VARIOUS BLOOD

INVESTIGATIONS
Submitted to:
Submitted by:
Prerna yadav
Mrs. Anita ma’am
Enrollment number: 02150306618
Tutor, faculty of college of Nursing
And
VMMC & SJH
Neha Sharma
Enrollment number: 04350306618
College of Nursing, VMMC and SJH
 Introduction
Blood test and analysis is one of the most
important diagnostic tools available to
physicians in healthcare system. Its data is
relied upon in the clinical setting for
interpretation of clinical diagnosis of the
disease.
 Definition
Blood test is a laboratory test in which a sample of blood is
withdrawn from the body to analyze the level of substances or cells
(such as glucose, hemoglobin or white blood cells etc.) that
indicates the presence or probable development of a particular
disease or medical condition (such as diabetes, cardiovascular
disease or cancer) or serve to indicate the degree of function of a
specific organ (such as liver or kidney).
 Uses of blood test
 Help to diagnose certain diseases and conditions
 Monitor chronic disease or conditions such as diabetes
or high cholesterol
 Find out if treatment for a disease is working
 Help diagnose bleeding or clotting disorder
 Find out if immune system is having trouble fighting
infections.
Preparation for blood test
Preparation for client
 Educate the client to avoid drinking or eating anything for
8 to 12 hours before the test except water
 Educate client to eat less fatty and fried food and avoid
alcohol would be two days prior to the test
 Don’t smoke one hour prior to test
 Avoid physical activity and stress prior to test
 Provide sitting or lying position on bed.
 Preparation of articles
 Syringe 1,5 or 10ML
 Needle 22 G and 24 G
 Clean gloves
 Biochemistry forms
 Needle holder
 Bowl with wet and dry cotton
 Mackintosh
 Glucometer meter with strips and lancets
 Kidney tray and paper bag
 Vacutainers or test tubes
Different vacutainer tubes
RED :- Plain vial, No Anticoagulant
USES:- for serological examination in biochemistry eg; blood grouping, LFT,
KFT and lipid profile.

GREY :- Contain sodium fluoride anticoagulant

USES:- for blood sugar level, blood alcohol level and GTT( glucose tolerance
test).

PURPLE :- Contains EDTA ( Ethylene Diamine tetra-acetic acid)

USES :- For hematological examination like CBC, ESR, TLC.
LIGHT BLUE :- 3.2% sodium citrate
USES :- For coagulation studies like PT and APTT.

GREEN :- Heparin
USES :- Chromosomal abnormality, plasma
determination, vitamin b6 and b1.

YELLOW :- Silica particles / serum sepratorer.

USES :- Serum electrolyte study like LFT/ KFT , Serum
urea level, tumor markers.
 Procedure
 Identify the patient, asses type of blood test, cause of taking sample.
 explain the procedure to the patient and calm the patient provide
comfortable position either sitting or lying down.
 Put Mackintosh under the puncture site.
 Ask patient to make a fist .
 Apply a tourniquet above the site (no need for ABG and blood sugar
test done via glucometer).
 Access the vein and clean the site with wet cotton; most common site is
median cubital.
 Then insert the needle and pull the plunger of syringe and fill the syringe
with required amount of blood
 Then release the tourniquet and remove the syringe from vein and applied
dry cotton on that puncture side
 Ask patient to apply pressure and bend the area of sight on elbow
 Put the blood in respective vacutainers and sent in the biochemistry lab
with proper identification and type of blood tests in investigation form
and tube should be labeled with patient identification and type of test.
 Nurses responsibility in the collection of blood
specimens
The following precautions are kept in mind when the whole blood is
collected
 The whole blood is collected by venipuncture under strict aseptic techniques. to collect by
venipuncture, a syringe of proper size is selected. the needle should be tight fitting to the tip
of the syringe and should be neither to short with medium sized bore (size 18,19 and 20)
 to collect whole blood the blood is collected in appropriate test tube with optimum quantity
of suitable anticoagulant
 the blood from the syringe should be transferred to the test tube as soon as collected.
 remove the needle from the syringe before transferring the blood into the test tube. Blood
should be thoroughly but gently mixed with the anticoagulant to prevent clotting.
 Frothing of blood is prevented when transferring or mixing the blood
 avoid keeping the blood at room temperature for a long time, since changes will
take place in the blood when the blood cannot be sent to the laboratory
immediately after the collection keep it in a refrigerator at 4 to 6 degrees Celsius
 all specimen should be labeled with clients name and other identification data
and sent to the laboratory with the forms
 reports are to be correctly attached on the patients file.

