Nurses Quick Reference to Common Laboratory And diagnostic Tests PDF Free

Nurses Quick Reference to Common Laboratory And diagnostic Tests PDF Free Download

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Contents of the book:


1 The Nursing Role in Diagnostic Testing 1
2 Nursing Standards and Protocols for Specimen Collection 47
3 Alphabetical List of Laboratory Tests of Body Fluids, Imaging Procedures,
and Special Studies of Body Functions 96

 APPENDIX
Standard Precautions 637

References 642
Index 649

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The Nursing Role in
Diagnostic Testing
1

1

Nursing Practice Standards
The nurse applies the diagnostic care model to all phases of testing to
include the requisite knowledge and skills to provide safe, informed

care; acts as a patient advocate; follows professional practice stan-
dards; communicates effectively; coordinates and manages the test-
ing environment; supports patients through the process; and uses a

collaborative approach to facilitate optimal patient outcomes.
Overview of Nursing Responsibilities
As an integrated part of their practice, professional nurses have long
supported patients and their families in meeting the demands and
challenges of diagnostic testing. This testing begins before birth and
frequently continues even after death. Testing before birth may
include amniocentesis, fetal ultrasound, and genetic testing. Testing
after death may include autopsy, organ transplant, death reporting,
and evidentiary or forensic testing. Nursing responsibilities and
interventions extend to all three phases of this testing process: the
pretest, intratest, and posttest periods. Each phase requires that its
own set of guidelines be followed. Nurses need a sound knowledge
and practice base to provide safe, effective care and to bring their
unique caring qualities to the diagnostic testing event. The nursing

process is a necessary, integral, and ongoing care planning and pro-
viding component because the nursing process is the nursing frame

of reference and foundation for all nursing practice. The sequence of

assessment, nursing diagnosis, planning, intervention, and imple-
mentation of the plan, together with evaluation, are all necessary

sequential steps. Application of the nursing process to diagnostic
testing facilitates and establishes a framework and comprehensive
plan to provide safe, competent care.
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Assessment focuses on procuring a detailed database about the
patient to facilitate testing and to correlate test findings with physical

findings and other patient status indicators to ensure accurate out-
comes. In the assessment phase, the nurse understands the reason and

need for the diagnostic test(s) being performed. Diagnosis is a clini-
cal judgment that identifies the patient response to an actual or poten-
tial health problem during diagnostic evaluation. Its uniqueness lies

in the fact that it is nurse-identified and nurse-treated. The diagnostic
planning phase has several crucial factors to consider, as the effect of
one test may have several implications on/for another. Planning
flows from the nursing diagnosis. This stage focuses on safety and
the physiologic, psychosocial, emotional, and spiritual needs of the
patient and family; the nurse develops strategies to meet these needs
during diagnostic evaluation.
Collaboration with other clinicians in the care planning is vital.
The nurse should include modalities to help patients cope with the

actual diagnostic procedure and test outcomes, as well as accommo-
date patients with special needs, such as hearing or sight impairment,

ostomy care, or diabetic care. The comatose, the confused, the child,
and the frail, elderly patient also require special consideration.
Nurses and other health care clinicians treat collaborative patient

problems simultaneously. During diagnostic tests, the nurse identi-
fies both nursing diagnoses and collaborative problems that require

appropriate and independent nursing interventions.
The setting in which testing takes place, age and developmental
stage, disabilities, information needs, coping style, and cultural
diversity must be considered. Because test preparation and actual
testing are often done at home or in a non–acute care setting, care

planning is vital for achieving the most desirable outcomes. As soci-
ety becomes more culturally blended, the need to appreciate, under-
stand, and engage within the realm of cultural diversity is imperative.

Interacting with patients and directing them through diagnostic test-
ing can present certain challenges if one is not somewhat familiar

with and sensitive to the patient’s health care belief system. Some-
thing as basic as clear communication in the face of language differ-
ences may make it necessary to arrange for a relative or translator to

be present at different stages of the testing process. It is important to
note that biocultural factors can affect derived diagnostic values.
Sensitivity to all of these foregoing issues will frequently influence
the patient’s response to and adherence with the actual procedure.

