NCM 103 FUNDAMENTALS OF NURSING PRACTICE

PROF. EJAY REANTILLO

JM DE GUZMAN BSN I - II

○ Ex. Patient is
DIAGNOSTIC TESTING claustrophobic which
may affect the MRI test
TOOLS TO PROVIDE INFORMATION ● Inform client and family when
ABOUT THE CLIENT test results will be available
● Screening during wellness ● Encourage the client and family
check to ask questions
● Confirm Diagnosis INTRATEST
● Monitor Illness ● Collect specimen
● Provide information about ● Perform or assist with procedure
response to treatment (ex. ○ Help with other
Chemotherapy patient always healthcare professionals
monitor CBC for WBC) ● Provide emotional and physical
support
3 PHASES ● Monitor client as needed
1. PRETEST ● Use correct labeling, storage,
2. INTRATEST and transportation of specimen
3. POSTTEST
POSTTEST
PRETEST
● Nursing care
● Instruct client and family about ● Perform follow up activities and
the procedure observations
● Explain purpose of the test ● Compare previous and current
○ Anticipate patient has test results
little knowledge about his ● Modify nursing interventions as
illness needed
● Report results to appropriate
● Instruct client and family about health team members
activity restrictions
○ (Ex. NPO patient) NURSING DIAGNOSIS
● Instruct client and family on the ● Anxiety or fear related to
reaction the diagnostic test may possible diagnosis or chronic
produce illness pending conclusion of
○ Possible effects that the diagnostic testing
patient may feel ● Lack of knowledge (state of
diagnostic test) related to
● Provide client with detailed insufficient information
information about diagnostic regarding the process for test
testing equipment
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

○ Normal value: 4500 -

BLOOD TEST 11,000 mm3
● Through venipuncture ○ Decreased WBC -
performed by phlebotomist immunocompromised
● Puncture of vein for collection of ○ Increased WBC - Infection
a blood specimen ● WBC differential
NEVER LET MONKEYS EAT BANANAS
COMPLETE BLOOD COUNT ○ Neutrophils - (50 to 70%)
first to fight acute
● Hemoglobin
infection
○ Oxygen delivery
○ Lymphocytes -
○ Men normal value: 13.5 -
responsible for chronic
18 g/dL
infection (25% - 35% WBC)
○ Women normal value: 12 -
○ Monocytes -( 4 - 6%)
15 g/dL
increased in viral infection
○ Low hemoglobin caused
○ Eosinophils - (1 - 3 %
by anemia, blood loss,
)increased in parasitic
pregnancy, leukemia,
infections
CKD
○ Basophils - (0.4 - 1%)
○ Increased RBC caused by
increased in allergic
polycythemia vera (
reactions
abnormally high RBC =
reddish skin),
SUFFIXES FOR DIAGNOSTIC TESTING
Dehydration
● Hematocrit (Hct) Cytosis - High
● Red blood cell count (RBC) Penia - low
○ Men normal value: 4.6 to
6 million /uL
○ Women normal value: 4.0 EXAMPLES
- 5.0 million/uL High RBC - Erythrocytosis
● Polycythemia Low RBC - Erythropenia
● RBC indices High WBC - Leukocytosis
● Leukocyte Low WBC - Leukopenia
● Platelets - low platelet count High Thrombocyte -
may result to bleeding Thrombocytopenia
○ Normal value - 150,000 - Low Thrombocyte -
400,000 uL
● White blood cell count
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

SERUM ELECTROLYTES ○ Poor skin turgor

● Routine for acid base ○ Dark urine
imbalances
● Serum electrolytes ● LOW SERUM OSMOLALITY -
○ Sodium - 135 - 145 mEq/L FLUID VOLUME EXCESS
○ Potassium - 3.5 - 5.3
mEq/L DRUG MONITORING
○ Chloride - 95 - 105 mEq/L ● Therapeutic level
○ Bicarbonate ions ○ Client taking medication
○ Calcium - 4.5 - 5.5 mEq/L within narrow therapeutic
or 8.5 - 10.5 mg/dL range
○ Magnesium - 1.5 - 2.5
mEq/L or 1.6 - 2.5 mg/dL ● Peak level
○ Highest concentration of
● Blood urea nitrogen (BUN) drug
● Creatinine
○ Produced by muscles ● Trough level
SUFFIXES ○ Lowest concentration of
Hyper - high drug
Hypo - low
Emia - in blood ARTERIAL BLOOD GASSES
● Usually taken by specialty
Examples nurses, medical technicians, and
High sodium - Hypernatremia respiratory therapists
Low sodium - Hyponatremia ● Take specimens of blood from
High potassium - Hyperkalemia radial, brachial or femoral
Low potassium - Hypokalemia arteries, so must prevent
High calcium - Hypercalcemia hemorrhaging by applying
Low calcium - Hypocalcemia pressure 5 to 10 minutes
● Usually taken for COPD patients
SERUM OSMOLALITY to check for acidosis or alkalosis
/pH level
● Measure of solute concentration
in the blood
● Evaluates fluid balance
● Normal: 280 - 300 mOsm/kg ARTERIAL VENOUS BLOOD
● HIGH SERUM OSMOLALITY - BLOOD
FLUID DEFICIT Bright color due Dark color due to
○ Pale conjunctiva
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

