iii.

Increased in polycythemia,
DIAGNOSTIC TESTS AND dehydration
COMMON PROCEDURES (except iv. Normal Adult Male Range:
40.7 to 50.3 %
nervous and cardio systems) v. Normal Adult Female
Range: 36.1 to 44.3 %
1. BLOOD TYPING: antigens: A, B, Rh c. RBC COUNT
2. INDIRECT COOMB’S TEST: screens for i. carry oxygen to the tissues
circulating Rh antibodies and transfer carbon dioxide
3. DIRECT COOMB’S TEST: determines to the lungs.
antibodies attached to RBC; (+) indicates ii. Normal Adult Male Range:
transfusion reactions, erythroblastosis 4.7 to 6.1 million cells/mcL
fetalis, hemolytic anemia iii. Normal Adult Female
Range: 4.2 to 5.4 million
4. PERIPHERAL BLOOD SMEAR: RBCs are cells/mcL
examined for size, shape, color and
structure
d. W.B.C. (WHITE BLOOD CELL
5. COAGULATION STUDIES:
COUNT)
a. Prothrombin time: PT/INR; the i. fight infection, defend the
actual amount of time needed by body by phagocytosis
blood to clot in seconds; <12 ii. Normal Adult Range: 4,500
seconds to 10,000 cells/mcL
b. Activated partial e. PLATELET COUNT
thromboplastin time: identifies i. vital to coagulation of the
deficiency in clotting factors, blood
prothrombin and fibrinogen; ii. Increased in dehydration or
normal: 25-40sec stimulation of the bone
c. Partial Thromboplastin Time: marrow where the cells are
60-90 sec produced
d. Bleeding time: determines iii. decreased in
platelet disorders, capillary immunocompromised px,
defects, and client’s ability to stop drug reactions, B12, or folic
bleeding acid deficiency
6. BLOOD CHEMISTRIES iv. Normal Adult Range: 150 -
a. HEMATOCRIT (HCT) 400 thous/uL
i. means "to separate blood" f. NEUTROPHILS AND
ii. measurement of the NEUTROPHIL COUNT
percentage of red blood i. main defender of the body
cells in whole blood against infection and
iii. Decreased in anemia, antigens
overhydration, increased ii. Increased in active
R.B.C. breakdown in the infection
spleen iii. Decreased in compromised
iv. Increased in polycythemia, immune system or
dehydration, major burns depressed bone marrow
v. Normal Adult Male Range: g. LYMPHOCYTES
40 - 54 % i. involved in protection of
vi. Normal Adult Female the body from viral
Range: 37 - 47 % infections
b. HEMOGLOBIN (HGB) ii. Increased in active viral
i. main transport of oxygen infection
and carbon dioxide in the iii. Decreased in exhausted
blood immune system
ii. Decreased in anemia, poor h. MONOCYTES
diet/nutrition, i. body's second line of
malabsorption problem defense against infection
and are the largest cells in
the blood stream
 ii. Increased in in tissue i. flow rates of 1-6L/min;
breakdown, chronic 24% (at 1L/min) to 44% (at
infections, carcinomas, 6L/min)
leukemia (monocytic), or ii. flow rates higher than
lymphomas. 6L/min don’t significantly
iii. Low levels indicate good increase oxygenation
health. iii. effective O2 concentration
i. EOSINOPHILS AND EOSINOPHIL can be delivered to both
COUNT nose breathers & mouth
i. protect against allergic breathers with the use of a
reactions and parasites nasal cannula
ii. Increased in allergic e. SIMPLE FACE MASK
response
iii. A low count is normal
i. 40%-60% for short term O2
therapy or to deliver O2 in
j. ESR
an emergency
i. Erythrocyte sedimentation
rate ii. minimal flow rate of 5L/min
ii. indirectly measures - to prevent the
inflammation rebreathing of exhaled air
k. CRP iii. Monitor for aspiration
i. C-reactive protein iv. the mask limits the client’s
ii. a test that measures the ability to clear the mouth
amount of a protein in the esp if vomiting occurs
blood that signals acute f. PARTIAL REBREATHER MASK
inflammation. i. 70%-90% with flow rates of
l. ANA 6-15L/min
i. Antinuclear Antibody test ii. the client rebreathes 1/3 of
ii. help screen for the exhaled tidal volume
autoimmune disorders iii. Make sure that the
