common diagnolastic procedures

7/28/2019 Common Diagnolastic Procedures

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Common Diagnostic Procedures



DiagnosticTesting

• Phases of Diagnostic Testing

Pretest

IntratestPost test



Pretest Phase

Preparing the client

–Knowing about the test

ordered

–Gathering equipment and

supplies



Intratest Phase

• Collecting the specimen

• Performing or assisting

• Providing emotional and physicalsupport

• Monitoring

• Correct labeling, storage, and

transportation of specimen



Post Test Phase

• Nursing care of client

• Performing follow-up activities and

observations

• Comparing the previous and current test

results

• Modifying nursing interventions as needed• Reporting the results



Common Blood Tests

• Complete blood count

• Serum electrolytes

• Serum osmolality

• Arterial blood gases

• Blood chemistry

• Metabolic screening

• Capillary blood glucose

• Drug monitoring (peak and tough levels)



Complete Blood Count

Hemoglobin

Hematocrit

RBC countRBC count

RBC indices

WBC countWBC differential



What is the complete blood

count test (CBC)?The complete blood count (CBC) is one of

the most commonly ordered blood tests.

The complete blood count is the

calculation of the cellular (formedelements) of blood. These calculations are

generally determined by special machines

that analyze the different components of blood in less than a minute.



• A CBC helps your health professional

check any symptoms, such as weakness,

fatigue, or bruising, you may have. A CBC

also helps him or her diagnose conditions,such as anemia, infection, and many other

disorders.

http://www.webmd.com/hw-popup/anemia

http://www.webmd.com/hw-popup/anemia



White blood cell (WBC,

leukocyte) count. • White blood cell count (WBC) is the

number of white blood cells in a volume of

blood.

• White blood cells protect the body against

infection. If an infection develops, white

blood cells attack and destroy the bacteria,

virus, or other organism causing it. Whena person has a bacterial infection, the

number of white cells rises very quickly.



White blood cell types (WBC

differential). • The major types of white blood cells are

neutrophils, lymphocytes, monocytes,

eosinophils, and basophils. Immature

neutrophils, called band neutrophils, arealso part of this test. Each type of cell

plays a different role in protecting the

body.

http://www.webmd.com/hw-popup/neutrophil

http://www.webmd.com/hw-popup/neutrophil



• The numbers of each one of these types

of white blood cells give important

information about the immune system. Too

many or too few of the different types of white blood cells can help find an infection,

an allergic or toxic reaction to medicines or

chemicals, and many conditions, such asleukemia.

http://www.webmd.com/hw-popup/immune-system-7922

http://www.webmd.com/hw-popup/allergic-reaction

http://www.webmd.com/hw-popup/leukemia

http://www.webmd.com/hw-popup/leukemia

http://www.webmd.com/hw-popup/allergic-reaction

http://www.webmd.com/hw-popup/immune-system-7922



Red blood cell (RBC) count

• Red cell count (RBC) signifies the

number of red blood cells in a volume of

blood.

• Red blood cells carry oxygen from the

lungs to the rest of the body. They also

carry carbon dioxide back to the lungs so it

can be exhaled.



• If the RBC count is low (anemia), the body

may not be getting the oxygen it needs. If

the count is too high (a condition called

polycythemia), there is a chance that thered blood cells will clump together and

block tiny blood vessels (capillaries). This

also makes it hard for your red blood cellsto carry oxygen.

http://www.webmd.com/hw-popup/polycythemia

http://www.webmd.com/hw-popup/polycythemia



Hematocrit (HCT, packed cell

volume, PCV). • This test measures the amount of space

(volume) red blood cells take up in the

blood. The value is given as a percentage

of red blood cells in a volume of blood. For example, a hematocrit of 38 means that

38% of the blood's volume is made of red

blood cells.

http://www.webmd.com/hw-popup/hematocrit

http://www.webmd.com/hw-popup/hematocrit



Hemoglobin (Hgb).

• Hemoglobin is the protein molecule within

red blood cells that carries oxygen and

gives blood its red color.

• The hemoglobin test measures the

amount of hemoglobin in blood and is a

good measure of the blood's ability to

carry oxygen throughout the body.



Red blood cell indices.

