DIAGNOSTIC PROCEDURES 1. Chest X-ray Requested by: Dr.

Garganta Date ordered: 12/1/11 Description: A chest x ray is a procedure used to evaluate organs and structures within the chest for symptoms of disease. Chest x rays include views of the lungs, heart, small portions of the gastrointestinal tract, thyroid gland and the bones of the chest area. X rays are a form of radiation that can penetrate the body and produce an image on an x-ray film. Another name for x ray is radiograph. Chest x rays are ordered for a wide variety of diagnostic purposes. In fact, this is probably the most frequently performed x- ray. In some cases, chest x rays are ordered for a single check of an organ's condition, and at other times, serial x rays are ordered to compare to previous studies. Purpose: It was done to our client as a part of the hospital routine and to detect any abnormal condition of the patient prior to surgery. Interpretation: No demonstrable active parenchymal infiltrate Calcified aortic arch Rest of the chest structure are unremarkable Impression: No significant pulmonary findings Atheromatous aorta

any Metal objects in the body are sensitive to radiopaque objects such as jewelry or radiation and can block X. hence it is done to avoid false results of the procedure. Instruct client to remove as to gain cooperation.Analysis: Nursing Responsibilities Before: 1.ray penetration metal buttons above the waist. Instruct the client to hold his breath and Holding breath and remaining still aids in to remain still when performing the obtaining accurate results of the procedure and procedure proper visualization is also obtained. Check the doctor’s order. After . 3. Reemphasize the purpose of the Reemphasizing the purpose of the procedure procedure to the client as well as his lets the nurse know what to anticipate as well significant others. A deep breath inflates the lungs to their maximum which increases the visibility of different tissues within the chest. During 4. Rationale To verify the procedures needed to be accomplished 2.

the more . bilirubin. The following data are examined during the procedure: urine color. changes in the concentration or dilution of the urine and the presence of drug metabolites in the urine. urobilinogen. Follow-up result and refer to the physician. Documentation means nursing care is done. Urine Analysis Requested by: Dr. nitrite. Ideally. specific gravity. Specimens obtained at other times may not be adequately concentrated. 5. Urine color comes from urochrome pigment. clarity. Garganta Date ordered: 12/1/11 Description: Urinalysis is a part of any complete physical examination but is particularly useful for clients with suspected kidney or urologic disorders. urinary cells. It is ordered widely and routinely to detect any abnormalities that require follow up.4. The darker the color. urinary casts and urinary crystals. 2. Document the procedure. Color variations may result from increased levels of urochrome or other pigments. Obtaining the result the soonest possible time helps physician to evaluate the condition of the client and to take necessary action if needed. ketone. hemoglobin. Color and Turbidity. presence of protein. The color of urine normally ranges from yellow to deep amber depending on the concentration. the urine specimen is collected at the morning’s first voiding. pH. glucose.

or vaginal discharge. It is a component of a red blood cell which has a high affinity to oxygen thus transporting it to the body cells from the lungs. pH testing is also useful for the classification of urine crystals. yeast. tending to be acidic in people who eat meat but more alkaline in vegetarians. However. pH varies with a person’s diet. several substances like proteins can seep into the urine. Urine Protein. Density is related to the number of particles in a specific volume of urine. The specific gravity of urine is a measure of the concentration of dissolved solutes (substances in a solution).5. and bacteria. as they are considerably large molecules. changes in specific gravity do not reflect systemic fluid volume. .0 to 8. Abnormal causes of turbidity include the presence of blood cells. in case of kidney or bladder damage. mucus. Normally protein molecules do not pass through the nephrons of the kidneys into the urine. kidney disease often results in retention of H+ (reduced acid excretion). A combination of pH indicators (methyl red and bromthymol blue) react with hydrogen ions (H+) to produce a color change over a pH range of 5. the specific gravity increases. As the concentration of the minerals. Specific Gravity. salts and compounds in the urine increases.concentrated the urine is and vice versa. For example. In kidney disease. pH. Urine Hemoglobin. The specific gravity of urine is density compared to water. Normal conditions giving rise to turbid urine include precipitation of crystals. pH measurements are useful in determining metabolic or respiratory disturbances in acid-base balance. and it reflects the ability of the kidneys to concentrate the urine (conserve water).