Implementation addresses the actual work and process of execut-
ing the plans for the pretest, intratest, and posttest phases. It includes

specific, measurable nursing interventions and patient activities.
2 OVERVIEW OF NURSING RESPONSIBILITIES
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Implementation of specific, independent nursing actions is based on the
diagnostic test(s) findings. Emphasis is placed upon proper specimen
collection and handling, performance of procedures, administration of

drugs and solutions following established guidelines, education, coun-
seling, proper patient preparation, provision of comfort and support,

assurance of safety, infection control, and prevention of complications.
Evaluation provides data about interpretation and an understanding

of x-rays (or x-ray films) and other test results, whether tests were com-
pleted (partially or not at all), effectiveness of care, and patient compli-
ance and reaction to testing. Follow-up testing and treatment modalities

are frequently decided in this stage. Comparing actual and expected out-
comes, along with initiation of posttest activities, comprises the major

evaluation components of the diagnostic phase. Outcomes are neutral
concepts or measures that describe patient responses that are influenced
by nursing interventions. Goal statements may be general or specific but

should be measurable. Reporting and recording the findings, implement-
ing plans, and evaluating outcomes complete the process.

The practice of nursing is based on following certain standards and

policies. These standards also influence and govern nursing responsibil-
ities and practice during diagnostic evaluation. Evidence-based practice

(EBP) refers to those activities that promote the best outcomes. The
American Nurses Association (ANA) code, ANA Congress of Nursing
Practice, The Joint Commission, Occupational Safety and Health
Administration (OSHA) standards, and Centers for Disease Control
and Prevention (CDC) precautions, together with agency, institutional,
and specialty organization policies and procedures, are categories of

standards that nurses are held to (TABLE 1.1). Regulation and accredita-
tion agencies require nursing practice to be evidence-based.

Challenges of the Testing Environment

Diagnostic testing, whether simple or sophisticated, occurs in many dif-
ferent environments. Certain tests can be done in the field, so to speak,

where the service is brought to the patient’s environment (eg, home,

shopping mall, pharmacy, church, mobile unit). Other more sophisti-
cated tests need to be done in a physician’s office, clinic, or hospital. If

equipment is extremely complex, such as magnetic resonance imaging
(MRI), or in ultrasound studies, procedures are commonly performed in

freestanding diagnostic centers. The most complex tests, such as endo-
scopic retrograde cholangiopancreatography (ERCP), cardiac catheter-
ization, or bronchoscopy, usually require hospital services.

CHALLENGES OF THE TESTING ENVIRONMENT 3

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TABLE 1.1 STANDARDS FOR DIAGNOSTIC EVALUATION
SOURCE OF STANDARDS FOR STANDARDS FOR EXAMPLES OF APPLIED STANDARDS
DIAGNOSTIC SERVICE DIAGNOSTIC TESTING FOR DIAGNOSTIC TESTING
Professional practice parameters of
American Nurses Association (ANA),
American Medical Association
(AMA), American Society of Clinical

Pathologists (ASCP), American Col-
lege of Radiology, Centers for Dis-
ease Control and Prevention (CDC),

and The Joint Commission health
care practice requirements
The guidelines of the major agencies,
such as American Heart Association,

American Cancer Society, and Amer-
ican Diabetes Association

Use a model as a framework for choosing

the proper test or procedure and in the inter-
pretation of test results. Use laboratory and

diagnostic procedures for screening, differen-
tial diagnoses, follow-up, and case manage-
ment.

Order the correct test and appropriately col-
lect and transport specimens. Properly

perform tests in an accredited laboratory
or diagnostic facility. Accurately report
test results. Communicate and interpret test
findings. Treat or monitor the disease and the
course of therapy. Provide diagnosis as well
as prognosis.

Test strategies include single test or combinations/

panel of tests. Panels can be performed in paral-
lel, series, or both.

Patients receive diagnostic services based
on a documented assessment of the need
for diagnostic evaluation. Patients have the right
to necessary information, benefits, or rights to
enable them to make choices and decisions that
reflect their need or wish for diagnostic care.

4
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Individual agency and institution

policies and procedures and quality-
control criteria for specimen collec-
tion, procedure statement for moni-
toring the patient after an invasive

procedure, and policy for universal

witnessed consent situations. State-
ments on quality improvement stan-
dards. Use standards of professional

practice and standards of patient
care. Use policy for obtaining
informed consent/witnessed consent.
Use policies for unusual situations.

State and federal government com-
municable disease reporting regula-
tions;