m. ASO TITER reservoir does not twist or
i. Antistreptolysin O titer kink
ii. a blood test to measure iv. Keep the reservoir bag
antibodies against inflated 2/3 full during
streptolysin O, a substance inspiration
produced by Group A v. deflation results in
Streptococcus bacteria decreased O2 delivered &
n. CEA rebreathing of exhaled air
i. Carcinoembryonic antigen g. NON-REBREATHER MASK
ii. protein normally found in i. most frequently
the tissue of a fetus; deteriorating respiratory
disappear after birth status requiring intubation
iii. In adults, CEA may be a ii. has a one-way valve
possible sign of cancer between the mask &
(GIT, repro) reservoir and two flaps
7. OXYGEN THERAPY: LOW-FLOW over the exhalation ports
SYSTEMS
iii. entire quantity of O2 from
a. provide oxygen at flow rates that
the reservoir bag
are lower than patients’
iv. the flaps prevent room air
inspiratory demands
from entering thru the
b. Entrains room air
exhalation ports
c. final concentration of oxygen
8. HIGH-FLOW OXYGEN DELIVERY
delivered depends on the
SYSTEM
ventilatory demands of the
a. 24% to 100% at 8-15L/min
patient, the size of the oxygen
reservoir, and the rate at which b. the high-flow systems provide a
the reservoir is filled constant FiO2 by delivering the
d. NASAL CANNULA (NASAL gas at flow rates that exceed the
PRONGS) patient’s peak inspiratory flow rate
 and by using devices that may or i. Mantoux test
may not entrain a fixed proportion ii. Tinne test
of room air c. Results read within 48-72 hrs:
c. VENTURI MASK inspect skin and circle induration
i. give accurate O2 and measure diameter in mm
concentration d. Negative: <5mm
ii. an adapter is located e. Doubtful: 5-10mm
between the bottom of the f. Positive: >10mm
mask & the O2 source 12.BRONCHOSCOPY
iii. the adapter contains holes a. Direct visual examination of the
of different sizes that allow larynx, trachea & bronchi with
only specific amounts of air fiberoptic bronchoscope
to mix with the O2 b. informed consent
iv. the adapter allows c. NPO postmidnight and after
selection of the amount of procedure until return of gag
O2 desired reflex
d. FACE TENT 13.PULMONARY ANGIOGRAPHY
i. useful for the client who a. Invasive fluoroscopic procedure
has facial trauma or burns with a catheter inserted into an
because it is not tight antecubital or femoral vein into
e. AEROSOL MASK the pulmonary artery
i. used for the client who has b. Involves an injection of iodine or
thick secretions radiopaque contrast material
f. TRACHEOSTOMY COLLAR OR T- c. Purpose: done to detect blood
PIECE clots and pulmonary
i. can be used to deliver high thromboembolism
humidity & the desired O2 d. Preparation:
to the client with a i. informed consent
tracheostomy ii. assess for allergies to
iodine & seafoods
ii. a special adapter, called T-
piece can be used to iii. Ask about: pregnancy
deliver any desired FIO2 to bleeding tendencies
the client with a iv. Maintain on NPO 8 hours
tracheostomy, prior to the procedure
laryngectomy or e. Avoid taking BP on the arm where
endotracheal tube the dye is injected up to 24 hours
9. CHEST X-RAY post procedure
a. Preparation: f. Inform patient about possible side
i. remove all jewelries & effects of the dye:
other metal i. cough
ii. objects ii. flushing
iii. ask about pregnancy iii. nausea
10.SPUTUM EXAM iv. salty taste
a. Obtain early morning sterile 14.THORACENTESIS
specimen thru expectoration from a. Insertion of a needle through the
deep in the lungs or tracheal chest wall into the pleural space
suctioning to:
b. 15 ml of sputum i. Obtain specimen
c. Preparation: ii. Remove pleural fluid
accumulation
i. obtain specimen before iii. Instill medication
antibiotic therapy
b. Preparation:
ii. rinse the mouth with water i. informed consent
prior to collection ii. USD or CXR prior
