Chapter 25 Quiz #1

Nurse role in diagnostic testing?

• Determine that the patient is not allergic to any dyes or preparations that may be used for the test, including allergies to iodine, shellfish, and contrast medium.

• Noting the health-care provider’s order,

  Occasionally scheduling the test or procedure.

• Educating the patient regarding the process, Administering laxatives or enemas to remove fecal material from the intestinal tract, which allows for better visualization of the intestine for various imaging tests

• Making certain written consent is obtained, if the procedure requires it; the health-care provider is responsible for explaining the diagnostic tests and answering the patient’s questions prior to the consent being signed

• Knowing when to withhold food and fluids,

  Preparing the patient,

  Assisting the examiner with performance of the test or procedure

Answer explanation

pg. 504

Noting the health-care provider’s order.

Occasionally scheduling the test or procedure.

Educating the patient regarding the process.

Safety: Determine that the patient is not allergic to any dyes or preparations that may be used for the test, including allergies to iodine, shellfish, and contrast medium.

Administering laxatives or enemas to remove fecal material from the intestinal tract, which allows for better visualization of the intestine for various imaging tests.

Making certain written consent is obtained, if the procedure requires it; the health-care provider is responsible for explaining the diagnostic tests and answering the patient’s questions prior to the consent being signed.

Knowing when to withhold food and fluids (Box 25.1).

Preparing the patient.

Assisting the examiner with performance of the test or procedure.

Your responsibilities after the diagnostic tests may include the following:

Obtaining specimens or delivering specimens to the laboratory.

Monitoring and assessing the patient’s condition after the test.

Reassuring or supporting the patient as needed.

Notifying the health-care provider of significant abnormal results.

Monitoring for complications.

Providing necessary postprocedure nursing care.

Being able to relate the significance of the test findings to the patient’s condition.

When to Withhold Food and Fluids

• Any type of endoscopy, such as EGD and colonoscopy

  Cardiac catheterization

• Any CT with contrast medium or dye

• Any test reflecting glucose levels, such as the glucose tolerance test and fasting blood glucose

• Lung and brain scans if contrast medium is used

  Cholesterol and lipid tests

Answer explanation

pg. 505

Withholding food and fluids, or permitting “nothing by mouth,” is known as keeping the patient NPO. Many tests require that the patient be kept NPO prior to the test, but there are no hard and fast rules for which tests require this. Each facility will have its own policies for diagnostic tests and whether or not preparation includes being kept NPO. Which blood chemistry tests include being kept NPO vary in different facilities. Some of the tests that commonly require the patient to be kept NPO for 6 to 8 hours include the following:

CATEGORIES OF DIAGNOSTIC TESTS

• Laboratory tests

• Radiology and imaging tests and procedures

• Ultrasonography

• Endoscopic examinations

• Graphic recording tests

Answer explanation

pg.505

Anatomy and Physiology Connection

Blood

• RBC

• WBC

Answer explanation

pg,505

Let’s briefly review the production of blood cells. In adults, red blood cells (RBCs) are produced by the bone marrow within the sternum, vertebrae, ribs, and pelvis. The kidneys release a protein known as erythropoietin, which acts on stem cells in the bone marrow to produce more RBCs. The RBC has a relatively short life span of approximately 120 days, after which it is destroyed by the reticuloendothelial system. White blood cells (WBCs) are mostly produced in the bone marrow, with limited production in the lymphoid tissues. Platelets (PLTs) are produced from large bone marrow cells known as megakaryocytes.

is the study of blood cells and the blood-forming tissues (the bone marrow)

Answer explanation

pg. 505

Most common test ordered

Answer explanation

COMPLETE BLOOD COUNT. The most common test ordered is the complete blood cell count (CBC), which measures the number of leukocytes, or WBCs; erythrocytes, or RBCs; and thrombocytes, also called platelets and abbreviated as PLTs. It also differentiates the percentages of the five types of WBCs (lymphocytes, neutrophils, eosinophils, basophils, and monocytes); measures the hemoglobin (Hgb), or iron pigment; and the hematocrit (Hct), which is the measurement of the percentage of packed RBCs compared to the whole blood volume. Each of these tests may be ordered as a stand-alone test as well as components of a CBC. Even as a new nursing student attending clinical experiences, it is important to comprehend the different components of a CBC because it is performed on every patient upon admission to a hospital. Table 25.2 lists the normal CBC values.

measures the hemoglobin (Hgb), or iron pigment

Answer explanation

which measures the number of leukocytes, or WBCs; erythrocytes, or RBCs; and thrombocytes, also called platelets and abbreviated as PLTs. It also differentiates the percentages of the five types of WBCs (lymphocytes, neutrophils, eosinophils, basophils, and monocytes); measures the hemoglobin (Hgb), or iron pigment; and the hematocrit (Hct), which is the measurement of the percentage of packed RBCs compared to the whole blood volume. Each of these tests may be ordered as a stand-alone test as well as components of a CBC. Even as a new nursing student attending clinical experiences, it is important to comprehend the different components of a CBC because it is performed on every patient upon admission to a hospital. Table 25.2 lists the normal CBC values.

the hematocrit (Hct), which is the measurement of the percentage of packed RBCs compared to the whole blood volume

Answer explanation

which measures the number of leukocytes, or WBCs; erythrocytes, or RBCs; and thrombocytes, also called platelets and abbreviated as PLTs. It also differentiates the percentages of the five types of WBCs (lymphocytes, neutrophils, eosinophils, basophils, and monocytes); measures the hemoglobin (Hgb), or iron pigment; and the hematocrit (Hct), which is the measurement of the percentage of packed RBCs compared to the whole blood volume. Each of these tests may be ordered as a stand-alone test as well as components of a CBC. Even as a new nursing student attending clinical experiences, it is important to comprehend the different components of a CBC because it is performed on every patient upon admission to a hospital. Table 25.2 lists the normal CBC values.

Barium Enema

• Rectal instillation of barium (a contrast medium) provides for radiographic visualization of the large intestine, to see its shape and any abnormalities that might be present.

• To detect cancerous tumors, obstructions, polyps, inflammatory disease, or diverticula in the colon.

• Explain the procedure. Offer assurance and support. The day before, perform bowel prep of laxatives and enemas according to facility or physician orders. Clear liquid diet. NPO after midnight.

• Administer milk of magnesia or laxative of choice to remove barium before it hardens.

  Monitor for constipation.

  Explain that stools will be white until barium is eliminated.

  Provide fluids and physician-ordered diet.

Answer explanation

pg. 506

Table 25.1

Bone Marrow Aspiration

• Under local anesthetic, a sample of marrow is removed from the sternum, tibia, or iliac crest by needle aspiration for evaluation of blood cell production.

• To diagnose some serious anemias, thrombocytopenia, and cancerous tumors, and to stage Hodgkin’s disease.

• Describe the procedure and explain that it only takes 10 to 20 minutes to perform.

  Assess for allergy to local anesthetic to be used.

  Explain there will be a feeling of pressure and a brief period of discomfort when the marrow is actually aspirated. Offer reassurance and support. Make certain written consent has been obtained.

  Administer sedative or analgesic 60 to 90 minutes prior to test. Assess vital signs for baseline.

• Hold pressure to puncture site and observe for bleeding at site.

  Apply dressing.

  Monitor vital signs for shock: ↓BP, ↑P.

  Monitor for signs of infection: ↓T, ↑P.

Answer explanation

pg. 506 Table 25.1