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Normal values for CBC RBC (M) 4.7-6.1/ (F) 4.2-5.

.4 Hgb (M) 14-18/ (F) 12-16 mg/dL Hct (M) 42-52/ (F) 33-47 % WBC 5-10,000 cells/cubic cm Differential count Neutrophils- 55- 70% Lymphocytes- 20-40% Monocytes- 2-5% Eosinophils- 1-4% Platelets 150,000-400,000 Increased WBC (Leukocytosis)- More than 10, 000 Increased Neutrophils-ACUTE bacterial infection Increased Lymphocytes-CHRONIC bacterial infection VIRAL infection Increased Eosinophils-PARASITIC infection Coagulation studies PT 12-16 seconds PTT 60-70 seconds aPTT 30-40 seconds

Enzymes/acids Uric acid SGOT/SGPT Rheumatoid factor Anti-DNA antibody CK-MB, LDH and Troponin

Purpose Gout detection Liver function test For Rheumatoid arthritis SLE diagnosis Identifies Cardiac damage or muscle damage

Purpose Measures the effectiveness of Warfarin

Serum Electrolytes Specimen: venous blood Pretest/Intratest/Post-test- same Commonly ordered: Sodium- 135-145 mEq/L Potassium- 3.5-5.0 mEq/L Chloride- 95-105 mEq/L Magnesium- 1.3 to 2.1 mEq/L Calcium- 8 to 10 mg/dL The BEST single screening test for coagulation disorders

Same as PTT, measures effectiveness of HEPARIN (more specific than PTT)

Bleeding time 1-9 minutes Blood Chemistry Specimen: Venous blood, serum Pretest/Intratrest/Post-test-same Examined are enzymes, hormones, lipid profile BUN , Creatinine, etc Place patient on NPO for 8 h *Creatinine is produced relatively constant by muscles, excreted by the kidneys and is the RELIABLE Reflection of Renal Status

Measures Platelet function

Normal values for : Creatinine: 0.7 to 1.4 mg/dL BUN: 10-20 mg/dL Creatinine clearance: 1.67 to 2.5 mL/s Serum uric acid: 2.5 to 8 mg/dL Blood osmolality= 250 to 290 mOsm/L

Diabetes Mellitus DIAGNOSTIC CRITERIA FBS equal to or greater than 126 mg/dL (7.0mmol/L) (Normal 8 hour FBS- 80-109 mg/dL)

DIAGNOSTIC CRITERIA OGTT value 1 and 2 hours post-prandial equal to or greater than 200 mg/dL Normal OGTT 1 and 2 hours post-prandial- is 140 mg/dL DIAGNOSTIC CRITERIA RBS of equal to or greater than 200 mg/dL PLUS the 3 Ps DIAGNOSTIC CRITERIA Glycosylated hemoglobin (HbA1c) is a monitoring test to assess the adherence to diabetic medication Arterial Blood Gases Specimen: arterial blood Pretest: obtain syringe with heparin, rubber stopper, container with ice Intratest: usual site-radial artery, perform Allens test Post-test: Apply direct pressure on site for 5-10 minutes, send specimen with occluded needle on ice



ESR (erythrocyte sedimentation rate) 10-20 mm/hour

Measures the rate at which the RBCs settle out of the anti-coagulated blood Elevates in inflammation auto immune diseases To detect hyperlipidemia

Blood lipids Cholesterol= 150200 mg/dL Triglycerides= 140200 mg/dL

Normal ABG values pH 7.35-7.45 pCO2 35-45 mmHg paO2 80-100 mmHg HCO3 22-26 mEq/L Base excess -2 to +2 O2 sat 95-98% Urine Analysis Specimens Clean-voided urine for routine urinalysis Clean-catch or midstream urine for urine culture Suprapubic and catheterized urine for urine culture Routine Urinalysis Specimen: Clean voided Pretest: give clean vial and instruct to void directly into the specimen bottle Intratest: Allow a 10 ml collection Post-test: prompt delivery to laboratory *First voided urine in a.m. is highly concentrated, more uniform concentration and with more acidic pH Urine Culture: Normal is <100,000 Specimen: clean catch, midstream or catheterized urine Pretest: Instruct to wash and dry genitalia/perineum with soap and water. (M)- circular motion, (F)-front to back direction Intratest: Midstream urine, 30-60 ml Post-test: Cap and label, prompt delivery and documentation Special Urine Collection Infants Special urine bag Or cut a hole of the diaper (front for the boy, middle for the girl) pulling out through the hole the special bag Children May use potty chair or bedpan Give another vial to play with, allow parent to assist Elderly Assistance may be required

