DIAGNOSTIC TEST

PURPOSE

NORMAL VALUES

SIGNIFICANCE

NURSING CONSIDERATIO NS

Abnormal Results: -To evaluate kidney -8 to 20 mg/dl function and aid in the diagnosis of renal disease BLOOD UREA NITROGEN -To aid in the assess of hydration -Elevated levels: renal disease, reduced renal blood flow (e.g. caused by dehydration), urinary tract obstruction, and increased protein catabolism (such as burns) -Apply direct pressure to the bleeding site. -Inform the patient that he may resume taking his usual medications after the test.

-Low levels: suggest severe hepatic damage, malnutrition, and over hydration Abnormal Results: -To evaluate function liver -In adults, normal indirect serum bilirubin levels are 1.1 mg/dl (SI, 19umol/L) To aid in the differential diagnosis of jaundice and monitor its progress -Elevated serum levels indicate damage -High indirect bilirubin usually hepatic of -Apply direct pressure to the venipuncture site to stop bleeding.

levels

-To aid in the diagnosis of biliary obstruction and hemolytic anemia BILIRUBIN, SERUM, DIRECT AND -To determine INDIRECT whether a neonate requires an exchange transfusion or phototherapy because of dangerously high unconjugated bilirubin levels

indirect bilirubin are also likely in severe hemolytic anemia -If hemolysis continues, direct and indirect bilirubin levels may rise -Other causes of elevated indirect bilirubin levels include congenital enzyme deficiencies such as Gilbert syndrome Elevated direct serum bilirubin levels usually indicate biliary obstruction -If obstruction continues, direct and indirect bilirubin levels may rise -In severe chronic hepatic damage, direct bilirubin concentrations may return to normal or near normal levels, but indirect bilirubin levels remain

elevated than 0.5 mg/dl(SI,<6.8umol/L )

Abnormal Results: SERUM CREATININE -To assess -In men, 0.8 to 1.2 mg/dl -Elevated levels glomerular filtration (SI, 62 to 115 umol/L) generally indicate renal disease that -To screen for renal -In women, 0.6 to 0.9 has seriously damage mg/dL (SI, 53 to 97 umol/L) damaged 50% or more of the nephrons -Apply direct pressure to the venipuncture site to stop bleeding.

-Inform the patient that he may resume his -Elevated levels may usual also indicate medications after gigantism and the test. acromegaly Abnormal Results:

BLEEDING TIME

-To assess overall hemostatic function (platelet response to injury and functional capacity of vasoconstriction) -To detect platelet

-3 to 6 minutes (SI, 3 to 6 min) in the template method; 3 to 6 minutes in the ivy method; and 1 to 3 minutes (SI, 1 to 3min) in the duke method.

-Prolonged bleeding time may indicate disorders linked to thrombocytopenia, such as hodgkins disease, acute leukemia, disseminated

-In a patient with a bleeding tendency (hemophilia), maintain a pressure bandage over the incision for 24 to

function disorders

intravascular coagulation, hemolytic disease of the newborn, schonlein-henoch purpura, severe hepatic disease (cirrhosis, for example), or severe deficiency of factors I,II,V,VII,VIII,IX, and XI.

48 hours to prevent further bleeding. -Check the test area frequently; keep the edges of the cuts aligned to minimize scarring. -Instruct the patient that he/she may resume his/her medication after the tests

Abnormal Results: -To aid diagnosis of polycythemia, anemia, or abnormal states of hydration HEMATOCRIT -HCT is usually measured electronically; electronic results are 3% lower than manual measurements which trap plasma in the -To aid in the column of packet RBCs calculation of erythrocyte indices -In men, 42% to 52% (SI, . 42 to 0.52) -Ensure subdermal bleeding has stopped before removing -High HCT indicates pressure polycythemia or hemoconcentration -If large caused by blood loss hematoma and dehydration. develops at the venipuncture -In women, 36% to 48% site, monitor (SI, 0.36 to 0.48) distal pulses. -Low HCT suggests anemia, hemodilution, or massive blood loss