The normal level of urinary bilirubin is below the detection limit of the test. excess ketoacids in the blood may cause life-threatening acidosis and coma.Urine Glucose. pregnancy. Leukoesterase is an enzyme found in some white blood cells. In diabetes. When the number of these cells increases in the urine or they are lysed. Bilirubin in the urine is derived from the liver. Urine Nitrite. Leukoesterase. including fever. and a positive test indicates hepatic disease or hepatobiliary obstruction. causing ketonuria. When blood glucose levels rise above 160 mg/dL. Ketones are compounds resulting from the breakdown of fatty acids in the body. especially neutrophils. and other forms of hepatic necrosis that impair the circulation of blood in the liver and surrounding organs. the urine . These ketoacids and their salts spill into the urine. which results in decreased production of urobilinogen. A positive test for nitrite indicates bacteruria. Ketones are also found in the urine in several other conditions. Presence of glucose may indicate infection or those with diabetes mellitus. glycogen storage diseases. Glucose is normally not present in the urine. the glucose will be detected in urine. These ketones are produced in excess in disorders of carbohydrate metabolism. Urine Ketones. or the presence of bacteria in the urine. Urine Bilirubin. The urobilinogen test is helpful in differentiating these conditions from obstructive jaundice. hepatitis. Urine Urobilinogen. Urobilinogen is a substance formed in the gastrointestinal tract by the bacterial reduction of conjugated bilirubin. and weight loss produced by a carbohydrate-restricted diet. Increased urinary urobilinogen occurs in prehepatic jaundice (hemolytic anemia). especially Type 1 diabetes mellitus.

red blood cells and white blood cells. The presence of cellular casts (casts containing RBCs. Urine Cells. These mineral salts may be a result of a diet. minerals and gelatinous materials clump around them and form a cast. Urine crystals come from various mineral salts. When cells. WBCs. Cellular casts and renal epithelial (kidney lining) cells are signs of kidney disease. Casts are described by the type of particle they have surrounded or the stage of the cast breakdown. if any. epithelial cells (from the lininf of the urinary tract). or leucine crystals in patients with severe liver disease or with maple syrup urine disease.will contain measurable amounts of leukoesterase. Types of cells abnormally present in the urine include tubular cells (from the tubule of the nephron). Urine Crystals. drugs. Normal crystals are formed from normal metabolic processes. . as the source of such cells. they may lead to the formation of renal calculi. or disease. urine contains few. A positive test indicates increasing leukocytes in the urine. Common crystals seen even in healthy patients include calcium oxalate. tyrosine crystals with congenital tyrosinosis or marked liver impairment. Casts are decribed as “granular” and “waxy”. bacteria and protein. A normal reading is no leukoesterase in the urine. however. bacteria or proteins are present in the urine. rather than the lower urinary tract. triple phosphate crystals and amorphous phosphates. Normally. There may be casts of cells. cells. The presence of leukoesterase in the urine is a sensitive screen for assessing urinary tract infections. Urine Casts. or kidney stones. Rarely crystals of cystine (in urine of neonates with congenital cystinuria or severe liver disease). Casts are structures formed around particles. Abnormal crystals are those formed as a result of an abnormal metabolic process and are always clinically significant. or epithelial cells) identifies the kidneys.

Results: CM &BACTERIOLOGY RESULT Physical Exam Color Yellow Amber-deep yellow Specific Gravity Clarity 1.010-1.6-8.025 Clear Normal Abnormal Normal REFERENCE INTERPRETATION .Purpose: It was done to our client as a part of the hospital routine and also to detect any abnormal condition prior to surgery.0 4.0 Normal 1.020 Slightly Turbid pH Urinary Cells WBC RBC Epithelial cells Bacteria Mucus Threads Renal Cells Yeast Cells Chemical Exam Protein Glucose Negative (-) Negative (-) 4-8 HPF 1-2 HPF Moderate Moderate Few 0-5 HPF 0-4 HPF Few Moderate-Few Negative (-) Negative (-) Negative (-) Abnormal Normal Abnormal Normal Abnormal 6.

Rationale To verify the procedures needed to be accomplished . Check the doctor’s order.Hemoglobin Ketone Nitrate Bilirubin Urobilinogen Leuko Esterase Urinary Casts Hyaline Cast Fine Granular Cast Coarse Granular Cast Waxy Cast Urinary Crystals Amorphous Phosphates Calcium Oxalates Triple Phosphates Uric Acid - Negative (-) Negative (-) Negative (-) Negative (-) Negative (-) Negative (-) - - 0-1/HPF Negative (-) Negative (-) Negative (-) - Urate/ Few Moderate-Few Normal - Negative (-) Negative (-) Negative (-) - Nursing Responsibilities Before: 1.

