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Describe the nurse’s role for each of the phases involved in diagnostic testing.
Concepts for Lecture
1. Diagnostic testing involves three phases: pretest, intratest, and post–
2. The major focus of the pretest phase is client preparation. The nurse
educates the client about the test based on client assessment as well
3. The intratest phase focuses on specimen collection and performing
or assisting with certain diagnostic testing. The nurse provides emo-
4.
During the post-test period, the focus is on the nursing care of the client,
follow-up activities, and observations. The nurse compares the previous
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List common blood tests.
Concepts for Lecture
34–1), serum electrolytes (see Box 34–1), serum osmolality, drug
2. The complete blood count includes hemoglobin, hematocrit, erythro-
cyte (RBC) count, leukocyte (WBC) count, RBC indices, and WBC
differential.
3. The most commonly ordered serum electrolytes are for sodium,
4. Serum osmolality is the measure of the solute concentration in the
C
HAPTER
34
DIAGNOSTIC TESTING
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Ask the students to bring the laboratory and
diagnostic test book required in the curricu-
lum. Divide the students into groups and
assign each group a specific diagnostic test.
Have the students describe the nurse’s role for
each phase of the assigned diagnostic test.
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Select specific laboratory test results for
memorization. Have a laboratory test “spelling
bee” type of game.
5. Therapeutic drug monitoring is conducted when the client is taking a
6. Blood levels of urea and creatinine are used to evaluate renal func-
7. Blood chemistry includes liver function tests, cardiac markers, lipo-
8. Metabolic screening evaluates newborns for congenital metabolic
9.
Capillary blood glucose specimens are taken to measure blood glucose.
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3
Discuss the nursing responsibilities for specimen collection.
Concepts for Lecture
1. Nursing responsibilities associated with specimen collection include
the following: Explaining the purpose of the specimen collection and
the procedure for obtaining the specimen; providing client comfort,
L
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4
Explain the rationale for the collection of each type of specimen.
Concepts for Lecture
1. The stool specimen is used to determine the presence of occult (hid-
2. Urine specimens are collected by the nurse for a number of tests:
3. Sputum specimens are usually collected for one or more of the fol-
4.
Throat culture samples are collected from the mucosa of the oropharynx
and tonsillar regions using a culture swab. The sample is then cultured
and examined for the presence of disease-producing microorganisms.
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Ask the students to bring the laboratory and
diagnostic test book required in the curricu-
lum. Divide the students into groups and
assign each group a specific diagnostic test.
Have the students describe the nurse’s respon-
sibilities for each assigned diagnostic test.
Share with the class.
• Discuss the agency’s policies and procedures
for reporting laboratory results to health
providers.
• Review procedures for delivery of specimens
to the laboratory.
clients describing the purposes for obtaining
• Have students discuss the rationales for the
CHAPTER 34 / Diagnostic Testing 235
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5
Describe how to collect and test stool specimens.
Concepts for Lecture
1. The nurse needs to determine the reason for collecting the stool
2. When obtaining a stool specimen, the nurse gives the following
instructions to the client: Defecate in a clean bedpan or bedside
3. When obtaining the stool specimen from the bedpan or bedside
commode, the nurse should follow medical aseptic technique
meticulously, wear gloves, and take care not to contaminate the out-
sent. Visible pus, mucus, or blood should be included in sample
specimens. The specimen label and the laboratory requisition must
4. For a stool culture, the nurse dips a sterile swab into the specimen,
5. A commonly used test product to measure occult blood is the He-
moccult test. To perform this test, the nurse or client uses a tongue
blade to place a small amount of stool on a slide or card and then
closes the card. The card is turned over and a few drops of a reagent
Certain foods, medications, and vitamin C can produce inaccu-
rate test results. False–positive results can occur if the client has
recently ingested red meat, raw vegetables or fruits (particularly rad-
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
to the laboratory?).
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Have the students review the laboratory book
required for the curriculum to determine other
methods of detecting occult blood in the stool.