• There are three red blood cell indices:

mean corpuscular volume (MCV), mean

corpuscular hemoglobin (MCH), and mean

corpuscular hemoglobin concentration(MCHC). They are measured by a

machine and their values come from other

measurements in a CBC.



• The MCV is the average volume of a red

blood cell. This is a calculated value

derived from the hematocrit and red cellcount. Normal range may fall between 80

to 100 femtoliters (a fraction of one

millionth of a liter).

• The MCH value is the amount of

hemoglobin in an average red blood cell.

This is a calculated value derived from the

measurement of hemoglobin and the red

cell count. Normal range is 27 to 32

picograms.



• The MCHC measures the concentration of

hemoglobin in an average red blood cell.

These numbers help in the diagnosis of

different types of anemia. This is acalculated volume derived from the

hemoglobin measurement and the

hematocrit. Normal range is 32% to 36%.



• Red Cell Distribution Width (RDW) is a

measurement of the variability of red cell

size and shape. Higher numbers indicate

greater variation in size. Normal range is11 to 15.



Platelet (thrombocyte) count.

• Platelets (thrombocytes) are the smallest

type of blood cell.

• They are important in blood clotting.

When bleeding occurs, the platelets swell,

clump together, and form a sticky plug that

helps stop the bleeding.



• If there are too few platelets

thrombocytopenia) , uncontrolled bleeding

may be a problem. If there are too many

plateletsthrombocytosis) , there is achance of a blood clot forming in a blood

vessel. Also, platelets may be involved in

hardening of the arteries (atherosclerosis).

http://www.medicinenet.com/script/main/art.asp?articlekey=100173


http://www.webmd.com/hw-popup/atherosclerosis-8374

http://www.webmd.com/hw-popup/atherosclerosis-8374





NORMAL VALUES



White blood cell (WBC, leukocyte) count

• Men and nonpregnant women:

• 4,500 –11,000/mcL3 or 4.5 –11.0 x

109/liter (SI units)

6/23/2013 copyright (your organization) 2003 24



• Pregnant women:

• 1st trimester: 6,600 –14,100/mcL or 6.6 –

14.1 x 109/L

• 2nd trimester: 6,900 –17,100/mcL or 6.9 –

17.1 x 109/L

• 3rd trimester: 5,900 –14,700/mcL or 5.9 –

14.7 x 109/L

• Postpartum: 9,700 –25,700/mcL or 9.7 –

25.7 x 109/L6/23/2013 copyright (your organization) 2003 25



White blood cell types (WBC differential)

• Neutrophils:

• 50% –62%

• Band neutrophils:

• 3% –6%

• Lymphocytes:

• 25% –40%

• Monocytes:

• 3% –7%

• Eosinophils:

• 0% –3%

• Basophils:

• 0% –1%




Red blood cell (RBC) count

• Men: • 4.7 –6.1 million

RBCs per

microliter (mcL)

or 4.7 –6.1 x1012/liter (SI

units)

• Women:

• 4.2 –5.4 million

RBCs per mcL

or 4.2 –5.4 x

1012/L

• Children:

• 4.0 –5.5 million

RBCs per mcL

or 4.6 –4.8 x1012/L

• Newborn:

• 4.8 –7.1 millionRBCs per mcL

or 4.8 –7.1 x

1012/L

6/23/2013 27

http://www.webmd.com/hw-popup/microliter-ml








Hematocrit (HCT) • Men:

• 42% –52% or 0.42 –0.52 volume

fraction (SI units)

• Women: • 37% –47% or 0.37 –

0.47 volume

fraction

• Children:

• 32% –44%

• Newborns:

• 44% –64%

• Pregnant

women:

• 1st trimester:

35% –46%

• 2nd trimester:30% –42%

• 3rd trimester:

34% –44%

• Postpartum:

30% –44%

copyright (your organization) 2003 28



Hemoglobin (Hgb)

• Men:

• 14 –18 grams per deciliter (g/dL) or

8.7 –11.2 millimoles

per liter (mmol/L)

(SI units)• Women:

• 12 –16 g/dL or 7.4 –

9.9 mmol/L

• Pregnant women: • 1st trimester: 11.4 –

15.0 g/dL or 7.1 –

9.3 mmol/L

• 2nd trimester:

10.0 –14.3 g/dL or 6.2 –8.9 mmol/L

• 3rd trimester: 10.2 –

14.4 g/dL or 6.3 –

8.9 mmol/L• Postpartum: 10.4 –

18.0 g/dL or 6.4 –

9.3 mmol/L

• Children: • 9.5 –15.5 g/dL

• Newborn:

• 14 –24 g/dL


http://www.webmd.com/hw-popup/grams-per-deciliter-gdl


http://www.webmd.com/hw-popup/millimoles-per-liter-mmoll


















Red blood cell indices

• Mean corpuscular volume(MCV):

• 82 –98 femtoliters (fL)

• Mean corpuscular hemoglobin(MCH):

• 26 –34 picograms (pg)

• Mean corpuscular hemoglobinconcentration (MCHC):

• 31 –38 grams per deciliter (g/dL)

or 31% –38%6/23/2013 copyright (your organization) 2003 30

http://www.webmd.com/hw-popup/femtoliter-fl

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Red cell distribution width

(RDW) • Normal:

• 11.5% –14.6%

•




Platelet (thrombocyte) count

• Children: 150,000 –450,000 platelets per

mm3 or 150 –450 x 109/liter (SI units)

• Adults: 150,000 –400,000 platelets per

mm3 or 150 –400 x 109/liter (SI units)

•


http://www.webmd.com/hw-popup/millimeter-mm

http://www.webmd.com/hw-popup/millimeter-mm



Serum Electrolytes/

Serum Osmolality• Serum electrolytes

– Sodium

– Potassium

– Chloride

– Bicarbonate ions



Electrolytes are measured by a process

known as potentiometry. This method

measures the voltage that develops

between the inner and outer surfaces of an ion selective electrode.

Electrolyte tests are performed on whole

blood, plasma, or serum, usually collectedfrom a vein or capillary.

http://www.answers.com/topic/potentiometry

http://www.answers.com/topic/capillary

http://www.answers.com/topic/capillary

http://www.answers.com/topic/potentiometry



Sodium

Sodium plays a major role in regulating

the amount of water in the body. Also, the

passage of sodium in and out of cells is

necessary for many body functions, liketransmitting electrical signals in the brain

and in the muscles. The sodium levels are

measured to detect whether there's theright balance of sodium and liquid in the

blood to carry out those functions.



• If a child becomes dehydrated because of

vomiting, diarrhea, or inadequate fluid

intake, the sodium levels can be

abnormally high or low, which can cause achild to feel confused, weak, and lethargic,

and even to have seizures.



Potassium

Potassium is essential to regulate how

the heart beats. Potassium levels that are

too high or too low can increase the risk of

an abnormal heartbeat. Low potassiumlevels are also associated with muscle

weakness.



Chloride

Chloride, like sodium, helps maintain a

balance of fluids in the body. If there's a

large loss of chloride, the blood may

become more acidic and prevent certainchemical reactions from occurring in the

body that are necessary it to keep working

properly.



Bicarbonate

Bicarbonate prevents the body's tissues

from getting too much or too little acid. The

kidney and lungs balance the levels of

bicarbonate in the body. So if bicarbonatelevels are too high or low, it might indicate

a problem with those organs.



NORMAL VALUES

• serum or plasma sodium: 135 –145 mmol/l; alert levels: less than



se u o p as a sod u 35 5 o / ; a e t e e s ess t a

120 mmol/l and greater than 160 mmol/l

• serum potassium: 3.6 –5.4 mmol/l (plasma, 3.6 –5.0 mmol/l); alert

levels: less than 3.0 mmol/l and greater than 6.0 mmol/l

• serum or plasma chloride: 98 –108 mmol/l

• sweat chloride: 4 –60 mmol/l

• serum or plasma bicarbonate: 18 –24 mmol/l (as total carbon

dioxide, 22 –26 mmol/l); alert levels: less than 10 mmol/l and

greater than 40 mmol/l• serum calcium: 8.5 –10.5 mg/dl (2.0 –2.5 mmol/l); alert levels:

less than 6.0 mg/dl and greater than 13.0 mg/dl

• ionized calcium: 1.0 –1.3 mmol/l

• serum inorganic phosphorus: 2.3 –4.7 mg/dl (children, 4.0 –7.0mg/dl); alert level: less than 1.0 mg/dl

