Manual of Laboratory & Diagnostic Tests by Fischbach, 7th Edition, Page764

DIAGNOSTIC PROCEDURES
Cytologic
and
Hystologi
c Studies
Date Done
October
20, 2012
Cytological studies indicate superficial soft tissue masses/inflammatory lesions, Intra-abdominal masses, Peripheral and
mesenteric lymph nodes, Internal organs, Body cavity effusions. Histology Indicates firm lesions, Diagnoses where architecture
is needed to make the diagnosis (e.g. small cell lymphoma, inflammation in hemodiluted samples)
Name of Test/
Procedure
Indication for the

test / Procedure
Normal
Findings
Actual Results
Interpretation and
Analysis
Biopsy
A diagnostic
procedure used to
investigate
superficial lumps or
masses. It is a
method of obtaining
diagnostic material
for cytologic (cell)
and histologic
(tissue) study that
causes a minimal
amount of trauma to
the patient. (Manual
of Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 763)
Benign or
negative: no
abnormal
cells or
abnormal
tissue
present
The specimen
consists of
vermiform
appendix 4.5 x
0.9 x 0.7 cm.
The serosa is
dark brown and
covered with
cream-yellow
purulent
exudates.
Sectioning
reveals a 0.1 cm
thick wall bearing
a 0.4 cm in
diameter point of
rupture at its
distal third
segment. The
lumen averages
0.6 cm in
diameter and
contains dark
brown fecal
Interpretation:
Appendectomy
(Amang
Rodriguez
Medical
Center)
Appendix
No
pathogenic
organisms
Nursing
Responsibilities
Pretest Patient Care

Explain the purpose and
An abnormal result of
procedure, benefits, and
the biopsy may be due
risks of the test. Even
to
though a local
anesthetic is used, the
Analysis:
procedure causes some
discomfort, and this
(Manual of Laboratory
should not be
& Diagnostic Tests by
minimized. If the
Fischbach, 7th Edition,
approach involves
page764)
passing near a rib, the
pain may be greater
because of the
sensitivity of the bone;
this is not a cause for
alarm.
Unexpected pain may
induce a vasovagal or
other undesirable
response. Other risks
include infection and
hematoma or
material. Block 3
Acute
Suppurative
appendicitis,
ruptured, with
periappendicitis
October
30, 2013
Biopsy
Mass above
Epiglotis
A diagnostic
procedure used to
investigate
superficial lumps or
masses. It is a
method of obtaining
diagnostic material
for cytologic (cell)
and histologic
(tissue) study that
causes a minimal
amount of trauma to
of Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 763)
Benign or
negative: no
abnormal
cells or
abnormal
tissue
present
No
pathogenic
organisms
The specimen
consists of 4.4 x
3.5 x 1.7 cm tan
brown,
irregularlyshaped, solid
and hard mass
having graybrown, smooth
cut surfaces.
Block 3
Confluent
aggregates of
dysplastic
squamous
epithelial cells
admixed with
keratin material
A Laryngeal
Malignancy
(Squamous cell
carcinoma)
cannot be ruledout
hemorrhage, depending
on the site aspirated.
Procedure
Use local anesthesia in
most cases. Aspirate
superficial or palpable
lesions without
Interpretation:
radiologic aid, but
aspirate nonpalpable
the Biopsy may be due
lesions using
to the
radiographic imaging as
an aid for needle
Analysis:
placement. Use sterile
(Medical and Surgical
technique.
Nursing by
Position the needle
Ignatavicius and
properly, then retract
workman, 5th Edition,
the plunger of the
page 1027)
syringe to create
negative pressure.
Move the needle up and
down, and sometimes
at several different
angles. Release the
plunger of the syringe
and remove the needle.
Express material
obtained onto glass
slides, which must
either be fixed
immediately in 95%
alcohol, spray fixed, or
November
1, 2013
November
2, 2013
Endotracheal
aspirate
Wound
discharge
It is a method of
obtaining diagnostic
material for cytologic
(cell) and histologic
(tissue) study that
causes a minimal
amount of trauma to
of Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 763)
Benign or
negative: no
abnormal
cells or
abnormal
tissue
present
It is a method of
obtaining diagnostic
material for cytologic
(cell) and histologic
(tissue) study that
causes a minimal
amount of trauma to
of Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 763)
Benign or
negative: no
abnormal
cells or
abnormal
tissue
present
No
pathogenic
organisms
Clinical
impression:
Hospitalacquired
Pneumonia
Isolated
organism:
Stenotrophomon
as maltophilia
Growth: Light
growth
No
pathogenic
organisms
Clinical
impression:
Surgical site
impression
Final reading:
Candida
Albicans
Remarks: Germ
tube result
Interpretation:
the pathology may be
due to the
air dried, depending on