Compare with the Hemoccult method.
236 CHAPTER 34 / Diagnostic Testing
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6
Compare and contrast the different types of urine specimens.
Concepts for Lecture
1. There are several types of urine specimens: clean voided for routine
2. A clean voided specimen is usually collected by the client with min-
imal instructions. Male clients generally are able to void directly into
3. Clean-catch or midstream urine specimens are collected when a
urine culture is ordered to identify microorganisms causing urinary
4.
Timed urine specimens require collection of all urine produced and
voided over a specific period of time, ranging from 1 to 2 hours to
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7
Describe how to collect sputum and throat specimens.
Concepts for Lecture
1. To collect a sputum specimen, the nurse follows these steps: Offer
mouth care so that the specimen will not be contaminated with
microorganisms from the mouth. Ask the client to breathe deeply
and then cough up 1 to 2 tablespoons or 15 to 30 mL of sputum.
Wear gloves and personal protective equipment to avoid direct
2.
To obtain a throat culture specimen, the nurse puts on clean gloves, then
inserts the swab into the oropharynx and runs the swab along the tonsils
and areas on the pharynx that are reddened or contain exudates.
S
UGGESTIONS FOR
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LASSROOM
A
CTIVITIES
• Review the procedures for obtaining each type of
specimen.
•
Show the equipment used for obtaining each
type of specimen.
•
Have the students obtain necessary urine speci-
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Demonstrate how to use suction to obtain
sputum specimens (e.g., sputum traps).
S
UGGESTIONS FOR
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LINICAL
A
CTIVITIES
• Have the students obtain sputum specimens on
assigned clients if appropriate.
CHAPTER 34 / Diagnostic Testing 237
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Describe visualization procedures that may be used for the client with gastro-
intestinal, urinary, and cardiopulmonary alterations.
Concepts for Lecture
1. Visualization procedures include indirect (noninvasive) and direct
2. Direct gastrointestinal visualization techniques include anoscopy, the
viewing of the anal canal; proctoscopy, the viewing of the rectum;
3. Indirect viewing of the gastrointestinal tract is possible with x-rays
4. Visualization of the urinary tract includes x–rays of the
kidneys/ureters/bladder (KUB), intravenous pyelography (IVP), and
retrograde pyelography. For an intravenous pyelogram, contrast
5. A number of visualization procedures can be done to examine the
cardiovascular system and respiratory tract. Electrocardiography
(ECG) provides a graphic recording of the heart’s electrical activity.
6.
A lung scan, also known as a V/Q (ventilation/perfusion) scan, records
the emissions from radioisotopes that indicate how well gas and blood
are traveling through the lungs. The perfusion scan (Q scan) is used to
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
• If possible, obtain videotapes or DVDs of vari-
ous visualization procedures and show them in
class.
•
Ask the students to bring the laboratory and
diagnostic test book required in the curricu-
lum. Divide the students into groups and
tional experience in various diagnostic centers
238 CHAPTER 34 / Diagnostic Testing
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Compare and contrast CT, MRI, and nuclear imaging studies.
Concepts for Lecture
1. Computed tomography (CT) is a painless, noninvasive x-ray proce-
2. Magnetic resonance imaging (MRI) is a noninvasive diagnostic
scanning technique in which the client is placed in a magnetic field.
Clients with implanted metal devices cannot undergo MRI because
3.
Nuclear imaging studies study the physiology or function of an organ
system, in contrast to CT, MRI, or x-ray studies, which visualize ana-
L
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Describe the nurse’s role in caring for clients undergoing aspiration/biopsy
procedures.
Concepts for Lecture
1. Aspiration is the withdrawal of fluid that has abnormally collected or
2. The nurse’s role in assisting with lumbar puncture, abdominal para-
centesis, thoracentesis, bone marrow biopsy, and liver biopsy is
extensive and is required before, during, and after these procedures.
