Diagnostic

and
Laboratory
Tests
What are Laboratory Tests?

THESE ARE TESTS THAT THESE TESTS MAY BE USED

PROVIDE INFORMATION FOR BASIC SCREENING AS
ABOUT THE CLIENT . PART OF A WELLNESS
CHECK.
 To help confirm a diagnosis,

Purposes of
Laboratory To monitor an illness

Tests
To provide valuable information
about the client’s response to
treatment.
 • Primary role of the nurse is to
Significance teach the client and family or
significant others how to prepare
of Laboratory for the test and the care that may
Tests to be required followingthe test.
Nurses • This includes Pretest,Intratest
and Post-test.
Pretest
- major focus is client preparation.

• Nursing Responsibilities:
• 1. Explain the purpose of the test.
• 2. Provide information about the procedure.
• know what equipment and supplies are needed for the specific test.
• whether food is allowed prior to or after testing.
• the length of time of the test.
• reaction the diagnostic test may produce (e.g., flushing when the dye is
injected).
Cont: Pretest

• 3. Instruct the client and family to ask any questions so that

the health care provider can clarify information and allay any
fears.
• 4. Ask female clients if pregnant prior to radiologic studies.
• 5. Prepare consent form, if required.
Intratest
- focus is on specimen collection and assisting with
certain diagnostic testing.
• Nursing Responsibilities:
• 1. Use standard precautions and sterile technique as appropriate.
• 2. Provide emotional and physical support while monitoring the client
during the procedure .
• 3. Ensure correct labeling, storage, and transportation of the specimen to
avoid invalid test results.

Post-test
- focus is on nursing care of the client, follow-up
activities and observations.

• Nursing Responsibilities:
• 1. Instruct the client and family about activity restrictions related to testing
(e.g., remain supine for 1 hour after testing is completed).
• 2. Inform the client and family of the time frame for when the results will be
available.
• 3. Compare the previous and current test results.
• 4. Reports the results to appropriate health team members.
Blood Tests

• Blood tests are commonly used diagnostic

tests that can provide valuable information
about the hematologic system and many
other body systems.
Venipuncture

• A venipuncture - puncture of a vein

for collection of a blood specimen.
• It can be performed by various
members of the health care team.
• A phlebotomist is a person from the
laboratory who performs
venipuncture, usually collects the
blood specimen for the tests
ordered by the primary care
provider.
Venipuncture: Nurse’s Role

• In some institutions,
nurses may draw blood
samples.
• The nurse needs to know
the guidelines for
drawing blood samples
for the facility and also
the state’s nurse practice
act.
Complete Blood Count

• Specimens of venous blood are

taken for a complete blood
count (CBC): Erythrocyte(red
blood cells count) which
includes hemoglobin and
hematocritmeasurements and
Leukocyte (white bloodcell
count), which includes
differential white bloodcell
count.
• The CBC is abasic screening
test and one of the most
frequently ordered blood tests.
a. Red blood cells

 also called Erythrocytes.

 One purpose of the RBC is to carry oxygen from the lungs to the tissues.
 It also carry a small amount of carbon dioxide from the tissues to the lungs
for elimination by exhalation.
 The production of erythrocytes is stimulated by the hormone erythropoietin
produced by the kidneys in response to a decrease in oxygen supply.
 Erythropoietin stimulates the stem cells of the bone marrow to increase the
production of RBC.
Two Components of Red Blood Cells:

• 1. Hemoglobin (hgb): iron-containing protein in

red blood cells that carries oxygen to cells.
• Hemoglobin combined with oxygen gives the
blood its characteristic red color.
• Abnormal levels might be a sign of anemia,
sickle cell, or other blood disorders
Cont: Two components of Red Blood Cells:

• 2. Hematocrit (hct): measure of how much of your

blood volume consists of red blood cells.
 The hct is expressed in percentage.
 For example, a hct if 25% means that there are 25mL
of RBC in 100mL of blood.
 A high hematocrit level can indicate dehydration  a
low hematocrit level may indicate anemia.
 An abnormal hematocrit may signal a blood disorder
or bone marrow disease.
b. White blood cells

 Also called leukocytes.

