Diagnostic Tests

Overview of noninvasive and invasive diagnostic testing

Diagnostic tests are either noninvasive or invasive. Noninvasive means the body is not entered with any type of instrument. The skin and other body tissues, organs, and cavities remain intact.

Invasive means accessing the bodys tissue, organ, or cavity through some type of instrumentation procedure.

Preparing a Client for Diagnostic Testing

Diagnostic testing is a critical element of assessment. The nurse plays a key role in scheduling and preparing the client for diagnostic testing. The emphasis of pretest is on appropriate test selection, proper patient preparation, individualized patient education, and emotional support (Fischbach & Dunning, 2008, p. 9).

Preparing a Client for Diagnostic Testing

Other key nursing measures to ensure client safety are to establish baseline vital signs, identify known allergies, and assess the effectiveness of teaching. The nurse has additional responsibilities:

Preparing the room (e.g., adequate lighting) Gathering and charging for supplies used during the procedure Testing the equipment to ensure it is functional and safe Securing proper containers for specimen collection

Care of the Client during Diagnostic Testing

Although the care of the client needs to be individualized for a specific procedure. Standard Precautions are initiated when exposure to body fluids presents a threat to the safety of the caregiver. Protective barriers, such as gloves and a gown, should be used during invasive procedures. The nurse is responsible for labeling any specimen with the clients name, room number (hospitalized clients), date, time, and source of the specimen.

Care of the Client after Diagnostic Testing

Nursing care post-procedure is directed toward restoring the clients pre-diagnostic level of functioning. The client is monitored closely for signs of respiratory distress and bleeding. Some diagnostic procedures require that the vital signs be measured every 15 minutes for the first hour, then gradually decreased in frequency until the client is stable

LABORATORY TESTS

Common laboratory studies are usually simple measurements to determine how much or how many analytes (a substance dissolved in a solution, also called a solute) are present in a specimen.

Purpose of Lab Tests

Laboratory tests are ordered by practioner to:

Detect and quantify the risk of future disease Establish and exclude diagnoses Assess the severity of the disease process and determine the prognosis Guide the selection of interventions Monitor the progress of the disorder Monitor the effectiveness of the treatment

SPECIMEN COLLECTION

The scheduling and sequencing of laboratory tests is an important function of the nurse. All tests requiring Venipuncture. Venipuncture, the puncturing of a vein with a needle to aspirate blood. Venipuncture is an invasive procedure can be performed by various members of the health care team. Laboratories employ a phlebotomist, an individual who performs venipuncture, to collect blood specimens.

Arterial Puncture

Arterial blood samples are drawn from a peripheral artery (e.g., radial or femoral) or from an arterial line. The arterial blood sample is collected in a 5-mL heparinized syringe. The syringe is then rotated to mix the blood with the heparin to prevent clotting. Assessment of arterial blood gases (ABG) reveals the ability of the lungs to exchange gases by measuring the partial pressures of oxygen (PO2) and carbon dioxide (PCO2) and evaluates the pH of arterial blood.

Urine Collection

Urine can be collected for various studies. The type of testing determines the method of collection. The different methods of urine collection are:

Random collection (Routine analysis) Timed collection Collection from a closed urinary drainage system Clean-voided specimen

Urine Collection container

RANDOM COLLECTION The prescribing practitioner usually writes the order for a UA (routine urine analysis), which is also called a random collection. It can be collected at any time using a clean cup. The urine does not have to be collected in a sterile container. TIMED COLLECTION Timed collection is done over a 24-hour period. The urine is collected in a plastic gallon container that contains preservative

COLLECTION FROM A CLOSED DRAINAGE SYSTEM A sterile specimen can be collected from a client with an indwelling Foley catheter with a closed drainage system. A sterile specimen is used to culture the urine. The urine specimen should not be obtained from the drainage bag. CLEAN-VOIDED SPECIMEN Clean-voided (clean-catch, or midstream) specimen collection is done to secure a specimen uncontaminated by skin flora. A clean-voided specimen should be obtained on first voiding in the morning.

Stool Collection

Explain to the client why the stool specimen is being collected. Instruct the client to defecate into a clean bedpan or container, discarding tissue into the toilet.

To determine the presence of occult (hidden) blood. To detect the presence of ova and parasites. To detect the presence of bacteria or viruses.

Sputum Specimens

Sputum is the mucous secretion from the lungs, bronchi, and trachea. It is important to differentiate it from saliva. Sputum specimens are usually collected for one or more of the following reasons:

For C & S to identify a specific microorganism and its drug sensitivities. For cytology to identify the origin, structure, function, and pathology of cells. For acid-fast bacillus (AFB), which also requires serial collection, often for 3 consecutive days. To assess the effectiveness of therapy

Culture and Sensitivity Tests

Culture refers to the growing of microorganisms to identify the pathogen. Culture and sensitivity (C&S) tests are performed to identify both the nature of the invading organisms and their susceptibility to commonly used antibiotics.

Blood Culture Swab (Throat) Culture Sputum Culture Urine Culture Stool Culture Wound Culture