the staining procedure
used by the laboratory.
The remaining material
may be placed in a
Analysis:
preservative solution,
such as 50% alcohol.
Nursing by
Check with your
Ignatavicius and
laboratory for
recommended fixation
page 1027)
requirements. Material
may also be sent to the
laboratory in the
syringe.
Interpretation:
Record the source of the
sample and method of
the pathology may be
collection so that
due to the
evaluation can be
based on complete
Analysis:
information.
(Medical and Surgical Clearly label specimens
Nursing by
collected from patients
Ignatavicius and
in isolation on the
specimen container and
page 1027)
on the requisition form
with an appropriate
warning sticker. Place
the specimen container
inside two sealed,
protective biohazard
bags before transport.
Posttest Patient
Aftercare
Monitor for signs of

inflammation and use
site care infection
control measures. Treat
pain, which may be
common in sensitive
areas such as the
breast, nipple, prostate,
and scrotum.
Monitor for specific
problems, which vary
depending on the site
aspirated (eg,
hemoptysis after a lung
aspiration).
Counsel about follow-up
procedures for
infections and malignant
conditions.
Hepatitis B
Serology
Test
Date Done
This test is an indication of previous infection, as well as current infection, and gives an indication of immunity (antibodies) to
future exposure, in the case of Hepatitis B.
Name of
Test/
Procedure
Indication for the

test / Procedure
Cut off value
Patient value
Interpretation and
Analysis
Nursing responsibilities
October 25,
2013
Hepatitis B
surface
antigen
(HBs Ag)
To screen for and

detect HBV
infections; earliest
indicator of acute
hepatitis B and
frequently identifies
infected people
before symptoms
appear
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 550)
Non-reactive
Non-reactive
Normal
Pre-test:
Assess patient's social
and clinical history and
knowledge of test.
Explain test purpose
and procedure.
This test indicates

that a person has
successfully
responded to the
hepatitis B vaccine
or has recovered
from an acute
hepatitis B
infection. (Manual
C.O.V.
10.000
October 25,
2013
Hepatitis B
antibody
(Anti-Hbs)
98.37
Reactive
Normal
Procedure:
Collect a 7-mL blood
serum sample in a redtopped tube or two
lavender-topped
ethylenediaminetetraac
etic acid (EDTA) tubes,
5 mL each, for plasma.
Observe standard
precautions. Centrifuge
promptly and
aseptically. Place
specimen in a
biohazard bag for
transport to the
laboratory. Send
specimens frozen on
of Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 581)
October 25,
2013
Hepatitis C
antibody
(Anti-HCV)
This test detects the

presence of
antibodies to the
virus, indicating
exposure to
hepatitis c virus.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 593)
C.O.V. 0.520
0.456
Non-reactive
Normal
dry ice. Check with

your laboratory for
protocols and whether
plasma or serum is
needed.
Be aware that some
specimens need to be
split into two plastic
vials before freezing
and sent frozen on dry
ice. Check with your
laboratory.
Post-test:
Explain significance of
test results and
counsel appropriately
regarding presence of
infection, recovery, and
immunity. Counsel
health care workers
and family regarding
protective and
preventive measures
necessary to avoid
transmission. Instruct
patient to alert health
care workers and
others regarding their
hepatitis history in
situations in which
exposure to body fluids
and wastes may occur.
LABORATORY STUDIES
Complete
Blood Count
This test is used to evaluate anemia, leukemia, reaction to inflammation and infections, peripheral blood cellular characters,
State of hydration and dehydration.
Date Done
Name of Test/
Procedure
Indication for the

