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Diagnostic Testing-Student Review

Foundations (Nova Southeastern University)

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NUR 3130 Diagnostic Testing Class Activity---Student Review Guide

Diagnostic Testing
 General questions on preparation and assessment post procedure
 What is invasive vs non-invasive testing?
 Stool guaiac/fecal occult blood test (FOBT)
 Bronchoscopy
 Blood cultures
 Wound culture
 Urine culture and sensitivity
 Lumbar puncture
 Liver biopsy
 Bone marrow biopsy
 Throat culture

Nurse’s Role and Responsibilities

 Purpose of procedure: Important steps in conducting procedure
 Pre procedure: assessment, teaching/what will occur during procedure, preparation required, consent if required
 During procedure (assisting person performing procedure if not RN, positioning if relevant), special instructions
 Post procedure: assessment and monitoring, positioning if relevant, teaching, discharge instructions if relevant

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NUR 3130 Diagnostic Testing Class Activity---Student Review Guide

Procedure Purpose Pre-Procedure During Procedure Post-Procedure

Stool guaiac Used to detect blood in -Assess the client -Have client bring in stool - A positive result from
FOBT 1 the stool -Educate the client on sample from home either the gFOBT or the
Initial screening: what will be done -Would need 3 consecutive FIT requires follow-up
-GI Bleeding -No laxatives, enemas, or stool samples for best testing, such as
-Cancer suppositories for 3 days determining colon cancer sigmoidoscopy or
In conditions such as: -Food: avoid eating red Collecting the stool: colonoscopy
-Ulcer disease meat, this could give a 1. Void first
-IBD false positive 2. Defecate into the required
-Intestinal polyps Postpone: container
- Women that are 3. DO NOT put toilet tissue
menstruating, postpone in the bedpan
until after cycle is finished4. Avoid contact with soap,
- Bleeding hemorrhoids or detergent, and disinfection
hematuria are present 5. Notify the nurse once
-Nose bleed or throat specimen is available
bleed Testing the stool:
1. Applying a stool
specimen to the test paper
2. Adding developing
solution to the back side of
the paper according to
directions
3. Blue color indicating
positive results
Stool guaiac Used to detect occult (pre pt) don’t use 1. Apply stool Follow lab instructions for
FOBT 2 blood in the stool. Used laxatives, enemas, or specimen to test sending stools to lab.
for initial screening for suppositories for 3 days. if paper
disorders such as cancers, a woman is menstruating 2. Add solution to the If positive, from gFOBT
GI bleeding, Ulcer post pone 3 days after back side of the test or FOBT requires follow
diseases, IBD, and menstruation. Postpone if paper up testing such as
intestinal polyps hematuria or bleeding Blue discoloration indicates sigmoidoscopy or

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NUR 3130 Diagnostic Testing Class Activity---Student Review Guide

3 consecutive samples hemorrhoids are present positive results. colonoscopy.

should be collected over and if pt. has had recent
several days to provide nose of throat bleeding.
most effective screening
for colon cancer. Sample Inform pt. abt the
can be collected at home procedure and what to
and be sent to HCP office expect.

Guaiac test is a chemical Answer any questions that

test to find presence of the pt. has about the
peroxidase in Hb procedure
molecules when blood is
present in the stool
sample. Positive test
reports of bleeding in GI
tract. Certain drugs can
give a false reading
Bronchoscopy -Direct examination of -Local anesthetic spray for -Sitting or supine position -Assess for bleeding
1 the larynx, trachea, and nose and throat. -Provide assistance episodes
bronchi using endoscope -Oxygen is administered -Secure specimen if needed. -Assess respiratory status
-Document findings for -NPO for 6-12 hours prior -Properly label, and send to -Place in semi-fowler
lung disease, tumors, -Check/Hold meds lab immediately position- prevent
infections, and chronic -Check NPO status -Assist person performing aspiration
cough -Baseline Vital Signs procedure -Reinforce diet/ Maintain
-Treatment tool to deliver -Consent form -NPO status until gag
medication -Arrange for transport reflex returns
-Remove foreign objects -Offer soothing liquid
-Biopsy gargle until gag reflex
returns
-Educating client on post-
op symptoms
-Relieving client anxiety

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NUR 3130 Diagnostic Testing Class Activity---Student Review Guide

Bronchoscopy To look at lungs and air
2 passages
-Pt may be asked to stop
taking anticoagulants
several days before
procedure.
-Pt may also be asked not
to eat or drink for 4-8
hours before procedure.
-Once anesthetic takes
effect, HCP will usually
insert flexible bronchoscope
tube through the pt’s nose
and throat into the bronchi.
-Pt will be monitored for
several hours after
procedure.
-Pt will be educated of the
probability of numbness
to their mouth and throat
for few hours.