 Produced by the bone marrow.
 The most important function of leukocytes is to destroy
pathogen thus helps body fight infection.
 If you have a fewer than normal WBC, you have a
higher risks of getting an infection.
 A high WBC may indicate that the immune system is
working to destroy an infection.
cont. b. White blood cells

- A low WBC count can be:

 A side effect of cancer treatment.
 Caused by an autoimmune disorder.
 Caused by virus.
• a. Neutrophils
• b. Eosinophils
Types of White Blood Cells:

• 1. Granulocytes
• c. Basophils
• 2. Agranulocytes
• a. Lymphocytes
• b. Monocytes
 An increase in one type of WBC can cause a decrease in
other types of WBC.
 For example, if you have a bacterial infection, you will
have an increase of neutrophils and a decrease in
lymphocytes.
 Conversely, if you have viral infection, you will have a
decrease in neutrophils and an increase in lymphocytes.
 Neutrophils are infection fighters that increase during
bacterial infections.
 Lymphocytes on the other hand, can increase in cases of
viral infections.
Clinical Implications
Clinical Implications
Sample CBC Result
 • A number of other tests may be performed on
blood serum (the liquidthat remains after the
Blood clotting of blood). These are often referred to as
a blood chemistry.
Chemistry • Common chemistry examinations include
determining certain enzymes that may be
present:
• Lactic dehydrogenase [LDH],creatinekinase
[CK], aspartate aminotransferase [AST], and
alanine aminotransferase [ALT]), serum
glucose, hormones such as thyroid hormone,
and other substances such as cholesterol and
triglycerides
 • These tests provide valuable diagnostic
cues. For example, cardiac markers
(e.g., CPK-MB, myoglobin, troponinT
and troponin I) are released into the
Blood blood during a myocardial infarction (MI,
or heart attack).
Chemistry
• Elevated levels of these markers in the
venous blood can help differentiate
between an MI and chest pain that is
caused by angina or pleuritic
pain.
 • Serum electrolytes are often routinely ordered
for any client admitted to a hospital as a
screening test for electrolyte and acid
–base
imbalances.

Serum • Serum electrolytes also are routinely assessed

for clients at risk in the community, for
Electrolytes example, clients who are being treated with a
diuretic for hypertension or heart failure.

• The most commonly ordered serum tests are

for sodium, potassium, chloride, and
bicarbonate ions.
Potassium
Potassium(K)
(K)

HYPERKALEMIA Functions:
• HYPOKALEMIA

• Normal Range:
• 1 It helps your nerve to function.
• 3.5-5.3 mmol/L • 2. It helps your muscle to contract.
• 3. It helps to move nutrients into cells and waste products out of cells.
• 4. It helps regulate fluid balance.
• The leading cause is • Usually results from vomiting, uncontrolled
diabetes, DHN, diarrhea, adrenal gland having had severe bleeding,
disorders, or use of diuretics. consuming excessive dietary
Sodium (Na)

Functions:
• Normal Range: •

potassium and some • May cause muscle cramps and

medications. weakness.
• May cause cardiac arrhythmia.
• 1. It helps keep water and
• 135-145 mmol/L electrolyte balance.
• 2. It helps transmit impulses in nerves and muscle fibers.
Sodium (Na)

• 3. It combines with chloride and bicarbonate to regulate acidbase

balance.
Hypernatremia hyperreflexia, seizures, and
coma.
• Usually caused by limited access
to water or an impaired thirst Hyponatremia
mechanism, and less commonly
• Common causes include
by diabetes insipidus.
diuretic use, diarrhea, heart
• May result to confusion, failure, liver and renal disease
neuromuscular excitability,
and SIADH.
• Symptoms include lethargy,
confusion,and fatigue.
 BLOOD CHEMISTRY: ELECTROLYTES
Test Name Function Value
Potassium (K) It helps keep water and electrolyte Normal Range: 3.5-5.3 mmol/L
balance. High potassium levels can
cause cardiac arrythmia, while low levels
may cause muscle cramps and
weakness.
Sodium (Na) Used to assess salt balance and 135-145 mmol/L
hydration levels.

