Mosby’s Diagnostic and Laboratory Test Reference

1056 Pages·2016·44.693 MB·English

by  Kathleen Deska Pagana, Timothy J Pagana, Theresa N Pagana

Many laboratory tests include the direction to perform rou
tine blood testing. The protocol for those tests is presented
here and will be cross-referenced within the many tests
requiring them.
Before
• Follow proper patient identification protocols to avoid
wrong patient events. Usually name and date of birth are
used as two identifiers:
PT Explain the procedure to the patient.
PT Tell the patient if fasting is necessary. (Fasting is most com
monly required with glucose and lipid studies.)
PT If fasting is required, instruct the patient not to consume
any food or fluids. Only water is permitted. Fasting require
ments usually vary from 8 to 12 hours.
PT Instruct the patient to continue taking medications unless
told otherwise by the health-care provider.
During
• Collect the blood in a properly color-coded test tube
(Table A, p. xiii), which indicates the presence or absence
of additives. Tube stopper colors may vary with different
manufacturers. If uncertain, verify with the laboratory.
After
• Apply pressure or a pressure dressing to the venipuncture
site.
• Assess the site for bleeding.
PT= Patient teaching
.,
I
I
!
Many laboratory tests include the direction to perform routine
urine testing. The protocol for those tests is presented here
and will be cross-referenced within the many tests requiring
them.
Before
• Follow proper patient identification protocols to avoid
wrong patient events. Usually name and date of birth are
used as two identifiers:
PT Explain the procedure to the patient.
PT Inform the patient if food or fluid restrictions are needed.
During
Random, fresh, or spot specimen
• Instruct the patient to urinate into an appropriate nonster
ile container.
24-hour specimen
1. Begin the 24-hour collection by discarding the first
specimen.
2. Collect all urine voided during the next 24 hours.
3. Show the patient where to store the urine.
4. Keep the urine on ice or refrigerated during the col
lection period. Foley bags are kept in a basin of ice.
Some collections require a preservative. Check with the
laboratory.
5. Post the hours for the urine collection in a prominent
place to prevent accidentally discarding a specimen.
6. Instruct the patient to void before defecating so that
urine is not contaminated by stool.
7. Remind the patient not to put toilet paper in the urine
collection container. .
8. Collect the last specimen as close as possible to the end
of the 24-hour period. Add this urine to the collection.
After
• Transport the specimen promptly to the laboratory.
PT= Patient teaching
)
MOSBY'S
[]!AGNOSTIC AN[]
lABOAATOAY lfSl
AfffAfNCf
Thirteenth fdition
Kathleen Deska Pagana, PhD, RN
Professor Emeritus
Department of Nursing
Lycoming College
Williamsport, Pennsylvania
http:// www.KathleenPagana.com
President, Pagana Keynotes & Presentations
Timothy J. Pagana, MD, FACS
Medical Director Emeritus
The Kathryn Candor Lundy Breast Health Center
Susquehanna Health System
Williamsport, Pennsylvania
Theresa Noel Pagana, MD, FAAEM
Emergency Medicine Physician
Virtua Voorhees Hospital
Voorhees, New Jersey
ELSEVIER
ELSEVIER
3251 Rivcrport L:inc
Sr. Louis, Missouri 63043
MOSBY'S DIAGNOSTIC AND 1.ABOI\ATOllY TEST REFERENCE,
THIR.TEEITTH EDITION ISBN: 978-0-323-39957-9
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With love and adoration,
we dedicate this book to our grandchildren:
Ella Marie Gaul
Jocelyn Elizabeth Gaul
Timothy William Gaul
Justin Aquinas Gaul
Juliana Kathleen Pcricci
Luke Michael Pericci
John Henry Bullen, V
Hunter Timothy Bullen
Crystal Botkin, MPH, CNMT, PET
Assistant Professor and Clinical Coordinator
Nuclear Medicine Technology Program
Doisy College of Health Sciences
Saint Louis University
St. Louis, Missouri
Laura Brennan, MS, RN
Assistant Professor
Elmhurst College
Elmhurst, Illinois
Doreen DeAngelis, MSN, RN
Nursing Instructor
Penn State University, Fayette Campus
Lemont Furnace, Pennsylvania
...
The 13th edition of Mosby's Diagnostic and Laboratory Test Refer
ence provides the user with an up-to-date, essential reference that
allows easy access to clinically relevant laboratory and diagnostic
tests. A unique feature of this handbook is its consistent format,
which allows for quick reference without sacrificing the depth of
detail necessary for a thorough understanding of diagnostic and
laboratory testing. All tests begin on a new page and are listed
in alphabetical order by their complete names. The alphabetical
format is a strong fearure of the book; it allows the user to locate
tests quickly without first having to place them in an appropriate
category or body system. The User's Guide to Test Preparation
and Procedures section outlines the responsibilities of health
care providers to ensure that the tests are accurately and safely
performed. Use of this guide should eliminate the need for test
repetition resulting from problems with patient preparation, test
procedures, or collection techniques. Information on radiation
exposure and risks has been added. Every feature of this book
is designed to provide pertinent information in a sequence that
best simulates priorities in the clinical setting.
The following information is provided, wherever applicable,
for effective diagnostic and laboratory testing:
Name of test. Tests are listed by their complete names.
A complete list of abbreviations and alternate test names follows
each main entry.
Type of test. This section identifies whether the test is, for
example, an x-ray procedure, ultrasound, nuclear scan, blood
test, urine test, sputum test, or microscopic examination of tis
sue. This section helps the reader identify the source of the labo
ratory specimen or location of the diagnostic procedure.
Normal findings. Where applicable, normal values are listed
for the infant, child, adult, and elderly person. Also, where appro
priate, values are separated into male and female. It is important