test / Procedure
Normal
Findings
Actual
Results
Interpretation and
Analysis
Nursing
Responsibilities
October 31,
2013
Hemoglobin
It is used to
determine the
concentration of
hemoglobin in whole
blood. It also serves
as an important
buffer in the
extracellular fluid.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 74)
135-180 g/L
98 g/L
Interpretation:
Pretest:
It is used to
determine the
concentration of
hemoglobin in whole
as an important
buffer in the
(Manual of
Laboratory &
Diagnostic Tests by
135-180 g/L
November 4,
2013
Hemoglobin
Decreased hemoglobin
may be due to the clients
Explain test
procedure. Explain
that slight discomfort
may be felt when skin
is punctured.
Avoid stress if
possible because
altered physiologic
status influences and
changes normal
hemogram values.
Select hemogram
components ordered
at regular intervals
(eg, daily, every other
day). These should
be drawn consistently
at the same time of
day for reasons of
accurate comparison;
Analysis:
Nursing by Ignatavicius
and workman, 5th Edition,
page 927)
84 g/L
Interpretation:
Analysis:
page 927)
Fischbach, 7th
Edition, page 74)
November 8,
2013
October 31,
2013
Hemoglobin
Hematocrit
It is used to
determine the
concentration of
hemoglobin in whole
as an important
buffer in the
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 74)
This test indirectly
measures the RBC
mass. The results
are expressed as
the percentage by
volume of packed
RBCs in whole
blood (PCV). It is an
important
measurement in the
determination of
anemia or
polycythemia.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
135-180 g/L
69 g/L
natural body rhythms

cause fluctuations in
laboratory values at
certain times of the
day.
Interpretation:
Dehydration or
overhydration can
dramatically alter
values; for example,
large volumes of IV
fluids can dilute the
blood, and values will
appear as lower
counts. The presence
of either of these
states should be
communicated to the
laboratory.
Fasting is not
necessary.
Analysis:
page 927)
0.40-0.54
0.29
Interpretation:
Decreased hematocrit
Analysis:
page 927)
Posttest:
Apply manual
pressure and
dressings to the
puncture site on
removal of the
Edition, page 74)

November 4,
2013
November 8,
2013
Hematocrit
Hematocrit
needle.

measures the RBC
mass. The results
are expressed as
the percentage by
volume of packed
RBCs in whole
important
measurement in the
determination of
anemia or
polycythemia.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 74)
0.40-0.54

measures the RBC
mass. The results
are expressed as
the percentage by
volume of packed
RBCs in whole
important
measurement in the
determination of
anemia or
0.40-0.54
0.26
Interpretation:
Monitor the
puncture site for
oozing or hematoma
formation. Maintain
pressure dressings
on the site if
necessary. Notify
physician of unusual
problems with
bleeding.
Resume normal
activities and diet.
Bruising at the
puncture site is not
uncommon. Signs of
inflammation are
unusual and should
be reported if the
inflamed area
appears larger, if red
streaks develop, or if
drainage occurs.
Analysis:
page 927)
0.21
Interpretation:
Analysis:
page 927)
polycythemia.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 74)
October 31,
2013
November 4,
2013
White blood cell
White blood cell
It helps diagnose
an infection or
inflammatory
process; it also may
be used to
determine the
presence of other
diseases that affect
WBCs
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 48)
It helps diagnose
an infection or
inflammatory
be used to
determine the
presence of other
WBCs
(Manual of
Laboratory &
5.0 x10^9/L
10.0
x10^9/L
21.19x10^9/
L
Interpretation:
Increased white blood cell
Analysis:
page 927)
5.0 x10^9/L
10.0
x10^9/L
17.95x10^9/
L
Interpretation:
Analysis:
page 927)
Diagnostic Tests by
Fischbach, 7th
Edition, page 48)
November 8,
2013
October 31,
2013
White blood cell
Lymphocytes
It helps diagnose
an infection or
inflammatory
be used to
determine the
presence of other
WBCs
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 48)
5.0 x10^9/L
10.0
x10^9/L
This test measures

the number of
lymphocytes in the
peripheral blood. It
operates in the
immune defenses of
the body.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 61)
0.20 0.40
20.13
x10^9/L
Interpretation:
Analysis:
page 927)
0.09
Interpretation:
Decreased lymphocytes
Analysis:
page 927)
November 4,
2012
November 8,
2012
October 31,
2013
Lymphocytes
Lymphocytes
Segmented
neutrophils
This test measures

the number of
lymphocytes in the
operates in the
immune defenses of
the body.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 61)
0.20 0.40
This test measures

the number of
lymphocytes in the
operates in the
immune defenses of
the body.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 61)
0.20 0.40
This test determines

the presence of
neutrophilia or
neutropenia.
(Manual of
Laboratory &
Diagnostic Tests by
0.60-0.70
0.18
Interpretation:
Analysis:
page 927)
0.12
Interpretation:
Analysis:
page 927)
0.93
Interpretation:
Increased segmenters
may be due to
Analysis:
Fischbach, 7th
Edition, page 52)
November 4,
2012
November 8,
2012
Segmented
neutrophils
Segmented
neutrophils