• serum magnesium: 1.8 –3.0 mg/dl (1.2 –2.0 meq/l or 0.5 –1.0

mmol/l)

• ionized magnesium: 0.53 –0.67 mmol/l

http://www.answers.com/topic/dioxide

http://www.answers.com/topic/inorganic

http://www.answers.com/topic/inorganic

http://www.answers.com/topic/dioxide



Arterial Blood Gases

• An arterial blood gas (ABG) test measures

the acidity (pH) and the levels of oxygen

and carbon dioxide in the blood from an

artery. This test is used to check how wellyour lungs are able to move oxygen into

the blood and remove carbon dioxide from

the blood.

http://www.webmd.com/hw-popup/ph

http://www.webmd.com/hw-popup/ph



• An ABG test uses blood drawn from an

artery, where the oxygen and carbon

dioxide levels can be measured before

they enter body tissues.

• Usually taken by specialty nurses,

Respiratory Therapists

• Take specimens of blood from radial,brachial, femoral arteries

A ABG



An ABG measures:

• Partial pressure of oxygen (PaO2). This

measures the pressure of oxygen

dissolved in the blood and how well

oxygen is able to move from the airspaceof the lungs into the blood.

• Partial pressure of carbon dioxide

(PaCO2). This measures how muchcarbon dioxide is dissolved in the blood

and how well carbon dioxide is able to

move out of the body.

• pH The pH measures hydrogen ions (H+)



pH. The pH measures hydrogen ions (H+)

in blood.

• Bicarbonate (HCO3). Bicarbonate is a

chemical (buffer) that keeps the pH of

blood from becoming too acidic or too

basic.

• Oxygen content (O2CT) and oxygensaturation (O2Sat) values. O2 content

measures the amount of oxygen in the

blood. Oxygen saturation measures howmuch of the hemoglobin in the red blood

cells is carrying oxygen (O2).

http://www.webmd.com/hw-popup/hemoglobin-7998

http://www.webmd.com/hw-popup/hemoglobin-7998



Normal Values

• pH 7.35 (7.4) to 7.45

• PaCO2 35 (40) to 45 mm Hg

• HCO3ˉ 22 (24) to 26 mEq/L (assumed

average values for ABG interpretation)

• PaO2 80 to 100 mm Hg

• Oxygen saturation >94%



Nursing alert

• Avoid suctioning prior to drawing of blood

• Place specimen on ice

• Apply firm pressure to the puncture site for

5-10 minutes

• Assess the puncture site for bleeding or

hematoma



Coagulation Studies

• Blood coagulation test is done to

determine presence of illness.

• Before you have surgery your doctor may

order blood tests to determine how quickly

your blood clots. This group of tests is

known as a coagulation study, individually

these tests are commonly referred to as aPT (Prothrombin Time), PTT(Partial

Thromboplastin Time), and INR

(International Normalized Ratio).



P th bi Ti Bl d



Prothrombin Time Blood

Test-PT• This test is done to evaluate the blood for

its ability to clot. It is often done before

surgery to evaluate how likely the patient

is to have a bleeding or clotting problemduring or after surgery.

Normal PT Values: 10-12 seconds (this

can vary slightly from lab to lab)



Common causes of a prolonged PT

include vitamin K deficiency, hormones

drugs including hormone replacementsand oral contraceptives, disseminated

intravascular coagulation (a serious

clotting problem that requires immediateintervention), liver disease, and the use of

the anti-coagulant drug warfarin.

Additionally, the PT result can be altered

by a diet high in vitamin K, liver, green tea,

dark green vegetables and soybeans.



Extended PTT times can be a

result of anticoagulation therapy,

liver problems, lupus and other diseases that result in poor

clotting.

I t ti l N li d R ti



International Normalized Ratio

Blood Test-INR

Normal INR Values: 1 to 2

The INR is used to make sure the results

from a PT test is the same at one lab as it

is at another lab. In the 1980’s the WorldHealth Organization determined that

patients may be at risk because the results

of a PT test would vary from one lab toanother, based upon the way the test was

done.