11.TUBERCULIN SKIN TEST iii. Position: sitting upright
a. PPD: signifies exposure to TB
with arms & head
b. Methods of administration:
 supported usually on v. HCO3 - 22 - 26 mEq/liter
overhead table 18.PULSE OXIMETER
iv. if unable to sit: pt lies on a. Non invasive that measures O2
the saturation of the client’s HgB
v. unaffected side with the b. Normal value: 95-100%
head of bed elevated at 45 c. Less than 85% -body’s tissues
degrees have a difficulty in becoming
c. Avoid valsalva oxygenated
d. Monitor: pneumothorax, air d. Less than 70% - Life threatening
embolism, & pulmonary edema; e. PREPARATION:
leakage from puncture site i. Maintain the transducer at
15.PULMONARY FUNCTION TESTS/ heart level
SPIROMETRY ii. Do not select an extremity
a. Evaluates lung mechanics, gas with an impediment to
exchange, & acid-base blood flow
disturbance thru spirometric 19. INCENTIVE SPIROMETER
measurements, lung volumes, and a. Use the lips to form seal around
ABGs the mouth piece
b. diagnoses lung disease, b. Inspire deeply
determines SOB, effect of c. Hold inspiration for a few seconds
medications, tx to lung fxn d. Forcefully exhale
i. Preparation: ask about e. Avoid the use of spirometry at
history of drug intake that mealtimes- it may cause nausea
ndepresses respiratory 20.CHEST DRAINAGE SYSTEMS
function a. Insertion of a catheter into the
ii. remove dentures intrapleural space to maintain
iii. inform patient to avoid constant negative pressure when
smoking & heavy meal 4-6 air/fluid have accumulated
hours prior b. Attached to underwater drainage
16.LUNG BIOPSY to allow for the escape of air/fluid
a. Obtain lung samples for analysis to prevent reflux of air into the
by culture or cytologic exam chest
b. Preparation: c. Air: 2nd or 3rd ICS, mid-axillary
i. NPO line
ii. Monitor for signs of d. Fluid: 8th or 9th ICS, mid-axillary
bleeding, pneumothorax, or line
air emboli e. Distal end of tubing must be
17.ARTERIAL BLOOD GAS (ABG) placed below water level
a. Measures the dissolved O2 & CO2 f. Oscillation of the fluid level within
in the bld the water-seal chamber: normally
b. Prior to collection: rise on inspiration and fall on
i. Rest for 30 mins expiration
ii. Avoid suctioning g. If oscillation stops and system is
iii. Do not turn off O2 unless intact, notify physician
ordered h. Clamp only if accidentally
iv. W or w/o O2, wait 20min dislodged
c. Post collection: i. Do not milk the tubes
i. Apply pressure to the j. During removal, instruct client to
punctured site for 5-10 perform Valsalva maneuver
minutes k. Continuous bubbling: suction
ii. Keep extremity extended chamber
6-8hrs l. Intermittent bubbling: collection
d. Normal values chamber (1-bottle), water seal
i. PaO2 - 75 - 100 mm Hg chamber (2 or 3-bottle)
ii. PaCO2 - 35 - 45 mm Hg m. Absence of intermittent bubbling
iii. pH - 7.35 - 7.45 in the collection chamber
iv. SaO2 - 94 - 100%
 i. If (-) resp distress: lung has e. Provide mouth care
fully re-expanded f. Contraindicated in ⇑ respiratory
ii. If (+) resp distress, distress, Hx of fractures, Chest
obstruction present incisions
iii. Call Healthcare provider for 23. AST (SGOT) AND ALT (SGPT)
both incidences a. sensitive indicators of liver
n. Things needed at the bedside: damage or injury from different
i. Vaselinized gauze types of disease liver problems or
ii. Clamp muscle damage
iii. Extra bottle with water b. normal range
o. Multisystem drainage system i. AST (SGOT): 5 - 40 u/L of
p. Pleur Evac serum
q. Heimlich flutter valve ii. ALT (SGPT) 7 - 56 u/L of
21.MECHANICAL VENTILATION serum
a. Modes: 24.UPPER GI SERIES (BARIUM
i. Assist/control mode SWALLOW)
 ventilator provides a a. Flouroscopic examination of upper
mechanical breath GI tract to determine structural
with a pre-set tidal problems and gastric emptying
volume or peak time