Precautions taken when collecting the blood for serum analysis

• Appropriate vial selection for serum analysis that is yellow

• Blood should be withdrawn slowly without much suction
• Do not shake the container, the container should be kept upright
• Follow all the precautions used in the collection of whole blood
 Different blood tests
01 CBC 02 03
SERUM BLOOD SUGAR
Complete blood count ELECROLYTES

04 05 06
GLUCOSE THYROID KIDNEY FUNCTION
TOLERANCE TEST FUNCTION TEST TEST

07 08 09
LIVER FUNCTION LIPID PROFILE ABG
TEST
 01:- CBC (complete blood count)
 The CBC is one of the most common blood tests.
 The CBC can help detect blood diseases such as anemia, infections, clotting problems,
blood cancers and immune system disorders.
Various components of CBC:-
A. RBC ( Red blood cells )
B. Hemoglobin
C. Platelets
D. Hematocrit
E. MCV (Mean corpuscular volume)
F. MCH (Mean corpuscular hemoglobin)
G. WBC (White blood cells)
 Neutrophils
 Eosinophils
 Basophils
 Monocyte
 Lymphocytes
A) RBC (red blood cells)
 Carry oxygen from the lungs to the rest of the body and carbon dioxide back to the
lungs.

NORMAL VALUE of RBC:-

MALE:- 4.3-5.9 X 106/ml
FEMALE:- 3.5-5.0 x 106/ml

POLYCYTHEMIA :- Increased RBC

CAUSE :- Polycythemia vera
cardiac and pulmonary disorders

ANEMIA :- decreased RBC count.

CAUSE :- Iron deficiency (most common)
excess bleeding
B) HAEMOGLOBIN
 Hemoglobin is protein in RBC that carries oxygen to body organs and transport
CO2 back to lungs.

NORMAL HEMOGLOBIN VALUE :-

MALE :-14-18 g/dl

FEMALE:-12-16 g/dl

LEVEL INCREASED :- polycythemia and dehydration

LEVEL DECREASED :- anemia and hemodilution
C) PLATELETS
A platelet count is a test to measure how many platelets you have in your blood.
Platelets help to form blood clots.

NORMAL VALUE OF PLATELETS :- 1.5 – 4 Lakh

LEVEL INCREASED :- Is known as “THROMBOCYTOSIS”

CAUSE : increased in case of disease infestation.

LEVEL DECREASED :- Is known as “THROMBOCYTOPENIA”

CAUSE : Acute leukemia
cancer chemotherapy
D) HEMATOCRIT
Hematocrit is a blood test that measures the percentage of the volume of whole blood
that is made up of red blood cells.

NORMAL VALUE :-
MALE :- 40 - 54 %
FEMALE :- 36 - 47%

LEVEL INCREASED :- In polycythemia vera and hemconcentration resulting from

blood loss, dehydration and shock.

LEVEL DECREASED :- severe anemia, anemia of pregnancy, acute massive blood

loss.
 E) MCV (Mean Corpuscular Volume)
 Average / Mean volume of RBC’s.
 Calculated using the hematocrit and RBC count.
 MCV (FL) = Hct (%) x 10
RBC count X (1012 /L)

NORMAL MCV RANGE :- 76-96 Femo litres

INCREASED LEVEL :- macrocytic anemia

DECREASED LEVEL :- microcytic anemia

 F) MCH (Mean corpuscular hemoglobin)
• Indicator of the average weight of hemoglobin in individual RBC’S.
• Calculate using the hemoglobin and RBC Count.
• MCH (pg) = Hemoglobin (g/dl) x 10
RBC Count x (1012/L)