Chloride (Cl) Assess water and electrolyte balance Normal Range: 96-109 mmol/L

(Ca) Assess parathyroid functioning and Normal Range: 8.5-10.8 mg/dL

calcium metabolism
PREPARATION

 Some blood tests will require you to fast for 8-12 hours
beforehand.
 Fasting before certain blood tests is important to help make sure
that your test results are accurate.
 Everything you eat or drink contains vitamins, proteins and other
nutrients that can cause the related levels in your blood to
temporarily spike or drop.
• As soon as the blood is taken, fast is over.
• A patient might want to bring a snack and a drink so he can eat
as soon as possible after the test.
Blood tests that will likely need to fast include:
• Fasting blood sugar (FBS) measures the amount
of glucose (sugar) in your blood to test for diabetes
or prediabetes.
Typical fasting time: At least 8 hours
• Lipid profile is used to check the level of
cholesterol and other blood fats. High levels put you
at risk for developing heart disease or having a
stroke. Typical fasting time: 9-12 hours
Clinical
Implications
Clinical Implications
 BLOOD CHEMISTRY FOR KIDNEY FUNCTION
TESTS:
CreatinineCreat
( ) High creatinine levels almost Normal Range: 0.6
-1.5 mg/dL
always are due to renal damage
.
.it is the best indicator of kidney
function.

BloodUrea Nitrogen Screens for renal

disease. 7-25 mg/dL
(BUN) Ureais made in the liver as a product
of amino acid metabolism. It is
measured to check kidney function.
A high BUN value can mean kidney
injury or disease.
Sample Blood Chemistry Result
 • The nurse contributes to the
Specimen assessment of a client’s health status
by collecting specimens of body fluids.
Collection • All hospitalized clients have at least one
and Testing laboratory specimen collected during
their stay at the health care facility.
FECALYSIS
a series of tests done on a stool (feces) sample to help
diagnose certain conditions affecting the digestive tract.
• Analysis of stool specimens can provide information about a
client’s health condition. Some of the reasons for testing feces
include the following:
a. To determine the presence of occult (hidden) blood.
b. To analyze for dietary products and digestive secretions
c. To detect the presence of ova and parasites.
d. To detect the presence of bacteria or viruses.
Collecting Stool Specimens

• the nurse follows medical aseptic

technique meticulously (reduces the
chance of contact with other articles
and the spread of microorganisms)
• Usually about 2.5 cm (1 in) of formed stool or 30mL of
liquid stool
• Guaiac Stool Exam / Fecal Occult Blood Test (FOBT)
• Also called Hemoccult test
Testing Feces for Occult Blood

• it detects the presence of fecal occult (hidden) blood.

• it detects gastrointestinal (GI) bleeding.
• uses a chemical reagent to detect the presence of the enzyme
peroxidase in the hemoglobin molecule.
• Blue color indicates a guaiac positive result, that is, the presence of
occult blood. No color or any color other than blue is a negative finding.
• Increase fiber in the diet for 48-72h
• No red meats, poultry, fish, turnips, horseradish
• Can trigger false alarm.
Cont. Testing
NORMAL Feces for Occult
CHARACTERISTIC OFBlood
STOOL

• Preparation:
NORMAL VALUES
• Withhold for 48h: Iron, steroids, Indomethacin, Colchicine
• Iron causes blackish/greenish discoloration of stool
• steroids, Indomethacin, Colchicine may cause GI irritation thereby, bleeding.

• 3 stool specimen for 3 successive days.

CHARACTERISTIC
• ODOR • AROMATIC
• COLOR • GOLDEN BROWN
• CONSISTENCY • FORMED
URINALYSIS

• WBC
• RBC
• BACTERIA

• Is a simple test that looks at a small sample of your

urine.
• It can help find problems that need treatment,
including urinary tract infections or kidney problems.
NORMAL CHARACTERISTIC OF URINE

• It can also help find serious diseases in the early

stages, like kidney disease, diabetes, liver disease or
other metabolic conditions
 CHARACTERISTIC NORMAL VALUES
NORMAL
• Color
CHARACTERISTIC OF URINE
• Deep amber/pale yellow (urochrome/urobilin)
• Odor • Odorless
• pH • 4.5-8.0
• Specific gravity • NORMAL
1.010-1.025
VALUES
• WBC • 0-5 HPF
• RBC • 0-5 HPF
CHARACTERISTIC
• Protein • None or trace
• Glucose • None
• Ketones • None
• Bilirubin • <0.3 mg/100mL
 • urobilinogen • 0.2-1.0 mg/100mL
Clinical Implications