pressure every time b. Client swallows barium sulfate or
the patient initiates other contrast media; sequential
a breath films taken as it moves through
ii. Intermittent Mandatory the system
Ventilation (IMV) c. NPO after midnight
 ventilator provides a d. barium will taste chalky
pre-set mechanical e. Laxatives after to expel barium,
breath (pressure or prevent obstruction or impaction
volume limited) 25.LOWER GI SERIES (BARIUM ENEMA)
every specified a. Barium instilled into the colon by
number of seconds enema, client retains the contrast
iii. Positive End Expiratory medium and then x-rays are taken
Pressure (PEEP) b. NPO 8hrs
 ventilator delivers c. Enemas until clear morning of the
additional positive exam
pressure at the end d. Laxatives or suppositories
of expiration e. Cramping may be experienced
iv. Controlled Mandatory during procedure
Ventilation (CMV) f. Laxatives after procedure to expel
 All breathes initiated barium
by ventilator 26.ENDOSCOPY
v. Continuous Positive Airway a. Direct visualization of the
Pressure (CPAP) esophagus, stomach, and
 (+) pressure duodenum by insertion of a lighted
throughout the fiberscope
cycle used on b. NPO 6-8hrs
clients on T-piece c. Local anesthetic will be used,
22.CHEST PHYSIOTHERAPY (CPT) assess for return of gag reflex, and
a. Deep breathing, positioning, hoarseness after
percussion, vibration, draining, 27.COLONOSCOPY
deep breathing, coughing a. Endoscopic visualization of the
b. Best time - morning upon arising, intestines
1 hr before meals or 2-3 hrs after b. NPO 8 hrs
meals c. Laxatives 1-3 days prior
c. Maintain position for drainage 5-20 d. Enemas until clear night before
mins after test
d. Stop if pain occurs
 e. Assess for rectal bleeding and d. you will lie on your left side
signs of perforation e. esophagus, stomach, and
28.SIGMOIDOSCOPY duodenum until it reaches the spot
a. Endoscopic visualization of the where the ducts of the biliary tree
sigmoid and pancreas open into the
b. Light supper and light breakfast duodenum
c. Bowel prep f. lie flat on your stomach
29.GASTRIC ANALYSIS g. will pass a small plastic tube
a. Insertion of NGT to examine through the scope will inject dye,
fasting gastric contents for acidity then xray or relieve obstruction
and volume h. complications: pancreatitis,
b. NPO 6-8 hrs infection, bleeding, and
c. No smoking, anticholinergics, perforation of the duodenum.
antacids 24 hrs prior i. some discomfort when the
30.ORAL CHOLECYSTOGRAM physician blows air into the
a. Injection of radiopaque dye and x- duodenum and injects the dye into
ray examination to visualize the the ducts
gallbladder j. NPO 6 to 8 hours before; NPO after
b. Low fat meal evening before the until return of gag reflex
test, NPO til morning of exam 34.INTESTINAL OSTOMIES
c. Check for iodine sensitivity a. GASTROSTOMY – opening
d. Administer dye tablets through the abdominal wall into
(Telepaque) the stomach (for feeding)
31.LIVER BIOPSY b. JEJUNOSTOMY – opening through
a. Specially designed needle inserted the abdominal wall into the
into the liver to remove a small jejunum (for feeding)
piece of tissue for study
b. NPO 6-8 hrs
c. ILEOSTOMY – opening into the
ileum for draining fecal material.
c. Hold breath during insertion
i. drainage constant, it is
d. Check coagulation studies
liquid, and cannot be
e. Position on the right side with
regulated
pillow against the abdomen
ii. contains digestive enzymes
f. Assess for hemorrhage,
that may damage the skin
pneumothorax
iii. must be worn continuously
32.HEMOCCULT/GUAIAC’S TEST
iv. odor minimal because few
a. 3 days before the test and during
bacteria present
the stool collection period:
b. Diet should have high fiber d. COLOSTOMY – opening into the
colon for excreting feces
content.
i. ascending colon – similar to
c. Avoid red meat in the diet.