NORMAL MCH RANGE :- 26-34 Picograms(pg)

INCREASED LEVEL :- macrocytic anemia

DECREASED LEVEL :- microcytic anemia

hyochromic anemia
 G) WBC (White Blood Cells)
 White blood cells help fight infections; also called LEUCOCYTES.
 There are 5 major types of cells :-

1. NEUTROPHILS (45-65%)
INCREASED NEUTROPHILS :- Known as “NEUTROPHILIA”
Cause:- The severity of the infection is indicated by the increased neutrophils.
DECREASED NEUTROPHILS :- Known as “NEUTROPENIA”
Cause :- anemia
suppression of bone marrow (by various drugs)
2. EOSINOPHILS
INCREASED EOSINOPHILS :- known as “eosinophilia”
Cause :- allergic reaction, auto-immune disorder, leukemia.
DECREASED EOSINOPHILS :- known as “eosinopenia”
Cause :- nutritional deficiencies
3.) BASOPHILS ( <1%)
INCREASED LEVEL :- known as “ BASOPHILIA”
Cause :- oral contraceptive disease.
hodgkin’s disease
DECREASED LEVEL :- Known as “ BASOPENIA”
Cause :- Nutritional deficiencies

4.) MONOCYTE (3-10%)

MONOCYTOSIS :- increased to fight with infections
found in kala-azar, typhoid, T.B, Malaria.
5.) LYMPHOCYTES (25-45%)
INCREASED LEVEL :- Known as “LYMPHOCYTOSIS”
Cause :- infections like T.B, whooping cough, lymphatic leukemia.
DECREASED LEVEL :- Known as “LYMPHOCYTOPENIA”
Cause :- HIV( destroy T-cells), excessive radiation.
02 :- SERUM ELECROLYTES
VARIOUS COMPONENTS OF SERUM ELECTROLYTES :-

1) Sodium
2) Potassium
3) Calcium
4) Chloride
5) Phosphorus
1.) SODIUM
Major extracellular cation.
NORMAL SODIUM LEVEL :- 135-145 meq/L
INCREASED LEVEL :- known as “HYPERNATREMIA”
Cause :- Dehydration, shock, fever, coma, renal failure.
Management :-
 water replacement by oral or IV route.
 Maintain I/O chart.
 Salt restricted diet.
DECREASED LEVEL :- known as “HYPONATREMIA”
Cause :- Excessive water intake, excessive infusion, inability of kidney to excrete
water, poor salt intake, excessive use of diuretics.
Management :- for indilutional hyponatremia :– restrict water intake.
increase sodium intake
 2.) POTASSIUM
Major intracellular cation.
NORMAL POTASSIUM LEVEL :- 3.5-5.1 meq/L
INCREASED LEVEL :- known as “HYPERKALEMIA”.
Cause :- Renal failure, serious burn, crush injuries, infection, acidosis.
Management :-
 Reduce dietary potassium
 Bicarbonate therapy
 Diuretics (furosemide)
DECREASED LEVEL :- known as “HYPOKALEMIA”
Cause :-Excessive diuretics use, excessive vomiting and diarrhea.
Management :-
 Symptomatic- for vomiting:- aniemetic
 for diarrhea:- antimotility drugs
 Potassium rich food ( green vegetables, tomato, coconut water)
 Sever hypokalemia (<3 meq/l):- IV therapy
 3.) CALCIUM
NORMAL CALCIUM LEVEL :- 9-11 mg/dl
INCREASED LEVEL :- known as “HYPERCALCEMIA”
Cause :- Tumor of parathyroid gland, hyperparathyroidism
Management :-
 Fluid and diuretic therapy
 Biphosphonates and calcium therapy
DECREASED LEVEL :- known as “HYPOCALCEMIA”
Cause :- pancreatitis, renal disease, accidental removal of parathyroid gland following
thyroidectomy.
Management :-
 IV calcium gluconate 10%
 Calcium and vitamin D Supplements.
4.) CHLORIDE
NORMAL CHLORIDE LEVEL :- 98-106 meq/l
INCREASED LEVEL :- In Uremia
DECREASED LEVEL :- In bacterial infections
Management:-
To treat underlying diseases.