to realize that normal ranges oflaboratory tests vary from institu
tion to instirution. This variability is even more obvious among
the various laboratory textbooks. For this reason, we have delib
erately chosen not to add a table of normal values as an appendix,
and we encourage the user to check the normal values at the
instirution where the test is performed. This should be relatively
easy because laboratory reports include normal values. Results
are given in both conventional units and the International Sys
tem of Units (SI units) where possible.
"
vi preface
Possible critical values. These values give an indication of
results that are well outside the normal range. These results
require health-care provider notification and usually result· in
some type of intervention. The Joint Commission is looking at
the timely and reliable communication of critical laboratory val
ues as one of its patient safety goals.
Test explanation and related physiology. Th.is section pro
vides a concise yet comprehensive description of each test. It
includes fundamental information about the test itself, specific
indications for the test, how the test is performed, what disease
or disorder the various results may show, how it will affect the
patient or client, and relevant pathophysiology that will enhance
understanding of the test.
Contraindications. These data are crucial because they alert
health-care providers to patients to whom the test should not
be administered. Patients highlighted in this section frequently
include those who are pregnant, are allergic to iodinated or con
trast dyes, or have bleeding disorders.
Potential complications. This section alerts the user to
potential problems that necessitate astute assessments and inter
ventions. For example, if a potential complication is renal failure,
the implication may be to hydrate the patient before the test and
force fluids after the test. A typical potential complication for
many x-ray procedures is allergy to iodinated dye. Patient symp
toms and appropriate interventions are described in detail.
Interfering factors. This section contains pertinent informa
tion because many factors can invalidate the test or make the
test results unreliable. An important feature is the inclusion of
drugs that can interfere with test results. Drugs that increase or
decrease test values are always listed at the end of this section
for consistency and quick access. A drug symbol (Y) is used to
emphasize these drug interferences.
ProcedW'c and patient care. This section emphasizes the
role of nurses and other health-care providers in diagnostic and
laboratory testing by addressing psychosocial and physiologic
interventions. Patient teaching priorities are noted \vith a spe
cial icon (Pr) to highlight information to be communicated to
patients. For quick access to essential information, this section is
divided into before, during, and after time sequences.
Before. This section addresses the need to explain the proce
dure and to allay patient concerns or anxieties. If patient consent
is usually required, this is listed as a bulleted item. Other impor
tant features include requirements such as fasting, obtaining
baseline values, and performing bowel preparations. Radiation
risk is addressed with x-rays and nuclear medicine studies.
preface vii
During. This section gives specific directions for clinical
specimen studies ( e.g., urine and blood studies). Diagnostic pro
cedures and their variations are described in a numbered, usu
ally step-by-step format. Important information, such as who
performs the test, where the study is performed, patient sensa
tion, and duration of the procedure, is bulleted for emphasis.
The duration of the procedure is very helpful for patient teaching
because it indicates the time generally allotted for each study.
After. This section includes vital information that the nurse
or other health-care provider should heed or convey after the
test. Examples include such factors as maintaining bed rest, com
paring pulses with baseline values, encouraging fluid intake, and
observing the patient for signs and symptoms of sepsis.
Abnormal findings. As the name implies, this section lists
the abnormal findings for each study. Diseases or conditions that
may be indicated by increased (A) or decreased ('Y) values are
listed where appropriate.
Notes. This blank space at the end of the tests facilitates indi
vidualizing the studies according to the institution at which the
test is performed. Variations in any area of the test ( e.g., patient
preparation, test procedure, normal values, postprocedural care)
can be noted here.
This logical format emphasizes clinically relevant information.
The clarity of this format allows for quick understanding of con
tent essential to both students and health-care providers. Color
has been used to help locate tests and to highlight critical infor
mation (e.g., possible critical values). Color is also used in the
illustrations to enhance the reader's understanding of many diag
nostic procedures ( e.g., bronchoscopy, fetoscopy, endoscopic
retrograde cholangiopancreatography (ERCP), pericardiocente
sis, transesophageal echocardiography (TEE)). Many tables are
used to simplify complex material on such topics as bioterror
ism infectious agents, blood collection tubes, hepatitis testing,
and protein electrophoresis. Extensive cross-referencing exists
throughout the book, which facilitates understanding and helps
the user tic together or locate related studies, such as hemoglo
bin and hematocrit.
Standard guidelines for routine blood and urine testing are
located on the inside front cover for easy access. A list of abbre
viations for test names is included on the book's endpapers.
Appendix A includes a list of studies according to body system.
This list may familiarize the user with other related studies the
patient or client may need or the user may want to review. This
should be especially useful for students and health-care provid
ers working in specialized areas. Appendix B provides a list of