ileostomy; odor requires
d. Avoid food with a high peroxide
control
content, such as turnips,
ii. transverse – odorous semi-
cauliflower, broccoli, horseradish,
formed drainage; no
and melon.
control
e. Avoid enemas or laxatives before
iii. descending – more solid
the stool specimen collection.
f. Avoid iron preparations, iodides, e. SIGMOIDOSTOMY – normal
bromides, aspirin, no steroidal consistency and frequency can be
anti-inflammatory drugs (NSAIDs), regulated; doesn’t have to wear
or vitamin C supplements greater appliance at all times
than 250 mg/day f. ASSESSING A STOMA
i. COLOR – should be red;
33. ERCP (ENDOSCOPIC RETROGRADE
pale or dark-colored hues
CHOLANGIOPANCREATOGRAPHY)
indicate impaired
a. provides radiographic visualization
circulation
of the bile and pancreatic ducts
b. x rays and an endoscope ii. SIZE & SHAPE - most
c. contraindicated in pancreatitis stomas protrude slightly
 from the abdomen; new of fluid; volume of solution
stomas appear swollen for stimulates peristalsis
2-3 weeks iv. soapsuds enema –
iii. STOMAL BLEEDING – increases the volume in the
immediate post-op - colon and irritates the
minimal bleeding mucosa; castile soap (pure
iv. COMPLAINTS – burning soap); ideal for use because
sensation indicates skin it is less irritating
breakdown c. VOLUME
g. apply barrier such as karaya gum i. LARGE VOLUME ENEMAS –
over the skin around the stoma to 500-1000ml for an adult;
prevent contact with any ii. hypertonic sol’n usually
excretions small volume
h. check for leakage and proper d. HIGH/ LOW ENEMAS –
fitting of bag i. LOW – given to cleanse the
i. disposable appliances can be kept rectum and sigmoid colon
on for 7 days ave 3-5days; must only; Assume left lateral
be changed when they begin to position
leak or when skin itches below the ii. HIGH – given to cleanse as
barrier far up the colon as
j. ODOR CONTROL: dark green possible; client must
vegetables in the diet change position from left
i. : bismuth subgallates lateral to dorsal recumbent
ii. : deodorizer in the pouch to right lateral
iii. : charcoal filter disk
k. initially, avoid high fiber foods and
e. CARMINATIVE ENEMA – release
gas, distending the rectum and
gas-producing foods
colon; expels flatus; uses 60-80ml
l. avoid heavy lifting and contact
of solution
sports
m. laxatives and enemas may cause f. OIL RETENTION ENEMA –
severe fluid and electrolyte i. given to soften feces and
imbalance lubricate the rectum
35.ENEMAS facilitating the passage of
feces; About 90-120ml of
a. CLEANSING ENEMA –
oil ( mineral, olive, or
i. given to remove feces
cottonseed oil) retained for
ii. to treat constipation
1-3hrs
and impaction
iii. prevent contamination g. RETURN-FLOW ENEMA – 100-
of sterile field during surgery 200ml of fluid is instilled and
iv. promote visualization of allowed to flow in and out of the
the intestine for certain rectum and colon to stimulate
diagnostic tests peristalsis; process repeated
v. as part of bowel several times until flatus expelled
training program to establish or abdominal distention relieved
regular bowel function 36.GASTROSTOMY
b. SOLUTIONS: a. Insertion of a catheter through an
abdominal incision into the
i. HYPERTONIC
stomach where it is secured with
SOLUTIONS – saline; draws
sutures
fluid from intestinal space
b. Alternative method of feeding
into the colon; fleet enema
either temporary or permanent,
ii. HYPOTONIC SOLUTIONS for clients who have problems with
– tap water; draws fluid from swallowing, ingestion and
the colon to the interstitial digestion
space; risk for circulatory c. Inspect and cleanse skin around
overload stoma frequently
iii. ISOTONIC SOLUTIONS – d. Assess residual before feeding
normal saline; no movement
 e. Irrigate tube before and after 39. CHOLEDOCHOSTOMY – opening of
feeding common bile duct, removal of stone, and
f. Measure/record any drainage insertion of a T-tube
g. High fowler’s during feeding and 40.TEST FOR ABNORMAL CONSTITUENTS