5.) PHOSPHORUS
NORMAL PHOSPHORUS LEVEL :- 2.4-4.1 meq/l
INCREASED LEVEL :- kidney and parathyroid gland dysfunction.
DECREASED LEVEL :- when calcium level become high.
03 :- BLOOD SUGAR
NORMAL VALUE :- 70-99 mg/dl
INCREASED LEVEL :- known as “HYPERGLYCEMIA” or “DIABETES”.
PRE-DIABETES :- 100-125 mg/dl
DIABETES :- >126 mg/dl
Causes :- Pancreatitis, Cushing syndrome, pancreatic cancer.
Signs and symptoms :- Increased thirst or hunger, blurred vision, frequent urination
and headache.
Management :-
 Fluid replacement (help to dilute excess sugar in blood )
 Electrolyte replacement
 Insulin therapy
DECREASED LEVEL :- known as hypoglycemia
Level below :- 70 mg/dl
Causes :- due to oral diabetes medication, excessive
alcohol drinking, insulin overproduction
Signs and symptoms :- fatigue, pale skin, anxiety,
sweating, irritability.
Management:-
 Immediate IV fluids D5, D10.
 If very high level administer injection Glucagon
(1MG) SC/IM.
 For regular assessment of blood sugar use glucometers

 Wash hands and wear gloves.

 Clean the site (most common site is tip of the ring finger) with the help of wet cotton.
 Turn on the glucometer, this is usually done by inserting a test strip.
 Use the Lancing device to Pierce the side of finger.
 Discard the first drop of blood with the help of cotton .
 Place the drop to the edge of the test strip.
 Apply cotton on the piercing site for some time.
 On the counting of five, glucometer shows the reading and document this reading on
patient file.
 04 :- Glucose tolerance test
Also known as “oral glucose tolerance test” (OGTT)
It can be used to screen for type 2 diabetes and also for diagnosis of gestational
diabetes.
Before the procedure :-
 Take first sample of blood from a vein of arm for assessing fasting blood glucose
level.
 Then advise patient to drink 250ML water which is containing 70 to 75 grams
sugar.
 After two hours again measure the blood glucose level.
After procedure :-

IF RESULT IS:-
140 mg/dl = indicate “NORMAL BLOOD
GLUCOSE LEVEL”

140-199 mg/dl = indicate “prediabetes”.

> 200 mg/dl = indicate “DIABETES”

 5. Thyroid Function Test:
This group of Test assess the thyroid gland which regulate the metabolism in the body.

Tests Normal Value Condition

TSH ( Thyroid Stimulating 0.4 – 4.0 mU/L decrease – Hyperthyroidism
Hormone)
increase – Hypothyroidism

T4 ( Thyroxine ) 9.0 – 25.0 pmol/L Increase – Hyperthyroidism

Decrease – hypothyroidism

T3 ( triiodothyronine) 3.5 – 7.8 pmol/L Increase – Hyperthyroidism

Decrease – hypothyroidism
Hypothyroidism:
 Decrease the function of thyroid hormones.

Causes:
Management:
 Autoimmune disorder
 Daily use of levothyroxine
 Iodine Deficiency
 Daily assess weigh
 Hereditary Problem
 Advise to do exercise.
Sign & Symptoms:
 Encourage patient to intake food
 Weight gain
 Fatigue rich in fibre, low calories and

 Hair loss increase fluid intake.

 Feeling cold ( cold sensitive)
 Slow hear rate
Hyperthyroidism:
• Overactive of thyroid gland.

Causes:
Management:
 Thyroiditis
 Daily use of Methimazole
 Family history
 Daily assess weigh
Sign & Symptoms:
 Weight loss  Enhance rest

 Rapid or irregular heartbeat  Provide cool and quite environment.