Steatorrhea Ova/Parasites Bacteria Viruses General Nursing consideration for stool collection Pretest: Determine purpose/s, obtain gloves, container and tongue blade Intratest: Instruct to defecate in clean bed pan Void before collection Do not discard tissue in bedpan Obtain 2.5 (1 inch) formed stool 15-30 ml of liquid stool Post-test: prompt delivery Occult Blood: Guaiac Test Detect the presence of enzyme: Peroxidase (+) blue color positive guaiac Restrict intake of red meats, some medications and Vitamin C for 3-7 days FALSE (+): red meat, raw fruits and vegetables especially radish, turnip, melon and horseradish; meds like aspirin, NSAIDS, iron and anticoagulants FALSE (-): Vitamin C, ingested 250 mg per day from any source Sputum Analysis For Culture and sensitivity For sputum cytology For sputum AFB For monitoring of the effectiveness of therapy Sputum examination Pretest: Morning specimen is collected Intratest: Mouthwash with plain water Deeply inhale x 2 then cough Wear gloves in collecting specimen Expectorate needed- 1-2 Tbsp or 15-30 ml Post-test: oral care and prompt delivery to lab

Timed-urine collection Collection of ALL urine voided over a specified time Refrigerated or with preservative Pretest: Specimen container with preservative, receptacle for collection, a post sign Intratest: At the start of collection, have patient void and discard the urine At the end of collection period, instruct to completely void and save the urine Post test: Documentation

VISUALIZATION PROCEDURES Invasive procedures are direct methods and need CONSENT Non-invasive procedures are indirect methods and may need written consent in some instances Visualization procedures They can be: Radiographic procedures Scopic procedures GIT Visualization Barium Swallow- UGIS Pretest: written consent, NPO the night Intratest: administer barium orally, then followed by X-ray Post-test: Laxative for constipation, increased fluids, assess for intestinal obstruction , warn that stool is light colored Barium Enema- LGIS Pretest: Informed consent, NPO the night, Enema the morning Intratest: Position on LEFT side, administer enema, then X-ray follow Post-test: Cleansing enema , Laxative for constipation, assess for intestinal obstruction Esophagogastroscopy Pretest: Informed consent, NPO for 8 hours, warn that gag reflex is abolished Intratest: Position on LEFT side during scope insertion Post-test: NPO until gag returns. Monitor for complications Anoscopy, proctoscopy, proctosigmoidoscopy, colonoscopy

Catheter specimen Sterile urine Insert needle of the syringe through a drainage port Only done with the rubber catheter not the plastic, silastic or silicone catheter. Intratest: Clamp catheter x 30 mins if no urine Wipe area where needle will be inserted 30-45 angle, 3 ml for culture Post-test : Unclamp catheter after collection

Stool Analysis Occult Blood GUAIAC test

Pretest: Consent, NPO, and enema administration the morning Intratest: Position on the LEFT side during scope insertion Post-test: Monitor for complications

Gallbladder Oral cholescystogram PTC ERCP Ultrasound IV Cholecystogram X-ray visualization of the gallbladder after administration of contrast media intravenously Pre-test: Allergy to iodine and sea-foods Intra-test: ensure patent IV line Post-test: increase fluid intake to flush out the dye, Assess for delayed hypersensitivity reaction to the dye like chills and N/V Oral Cholecystogram X-ray visualization of the gallbladder after administration of contrast media Done 10 hours after ingestion of contrast tablets Done to determine the patency of biliary duct Endoscopic retrograde cholangiopancreatography