3. During the lumbar puncture procedure the nurse assists the client to
maintain the position by supporting the client behind the neck and
4. After the lumbar puncture procedure, the nurse assists the client into
the dorsal recumbent position with one pillow for 1 to 12 hours; pro-
vides analgesics, if ordered, for headache as necessary; offers oral
S
UGGESTIONS FOR
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LASSROOM
A
CTIVITIES
•
Obtain examples of CT, MRI, and nuclear
imaging scans to share with the class.
S
UGGESTIONS FOR
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LINICAL
A
CTIVITIES
S
UGGESTIONS FOR
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LASSROOM
A
CTIVITIES
•
If possible, obtain equipment used to perform
these procedures. Demonstrate the equipment
for the students.
S
UGGESTIONS FOR
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LINICAL
A
CTIVITIES
5. When caring for a client undergoing an abdominal paracentesis, the
6. During the abdominal paracentesis procedure, the nurse provides
verbal support; observes for signs of distress; monitors color, pulse,
7. After the abdominal paracentesis procedure, the nurse monitors for
signs of hypovolemic shock, scrotal edema, vital signs, urine output,
and drainage from the puncture site every 15 minutes for 2 hours and
8. When caring for a client undergoing a thoracentesis, the nurse ex-
plains that some discomfort and pressure may be felt when the nee-
9. During the thoracentesis procedure, the nurse provides verbal sup-
10. After the thoracentesis procedure, the nurse monitors pulse, respira-
tions, and skin color; removes no more than 1000 mL within the first
11. When caring for a client undergoing a bone marrow biopsy, the
nurse explains that pain may occur when the marrow is aspirated and
12. During the bone marrow biopsy procedure, the nurse provides verbal
support; observes for pallor, diaphoresis, or faintness; applies a
13. After the bone marrow biopsy procedure, the nurse assesses for dis-
14. When caring for a client undergoing a liver biopsy, the nurse gives
preprocedure medications 30 minutes prior to the procedure or as or-
dered; gives vitamin K as ordered for several days prior to the
15. During the liver biopsy procedure, the nurse provides verbal support;
instructs the client to take several deep inhalations and expirations,
16.
After the liver biopsy procedure, the nurse assists the client to a right
side-lying position with a small pillow or bath blanket under the biopsy
L
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11
Verbalize the steps used in:
a. Obtaining a capillary blood specimen to measure blood glucose.
b. Collecting a urine specimen for culture and sensitivity by clean catch.
Concepts for Lecture
ESSENTIAL/
CRITICAL
ELEMENT?
COMPETENCY
DEMONSTRATED?
Yes
No
ESSENTIAL/
CRITICAL
ELEMENT?
COMPETENCY
DEMONSTRATED?
Yes
No
242 CHAPTER 34 / Diagnostic Testing
Variation: Obtaining a Urine Specimen from a Closed Drainage System
L
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12
Recognize when it is appropriate to delegate diagnostic testing skills to unli-
censed assistive personnel.
Concepts for Lecture
1. Nurses often assume the responsibility for specimen collection.
2. UAP may obtain and collect stool specimen(s). The nurse, however,
needs to consider the collection process before delegating this task.
3. Check the applicable nurse practice act and the facility policy and
4.
UAP may perform the collection of a clean-catch or midstream urine
specimen. It is important, however, that the nurse inform the unlicensed
individual about how to instruct the client in the correct process for
CHAPTER 34 / Diagnostic Testing 243
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13
Demonstrate appropriate documentation and reporting of diagnostic testing
information.
Concepts for Lecture
1. Document glucose monitoring to include the method of testing and
results on the client’s record. If appropriate, record the client’s un-
2. Record collection of specimens on the client’s chart and on the nurs-
ing care plan. Include in the recording the date and time of the col-
3. Indicate pertinent information on the laboratory slip, such as if the
4. Document the collection of the sputum specimen on the client’s
chart. Include the amount, color, consistency (thick, tenacious,