Abnormal Results: UNSTABLE HEMOGLOBIN -To detect hemoglobin. of -Heat stability test result is negative, isopropanol solubility test result is stable -A positive heat stability test result or unstable, solubility test result, especially with hemolysis, strongly suggest the presence of unstable Hb. -Make sure the subdermal bleeding has stopped before removing pressure -Instruct the patient that he may resume medications stopped before the test. -If a large hematoma develops at the venipuncture site, monitor pulses distal to the site. Abnormal Results: -To evaluate platelet Adults: 140,000 production 400,000/ul (SI, 140 400x10/L) -To assess the effects of chemotherapy or radiation therapy on platelet production to -A count below to 50,000/ul can cause spontaneous bleeding, when the count is below 5,000/ul, fatal central nervous system bleeding or massive GI -Make sure that subdermal bleeding has stopped before removing pressure -Tell the patient that he may

PLATELET COUNT

-To diagnose and monitor severe thrombocytosis or thrombocytopenia.

hemorrhage possible

is resume any medications stopped before -A decreased count the test (thrombocytopenia, 80 to 100 million -If a large platelets per ml) can hematoma result from aplastic develops, or hypoplastic bone monitor pulses marrow; infiltrative distal to the bone marrow venipuncture site disease, such as leukemia, or disseminated infection. -An increased count (thrombocytosis can result from hemorrhage, infectious disorders, iron deficiency anemia, recent surgery, pregnancy, splenectomy or inflammatory disorders. In such cases, the platelet count returns to normal after the patient recovers from the primary disorder

Abnormal Results: -To evaluate the extrinsic coagulation system (factors V,VII, and prothrombin and fibrinogen) -PT should be 10-14 seconds (SI. 10 to 14s) depending on the source of tissue thromboplastin and the type of sensing devices used to measure -To monitor response clot formation to oral anticoagulant therapy -In a patient receiving oral anticoagulants, PT should be from 1 to 2 times the normal control value -Prolonged PT may indicate deficiencies in fibrinogen, prothrombin, factors V, VII, or X (specific assays can pinpoint such deficiencies), or vitamin K. it may also result from ongoing oral anticoagulant therapy -Make sure subdermal bleeding has stopped before removing pressure

PROTHROMBIN TIME

-Instruct the patient that he may resume his usual diet and medications discontinued -A prolonged PT that before the test exceeds 2 times the control value -If a large usually indicates hematoma abnormal bleeding develops at the venipuncture site, monitor pulses distal to the site.

Abnormal Results: -To detect enzyme deficiencies and metabolic disturbances (such as gout) that affect uric acid production -250 to 750 mg/24 hours (SI, 1.48 to 4.43 mmol/d), depending on patients diet. -Increased levels may result from chronic myeloid leukemia, polycythemia, vera, multiple myeloma, -Instruct patient that may resume usual diet medications. the he his and

URIC ACID, URINE

-To help measure the efficiency of renal clearance and to determine the risk of stone formation

early remision in pernicious anemia, lymphosarcoma and lymphatic leukemia during radiotherapy, or tubular reabsorption defects, such as fanconis syndrome and hepatolenticular degeneration -Decreased levels occur in gout (when uric acid production in normal but excretion inadequate) and in severe renal damage such as that resulting from chronic glorulonephritis, diabetic glomerulosclerosis, and collagen disorders

Nonstress, Fetal (NST, Fetal Activity Determination)

-The NST is a method to evaluate the viability of a fetus. It documents the placentas ability to provide an

-Explain the procedure to the client. -Encourage the verbalization of

adequate blood supply to the fetus. The NST can be used to evaluate any highrisk pregnancy in which fetal wellbeing may be threatened. These pregnancies includes those marked by diabetes, hypertensive disease of pregnancy (toxemia), intrauterine growth retardation, Rh-factor sensitization, history of stillbirth, postmaturity, or low estriol levels.

