allergy

IgE is usually measured by radioallergosorbent testing (RAST) or allergy skin testing

Tests for reaction to certain respiratory and food allergy stimulants

Blood test - no special prep is needed

Scans & X-Rays

Diagnostic Test Nursing Considerations

Computed tomography Noninvasive, painless process

Magnetic Resonance Used for diagnosing heart problems

Radiographs (X-Rays) Chest x-ray to detect heart and lung physiology

May be done in two stages:

1) lung perfusion scan

Positron emission Used when cancer is suspected

Pulmonary artery Used to detect narrowing, blockages, vessel malformation

Electroencephalograph Painless test measures brain activity through the skull

(EMG) dysfunction and spinal cord disease

Two sets of needle electrodes are used

Polysomnogram Used to measure brain and body activity during sleep

Diagnostic Test Nursing Considerations

Electrocardiogra 12 lead EKG takes about 10 minutes to perform at the beside

Uses sound waves to produce a video image of your heart

Image can be used to determine ejection fraction

Other types of echocardiography

Alkaline Measurement is used in the management of Paget's disease and osteoporosis

Rheumatoid Detects the level of rheumatoid factor (RF) antibody

Involves the use of radioactive substance (technetium-99m-labelled pyrophosphate) that is absorbed by

Dual-energy X- Used for screening for or diagnosing osteoporosis

Arthroscopy Fiberoptic scope is inserted into a joint space

Joint aspiration Synovial fluid is examined (for bacteria or crystals)

Nerve conduction Measures the speed impulses travel through a nerve

(Normal Adult) Laboratory Values for Urine Tests

Category Normal Values

Bacteria none or less than 1000/mL

(granular) Casts none to few

Chloride 110 - 250 mEq/24 hour

Color pale yellow

Creatinine clearance men: 90 - 140 mL/min women: 85 - 125 mL/min

Glucose less than 0.5 grams/day

Magnesium 7.4 - 12.2 HPF

Odor specific aromatic odor, similar to ammonia

Osmolality 500 - 800 mOsm/L

Potassium 25 - 125 mEq/24 hour

Red blood cells less than 3 cells/high-powered field

Sodium 40 - 220 mEq/24 hour

Specific gravity 1.016 - 1.022

White blood cells less than or equal to 4 cells/high-powered field

Uric Acid 3 - 7 mg/dL (or 250 - 750 mg/24 hour)