SPECIMEN COLLECTION AND

to oxygenated deoxygenated
TESTING

BLOOD CHEMISTRY ● Note relevant information on

laboratory requisition slip
● Transport specimen to
● Serum glucose and hemoglobin laboratory promptly
A1c (bhA1c) and hormones ● Report abnormal laboratory
○ Glucose bind to RBC findings to healthcare provider
○ To monitor glucose level in a timely manner
after 3 to 4 months
● Diabetes, endocrine function STOOL SPECIMEN
● Triglycerides, cholesterol
● Lipoprotein profile USED TO DETERMINE
○ HDL - 29 - 77 mg/dl ● Dietary products and digestive
○ LDL 60 - 160 mg/dl secretions
● Other substances ○ Steatorrhea - excessive
amount of fats
METABOLIC SCREENING
● Presence of ova and parasites
● Presence of bacteria or viruses
● For newborns ● Presence of occult (hidden)
● Phenylketonuria blood
● Congenital hypothyroidism ○ Guaiac test
● Sickle cell disease
● Galactosemia MELENA

CAPILLARY BLOOD GLUCOSE Black tarry stool which indicates

bleeding on upper GI tract
● Often taken to measure blood HEMATOCHEZIA
glucose
● Clients can perform on Fresh blood stool on lower GI
themselves tract common with hemorrhoids
● Many advances in choices for
glucose meters Goat like stools
● Puncture lateral part because it ● May indicate colon cancer
has less nerve endings/pain
STOOL COLLECTION
● Determine reason for collecting
stool specimen
● Determine correct method of
obtaining and handling
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

● UAP may obtain and collect ○ Discomfort during or

stool specimen after defecation
● Know amount of stool to collect ○ Status of perianal skin
(1 inch only) for liquid stool (15 -
30 ml)
FECAL OCCULT BLOOD TESTING
COLLECTING STOOL SPECIMENS ● Hemoccult (guaiac) or fecal
1. Instruct client immunochemical test
● Defecate in clean bedpan or ● Instruct about foods and
bedside commode medications to be restricted
● If possible, do not contaminate prior to test (3 days prior to
the specimen with urine or test)
menstrual discharge ○ Ex. red meats, liver,
● Do not place toilet tissue in processed meats, raw
bedpan after defecation vegetables
● Notify nurse after defecation \ ○ Ex. Medications such as
● Follow medical aseptic aspirin, NSAIDS, and
technique meticulously IRON
● Send specimen to labatorary ○ THESE FOODS AND
immediately MEDICATIONS CAN GIVE
○ Any bleeding from anus FALSE POSITIVE RESULT
after defecation ○ VITAMIN C MORE THAN
2. Taking stool culture 250 MG CAN CAUSE
● Not delegated to UAP FALSE NEGATIVE
● Dip a sterile swab into the RESULT
specimen
● Using sterile technique, place ● Add two drops of a reagent onto
the swab smear on back of card
● Observe for color change
3. DOCUMENT ALL RELEVANT ● Blue color indicated guaiac
DATA positive
● Record date and time of ● Anything other than blue is
collection negative
● All nursing assessments
○ Presence of abnormal URINE
constituents pH normal is 6 level
○ Results of test for occult Neutral is 7 level
blood if obtained
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

● Clean voided specimens for INDWELLING CATHETER SPECIMEN

routine urinalysis ● Obtained from closed drainage
○ Best time to collect urine systems via needle or needleless
specimen is morning port
● Clean catch or midstream urine ● May need to clamp 30 minute
specimens for urine culture ● Insert needle (30 - 45 degrees
● Timed urine specimens for through self sealing rubber’ 90
variety tests that depend on degrees into
client specific health problem
○ Ex. Within 1 hour collect HELLO, GUYS! I JUST WANT TO SAY THAT
and store it in cool I AM PROUD OF YOU FOR MAKING IT
storage THIS FAR DESPITE FACING COUNTLESS
○ Ex. 24 hour timed urine CHALLENGES. KEEP BELIEVING IN
● For bedridden, use bedpan YOURSELF. KAYANG-KAYA MO 'YAN! I'M
ROOTING FOR YOU!!- JM

