diagnosting testing bsc 2nd sem.pptx....

diagnosting testing help to determine / monitoring the patient condition and find out disease, and evaluate progress of patient.

1. Diagnosting testing IN NURSING FOUNDATION (as per new syllabus bsc nursing 2 nd sem ) Mrs. Ritu prajapati Assistant professor

2. content Introduction Definition Phases of diagnostic testing Complete blood count Serum electrolyte Liver function test Serum glucose-AC,PC,HbA1c Monitoring capillary blood glucose (glucometer random blood sugar )

3. Stool routine examination Urine testing – albumin, acetone, pH, specific gravity Urine culture, routine timed urine specimen Sputum culture Overview of radiological & endoscopic procedure

4. Introduction A diagnostic test is designed to investigate or diagnose and monitor the disease, interventions and the multifactor that could affect the normal individual profile. It helps the physician in understanding the status of the patient and help him in preparing treatment outline or the interventional therapy according to patient condition of the patient.

5. Definition A diagnostic test is the test which helps in locating and identifying the abnormality, deficiency or deviation from the normal in different organs or parts of body.

6. Pretest phase First phase in the laboratory process. • This includes the collection of specimen, transporting and processing of sample. • this phase also includes the issues regarding the handling and collection of the specimen. • During the pretesting phase, which is also known as the preanalytic phase, there are chances of errors while handling the specimen and processing the specimen. • Therefore, the preanalytical phase should have rigorous control measures to avoid any unnecessary hindrances or errors.

7. Intra-test phases The second phase is also known as the analytic phase. • This phase is usually considered as the ‘actual’ phase of the diagnostic testing or laboratory testing and the ultimate results of the diagnostic test.

8. Post test phases The post-analytic phase is the final phase of the laboratory process. This phase culminates in the production of a final value, result, or the case of histology, a diagnostic pathology report. The testing results in transmission detection, interpretation by doctor and treatment, follow-up and retesting to evaluate the outcome of the condition.

9. Complete blood count

10. Complete blood test This is the process of collecting or withdrawing blood samples through Venepuncture for routine lab investigation to measure the various components of blood which includes the red blood cells, white blood cells, hemoglobin, hematocrit and platelets.

11. To evaluate any abnormality in the blood profile . To supplement the diagnosis and treatment related to a specific condition. To monitor variation in the blood. Purpose

12. Various component of blood measured under complete blood count Red blood cell( that carry the oxygen in blood)

13. WBC ( WHITE BLLOD CELL) HEMOGLOBIN PLATELATE

14. Equipment Alcohol swab Purple vial Needle Syringe and vacutainer Tourniquet TECHNIQUES- Label the test tube Identify the client Collect 1ml -5ml of sample of blood depending on the test Gently shake the tube Deliver the tube to the lab

15. CBC Normal range

16. SERUM ELECTROLYTE vial USED FOR SERUM ELECTROLYTE

17. Serum electrolytes Electrolytes are involved in many essential processes in the body. They play a vital role in conducting nerve impulses, contracting muscles, keeping body hydrated and regulating the pH levels. it is a blood test that measures the levels of the body’s means electrolyte

18. Vial used of liver function test LIVER FUNCTION TEST

19. Liver function test Liver function test also known as a liver panel are blood tests that measure different enzymes, proteins, and other substances made by liver. liver function test helps to monitor liver disease or liver damage

20. 1. ASPIRATE TRANSMINASE test (AST):- A spirate transaminase test is an enzyme that found in liver, heart, muscles. It helps to metabolize amino acids like ALS, AST is normally found in blood at low levels. If increase in AST levels may indicate liver damage. NORMAL VALUE 29 TO 33 UNITS PER LITER 2. Alanine TRANSMINASE test (AST):- Alanine Transaminase test is enzyme found in the liver that helps convert protein in to energy for the liver cells NORMAL VALUE 7 TO 55 UNITS PER LITER 3. ALKALINE PHOSPHATES TEST:- Alkaline phosphates is an enzyme found in the bones, liver, bile ducts. High level of ALP may indicate liver inflammation, blockage of bile ducts, or bone disease. NORMAL VALUE :- 40 TO 129 U/L