page 998)

the presence of
neutrophilia or
neutropenia.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 52)
0.60-0.70

the presence of
neutrophilia or
neutropenia.
(Manual of
Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 52)
0.60-0.70
0.81
Interpretation:
may be due to
Analysis:
page 998)
0.86
Interpretation:
may be due to
Analysis:
page 998)
Clinical
Chemistry
Date done
October 31,
2013
November 2,
2013
November 4,
2013
Blood chemistry testing identifies many chemical blood constituents. It is often necessary to measure several blood
chemicals to establish a pattern of abnormalities. A wide range of tests can be grouped under the headings of enzymes,
electrolytes, blood sugars, lipids, hormones, proteins, vitamins, minerals, and drug investigation.
Name of Test/
Procedure
Indication for the

Test/ Procedure
Normal
Findings
Potassium
It evaluates changes
in body potassium
levels and diagnoses
acid-base and water
imbalances.
Fischbach, 7th
Edition, page 961)
3.5-5.1
umol/L
in body potassium
acid-base and water
imbalances.
Fischbach, 7th
Edition, page 961)
3.5-5.1
umol/L
Potassium
Potassium
in body potassium
Actual
Result/
Findings
4.0 umol/L
Interpretation and
Analysis
Nursing
Responsibilitie
Normal
Pre-test:
3.2 umol/L
Explain purpose
procedure.
Encourage
relaxation.
Be aware that
tourniquet
application shou
be as brief as
possible when
drawing to prev
venous stasis a
hemolysis.
Ensure that
supplements ar
taken within 8 to
Interpretation:
Decreased potassium may
be due to the clients
Analysis:
page 927)
3.5-5.1
umol/L
2.8 umol/L
Interpretation:

acid-base and water
imbalances.
Fischbach, 7th
Edition, page 961)
November 5,
2013
Potassium
October 31,
2013
Sodium
November 4,
Sodium
Decreased potassium may

be due to the clients
hours before the

blood sample is
drawn.
Analysis:
page 927)
in body potassium
acid-base and water
imbalances.
Fischbach, 7th
Edition, page 961)
3.5-5.1
umol/L
It is used to determine
electrolytes, acidbase balance, water
balance, water
intoxication, and
dehydration. (Manual
of Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 964)
135-146
It is used to determine
135-146
3.5 umol/L
Post-Test:
Interpret test re
monitor change
body potassium
intervene as
appropriate.
Be aware that
recognizing sign
and symptoms
hypokalemia an
hyperkalemia is
important. Many
these originate
nervous and
muscular system
and are usually
nonspecific and
similar.
Normal
146 mEq/L
Normal
135 mEq/L
Normal
mEq/L
2013
October 31,
2012
Creatinine
electrolytes, acidbase balance, water

balance, water
intoxication, and
dehydration. (Manual
of Laboratory &
Diagnostic Tests by
Fischbach, 7th
Edition, page 964)
mEq/L
It diagnoses impaired
renal function. It is a
more specific and
sensitive indicator of
kidney disease than
BUN.
71-115
umol/L
342 umol/L
Increased creatinine may

be due to
Analysis:
Fischbach, 7th
Edition, page 961)
November 2,
2013
Creatinine
more specific and
kidney disease than
BUN.
Fischbach, 7th
Interpretation:

page 998)
71-115
umol/L
273 umol/L
Interpretation:
be due to
Analysis:
Remember that
potassium blood
level rises 0.6 m
(0.6 mmol/L) for
every 0.1 decre
in blood pH.
Edition, page 961)

November 4,
2013
Creatinine
more specific and
kidney disease than
BUN.

page 998)
71-115
umol/L
222 umol/L

be due to
Analysis:
Fischbach, 7th
Edition, page 961)
November 5,
2013
Creatinine
more specific and
kidney disease than
BUN.
Fischbach, 7th
Edition, page 961)
Interpretation:

page 998)
71-115
umol/L
198 umol/L
Interpretation:
be due to
Analysis:
page 998)
Arterial
Blood Gases
This test is obtained to assess adequacy of oxygenation and ventilation, to evaluate acid-base status by measuring the
respiratory and non-respiratory components, and to monitor effectiveness of therapy.
Date Done
Name of Test/
Procedure
Indication for the test