-Pt understands and will

Blood Cultures Used to detect the To start, clean the skin to
presence of bacteria or prevent any
fungi in the blood, to microorganisms from
identify the type present, contaminating the test.
and to guide treatment Ask the client about any
Do not need consent for medications they may be
this test. taking. Include
prescriptions and
nutritional supplements
Do not get your specimen
from the same site
because there might be
contamination on one site
*If antibiotic is ordered,
obtain cultures first and
then start the antibiotic.
Blood is obtained by
inserting a needle into a
vein in the arm. The
phlebotomist will put the
blood into two culture
bottles containing broth to
grow microbes. These two
bottles constitute one blood
culture set. A second set of
blood cultures should be
collected from a different
site, immediately after the
first venipuncture. Each
culture set contains 2
bottles: for aerobic and
anaerobic bacteria.
be aware that he/she will
not be able eat or drink
until numbness wears off.
After the draw, the
healthcare provider covers
the puncture site with
some gauze and a
bandage.
If test is positive for
bacteria or yeast in the
blood HCP may begin
treatment via intravenous
broad-spectrum
antibiotics

Wound Culturing of wound Assess pt for possible pain After finding an area of the While not touching the
Cultures allows identification of reducing interventions wound free of necrotic outside of the tube, place
the infecting organism before culturing and tissue, use clean gloves and swab into tube and label

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NUR 3130 Diagnostic Testing Class Activity---Student Review Guide

and appropriate administer if necessary;
intervention remove dressing, if any,
and assess it.
Urine C/S To assess for renal Examination of the
function; urine urinary bladder, palpation
characteristics (specific of the kidneys, inspect the
gravity, bacteria, urethral orifice,
abnormal constituents) assessment of skin in
perineal area, bladder
scan.
Tests are usually done to
determine bacterial
presence and sensitivity
for subsequent antibiotic
needed.
If pt has urinary drainage
catheter, nurse should
explain that urine will be
obtained from collection
port.
If pt. is continent, explain
the clean catch method
(first clean area with soap
and water, have pt. void
about 30 ml for waste, and
then collect midstream
urine before bladder
empties).
a swab to insert and press accordingly (include date
into wound, using enough and time). Send specimen
pressure to express fluid. to lab in a biohazard bag
Rotate swab several times within optimal time.
and avoid touching intact
skin around wound.
The client will not have to Nurse must label and send
comply with any restriction specimen to lab as soon as
with catheter collection but possible. If specimen has
possibly stay in bed to keep to sit for any time, it
catheter bag stationary for should be on ice.
collection.
For continent pts. Or those
without catheters, explain to
client the cleaning process
while doing so and
determine if they can stop
their stream midway to
catch the midstream cleanly.

Lumbar To collect cerebrospinal Medical History, Physical Client lies on left lateral Lie down (flat) after the

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NUR 3130 Diagnostic Testing Class Activity---Student Review Guide

Puncture fluid to run lab analysis, Exam, CBC to check for side with legs flexed at the procedure to avoid a
check cerebrospinal fluid bleeding and clotting knee and pulled inwards “spinal headache”. Do not
pressure, to inject disorders, CT and MRI towards chest. Upper thorax partake in strenuous
anesthesia or other may be done to check for should be curved. Wash activities for the rest of
medication, or inject dye any abnormal swelling. back with antiseptic soap or the day. Take pain
for visualization with HCP may recommend to iodine and cover with sterile medication PRN (usually
diagnostic imaging. not consume any food or sheet. acetaminophen will help)
liquids starting at Local anesthetic is injected
This can help diagnose midnight the day before. into lower back. Then, a
serious bacterial, fungal, thin, hollow needle is
and viral infections such injected into the spinal canal
as meningitis, and CSF pressure is
encephalitis, and measured. A small amount
syphilis, subarachnoid of fluid is drawn and if
hemorrhages, cancers needed, a drug or substance
involving the CNS, and is injected. The needle is
certain inflammatory then removed and the
conditions such as MS puncture site is covered
and Guillain-Barre with a bandage.
syndrome.
Liver Biopsy Invasive procedure to Fine needle aspiration for Test may be done at bedside Strict bed rest for at least
confirm diagnosis of cytology (cell) and or designated area under 6 hours. Position on right
chronic hepatitis, liver histology (tissue). local anesthesia. Obtain side. Assess for bleeding.
cirrhosis, evaluate Explain purpose, specimen with ultrasound or Observation for 24 hours.
severity of disease and procedure, benefits and CT guidance. Review test results.
establish etiology of risks. Consent required. Place tissue specimens in Note VS changes;
abnormalities. Ask about prior reaction formalin solution. compare with baseline
to any local anesthetics. Position during procedure: values and notify HCP.
Discontinue all aspirin, supine with right arm above Monitor q 15 minutes for
anticoagulants, NSAIDs head. During biopsy, client first hour, every 30
for at least 7 days before takes deep breath in, blows minutes next 2 hours, and
procedure when possible. air out and then holds 1/hour for next 4 hours.
NPO 4-6 hours before breath. Then every 4 hours until