Pretest: Consent, NPO, client teaching, anti-anxiety drugs Intratest: gag reflex is abolished, instruct to remain still during procedure, FOWLER or SUPINE Post-test: NPO until gag reflex returns, monitor patient for complication like perforation/bleed Pulmonary function test Test to determine lung volumes and capacities Cardiac Visualization Invasive: angiography. Cardiac catheterization Non-invasive: ECG, Echocardiography, Stress ECG

ECHOCARDIOGRAM Non-invasive test that studies the structural and functional changes of the heart with the use of ultrasound No special preparation is needed Angiography Pretest: informed consent, allergy to dyes, seafood and iodine Intratest: Monitor VS Post-test: maintain pressure dressing over puncture site Immobilize for 6 hours Cardiac Catheterization Introduction of catheter into heart chambers Pretest: informed consent, allergy to dyes, seafood and iodine, NPO 8-12 hours Intra-test: Empty bladder, Monitor VS, explain palpitations Post-test: maintain pressure dressing over puncture site Immobilize for 6-8 hours with extremity straight

Examination where a flexible endoscope is inserted into the mouth and via the common bile duct and pancreatic duct to visualize the structures Iodinated dye can also be injected after for the x-ray procedure Pre-test: consent, NPO for 12 hours, Allergy to sea-foods, Atropine sulfate Intra-test: Gag reflex is abolished, Position on LEFT side Post-test: NPO until gag reflex returns, Position side lying and monitor for perforation and hemorrhage Percutaneous Transhepatic Cholangiogram Under fluoroscopy, the bile duct is entered percutaneously and injected with a dye to observe filling of hepatic and biliary ducts

Myelography Radiographic examination of the spinal column and sub-arachnoid space to help diagnose back pain causes Pre-test: Consent, NPO, allergy to seafoods Intra-test: like LT Post-test: supine for 12 hours Arthroscopy Insertion of fiber optic scope into the joint to visualize it, perform biopsy Performed under OR condition After care: Dressing over the puncture site for 24 hours to prevent bleeding Limit activity for several days (7 usually)

Ultrasound of the liver, gallbladder and pancreas Consent MAY be needed Place patient on NPO!!! Laxative may be given to decrease the bowel gas Urinary Visualization Non-invasive: KUB, IVP, Ultrasound Pretest: Elicit allergy to iodine and seafood, NPO after midnight Intra-test: IV iodinated Dye is administered then X-ray is taken Post-test: Increase fluids to flush the dye. Documentation, VS monitoring Urinary Visualization Invasive: retrograde cystourethrogram Pretest: Elicit allergy to iodine and seafood Intra-test: catheter is inserted with dye is administered then X-ray is taken as patient voids Post-test: Increase fluids to flush the dye. Documentation, VS monitoring Pulmonary visualization Invasive: Bronchoscopy, laryngoscopy Non-invasive: CXR and Scan Bronchoscopy Purpose: Diagnostic and therapeutic

Arthrogram X-ray visualization of the joint after introduction of contrast medium Pre-test: consent, allergy to seafoods Post-test: Dressing over puncture site and limit joint activity

Electromyelography Records the electrical activity in muscles at rest and during involuntary and electrical stimulation Detects disorders such as MG, MS and Parkinsons Explain the use of electrode inserted into the muscles Mild discomfort may be experienced About 45 minutes for one muscle

MRI Painless, non-invasive, no radiation Creates a magnetic field Contraindications:

(+) pacemaker (+) metal prosthesis Client teaching: Lie still during the procedure for 60-90 minutes Earplugs to reduce noise discomfort Claustrophobia No radiation


Position post-procedure: RIGHT side-lying with folded towel/pillow under biopsy site for 4-6 hours Papanicolau Smear Done as screening test for cervical cancer, for culture Pre-test: no coitus for 2-3 days, no menstrual bleeding Intra-test: Lithotomy, speculum with water for lubrication, specimen obtained for cervix and vagina Post-test: monitor for bleeding