• Sources:



The ―normal‖ range for one lab would be

different than a ―normal‖ value from

another lab, creating problems for patients

who were being treated in severallocations. In order to standardize the

results between labs, the INR was

created. The INR result should be thesame, regardless of the location where the

tests are performed.



Nursing Alerts

• PTT – critical level 175 seconds

• PT – critical level 24 seconds

• Clotting Time – 12 minutes

• If pt is taking anticoagulant, when the

blood level value exceeds the critical value

withold the next dose

• For pt taking heparin monitor PTT

• For pt taking coumadin monitor PT



BLOOD CHEMISTRY



Renal function test

• Kidney function tests is a collective

term for a variety of individual tests

and procedures that can be done to

evaluate how well the kidneys are

functioning. A doctor who orders

kidney function tests and uses theresults to assess the functioning of

the kidneys is called a nephrologist.

There are a number of urine tests that



• There are a number of urine tests that

can be used to assess kidney

function. A simple, inexpensivescreening test—a routine urinalysis—

is often the first test conducted if

kidney problems are suspected.• If results indicate a possibility of

disease or impaired kidney function,

one or more of the followingadditional tests is usually performed

to pinpoint the cause and the level of

http://www.answers.com/topic/pinpoint

http://www.answers.com/topic/pinpoint



• The test is performed on a timed urine

specimen—a cumulative sample collected

over a two to 24-hour period.

Determination of the blood creatinine levelis also required to calculate the urine

clearance.

http://www.answers.com/topic/cumulative

http://www.answers.com/topic/cumulative



Urea clearance test

• Urea is a waste product that is created by

protein metabolism and excreted in the

urine. The urea clearance test requires a

blood sample to measure the amount of urea in the bloodstream and two urine

specimens, collected one hour apart, to

determine the amount of urea that isfiltered, or cleared, by the kidneys into the

urine.

Urine osmolality test

http://www.answers.com/topic/protein-metabolism

http://www.answers.com/topic/urea

http://www.answers.com/topic/urea

http://www.answers.com/topic/protein-metabolism



Urine osmolality test• Urine osmolality is a measurement of the

number of dissolved particles in urine. It isa more precise measurement than specific

gravity for evaluating the ability of the

kidneys to concentrate or dilute the urine.Kidneys that are functioning normally will

excrete more water into the urine as fluid

intake is increased, diluting the urine. If

fluid intake is decreased, the kidneys

excrete less water and the urine becomes

more concentrated

http://www.answers.com/topic/dilute

http://www.answers.com/topic/dilute



• The test may be done on a urine

sample collected first thing in the morning,

on multiple timed samples, or on a

cumulative sample collected over a 24-hour period. The patient will typically be

prescribed a high-protein diet for several

days before the test and be asked to drinkno fluids the night before the test.

Urine protein test



Urine protein test

• Healthy kidneys filter all proteins from the

bloodstream and then reabsorb them,allowing no protein, or only slight amounts of

protein, into the urine. The persistent

presence of significant amounts of protein inthe urine, then, is an important indicator of

kidney disease. A positive screening test for

protein (included in a routine urinalysis) on a

random urine sample is usually followed up

with a test on a 24-hour urine sample that

more precisely measures the quantity of

rotein.

Normal Value

http://www.answers.com/topic/urinalysis

http://www.answers.com/topic/urinalysis



• Creatinine clearance. For a 24-hour urine collection, normal

results are 90 mL/min –139 mL/min for adult males younger

than 40, and 80 –125 mL/min for adult females younger than

40. For people over 40, values decrease by 6.5 mL/min for each decade of life.

• Urine osmolality. With restricted fluid intake (concentration

testing), osmolality should be greater than 800 mOsm/kg of

water. With increased fluid intake (dilution testing), osmolalityshould be less than 100 mOSm/kg in at least one of the

specimens collected. A 24-hour urine osmolality should

average 300 –900 mOsm/kg. A random urine osmolality

should average 500 –800 mOsm/kg.• Urine protein. A 24-hour urine collection should contain no

more than 150 mg of protein.

• Urine sodium. A 24-hour urine sodium should be within 75 –

200 mmol/day.