21. 4. ALBUMIN TEST:- A lbumin is the main protein made by liver. That fight against infections. Lower than normal levels may indicate liver damage. Normal value 3.5 to 5.0 gm/ deciliter 5. Bilirubin test :- Bilirubin is the waste of product from the breakdown of red blood cells. Elevated levels indicate liver damage. Normal value- 0.1 to 1.2mg/dl

22. Purpose: To diagnose liver diseases, such as hepatitis. To monitor treatment of liver disease. These tests can show how well the treatment is working. To check how badly a liver has been damaged or scarred by disease, such as cirrhosis. To monitor side effects of certain medicines. For any symptoms of any liver problems or liver disease such as: - Jaundice fever – skin and eyes turn yellowish - Swelling and pain of the abdominal - Swelling of legs and ankles - Itching of the skin - Dark color Urine - Stool is either bloody, tar- coloured or pale - Fatigue

23. Lipid /lipid protein Vial use for lip profile

24. Lipid /lipid protein Lipid profile (or lipid panel) is a blood test that measures the concentrations of fats and cholesterol in the blood, and can be used to assess ‘good cholesterol’ versus ‘bad cholesterol’ levels

25. Serum glucose-AC,PC,HbA1c Monitoring capillary blood glucose (glucometer random blood sugar )

26. Serum glucose –AC, PC, HbA1c Hemoglobin A1c is a measure of the degree to which hemoglobin is glycosylated in erythrocytes and is expressed as a percentage of total hemoglobin concentration. • HbA1c levels provide an indication of the average blood glucose concentration during the preceding 2–3 months, including both pre-and postprandial glycemia .

27. Monitoring capillary blood glucose (glucometer random blood sugar) Monitoring of the blood glucose level of the patient, who is at risk of hyperglycemia or hypoglycemia, using a portable glucometer by putting the drop of blood on the glucometer strip using the needle or lancet . PURPOSE • To monitor the blood glucose level of the patient. • To educate the patient regarding diet management and medication. • To encourage the patient about compliance with the treatment regimen.

28. Article C lean tray containing • Glucometer • Testing strips • Sterile lancet or 26FG sterile needle • Dry cotton swab and alcohol swab • Clean gloves Hand rub

29. procedure Collect the article at the bedside and check physician order. doctor can prescribe random blood sugar, fasting blood sugar, postprandial blood sugar, and also check confirm the frequency of testing. Before using the glucometer check the details on how to use this. Explain the procedure. Assess the patient for nil per oral for fasting blood sugar and also asked about the meal for postprandial blood sugar. Check the hands of patient for cleanliness. Wash hands and wear gloves. Turn the glucometer on. Adjust the gluco -strip in to the glucometer.

30. For puncturing the finger of the patient use the sterile lancet or needle and also select appropriate site. Clean the site of finger with 70% alcohol swab in circulatory motion from central to peripheral. Let the finger dry. Hold the lancet or needle in perpendicular way to the skin and prick the finger. Take the drop of blood on the strip. Squeeze the finger to from the complete blood drop. After this apply the dry cotton swab on the puncture site. Read the results of blood sugar on the monitor of glucometer. Turn off the glucometer. Dispose of article. Remove gloves and discard them Wash hand Record the sugar level.

31. FASTING BLOOD SUGAR This is a test that helps in determining the amount of glucose (sugar) in a blood sample after an overnight fast. The fasting blood glucose test is commonly used to detect diabetes mellitus. The normal range for blood glucose is 70–100 mg/ dL . • A blood sample can be taken in a lab, physician’s office, or the hospital . The test is done in the morning, before the person has taken breakfast.