ASPIRATION AND BIOSPY Aspiration: withdrawal of fluid Biopsy: removal and exam of tissue Invasive procedure needs INFORMED CONSENT Lumbar Puncture Withdrawal of CSF from the arachnoid space Purpose: diagnostic and therapeutic To obtain specimen, relieve pressure and inject medication Pretest: consent, empty bladder Intra-test: Site used-between L4/L5 Position- flexion of the trunk Post-test: Flat on bed (8-12 hours) Offer fluids to 3 Liters Oral analgesic for headache Monitor bleeding, swelling and changes in neurologic status Abdominal Paracentesis Withdrawal of fluid from the peritoneal space Purpose: diagnostic and therapeutic Pretest: consent, empty bladder Position: sitting Site: midway between the umbilicus and symphysis Intratest: 1,500 ml maximum amount collected at one time, Monitor VS Post-test: monitor VS, bleeding complication Measure abdominal girth and weight Thoracentesis Removal of fluid from the pleural space Purpose: Diagnostic and therapeutic Pretest: Consent, teach to avoid coughing Position: sitting with arms above head Intra-test: Support and observation Post-test: Assess VS Position Post-procedure: lie on the UNAFFECTED SIDE with head elevated 30 x 30 minutes to facilitate expansion of the affected lungs Bone marrow Biopsy Removal of specimen of bone marrow Purpose: diagnostic Pretest: consent, teach that procedure is painful Site: POSTERIOR SUPERIOR ILIAC CREST (adult); PROXIMAL TIBIA (pedia) Position: prone or lateral Intratest: Monitor, maintain pressure dressing over punctured site X 10 mins Post-test: Asses for discomfort, administer prescribed pain meds Liver Biopsy Liver tissue obtained for diagnostic purpose Pretest: consent, administer Vitamin K, monitor bleeding parameters, NPO 2 hours before procedure Position: Supine or semi-fowlers with upper right quadrant of abdomen exposed Intra-test: Monitor VS Take few deep inhalation and exhalation and hold final breath in exhalation x 10 seconds as needle is injected Post-test: monitor VS, bleeding

The CVP is the pressure within the SVC Reflects the pressure under which blood is returned to the SVC and right atrium CVP Normal CVP is 0 to 8 mmHg/ 4-10 cm H2O Measuring CVP 1. Position the client supine with bed elevated at 45 degrees (CBQ) 2. Position the zero point of the CVP line at the level of the right atrium. Usually this is at the MAL, 4th ICS 3. Instruct the client to be relaxed and avoid coughing and straining. Tubes Levine Salem Sump tube Gastrostomy tube Jejunostomy tube Drainage

Penrose Drain Hemovac Pleuravac Jackson-Pratt DRE Position: Left Lateral or Sims position with upper leg acutely flexed. Females can also be examined in lithotomy Ask client to BEAR DOWN To accentuate rectal fissure, prolapse ,polyps To relax the anal sphincter

Snellens Chart: test for visual acuity 20 ft or 6 m distance 3 readings: L, R and Both eyes Report: 20/ xxx Numerator: denotes the distance from the chart Denominator denotes the distance from which the normal eye can read the chart 20/60: the person can see at 20 feet, what a normal person can see at 60 feet. Webers test Test for lateralization and bone conduction Tuning fork is placed on top of head NORMAL: sound is heard in BOTH ears, localized at the center of the head: WEBER NEGATIVE Sound is heard BETTER in the affected ear: Bone conductive hearing loss Sound is heard only or better on the NORMAL ear: Sensorineural heating loss ABNORMAL: WEBER POSITIVE Rinnes Test Test for AIR and BONE conduction Tuning fork is initially placed on the mastoid process until no vibration is heard Tuning fork is now placed in front of the ear until sound disappears

Air conduction is LONGER than bone conduction Normal is POSITIVE Rinnes CONDUCTIVE HEARING LOSS: Bone conduction is GREATER than or equal to the AIR conduction Abnormal is NEGATIVE RINNEs SENSORINEURAL HEARING LOSS: No bone conduction and air conduction vibration can be assessed NEGATIVE RINNEs