Normal Value

http://www.answers.com/topic/osmolality

http://www.answers.com/topic/dilution

http://www.answers.com/topic/dilution

http://www.answers.com/topic/osmolality



Normal Value

• Normal urine is transparent. Turbid

(cloudy) urine may be caused by either normal or abnormal processes. Normal

conditions giving rise to turbid urine

include precipitation of crystals, mucus, or vaginal discharge. Abnormal causes of

turbidity include the presence of blood

cells, yeast, and bacteria.

• Glucose: negative (quantitative less than



• Glucose: negative (quantitative less than

130 mg/day or 30 mg/dL).

• Bilirubin: negative (quantitative less than0.02 mg/dL).

• Ketones: negative (quantitative 0.5 –3.0

mg/dL).• pH: 5.0 –8.0.

• Protein: negative (quantitative 15 –150

mg/day, less than 10 mg/dL).• Blood: negative.

• Nitrite: negative.



• Specific gravity: 1.003 –1.025.

• Urobilinogen: 0 –2 Ehrlich units

(quantitative 0.3 –1.0 Ehrlich units).

• Leukocyte esterase: negative.

• Red blood cells: 0 –2 per high power field.

• White blood cells: 0 –5 per high power field(0 –10 per high power field for some

standardized systems).



Nursing Alerts

• First voided urine for urinalysis

• Use clean container

• Decreased sp. gr. Diabetes insipidus

• Increased sp. gr. Diabetes mellitus

• (+) Protein: nephrotic syndrome

• (+) Glucose: D.M. infection

Creatinine test



Creatinine test• This test measures blood levels of

creatinine, a by-product of muscle energymetabolism that, similar to urea, is filtered

from the blood by the kidneys and

excreted into the urine.• Creatinine is affected very little by liver

function, an elevated blood creatinine

level is a more sensitive indicator of impaired kidney function than the BUN.



• N.V. 0.6 to 1.3 mg/dl

• Nursing considerations: instruct the client

to avoid excessive for 8 hours and

excessive red meat intake for 24 hrsbefore the test.



Blood urea nitrogen test (BUN)

• Urea is a byproduct of protein metabolism.Formed in the liver, this waste product is

then filtered from the blood and excreted

in the urine by the kidneys. The BUN test

measures the amount of nitrogen

contained in the urea. High BUN levels

can indicate kidney dysfunction, but

because BUN is also affected by proteinintake and liver function, the test is usually

done together with a blood creatinine, a

more specific indicator of kidney function.

http://www.answers.com/topic/metabolism

http://www.answers.com/topic/metabolism



• N.V.: 8 – 25 mg/dl

• Nursing considerations: should be

analyzed together with creatinine



Other blood tests.

• Measurement of the blood levels of other

elements regulated in part by the kidneys

can also be useful in evaluating kidney

function. These include sodium,potassium, chloride, bicarbonate, calcium,

magnesium, phosphorus, protein, uric

acid, and glucose.

Cardiac markers

http://www.answers.com/topic/chloride

http://www.answers.com/topic/magnesium

http://www.answers.com/topic/uric-acid




http://www.answers.com/topic/magnesium

http://www.answers.com/topic/chloride



Cardiac markers • Cardiac marker tests identify blood chemicals

associated with myocardial infarction (MI),commonly known as a heart attack. The

myocardium is the middle layer of the heart wall

composed of heart muscle. Infarction is tissue

death caused by an interruption in the bloodsupply to an area.

http://www.healthline.com/galecontent/cardiac-marker-tests

http://www.healthline.com/adamcontent/heart-attack











• Cardiac markers help physicians to assessacute coronary syndromes and to identify

and manage high-risk patients.

• Creatine kinase-MB (CK-MB), myoglobin,homocysteine, C-reactive protein (CRP),

troponin T (cTnT), and troponin I (cTnI)

are all used for assessment of thesuspected acute myocardial infarction.

CK-MB, cTnT, and cTnI may also be used

to identify and manage high-risk patients.

C

http://www.healthline.com/adamcontent/myoglobin-urine

http://www.healthline.com/adamcontent/c-reactive-protein









Creatine Kinase

• Creatine kinase is an enzyme found inmuscle and brain tissue that reflects tissue

catabolism resulting from cell trauma.

• The test for CK is performed to detectmyocardial or skeletal muscle damage or

central nervous system damage.