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NUR 3130 Diagnostic Testing Class Activity---Student Review Guide
procedure.
Bone Marrow Removal of specimen of Check vital signs
Biopsy 1 bone marrow for Consent
laboratory study. Used to History of medications
confirm a bone marrow Allergies
disorder or a blood Ask about pregnancy
cancer diagnosis. When
they see signs and Teaching: Inform the
symptoms that indicate a clients of the risks and
problem with Blood Cell benefits associated with
Production. Often the the procedure. Ask the
initial changes are noted client to remove clothing
on a CBC. and change into a gown,
Position depends on any
the bone being used.
Client may need to lie on
their side or stomach if the
pelvic bone is being used.
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Have client lie as still as
possible.
Small incision made over
the biopsy site. Biopsy
needle is inserted through
the bone and into the bone
marrow.
A bone marrow aspiration is
done first. The provider will
use a syringe to pull a small
liquid sample of the bone
marrow cells through the
needle. It is common to feel
pressure as the needle is
placed into the bone and
you will feel a pulling
feeling when the marrow is
removed.
The provider will remove a
small, solid piece of bone
marrow called a core
biopsy.
The biopsy needle will be
removed, firm pressure will
stable.
Maintain NPO for 2
hours; then resume
previous diet.
Assess and treat for pain.
Once you are home, keep
the biopsy area clean and
dry.
Take a pain reliever as
recommended by the
provider. Aspirin/NSAIDs
may increase your risk for
bleeding.
Call your provider if you
experience a fever,
redness, swelling,
bleeding, or other
drainage from the biopsy
site, or more pain around
the biopsy site.
You may go back to your
regular diet unless
otherwise specified.

NUR 3130 Diagnostic Testing Class Activity---Student Review Guide
Bone Marrow Find out the cause of
Biopsy 2 problems with red blood
cells, white blood cells,
or platelets.
Diagnose bone
marrow disorders.
Diagnose and monitor
certain types of cancers,
including leukemia,
multiple myeloma, and
lymphoma. Removal of
the liquid portion of bone
marrow for lab testing.
Invasive procedure.
Specimen obtained from
sternum, iliac crest, iliac
crest, proximal tibia in
children.
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Obtain consent for the
procedure. Obtain clients
medications (high risk of
bleeding for certain meds)
and medical history. Take
vital signs. Inform client
about the procedure with
what is going to be done
and what it is for.
Typically allowed to eat
or drink depending on
HCP orders. May need to
not take certain
medications. Answer any
questions the client or
family members might
have. Sedation/anesthetic
will be used.
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be applied for a few minutes
until the bleeding stops, a
sterile bandage will be
applied, and the sample will
be sent to the lab.
Apply pressure to the area
of biopsy.
Client may or may not be
sedated. If not sedated, a
numbing anesthetic is used
at the site of the procedure.
HCP uses a small needle
and inserts in a specific
location into a bone all the
to the spongy tissue of the
bone to collect the liquid
portion of the bone marrow.
It makes cause a sharp
pressure or stinging pain.
The aspiration only takes a
few minutes. Monitor vital
signs throughout the
procedure.
Recovery usually takes 1
hour. Tenderness and pain
may occur after the
numbing agent wears off.
Nurse observes for edema,
bleeding, pain, hematoma
formation, and infections
at procedure site post op.
May not be able to drive
s/p if sedation was used.
Explain to take it easy for
the day and rest of the
week due to stiffness and
pain may be present. A
bruise may appear. Talk
to HCP about pt taking
pain reliever for the
following week if pain is
consistent but typically
not aspirin/NSAIDs since
it could increase bleeding.
HCP may prescribe pain
medications. Client can
also ice site if needed and
helps. Inform the client to
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NUR 3130 Diagnostic Testing Class Activity---Student Review Guide

keep the dressing clean

and dry for at least 24
hours. Notify HCP of
fever, chills, persistent
redness, pain, bleeding
due to risk of infections.
Monitor vital signs post
procedure.
Throat The purpose of a throat Encourage client to stay Tilt head back and open Your HCP may suggest
Culture swab culture is to detect still during the procedure. mouth as wide as possible. over-the-counter drugs,
the presence of Be sure to tell the HCP if If the back of the throat such as ibuprofen or
organisms in you have taken any cannot be seen clearly, the acetaminophen, to help
the throat that could antibiotics recently and try tongue will be pressed down relive throat pain or
cause infection. For to have the client avoid with a tongue depressor to reduce fever. Most people
example, the presence of provide a better view. A start to feel better after a
antiseptic mouthwash
group A streptococcus clean, soft cotton swab will day or two, but if
before the test as this
bacteria (Streptococcus be lightly brushed over the symptoms continue to
pyogenes) in could affect test results. back of the throat, over the persist after 48 hours you
your throat is a key sign tonsils, and over any red or may need to contact your
that you may have sore areas to collect a HCP again. Results may
strep throat. sample. take several days.

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