• Specific gravity is an indicator of urine concentration, or the

amounts of solutes (metabolic wastes and electrolytes)
present in the urine.
• The specific gravity of distilled water is 1.00; the specific
gravity of urine normally ranges from 1.010 to 1.025.
• Urinary pH is measured to determine the relative acidity or
alkalinity of urine and assess the client’s acid–base status.
• Urine normally is slightly acidic, with an average pH of 6 (7 is
neutral, less than 7 is acidic, greater than 7 is alkaline).
• Glucose Urine is tested for glucose to screen clients
for diabetes mellitus and to assess clients during
pregnancy for abnormal glucose tolerance.
• Normally, the amount of glucose in the urine is
negligible, although individuals who have ingested
 large amounts of sugar may show small amounts of
glucose in their urine.
• Protein molecules normally are too large to escape from
glomerular capillaries into the filtrate. If the glomerular
membrane has been damaged, however (e.g., because of an
inflammatory process such as glomerulonephritis), it can
become “leaky,” allowing proteins to escape.
• Urine testing for the presence of protein generally is done
with a reagent strip (commonly referred to as a dipstick).
Urine Specimens
Clean Voided Urine Specimen

The nurse is responsible for collecting urine specimens for a number of tests:
1. Clean voided urine specimens for routine urinalysis.
2. Clean-catch or midstream urine specimens for urine culture 3.
Timed urine specimens for a variety of tests that depend on the
client’s specific health problem.
4. Urine specimen collection may require collection via straight
catheter insertion.

• Routine urine examination: done on the first voided

specimen in the morning because it tends to have a
 higher, more uniform concentration and a more acidic
pH than specimens later in the day.
• At least 10mL of urine is generally sufficient for a
routine urinalysis.
• The specimen must be free from fecal contamination.
 How-Catch
Clean to collect a mid-stream
or Midstream urine
Urine Specimen

 Clean-catch or midstream voided specimens are

collected when a urine culture is ordered to identify
microorganisms causing urinary tract infection. Care is
taken to ensure that the specimen is as free as possible
from contamination by microorganisms around the urinary meatus. Clean-catch
specimens are collected into a sterile specimen container with a lid.

• Firstly, pass a small amount of urine into the toilet and

then start collecting your urine into the container.
 Timed Urine Specimen

• You do not have to fill the container to the brim. After

collecting the desired amount (at least 10 mL) finish
passing the urine into the toilet.
• Timed urine specimen is collected to measure the
concentration of these substances in urine over a
specified length of time usually 8h or 24h.
 Objectives of Timed Urine specimen

• Timed specimens generally either are refrigerated or

contain a preservative to prevent bacterial growth
decomposition of urine components.
• 1. To assess the ability of the kidneys to concentrate
and dilute urine.
• 2. To determine the disorders of glucose metabolism
(DM).
• 3. To determine levels of specific constituents in the
urine (albumin, amylase, creatinine, urobilinogen,
certain hormones such as estriol, or corticosteroids).
• obtain a specimen container with preservative in the
laboratory.
• provide a clean receptacle to collect urine.
 To collect timed urine specimen:

• post signs in the client’s chart, kardex, room, and

bathroom alerting personnel to save all urine during the
specified time
• In this collection, the bladder is emptied prior to
beginning the timed collection.
period in the container.
 • Save all urine produced during the timed collection
• At the end of the collection period, instruct the client to
completely empty the bladder. Take the entire amount
of urine collected to the laboratory with the completed
requisition.
• Record collection of specimen, time and any pertinent
observation.
Indwelling Catheter Specimen

• Sterile urine specimens can be

obtained from closed drainage system by

inserting a sterile needle attached to a syringe through a drainage port
in the tubing.
Clinical Implications
 Electrocardiography (ECG)

• It provides a graphic recording of the heart’s electrical activity.