2. Instruct the patient (and guardian) that The first urine in the stream serves to flush the urine specimen should be collected contaminating cells and microbes from the during midstream. After 7. Label the specimen ward bottle and with For proper identification. outer urethra. 6. possible contaminants that could interfere with the results of the procedure. Instruct the client to wash the perineal To ensure that the specimen is clean and out of area prior to collecting of specimen. Forward specimen bottle according To avoid delay in examining the urine and to immediately to hospital protocol. Explain to the patient (and guardian) To gain patient’s cooperation. that urine specimen is required and the purpose of the procedure. lead tightly on the container. . 4. avoid sedimentation and chemical changes of urine. Obtain the specimen bottle and put the To prevent spillage of the specimen. During 5. number correctly. 3. room patient’s name.

Complete Blood Count Requested by: Dr. mean cell volume. It is also ordered widely and routinely to detect any abnormalities that require follow up. hematocrit. . It carries oxygen and gives the blood cell its red color. The hemoglobin test measures the amount of hemoglobin in blood and is a good measure of the blood's ability to carry oxygen throughout the body. Document the procedure. white blood cells (segmenters. mean cospular hemoglobin concentration (MCHC). white blood cell count. anti-streptolysin O titer and C3. Documentation means nursing care is done. red blood cells. monocytes. eosinophils.8. If they are healthy and they have cell populations that are within normal limits. mean cell hemoglobin. The hemoglobin molecule fills up the red blood cells. lymphocytes. hematocrit and hemoglobin level. Many patients will have baseline CBC tests to help determine their general health status. Garganta Date ordered: 12/1/11 Description: A complete blood count (CBC) includes a number of studies: red blood cells count. Analysis: 3. then they may not require another CBC until their health status changes or until their doctor feels that it is necessary. The procedure evaluate the following blood components: hemoglobin. Hemoglobin. basophils). platelet count.

the body may not be getting the oxygen it needs. lymphocytes. They also carry carbon dioxide back to the lungs so it can be exhaled. Red blood cells carry oxygen from the lungs to the rest of the body. The numbers of each one of these types of white blood cells give important information about the immune system. Red Blood Cell. If the RBC count is low (anemia). are also part of this test. monocytes.Hematocrit.    The MCV shows the size of the red blood cells. This test measures the amount of space (volume) red blood cells take up in the blood. called band neutrophils. These numbers help in the diagnosis of different types of anemia. This also makes it hard for the red blood cells to carry oxygen. The MCH value is the amount of hemoglobin in an average red blood cell. The major types of white blood cells are neutrophils. mean corpuscular hemoglobin (MCH). Hematocrit and hemoglobin values are the two major tests that show if anemia or polycythemia is present. there is a chance that the red blood cells will clump together and block tiny blood vessels (capillaries). Too many or too few of the different types of white blood cells can . For example. The MCHC measures the concentration of hemoglobin in an average red blood cell. a hematocrit of 38 means that 38% of the blood's volume is made of red blood cells. Immature neutrophils. and basophils. They are measured by a machine and their values come from other measurements in a CBC. Red Blood Cell Indices. eosinophils. White Blood Cell (Differential Count). The value is given as a percentage of red blood cells in a volume of blood. and mean corpuscular hemoglobin concentration (MCHC). If the count is too high (a condition called polycythemia). Each type of cell plays a different role in protecting the body. There are three red blood cell indices: mean corpuscular volume (MCV).

and T cells.  Segmenters are neutrophils with a filament between the lobes of its nucleus. Segmenters increase when there is inflammatory process and are further increased when injury is the extensive.help find an infection. The two major classes of lymphocytes are: B cells. Both B cells and T cells recognize specific antigen targets. and changes in their levels can indicate changes in a patient's health. They make up about 1 to 3% of the total number of white blood cells.  Lymphocytes are small white blood cells that bear the major responsibility for carrying out the activities of the immune system. Depending on a patient's level of health.  Monocytes are a type of leukocyte or white blood cell which play a role in immune system function. They can be counted as part of a blood test. Neutrophils are the first to arrive in the injury.  Eosinophils are a type of white blood cell produced in the bone marrow. The gastrointestinal (GI) tract typically has the highest number of eosinophils relative to other organs. Eosinophils protect the body killing bacteria and parasites. they number about one trillion. an allergic or toxic reaction to medicines or chemicals. which are processed in the thymus. and many conditions. which grow to maturity independent of the thymus. As a general rule. Eosinophils can circulate in the blood and also are found outside blood vessels in other organs in the body. monocytes make up between one and three percent of the total white blood cells in the body. and a high count indicates that a problem is present. but can cause . a low monocyte count is a good sign. such as leukemia.