30min after OF URINE
h. Feeding at room temp a. SPECIFIC GRAVITY – measures
i. Expect bloody drainage for approx urine concentration
12 hrs with gradual change to i. normal 1.01-1.025
green, then to yellow i. high value indicates
37.NASOGASTRIC TUBES fluid deficit,
a. Soft rubber or plastic tube inserted dehydration, or excess
through a nostril and into the solutes
stomach for gastric b. URINARY pH – measures the
decompression, feeding, or relative alkalinity or acidity of
obtaining specimens for analysis urine; normal- slightly acidic
of stomach contents
b. Types
c. GLUCOSE – for screening DM and
gestational diabetes; normal (-)
i. Levin: single lumen, non-
glucose
vented
d. KETONES – test for ketoacidosis
ii. Salem Sump: tube within a
i. starvation, alcoholism,
tube, vented to provide
fasting or on high-protein
constant flow of
diet
atmospheric air
ii. normal (-) ketones
c. Measure tube from tip of nose, to
earlobe, to xiphoid 41. PROTEIN – indicative of glomerular
d. Bend head forward during membrane damage, infection or
insertion (opens the esophagus inflammation; normal (-) protein
and closes the trachea) 42.BUN/CREATININE
e. May be asked to drink water from a. evaluate kidney function
a straw and swallow to facilitate b. Increased in kidney disease, CHF,
insertion shock, stress, recent heart attack,
f. Assess position or severe burns, to conditions that
i. Aspirate contents cause obstruction of urine flow, or
ii. Inject air to dehydration
iii. x-ray c. Creatinine: 0.8 to 1.4 mg/dL.
g. Periodic saline gargles to prevent d. BUN: 7 - 20 mg/dl
dryness 43.URINE BENCE-JONES PROTEIN
h. Mouthcare a. associated with multiple myeloma
i. Hard candy or gum to stimulate 44.ALKALINE PHOSPHATASE
the flow of saliva a. evidence of liver and bone disease
j. Assess for metabolic alkalosis 45.Acid phosphatase
38.CHOLECYSTECTOMY a. Increased in prostrate cancer
a. postop: T-tube- 300-500 ml 1st 46. RETROGRADE PYELOGRAPHY –
24hrs, then 200ml/day for 3-4 contrast medium instilled into the kidneys
days via the urethra, bladder and ureters
b. maintain patency 47.URINARY CATHETERIZATION
c. prevent bile leakage to a. Insertion of a catheter through the
peritoneum external meatus and the urethra
d. monitor bile drainage (separate and into the bladder
recording sheet) b. For relief of urinary retention,
e. Monitor color of urine and stools prevention of bladder obstruction,
(stools will be light colored if bile is instillation of medication
flowing through t-tube but normal c. Sterile procedure
color should reappear as drainage d. Insert 7.5 cm female, 17-25cm
diminishes male
f. Avoid heavy lifting or at least 6 e. Empty collection bag q 8hrs or
weeks PRN
48.DIALYSIS h. Inflow: Allow dialysate to flow
a. Removal by artificial means of unrestricted into peritoneal cavity.
metabolic wastes, excess - 10-20 minutes
electrolytes, and excess fluid from i. Dwell: Allow fluid to remain in
clients with renal failure peritoneal cavity for prescribe
b. Purpose period - 30-45 minutes
i. Remove end products of j. Drain: Unclamp outflow tube and
protein metabolism from allow to flow by gravity.
blood k. COMPLICATIONS
ii. Maintain safe levels of i. Peritonitis
electrolytes ii. Respiratory difficulty
iii. Correct acidosis and iii. Protein loss
replenish blood bicarb l. Most serum proteins pass through
system the peritoneal membrane and are
c. ACCESS lost in the dialysate fluid.
i. AV fistula m. Monitor serum protein levels
ii. AV shunt closely.
iii. Subclavian or femoral vein 50.CONTINUOUS AMBULATORY
catheterization PERITONEAL DIALYSIS
d. Have client void.
e. Chart client’s weight.
a. A continuous type of peritoneal
dialysis at home by the client or
f. Assess vital signs before and
significant others.
every 30 mins. during procedure.
b. Dialysate is delivered from
g. Withhold antihypertensives, flexible plastic containers
sedatives, and vasodilators to through a permanent
prevent hypotensive episode peritoneal catheter.