the patients fears. The necessity for the study usually raises realistic fears in the expectant mother. -If the patient is hungry, instruct her to eat before the NST is begun. Fetal activity is enhanced with a high maternal serum glucose level. During -After the patient empties her bladder, place her in the Sims position. -Place an external fetal monitor on the patients abdomen to record the FHR. The mother can indicate fetal movement by pressing a button on the fetal

monitor whenever feels the move.

she fetus

-The FHR and fetal movement are concomitantly recorded on a two-channel strip graph. -Observe the fetal monitor for FHR accelerations associated with fetal movement. -If the fetus is quiet for 20 minutes, stimulate fetal activity by external methods, such as rubbing or compressing the mothers abdomen, ringing a bell near the abdomen, or placing the pan on the abdomen and hitting the

pan. -Note that a nurse performs the NST in approximately 20 to 40 minutes in the physicians office or a hospital unit. -Tell the patient that no discomfort is associated with the NST. After -If the results detect a nonreactive fetus, calmly inform the patient that she is a candidate for the CST.

Abnormal Results: SERUM URIC ACID -To confirm the diagnosis of gout -To help detect renal dysfunction In men, 3.4 to 7 mg/dl In women,2.3 to 6 mg/dl -Increased uric acid levels may indicate gout or impaired kidney functions. -Apply direct pressure to the venipuncture site until bleeding stops.

-Levels may also rise in heart failure, glycogen storage disease (type 1 von Gierkes disease), infection, hemolytic and sickle cell anemia, polycythemia, neoplasms, and psoriasis -Low uric acid levels may indicate defective tubular absorption such as acute hepatic atrophy. Tests Results and Clinical Significance Protein -To screen the patients urine for the renal or urinary tract disease Color: straw to dark yellow Odor: slightly aromatic Appearance: clear Specific gravity: 100 Increased Levels Nephrotic syndrome Glomerulonep hritis Malignant hypertension Diabetic glomeruloscle rosis Polycystic disease Lupus

-Inform the patient that he may resume he usual diet and medications stopped before the test.

Urinalysis (UA)

-Inform patient that may resume usual diet medications.

the he his and

-To help detect metabolic or Protein systemic disease - 0-8 mg/dl unrelated to renal - 50-80 disorder mg/24 hr (at rest) - <250 mg/24 -To detect hr (during exercise) substances (drugs)

erythematosu s Goodpasture s syndrome Heavy-metal poisoning Bacterial pyelonephritis Nephrotoxic drug therapy Renal disease involving the glomeruli is associated with proteinuria. Trauma.Protei n can spill into the urine as a result of traumatic destruction of the bloodurine barrier. Macroglobulin emia. With increased globulin within the blood, albumin is secreted in an attempt to to maintain

ocncotic homeostasis. Multiple myelomas. Classically, mulptiple myelomas produce large amounts of protein (e.g., Bence-Jones protein) in the urine. Preeclampsia Congestive heart failure The pathophysiolo gic factors of these observations are many. Suffice it to say that albumin leaks from the glomeruli, which are temporarily damage by this illnesses. Orthostatic proteinuria. As many as 20% of normal male

patients have small amounts of protein in the urine when urine specimens are obtained from patients in the upright position. The pathophysiolo gy is not known with certainty. It may be associated with passive congestion of kidney in the upright position. This phenomenon is can be diagnosed by obtaining a urine specimen before arising and another after the patient has been up for two hours. The first has no protein,

the latter does. Severe muscle exertion. Prolonged muscular exertion can be associated with small amount of protein in the urine. Renal vein thrombosis. Congestion of the kidney is associated with proteinuria. Bladder tumors. Tumors of the bladder secrete protein into the lumen of the bladder. Urethritis or prostatitis. Inflammation in the periurethral glands or urethra can cause

proteinuria. Amyloidosis. Often associated with proteinuria, it may be o severe as to cause nephritic syndrome. Usually, amyloidosis of the kidney is due to other severe, ongoing disease.