/ Procedure
Normal
Findings
Actual
Results
Interpretation and Analysis
Nursing
Responsibilities
October 31,
2013
pH
It measures the body's

chemical balance and
represents a ratio of
acids to bases. It is
also an indicator of the
degree to which the
body is adjusting to
dysfunctions by means
of its buffering
systems. (Manual of
Laboratory &
Diagnostic Tests by
page 943)
This test measures the
pressure exerted by
the O2 dissolved in the
plasma. It evaluates
7.35-7.45
mmHg
7.42
mmHg
Normal
Pre-Test:
October 31,
2013
Partial
pressure of
oxygen
(PaO2)
80-100
mmHg
96 mmHg
Normal
Explain the
purpose and
procedure for
obtaining an arterial
blood sample.
If the patient is
apprehensive,
explain that a local
anesthetic can be
used.
Have the patient

assume a sitting or
supine position.
the ability of the lungs

to oxygenate the blood
and is used to assess
the effectiveness of
oxygen therapy.
page 937)
October 31,
2013
Obtober 31,
2013
Partial
pressure of
carbon dioxide
(PCO2)
Bicarbonate
(HCO3)
This test measures the

pressure or tension
exerted by dissolved
CO2 in the blood (10%
of CO2 is carried in
plasma and 90% in red
blood cells) and is
proportional to the
partial pressure of CO2
in the alveolar air. The
test is commonly used
to detect a respiratory
abnormality and to
determine the alkalinity
or acidity of the blood.
page 932)
35-45
mmHg
It indicates issues with

kidney function. This
test is a general
22-26
mEq/L
37 mmHg
24 mEq/L
Perform the
modified Allen's test
to assess collateral
circulation before
performing a radial
puncture, as follows:
Elevate the
patient's wrist with a
small pillow, and ask
the patient to extend
the fingers downward
(this flexes the wrist
and positions the
radial artery closer to
the surface).
Meanwhile,
ensure that all air
bubbles in the blood
sample are expelled
as quickly as
possible. Air in the
sample changes ABG
values. Cap the
syringe and gently
rotate to mix heparin
with the blood.
Normal
Interpretation:
Increased bicarbonate may
Label the sample
October 31,
2013
Base excess
measure of the
alkalinity or acidity of
venous, arterial, or
capillary blood. This
test measures the CO2
contributions from
dissolved CO2 gas,
total H2CO3, HCO3-,
and
carbaminohemoglobin
(CO2HHb). (Manual of
Laboratory &
Diagnostic Tests by
page 938)
This test quantifies the
patient's total base
excess or deficit so
that clinical treatment
of acid-base
disturbances
(specifically those that
are nonrespiratory in
nature) can be
initiated. (Manual of
Laboratory &
Diagnostic Tests by
page 946)
be due to the
with patient's name,

identification number,
date, time, mode of
O2 therapy, and flow
rate.
Analysis:
Place the sample

on ice and transfer it
to the laboratory. This
prevents alterations
in gas tensions
resulting from
metabolic processes
that continue after
blood is drawn.
Post-Test:
Evaluate color,
motion, sensation,
degree of warmth,
capillary refill time,
and quality of pulse in
the affected extremity
or at the puncture
site.
Monitor puncture
site and dressing for
arterial bleeding for
several hours. No
vigorous activity of
the extremity should

be undertaken for 24
hours.

Manual of Laboratory & Diagnostic Tests by Fischbach, 7th Edition, Page764

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Manual of Laboratory & Diagnostic Tests by Fischbach, 7th Edition, Page764

Uploaded by

Copyright:

Available Formats

DIAGNOSTIC PROCEDURES

Indication for the

Pretest Patient Care

air dried, depending on

Monitor for signs of

Indication for the

Cut off value

To screen for and

This test indicates

This test detects the

dry ice. Check with

Indication for the

natural body rhythms

Edition, page 74)

This test indirectly

This test indirectly

White blood cell

White blood cell

White blood cell

This test measures

This test measures

This test measures

This test determines

(Medical and Surgical

This test determines

This test determines

Indication for the

levels and diagnoses

Decreased potassium may

hours before the

electrolytes, acidbase balance, water

Increased creatinine may

(Medical and Surgical

Edition, page 961)

and workman, 5th Edition,

Increased creatinine may

(Medical and Surgical

Indication for the test

Interpretation and Analysis

It measures the body's

Have the patient

the ability of the lungs

This test measures the

It indicates issues with

Label the sample

with patient's name,

Place the sample

the extremity should

You might also like