 Sweating
 Heat Sensitive
 Increase hunger
6. Liver Function Test:
This group of test indirectly assess the health of the liver cells by measuring enzymes
arising from the cells & also assess substances produced by the liver and used else
where in the body.

Tests Normal Value Conditions

Aspartate Transaminase Test (AST) 0 – 35 U/L Increase with MI and liver injury.

Alanine Transaminase Test (ALT) 0 – 35 U/L Increase negligible unless parenchymal liver
disease.
Alkaline Phosphate Test (ALP) 53 – 128 U/L Increase with obstructive liver disease.

Total Bilirubin 0.1 – 1 mg/dl Increase with haemolysis, cholestasis, liver

injury.
Management of altered liver function:
 Promote rest.

 Restrict Sodium in diet, envoy

 Avoid alcohol.

 Exchange transfusion and

phenobarbitone if jaundice .
 7. Kidney Function Test:
 This Test done to diagnose the disease or disorders of kidney & urinary tract and systematic diseases that
effect the kidney function.

Test Normal value Condition

Blood Urea Nitrogen 7 – 20 mg/dl Dehydration, burns, high protein diet.

Serum Creatinine Women= 0.6 – 1.1 mg/dl Kidney failure, kidney infection, glomerulonephritis,
Men = 0.7 – 1.3 mg/dl blockage in urinary tract.

Urine Albumin 0-8 mg/dl Nephrotic syndrome, Diabetic nephropathy, Renal

failure.
Management of Altered Kidney Function:
 Encourage intake of fluid if not contraindicated

 Corticosteroid such as prednisolone if nephritic Syndrome

 Monitor Intake & output

 Diuretics & antidiuretic drugs

 Dialysis & Kidney transplant if

kidney failure.
 8. Lipid Profile:
 A Lipid profile or Lipid panel is a panel of blood tests used to find abnormalities
in lipids, such as cholesterol, triglycerides. The result of this Test can identify
certain genetic diseases and can determine approximate risks for cardiovascular
diseases.

Component Normal Value Category Condition

HDL ( Good Cholesterol) < 40 mg /dl A major risk for heart Lower value have more
disease. risk of CV disease.

40 – 59 mg/dl The higher, the better.

60 mg/dl or above Considered protective

against heart disease.
Component Normal range Category Conditions
LDL ( Bad Cholesterol) < 100 mg/dl Optimal Coronary artery disease,
arthrosclerosis, stroke,
100 – 159 mg/dl Borderline High High cholesterol diet.

160 – 190 or above Very high

Triglyceride < 150 mg/dl Optimal Diabetes, Kidney disease,

Heart disease.
150 – 199 mg/dl Borderline high

200 – 499 mg/dl High

500 mg/dl Very high

Total Cholesterol < 200 mg/dl Desirable Coronary heart disease,

Stroke, HTN, Diabetes.
200 – 299 mg/dl Borderline high

240 mg/dl or above High

Management Of Altered Lipoprotein Or Cholesterol:
 Regular use of statin.

 Encourage for exercise and reduce

body weight.

 Control blood pressure.

 Eat low fat diet or spicy food.

 Do not smoke.
 9. ABG
 Arterial Blood gas analysis is an essential part for diagnosing & managing the
patient's Oxygenation status, ventilation status and Acid-base balance.

→ Blood drawn from arteries (radial, brachial & femoral ).

PURPOSE:
 To determine the presence & type of acid-base imbalance.

 To check for severe breathing and lung disease

 Assessment of response to therapeutic intervention such as medical ventilator .

Indication:
 Respiratory failure

 ventilated patient

 poisoning

 Sepsis & burn.

 Cardiac failure

 Renal Failure
 Preparation Of Client:
 To record the temperature of client.

 Record inspired O2 concentration of client.

 Explain the procedure & reduce the anxiety.

 Heparinized the syringe to prevent blood clotting.

 Done Allen's test.

 →The Allen's test is done to assess the arterial blood flow to the hand.

 This test can be performed for either the ulnar or radial artery.

 Ask patient to clench the fist.