(unless ordered otherwise).
h. Ensure bed rest with frequent
c. Following infusion of the dialysate
into the peritoneal cavity, the bag
position changes for comfort.
is folded and tucked away during
i. Inform client that headache and
the dwell period.
nausea may occur.
51.RADIOACTIVE IODINE UPTAKE (RAIU)
j. Monitor closely for signs of
a. A thyroid function test that
bleeding since blood has been
measures the absorption of the
heparinized for procedure.
iodine isotope to determine how
k. Avoid restrictive clothing
the thyroid gland is functioning.
l. Do not use arm with shunt or
fistula for IV infusion, injections, b. Administration of I123 or I131 orally
BP reading using cuff in 24 hrs followed by a scan of
49.PERITONEAL DIALYSIS the thyroid for the amount of
a. Introduction of a specially radioactivity emitted.
prepared dialysate solution into c. Normal value is 5-35% in 24 hours
the abdominal cavity, where the d. Elevated values indicate
peritoneum acts as a semi- hyperthyroidism, thyrotoxicosis,
permeable membrane between decreased iodine intake or
the dialysate and blood into the increased iodine excretion.
abdominal vessels. e. Decreased values indicate
b. Chart client’s weight. hypothyroidism, thyroiditis, low
c. Assess V/S before, q15 min during T4, use of antithyroid meds.
f. Thyroid medication/iodine must be
first exchange, &qH thereafter.
discontinued 7-10 days prior to
d. Assemble specially prepared
test.
dialysate solution with added
g. NPO post MN; if iodine is used
medications.
client will fast an additional 45
e. Have client void.
minutes after ingestion of
f. Warm dialysate solution to body
radioactive isotope & scan is done
temperature.
after 24 hours.
g. Assist physician with trocar
h. Assess allergy to iodine
insertion.
 i. Not for pregnant/lactating e. Post-test: maintain pressure
mothers, flush commode twice dressing and watch out for
j. Harmless to self and others bleeding
because of use of a tracer dose f. Cells can be checked for
only chromosome problems. Cultures
k. Should be assessed for nausea for can also be done to look for
2 hrs after the procedure infection.
52.2HR POST PRANDIAL BLOOD SUGAR: g. for stem cell transplantation or
a. measurement of glucose 2 hrs chromosomal analysis
after ingestion of a meal h. HARVEST SITES: back of the
b. Fast from midnight hipbone, or posterior iliac crest.
c. Client eats meal consisting of at sternum (breastbone) (Tibia in
least 75g carbo or ingests 100g infants)
glucose i. needle twists into the bone
d. Blood drawn 2 hrs after meal :normal to feel pressure at the site
53.ORAL GLUCOSE TOLERANCE TEST: and hear a crunching sound
a. most specific and sensitive test for j. a quick, shooting pain down your
DM leg during aspiration
b. Diet for 3 days prior to test should k. Post-op: apply pressure; remain
include 200g carbo and at least still for 10-15min
1500kcal/day l. takes about 20 minutes.