32. Random blood sugar A random blood sugar (RBS) test is the testing of the blood sugar level at any time or random time of the day. According to American Diabetes Association: ➢The RBS test is done within 1 or 2 hours of eating then the RBS normal value should be 180 mg/ dL . ➢ The RBS normal range should be anywhere between 80 and 130 mg/ dL prior to eating for healthy blood sugar levels in the body.

33. Stool examination

34. Stool examination Definition : It is a method of obtaining stool specimen from the patient . Purpose : To check the stool for the presence of specific material (blood, ova, parasite or bacteria like Salmonella and Shigella , etc .)

35. Article :- A clean specimen container (routine examination ), Sterile specimen container (culture) • A spatula/sterile swab stick for stool culture • Dry bedpan • Clean gloves • Disposable mask • Tissue paper • Laboratory requisition forms

36. procedure Check the physician order and identify the patient. Explain the patient to defecate into clean, dry bedpan and instruct not to contaminate specimen with urine. Wear gloves and with help of spatula collect the freshly defecated sample in a clean/ sterile wide mouth container. For fecal or rectal swab, a small amount of stool is collected by inserting the sterile cotton swab into the stool and rotating it. Collect the sample and send laboratory. Wrap spa

37. Physical analysis Analysis of the quantity, colour , consistency, odour and shape of the stool, also parasites if found

38. Culturing stool The stool can be cultured for disease-causing bacteria. • A stool sample is placed in an incubator for at least 48–72 hours and any disease-causing bacteria are identified and isolated. • Not all bacteria in the stool cause problems; in fact, about half of stool is bacteria, most of which live there normally and are necessary for digestion. For a stool culture, the lab will need a fresh or refrigerated sample of stool. The best samples are of loose, fresh stool; well-formed stool is rarely positive for disease-causing bacteria. Sometimes , more than one stool will be collected for a culture. • Culture is then tested for the presence of microorganisms (gram-positive/ negative or virus or bacteria). Stool culture • After identification of the organism, culture is then tested for antibiotics, that are effective to kill the grown microorganism. Based on the results antibiotics are added to the treatment.

39. URINE TESTING – ALBUMIN, ACETONE, PH, SPECIFIC GRAVITY

40. Collection urine specimen and urine testing For detecting the presence and growth of microorganisms in the urine sample, a small amount (30–60 mL) of urine is collected. Purposes • To identify the antibiotic sensitivity of the pathogen in the urine sample. • Culture pathogenic microorganisms are present in the urine .

41. Articles • Sterile container • Sterile needle if required in case of catheterized client • Soap and water • Bedpan • Laboratory form Procedure

42. Procedure Assemble all the article and explain the procedure to the patient about the collection of specimen. Provide privacy of patient Wash hand and wear gloves. Give bedpan to the bedridden patient. Instruct the patient to direct the first and last part of urine stream into the toilet or bed pan, collect the middle part of stream into container. Remove the specimen container after collecting the required amount of specimen. Remove the bed pan and make patient comfortable. Label the specimen and send laboratory. Remove gloves and wash hand

43. Urine testing- albumin, acetone

44. Test urine ph

45. purpose To determine the concentration level of the urine. To measure the specific gravity of urine.

46. Specific gravity

47. Procedure Explain the complete procedure of patient. Give the container to the patient and instruct the patient to collect the urine. Wear gloves Fill 3/4 th of glass jar with urine. Keep urinometer inside the jar. Urinometer should not touch the bottom and the side of jar and should float freely in the jar. When the urinometer sets the jar read the specific gravity directly from the scale marked on the calibration scale. Ensure reading at the eye level. Read at the lowest point of the meniscus for an accurate reading.

48. After the procedure Discard the urine and rinse jar, urinometer under running water. Replace the article after washing. Complete the documentation procedure.

49. Test for albumin in urine This test (hot and cold test) used to find out the presence of albumin in the urine. Procedure:-(cold method) Explain the procedure to the patient and provide the container to the patient and ask the patient to collect urine the container. Take 2ml of the nitric acid in the dry clean test tube. Pour same amount of the urine in the dropper from the side of the tube. Presence of the white ring on the junction of urine and acid shows the presence of albumin. Discard the collected material and rinse off the articles. Replace the articles after the proper washing of article. Documents the finding.