CLEAN VOIDED URINE

URINE TESTING
● Usually adequate for routine
● Specific gravity
examination
○ An indicator of urine
concentration or the
CLEAN CATCH OR MIDSTREAM
amount of solutes
URINE SPECIMEN
present in the urine
● Urine culture to identify ○ SG - urine concentration
microorganisms causing urinary ○ Normal 1.010 - 1.025
tract infection ○ High SG - concentrated
● Care taken to ensure specimen ○ Low SG - diluted
is free from contamination ● Urinary pH
around the urinary ○ Normal - 6 pH
decomposition of urine ● Glucose
components ○ Presence of Glucose is
● Non Sterile specimen abnormal
○ Glucosuria - diabetes
TIMED URINE SPECIMEN mellitus
● Collection of all urine produced ● Ketones
○ End product of fatty acids
● Protein
○ Proteinuria - presence of
protein in urine
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

○ Protein is too large to be tablespoons (15 - 30 mL)

filtrate in the glomerulus sputum
● Occult blood ○ On the book it says, 1 to
○ Hematuria - presence of 2 teaspoons or (4 to 10
blood in urine mL)
● Osmolality ● Ask client to expectorate
○ Low osmolality - fluid directly into the specimen
excess container
○ High osmolality - fluid ● Make sure sputum does not
deficit contact outside of container
○ 50 TO 1200 mOsm/kg ● Offer mouthwash following
sputum collection
SPUTUM SPECIMEN ● Label and transport specimen to
● Mucous secretion from lungs, laboratory
bronchi, and trachea ● Document findings, including
● Different from saliva hemoptysis
● UAP can obtain specimen ● Hemoptysis - blood in sputum
● Reasons to collect common with TB
○ To identify specific
microorganism and its THROAT CULTURE
drug sensitivities ● Collected from mucosa of
○ CYTOLOGY - to identify oropharynx and tonsillar
origin, structure, function regions using culture swab
and pathology of cells ● Cultured and examined for
○ Acid fast bacillus (AFB) - presence of disease producing
to test for TB microorganisms
○ Assess effectiveness of COLLECTING THROAT CULTURE
therapy ● Put on clean gloves
● Insert swab into oropharynx
● Expectorate - sputum ● Run swab along tonsils and
areas that are reddened or
COLLECTING SPUTUM SPECIMENS contain exudate
● Offer mouth care ● Place swab in sterile test tube
● Wear gloves and PPE to avoid ● Label and send to laboratory
direct contact with the sputum ● Document
● Ask client to breathe deeply,
then cough up 1 to 2 VISUALIZATION PROCEDURES
● INDIRECT (NONINVASIVE)
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

● DIRECT (INVASIVE) “OSCOPY” eat more foods rich in

● BODY ORGAN AND SYSTEM fiber and that the stool
FUNCTION will be white colored
○ Includes fluoroscopic
CLIENTS WITH GASTROINTESTINAL examination
ALTERATIONS ■ Projection of x ray
observation onto
● DIRECT (INVASIVE) screen
○ ANOSCOPY - visualize ■ PREGNANT must
anus be avoided to x rays
○ PROCTOSCOPY - as it will affect the
visualize rectum baby
○ PROCTOSIGMOIDOSCOP ■ To know if the
Y - visualize rectum and patient is
sigmoid colon pregnant, ask LMP
○ COLONOSCOPY - LAST MENSTRUATION PERIOD
visualize whole large ● “Ma'am may I know when is
intestine your last menstruation”

INDIRECT (NON INVASIVE) CLIENTS WITH URINARY

ALTERATIONS
● X RAYS
● X rays of kidneys/ureters/bladder
○ Introduction of a
● Intravenous pyelography IVP
radiopaque substance,
and retrograde pyelography
such as barium sulfate
○ Need to inject contrast
through swallowing or
medium directly to
enema
kidney pelvis via urethra
○ Barium sulfate - chalky
to ureters and bladder
substance that can be
● Renal ultrasonography
swallowed by the patient
○ Non invasive test that
or anus to outline the
uses reflected sound
organs in upper GI tract
waves to visualize the
○ After swallowing barium
kidneys
sulfate, it needs to be
● Cystoscopy
excreted via increasing
○ Cystoscope - visualize,
fluid intake to urinate or
bladder, ureter, and
via defecate
urethra
○ After taking barium
○ Lighted instrument
sulfate, teach the client
inserted through urethra
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