c. Fast from midnight before test m. If sedative used, assess LOC
d. FBS and urine glucose obtained before resuming
e. Client ingests 100g glucose; blood n. Pain meds if harvest done in
drawn at 30-60min and hourly for several places
3-5 hrs o. COMPLICATIONS
f. During test, assess the client for i. Bleeding from the biopsy
reactions such as dizziness, site
sweating, and weakness ii. Infection of skin or the
54. GLYCOSYLATED HEMOGLOBIN bone (osteomyelitis)
(HEMOGLOBIN A₁C) p. PREPARING FOR THE
a. Reflects the average blood sugar TRANSPLANT(ALLOGENIC)
level for the previous 100-120
days. Glucose attaches to a minor Donor suitability determined (HLA) human
hemoglobin. This attachment is Leukocyte testing, and mixed leukocyte
irreversible culture (MLC) typing
b. Fasting not necessary ↓
c. Evaluates long term control of bone marrow harvest under GA
blood sugar ↓
55.SCHILLING TEST chemotherapy and/or radiation (total body
a. Measures absorption of radioactive irradiation)
vitamin B₁₂ both before and after ↓
parenteral administration of The bone marrow is infused IV
intrinsic factor ↓
b. Definitive test for pernicious Engraftment
anemia ↓
c. Uses 24hr urine collection Antibiotics/irradiated blood for
56.BONE MARROW ASPIRATION BT/hospitalization for 3 months
a. Usually involves aspiration of the
marrow to diagnose diseases like q. After care
leukemia, aplastic anemia r. Blood culture 2x a week
b. Usual site is the sternum and iliac s. Change IV set-up daily
crest t. Fresh fruits, vegetables, plants
c. Pre-test: Consent and cut flowers will be prohibited
d. Intratest: Needle puncture may be in the patient's room
painful u. Mouth care for stomatitis and
mucositis
 v. Avoid glycerin, lemon swabs, ii. Intact; red and doesn’t
alcohol based blanch with external
w. May apply viscous lidocaine pressure
x. Monitor for diarrhea b. STAGE II:
y. laminar airflow room or on strict i. Area in which top layer of
reverse isolation skin is missing
z. Sterilized toys ii. Ulcer is shallow with a pink
aa. Complication: Graft vs Host to red base; white or yellow
disease (GVHD) eschar may be present
i. Acute: first 100 days post- c. STAGE III:
transplant affects skin, gut, i. Ulcer that extends to
liver, marrow, and dermis and subcutaneous
lymphoid tissue tissues
ii. Chronic: 100-400 days ii. White, gray, yellow eschar
post-transplant; multiorgan present at the bottom of
involvement the ulcer, ulcer crater may
57.ARTHROSCOPY have a lip or edge
a. A direct visualization of the joint iii. Purulent drainage is
cavity common
b. Pre-test: consent, explanation of d. STAGE IV:
procedure, NPO i. Deep ulcers extend into
c. Intra-test: Sedative, Anesthesia, muscles and bones
incision will be made ii. Foul smelling; brown/ black
d. Post-test: maintain dressing, eschar
ambulation as soon as awake, mild iii. Purulent drainage is
soreness of joint for 2 days, joint common
rest for a few days, ice application 62.SKIN BIOPSY-
to relieve discomfort a. scalpel excision or by a skin punch
58.BONE SCAN that removes a small core of
a. Imaging study with the use of a tissue.
contrast radioactive material 63.IMMUNOFLUORESCENCE (IF)
59.DEXA- DUAL-ENERGY XRAY TESTING-
ABSORPTIOMETRY a. antigen or antibody is combined
a. Assesses bone density to diagnose with a fluorochrome dye and used
osteoporosis to localize the site of an immune
b. Uses LOW dose radiation to reaction. Antibodies can be made
measure bone density fluorescent by attaching them to a
60.MYELOGRAPHY dye
a. Lumbar puncture used to withdraw 64.PATCH TESTING-
a small amount of CSF, which is a. is performed to identify
replaced by a radiopaque dye substances to which the patient
b. Pretest has developed an allergy. The
i. NPO after liquid breakfast suspected allergens are applied to
ii. Check for iodine allergy normal skin under occlusive
iii. Consent patches
c. Post test 65.SKIN SCRAPINGS-
i. Oil-based (pantopaque) flat a. Performed with a scalpel blade
for 12 hours moistened with oil so that the
ii. Water-based (amipaque) scraped skin adheres to the blade.
semi-fowler’s; assess The scraped material is
meningeal irritation transferred to a glass slide with a
61.STAGES OF PRESSURE ULCER cover slip and seen
a. STAGE I microscopically.
i. Reddened area that returns 66.TZANCK SMEAR-
to normal color after 15-20 a. used to examine cells from
mins of pressure relief, blistering skin conditions. The
such as turning the client secretions from a suspected lesion
 are applied to a glass slide and
examined after staining.
67.WOOD’S LIGHT-
a. uses a special lamp for producing
long-wave UV rays (black light)
that result in a characteristic dark
purple fluorescence. It is done in a
darkened room.
68.CLINICAL PHOTOGRAPHS-
a. taken to show the nature and
extent of the skin condition and to
reveal progress or improvement
resulting from treatment