 Apply firm pressure to radial & ulnar arteries, to obstruct blood flow to hand.

 Release the pressure on ulna artery to determine the Allen test is positive or
negative.

 Positive Allen Test - if hand flushes within 5-15 sec it indicate that ulnar
artery has good blood flow & good for radial artery to puncture.

 Negative Allen test- if hand doesn't flush within 5-15 sec it indicate ulnar
circulation is inadequate, in this situation, the radial artery supplying arterial
blood to that hand, should not be Punctured or block.
 Preparation of equipment
 Gloves

 2-3 ml syringe with 20, 23, 25 G needle.

 0.1ml sodium heparin. Bowel with day

& wet cotton.

 Paper bag & kidney tray

 Mackintosh
Procedure
 Wash hand & wear gloves.

 Place mackintosh under patient's wrist

 Palpate the artery to be punctured. Done Allen test

 Clean the area

 Palpate the radial artery for pulsation.

 Puncture the artery at 60-90° angle

 Withdraw 2-3ml of blood for sample

 Once the sample has been taken, withdraw the needle & apply firm pressure over site with dry cotton.

 Remove the air bubble from syringe & needle.

 Cap the needle & send it to the laboratory with patient identification data and type of test.
 Observe the Normal & Abnormal values:
Components Normal Value Abnormal Condition
pH 7.35 – 7.45 Increase respiratory and metabolic alkalosis.

Decrease R & M acidosis.

PaCO2 35 – 45 mm Hg Increase respiratory acidosis

Decrease respiratory alkalosis

PaO2 80 - 100 mm Hg Increase polycythaemia

Decrease anemia, Chronic obstruction, pulmonary disease

HCO3 22 – 26 mEq/L Increase metabolic alkalosis

Decrease metabolic acidosis

SO2 95 – 100 % Increase deep or rapid breathing.

Decrease high altitude, upper or middle airway obstruction, alveolar lung

disease.
Management of Metabolic Acidosis:
 IV Sodium bicarbonate.
 Insulin, diabetic drugs, fluids, if acidosis due to diabetes. ( Diabetic ketoacidosis)
 Haemodialysis if kidney disease or failure.

Management Of Metabolic Alkalosis:

 Sodium infusion
 Potassium Replacement
 Stopping the medication that caused condition, e.g.- high doses of diuretics
Management of Respiratory Acidosis:
 Maintain patent airway & provide humidification via oxygen therapy.

 Provide semi-fowler’s position.

 Provide chest physiotherapy and suction if required.

Management of Respiratory Alkalosis:

 Encourage patient to breath slowly and deeply.
 Speak in low, calm tone of voice.
 Provide safe environment.
Care Of Patient After Procedure:
 Leave the pressure bandage on the punctured site for 15-30 minutes.
 Instruct patient to avoid activities that may strain the arm used during procedure (such as
exercise & heavy lifting).
 Advise patient for Drink more liquids.°
 Educate patient to avoid alcohol, strenuous exercise. smoking, ca- affine etc.
 close observation of punctured site for bleeding, discomfort, swelling or bruising.
 If patient feel discomfort, Swelling, bruising, place cold pack and pressure over the site for
10-15 min. If bleeding occurs, Advise patient to raise the arm & apply pressure on the site.
 Educate patient to inform the Healthcare provider, if there is excessive bleeding fever, pain
redness, warmth, numbness in the arm.
 Document the patient condition, type of tests done, and any abnormal findings.
 Summary
In this presentation , we have included the introduction and definition
of blood test, uses of blood test, enlist of different blood test,
preparation for blood test in which preparation for client, preparation
of articles and different vacutainer tubes, procedure and observation
of normal and abnormal values of CBC , serum electrolytes, Blood
sugar, Glucose tolerance test, Thyroid function test, Liver function
test, Kidney function test, Lipid profile, ABG test in which its
introduction, purposes, indication, procedure, preparation of client,
Allen's test, preparation of equipment, observe of normal & abnormal
values and last care of patient after procedure.

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Thank
you
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