○ Perfusion- scan Q scan

CLIENTS WITH CARDIOPULMONARY where blood flows
ALTERATIONS through the lungs
● Electrocardiography, ○ Ventilation scan V scan
electrocardiogram ECG
○ Can examine ● LARYNGOSCOPY
cardiomegaly, heart ○ TO visualize larynx
attacks
○ Side effects of ● Bronchoscopy
medications ○ To visualize bronchus
(hypokalemia etc.) ○ After inserting an
● Stress electrocardiography instrument, there will be
○ To assess client’s response hoarse voices or paos due
to workload like exercise to anesthesia
● Angiography ○ Abnormal: 6 months na
○ Radiopaque dye injected paos pero dapat
into the vessel of the mawawala lang from 2 to
artery or femoral artery to 3 days, DOB due to
heart to examine bronchial spasms
narrowing or blockage of ● COMPUTED TOMOGRAPHY
heart ○ Ct scan, or computerized
○ Ask patient for any axial tomography
allergies such as iodine ○ Painless, noninvasive x ray
● Echocardiogram procedure
○ 2D echocardiogram it is ○ Distinguishes minor
like an ultrasound for differences in the
structures of the heart density of tissues
(non invasive) ○ Produces three
○ Examines the activities dimensional image of
of the left ventricles organ or structure
○ More sensitive than x ray
● LUNG SCAN (V/Q SCAN) machine

○ How well the air is flowing

● MAGNETIC RESONANCE
to the lungs
IMAGING
○ VQ SCAN - is used to
assess pulmonary ○ Non invasive diagnostic
embolism scanning technique
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

○ Magnetic field, no ○ Use radiopharmaceutical

exposure to radiation labeled with a
○ Not done on clients with radioisotope
implanted metal devices ○ Administered by various
■ Ex. Accessories, routes
jewelries, heart ○ Distinguish “hotspots and
pacemaker “coldspots”
■ If metal devices are ○ Positron emission
present, will not tomography (PET)
proceed to MRI ■ Non invasive
scan radiologic study
■ Consider
claustrophobic ● ASPIRATION
patients ○ Withdrawal of fluid that
○ Provides better contrast has abnormally collected
between normal and ○ To obtain a specimen
abnormal tissue than CT ○ Invasive procedure
scan ○ Requires strict sterile
technique

● NUCLEAR IMAGING STUDIES ● BIOPSY

○ Removal o and
● PET SCAN examination of tissue
○ Involves injection of ○ Performed to determine a
inhalation of a diagnosis or malignancy
radioisotope ● LUMBAR PUNCTURE
○ Images created as ○ CSG withdrawn through
radioisotope is distributed needle L3-L4, L4 - L5
in body ○ Client is positioned
○ Allows study of various laterally with head bend
aspects of organ toward chest
function ○ Knees flexed onto
○ May evaluate blood or abdomen
organ growth ○ Back at edge of bed or
○ Involve therapeutic use of examining table to
radioactive isotopes for increase pressure
diagnostic purposes ○ CSF pressure reading
taken using a manometer
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

○ After taking CSF, expect Upper anterior: Air remove

spinal headache
therefore encourage fluid BONE MARROW BIOPSY
intake or give medication ● Removal of specimen of bone
● ABDOMINAL PARACENTESIS marrow for laboratory study
○ Obtain fluid specimen for ● Bones usually used
laboratory study ○ Sternum
○ Relieve pressure on ○ Iliac crest
abdominal organs caused ○ Anterior or posterior iliac
by accumulation of fluid spines
in abdominal cavity ○ Proximal tibia in children
(ascites) ○ Posterior superior iliac
○ Insertion of trocar and crest is preferred site
cannula to drain fluid
○ Monitor Blood pressure ● To assess leukemia
● THORACENTESIS ● Position: Pronation
○ Excess fluid can
accumulate in pleural
cavity as result of injury, ● LIVER BIOPSY
infection or other ○ SHORT PROCEDURE
pathology ○ PERFORMED AT CLIENT’S
○ To remove excess fluid or BEDSIDE
air to ease breathing ○ SAMPLE OF LIVER TISSUE
○ Also performed to IS ASPIRATED
introduce ○ After biopsy, let client lay
chemotherapeutic drugs down on the insertion site
intrapleurally to increased pressure/
○ Position: Sitting position avoid leakage
with arms above head to ○ Also avoid anticoagulant
provide access and open drugs
intercostal space ○ Client exhales and is
instructed to hold his or
POSITIONS THAT ARE COMMON her breath while primary
● Sitting on one side with arm care provider inserts
elevated and held forward needle
● Sitting and leaning forward with ○ After needle is withdrawn,
arms reaching over pillow nurse applies pressure to
Lower posterior: fluid remove site to prevent bleeding
NCM 103 FUNDAMENTALS OF NURSING PRACTICE
PROF. EJAY REANTILLO
JM DE GUZMAN BSN I - II

○ May position client on the

biopsy site