Electrodes placed on the skin transmit the electrical impulses to
an oscilloscope or graphic recorder.
• With the wave forms recorded, the electrocardiogram (ECG)
can then be examined to detect dysrhythmias and alterations in
conduction indicative of myocardial damage, enlargement of
the heart, or drug effects.
Stress
Electrocardiography
• It uses ECGs to assess the client’s
response to an increased cardiac
workload during exercise.
• As the body’s demand for oxygen
increases with exercising, the cardiac
workload increases, as does the oxygen
demand of the heart muscle itself.
• Clients with coronary artery disease may
develop chest pain and characteristic
ECG changes during exercise.
Visualization
Procedures

• Visualization procedures
include indirect
visualization (non-
invasive) and direct
visualization (invasive)
techniques for visualizing
body organ and system
functions.
 CHEST X-RAY

• An X-ray is an imaging test that uses small amount of

radiation to produce pictures of the organs, tissues,
and bones of the body.
• When focused on the chest, it can help spot
abnormalities or diseases of the airways, blood
vessels, bones, heart, and lungs.
 PREPARATION

• Chest X-rays can also determine if you have fluid in

your lungs, or fluid or air surrounding your lungs.
• Need to remove any jewelry, eyeglasses, body piercings, or
other metal on your person. Tell your doctor if you have a
surgically implanted device, such as a heart valve or
pacemaker. Your doctor may opt for a chest X-ray if you have
metal implants.
 PREPARATION
• Before the X-ray, you’ll undress from the waist up and change
into a hospital gown because buttons and zippers may
interfere with the image.
• A chest X-ray may be performed in a standing, sitting, or lying
position. This position depends on the condition of the patient
and the reason for the X-ray.
• Usually, two shots are taken: one from the back of the chest
and one from the side. (Chest X-Ray PA/Lat or AP/Lat)
• When patient cannot stand, the x-ray room has a table where
the patient can lie or sit down and a large x-ray machine
hanging from the ceiling is used.
PREPARATION

• The technician will position the patient, then step

behind a wall or to an adjoining room to separate the
machine to prevent them from exposure to radiation.
• The X-ray image is black and white. Dense body parts
that block the passage of the X-ray beam through the
body such as the heart and bones, appear white on the
X-ray image. Hollow body parts, such as the lungs,
allow X-ray beams to pass through them and appear
black.
 Angiography
- X-ray of the blood vessels
• It is an invasive procedure requiring informed
consent of the client.
• A radiopaque dye is injected into the vessels
to be examined.
• Using fluoroscopy and x-rays, the flow
through the vessels is assessed and areas of
narrowing or blockage can be observed .
Computed
Tomography (CT)
• It is also called CT scanning,
computedtomography, or
computedaxial tomography (CAT), is a painless, noninvasive- x
ray procedure that has the unique capability of distinguishing
minor differences in the density of tissues.

• The CT produces a three-dimensional image of the organ or

structure, making it more sensitive than the
-rayxmachine
.

• Unlike a simple-ray
x study, it offers a much higher level of
detail, creating computerized, 360
-degree views of the body’s
structures.

• They take longer than-rays

x but are still fast (about 1 minute).
Magnetic Resonance Imaging (MRI)

• It is a noninvasive diagnostic
scanning technique in which the
client is placed in a magnetic
field.

• Clients with implanted metal

devices (e.g., pacemaker, metal
hip prosthesis) cannot undergo an
MRI because of the strong
magnetic field.
 Advantages

1. There is no exposure to radiation.

Magnetic 2. Another advantage to the MRI is that it provides a

Resonance better contrast between normal and abnormal tissue than
the CT scan.

Imaging
Disadvantage

1. It is, however, more costly.

Magnetic Resonance Imaging

• The MRI is commonly used for visualization of the brain, spine,

limbs and joints, heart, blood vessels, abdomen, and pelvis.
• The procedure involves the client lying on a platform that
moves into either a narrow, closed, high-magnet scanner, or
into an open, lowmagnet scanner. The client must lie very still.
• Earplugs are offered to the client to reduce the discomfort from
the loud noises that occur during the test.
• The procedure lasts between 60 and 90 minutes
Questions?
Thank you!