unit 18 lab skills
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Unit 18 Lab Skills
J.J. Nelson RN
Clinical Laboratory Improvement Amendments (CLIA) test
TESTS GRANTED WAIVED STATUS UNDER CLIA This list includes updates from Change Request 7435 CPT CODE(S) TEST NAME MANUFACTURER USE
81002 Dipstick or tablet reagent urinalysis – non-automated for bilirubin, glucose, hemoglobin, ketone, leukocytes, nitrite, pH, protein, specific gravity, and urobilinogen Various Screening of urine to monitor/diagnose various diseases/conditions, such as diabetes, the state of the kidney or urinary tract, and urinary tract infections
81025 Urine pregnancy tests by visual color comparison Various Diagnosis of pregnancy 82272 Fecal occult blood Various Detection of blood in feces from whatever cause, benign or
malignant (colorectal cancer screening) 82962 Blood glucose by glucose monitoring devices cleared by the FDA for home use Various
Monitoring of blood glucose levels 83026 Hemoglobin by copper sulfate – non-automated Various Monitors hemoglobin level in blood
84830 Ovulation tests by visual color comparison for human luteinizing hormone Various Detection of ovulation (optimal for conception)
85013 Blood count; spun microhematocrit Various Screen for anemia 85651 Erythrocyte sedimentation rate – non-automated Various Nonspecific screening test for
inflammatory activity, increased for majority of infections, and most cases of carcinoma and leukemia INFLUENZA NASO-PHARYNGEAL
THERE ARE MORE BUT THESE ARE THE MOST COMMON
Characteristics of urine
Volume - polyuria. oliguria, anuria
Color- straw coloredPale or colorless=dilute urine
Dark yellow, orange brown=concentrated urine
Beer brown=bilirubin or bile
Cloudy red=RBC
Clear red=hgb, increased RBC destruction
Transparency (turbidity or clarity)Cloudy=mucus, pus, WBC, or old specimen
Milky=fats,lipids
Urine Characteristic cont.
Odor – faint or no odor
pH - High acid=starvation, diarrhea, diabetes
Alkaline=infection, renal failure, old specimen, vegetarian diet
Specific Gravity Bacteria Nitrates
Albumin- RBC Glucose
Acetones (ketones) WBC
Blood- Bilirubin
Pus- Urobilogen
Urinalysis
Physical
Chemical
Microscopic
FRESH SPECIMEN IS NEEDED FOR ACCURATE RESULTS.Examination within one hour of collection or refrigerate specimen
What standard precautions?
Reagent Strips (Dipsticks)
Note:
*Expiration date
*Store cool, dry dark area
*Close immediately
*Do not touch pads
*Consider bottle contaminated!!!
*That includes in classroom!!!
Notice where the strip handle is located and the time requirement for each pad. Brand names may vary with time and pad locations.
Quality Control Checks
Quality control procedures should be performed with each new lot of reagent strips, and as often as required by the laboratory's (office) procedure.
Automated strip readers
TERMS
Albuminuria
Proteinuria
Hematuria
Pyuria
Bilirubinuria
CHARTING
Take care not to contaminate the written lab slip.
Blood Test 18:3 & 18:10
Skin puncture (capillaries) Venipuncture Arterial puncture
Skin Puncture
Remember-
Do not use thumb and index finger Check sites for edema, callouses, scars or open
areas. Use warm site and do not milk Automatic lancet for individual use only Wipe away first drop Let patient help with gauze Perform standard precautions
BLOOD GLUCOSE MONITORING
FBS 80-120mg/dl of blood Hgb A1C amount of glucose attached to hgb Keep strip bottle closed tightly. Check expiration date on strips Calibrate Glucometer with each new bottle of
strips (with chip and low sugar solution) Completely fill strip as recommended
by manufacturer Record in meter memory and in diary. Disinfect area
CHARTING
Outpatient’s chart in diary
Inpatients. You chart date,time, “Pt.instructed on use of blood glucose monitor. Pt verbalized understanding”, Blood Glucose number, “from location”, signature and title
PATIENT EDUCATIONPATIENT EDUCATION
Unit 18J.J. Nelson RN,CMA
Glucose tests
FBS-fasting (in Chem Panel or Complete Metabolic Panel)
Hgb A1C -nonfastingGTT (2-6 hours)-fasting &
multiple blood drawsUrine-glucose is abnormal in
urine
STOOL SPECIMENS Hemoccult-use card Stool for O&P-special
bottle with mark to fill to.
Stool for C&S-special bottle with mark to fill to.
Do not contaminate with urine of blood (menses)
URINE
Routine UA Urine C&S-
midstream, clean catch, sterile cup
24 hour specimen
FASTING LABS
LIPID PANELSCEMISTRIES
(CHEM 6/CHEM PANELS)
Phenylketonuria• multiple tests in addition to PKU e.g. thyroid
SPUTUM SPECIMEN
Not saliva Deep from lungs.
(may use nebulizer)
Sterile container No smoking prior
to test
Cardiac Test• EKG• Echocardiogram• Stress Test (exercise or chemical); take cardiac meds, wear exercise cloths• Holter Monitor-24 hour recording….need good electrode attachment. Avoid microwaves, Record in diary and use “event button”.
Holter Monitor
MEDICAL IMAGING
ULTRASOUNDS –• Abdominal is NPO• Fetal and Pelvic drink 24-30 ounces noncarbonated
fluid 45 min -1 hour before exam
•MRI- MAGNETIC RESONANCE IMAGING• Patient must be metal free• Claustrophobia may be medicated• Very noisy• Must lay very still, in tight quarters
MEDICAL IMAGING CONT.
X-Rays=radiationRisk for pregnant women. (Neg. HCG)UGI-NPO, swallow barium. FluoroscopySMALL BOWEL- Laxative day before
exam, NPO and same as UGIBARIUM ENEMA- CL diet evening meal
before, NPO, Laxatives prior, barium is injected into rectum. Must also follow up with laxatives)
X-Rays continued
Angiogram NPO prior to testIVP- Iodine is used in injection. Ask about
sea food allergies. NPO, Laxatives IV.Voiding Cystogram uses catheter and
fluoroscopyMammogram No deo, lotion powder. Wear
clothes to make breast accessibleCT scan ABD and brain require contrast
media and NPO for 4 hours prior to test
CT SCAN MRI
SCOPES
COLONOSCOPY SIGMOIDOSCOPY
• Light-liquid diet day before
• NPO after MN
• Enemas/laxatives night before and in am
• Biopsies can cause some rectal bleeding
EEG (Electroencephalogram)
ALLERGY SKIN TEST Multiple scratches or
punctures Not take allergy meds
for at least 24 hours Must lie still May cause red, itching
areas
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