and asthma symptoms. especially those related to allergies and asthma. Platelets (thrombocytes) are the smallest type of blood cell. Purpose: It was done to our client as a part of the hospital routine and also to detect any abnormal condition prior to surgery. the platelets swell.800-5. Results: COMPONENTS RESULT NORMAL VALUE Complete Blood Count Hemoglobin Hematocrit Red blood cells 127. They are important in blood clotting. If there are too few platelets.37-0. and release chemical mediators causing allergic symptoms when the IgE binds to its specific allergen.00 g/L 0. clump together. there is a chance of a blood clot forming in a blood vessel. If there are too many platelets. uncontrolled bleeding may be a problem. bronchoconstriction. Basophils are a type of white blood cell that is involved in inflammatory reactions in the body.42 vol % 3.500 Normal Normal SIGNIFICANCE .00 g/L 0. Platelet. and form a sticky plug that helps stop the bleeding. When stimulated.38 110-160. When bleeding occurs.problems when they react incorrectly and cause allergies and other inflammatory reactions in the body.  Basophils play a part in the allergic response as they have IgE on their surface. basophils release histamine and other enzymes that can lead to inflammation.

26-0.00 10g/L Normal Differential Count Segmenters Lymphocytes Monocytes Eosinophils Basophils Platelet count 0. This current radiates from the heart in all directions and.02 308 000 0.40 0.22 0.00-10. on reaching the skin.Mean cell volume Mean cell haemoglobin MCHC concentration White blood cell 9. Electrocardiogram (ECG) Requested by: Dr.50-0. The standard resting ECG uses five electrodes .01-0.60 0. is measured by electrodes connected to an amplier and strip chart recorder.01 150-350 10^g/L Decreased/Low Normal Normal Analysis: 4. Garganta Date ordered: 12/1/11 Description: Electrocardiography is the most commonly used test for evaluating cardiac status.00-0.04 0. graphically records the electrical current (electrical potential) generated by the heart.5 x 10g/L 80-100 fL 27-32 pg 31-35 g/dL 6.08 0.00-0.

arms.II.to measure the electrical potential from 12 different leads. and the T wave. and aVr). and the T wave. the QRS complex. aVL. Electrode tabs can remain on the patient’s chest. The entire ECG tracing is displayed on a screen so abnormalities can be corrected before printing. An ECG is used to measure:     Any damage to the heart How fast your heart is beating and whether it is beating normally The effects of drugs or devices used to control the heart (such as a pacemaker) The size and position of your heart chambers Purpose: It was done to the client to detect any abnormalities in the patient since she will undergo operation. Check the doctor’s order. The P wave depicts atrial depolarization. and legs to provide continuous lead placement for serial ECG studies. the QRS complex. and the precordial. or chest. ventricular depolarization. ventricular repolarization. the augmented limb leads (aVf. ECG tracings normally consist of three identifiable waveforms: the P wave. Interpretation: LAD Nursing Responsibilities Before: 1. To verify the procedures needed to be NSSTTC Rationale .III). the standard limb leads (I. then it’s printed on one sheet of paper. leads (V1 through V6). Computerized ECG machines use small electrode tabs that peel off a sheet and adhere to the patient’s skin.

Reemphasize the purpose of the Reemphasizing the purpose of the procedure procedure to the client as well as his lets the nurse know what to anticipate as well significant others. as to gain cooperation. Ask the patient to remain still during the Any movement. important to be relaxed and relatively warm during an ECG recording. After 4. can alter the results. So it is seconds as the test is being done. 3. During 4. Remove all metal objects in the body ECG makes use of electricity hence metal including watch or jewelries. objects connected to the body may interfere the result and may harm the patient during the procedure.accomplished 2. including muscle tremors such procedure and also ask to hold breath for a few as shivering. Follow-up result and refer to the physician. Obtaining the result the soonest possible time helps physician to evaluate the condition of the client and to take necessary action if needed. .