50. Albumin hot test procedure Explain the whole procedure to the patient and provide instructions regarding the collection of urine. Fill the test tube with 3/4 th part with urine. Check paper. If alkaline add one drop of acetic acid to make it acidic. Light the sprit lamp and boil the top 1/3 rd of the urine. Keep the mouth of test tube away from the face. Observe the tube for cloudy appearance, if the urine becomes cloudy, this indicate presence of albumin. Add 5 drops of 2% of acetic acid and look for the appearance. If the urine become clear then it indicates presence of phosphates, and if the cloudy persists then it confirm the presence of albumin.

51. Normal urine has no albumin present, after the whole process, discard the urine and rinse the jar and urinometer Replace articles. Documents the finding.

52. Test for acetone in urine Testing of the urine specimen for identifying the presence of acetone. procedure:- Explain the whole procedure to the patient and provide the labeled container to the patient. In a clean and dry tube keep 2cm of ammonium sulfate crystals. Pour 5ml of urine into the tube and shake till it gets dissolved in to each other. Add1-2 crystals of sodium nitroprusside and shake it Pour 2ml of concentrated liquor ammonia from the side of tube to from a layer. A purple ring is formed at the junction of urine indicates the presence of acetone in the urine. Discard the urine and rinse the article. Document the finding.

53. Sputum culture

54. Sputum culture Sputum culture is the test that checks for bacteria or another type of organism that may be causing an infection in lungs or the airways leading to the lungs. Sputum also known as phlegm, is thick type of mucus made in the lung. Indication Detect the etiology of respiratory infection. Confirmatory diagnosis of tuberculosis. Monitoring the response to therapy for respiratory infection.

55. Collection of sputum for culture Collection of coughed out sputum for culture to identify respiratory pathogens (acid-fast bacillus, streptococci, pneumococci, diphtheria bacilli ). Purposes Identify respiratory pathogens. Look for the color of sputum like hemoptysis, greenish color in bronchitis, rusty color in pneumonia .

56. Article . Sterile specimen container • Tissue paper • Sputum mug with disinfectant • Sterile gloves • Disposable mask

57. procedure Check the physician orders. Explain the procedure to the patient . Explain the patient that he has expectorate the sputum into the sterile labeled container, without disinfecting it. Ask the patient to sit erect in bed. Wash the hand and put on gloves. Ask the patient to rinse the mouth with plain water in the morning. Keep a sterile specimen container ready for sample and take a tissue paper in hand. Remove the lid of container and place with inner side facing upward. instruct the patient to take deep breath and then cough out yin to container.

58. Cont …. The specimen should be at least 5 ml. Assess the sputum specimen to ensure it is sputum and not saliva. Sputum appears thick and opaque, whereas saliva appears thin, clear and watery. If a patient unable to expectorate a sputum sample, interventions may include nebulizer, deep breathing exercises, chest percussion, postural drainage. If the intervention are not successfully a sputum sample may be obtained via oropharyngeal or endotracheal suction. Mouth should be rinsed with plain water and not with antiseptic mouth wash. Close the container without touching inside of the lid. Provide tissue paper to the patient. Replace the articles and discard the waste and rinse the article. Document the finding related to specimen .

59. Radiological procedure Radiology is a branch of medicine that uses imaging technology to diagnose and treat disease. Radiology Diagnostic Interventional. Diagnostic radiology This branch helps in visualizing the structures inside the body and helps the physician in identifying certain medical conditions. Using these diagnostic procedures doctors can monitor the progression of the disease and the way how the body responds to the treatment received .

60. Radiological studies

61. Endoscopic procedure An endoscopy procedure involves inserting a long, flexible tube (endoscope) down the throat and into the esophagus to visualize the gastrointestinal system . There are several types of endoscopy like those using natural body opening including esophago gasro duodenoscopy which is often called upper endoscopy, gastroscopy and entercopy .