• Isoenzymes includes:

– CK – MB found mainly in the cardiac muscle

– CK – BB is found mainly in brain tissue

– CK – MM found mainly in the skeletalmuscles

N l V l



Normal Value

• Total CK: Reference value is 38 –174units/L for men and 26 –140 units/L for

women. The values begin to rise within

four to six hours and peak at 24 hours.Values return to normal within three to four

days.

CK MB R f l i



• CK-MB: Reference value is

10 –13 units/L. The valuesbegin to rise within three to

four hours and peak at 10 –24 hours. Values return to

normal within two to four

days .

NURSING CONSIDERATIONS



NURSING CONSIDERATIONS• Invasive procedures and IM

injections may elevate CK levelsfalsely.

• If the test is to evaluate skeletalmuscle, instruct the client to avoid

strenuous activities for 24 hrs before

the test

Myoglobin





• is a protein found in both skeletal and

myocardial muscle. It is released rapidlyafter tissue injury and may be elevated

as early as one hour after myocardial

injury, though it may also be elevateddue to skeletal muscle trauma.

• However, if myoglobin values do not rise

within three to four hours after a personshows acute symptoms, it is highly

unlikely that he or she had an MI.

N l V l



Normal Value

• Myoglobin: Reference value is

less than 110 nanograms/mL.

The values begin to rise withinone to two hours and peak at four

to eight hours. Values return to

normal within 12 –24 hours.

T i





Troponins

• A regulatory protein found in the striatedmuscle (skeletal and myocardial)

• Increased amounts of troponins are

released into the blood stream when aninfarction causes damage to the

myocardium



• Cardiac troponin T (cTnT) and cardiactroponin I (cTnI) are the newest additions

to the list of cardiac markers.

• Cardiac troponins are specific to heartmuscle. They have enabled the

development of assays (tests) that can

detect heart muscle injury with greatsensitivity and specificity

• While these markers have been used mainly to



While these markers have been used mainly to

aid in the diagnosis of chest-pain patients with

nondiagnostic electrocardiograms, they are also

used as prognostic indicators of a MI. According

to the American Heart Association, "Several

studies have identified a measurable

relationship between cardiac troponin levels andlong-term outcome after an episode of chest

discomfort. They suggest that these tests may

be particularly useful to evaluate levels of risk. In

other words, it's possible that the results of atroponin test could be used to identify people at

either low risk or high risk for later, serious heart

problems."

http://www.healthline.com/galecontent/electrocardiography

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• Troponin I: value is usually less than 0.6ng/ml; greater than 1.5 ng/ml is consistent

with MI

• Troponin T: greater than 0.2 ng/ml isconsistent with MI

• No need for fasting

L t t D h d (LDH)



Lactate Dehydrogenase (LDH)

• Lactate dehydrogenase catalyses theconversion of pyruvate to lactate. LDH-1

isozyme is normally found in the heart

muscle and LDH-2 is found predominatelyin blood serum. A high LDH-1 level to

LDH-2 suggest MI. LDH levels are also

high in tissue breakdown or hemolysis. Itcan mean cancer , meningitis, encephalitis,

or HIV.

http://en.wikipedia.org/wiki/Pyruvate

http://en.wikipedia.org/wiki/Lactate

http://en.wikipedia.org/wiki/Cancer

http://en.wikipedia.org/wiki/Meningitis

http://en.wikipedia.org/wiki/Encephalitis

http://en.wikipedia.org/wiki/HIV

http://en.wikipedia.org/wiki/HIV

http://en.wikipedia.org/wiki/Encephalitis

http://en.wikipedia.org/wiki/Meningitis

http://en.wikipedia.org/wiki/Cancer

http://en.wikipedia.org/wiki/Lactate

http://en.wikipedia.org/wiki/Pyruvate



• LDH begins to rise about 24 hrs after MIand peak in 48 – 72 hours; returns to

normsl within 7 – 14 days

• Lactate dehydrogenase – 140-280 units/L

• Isoenzymes

– LDH 1 14 - 26%

– LDH-2 29 – 39%

N rsing Considerations



Nursing Considerations

• The LDH isoenzymes should

be interpreted in view of the

clinical findings• Testing should be repeated on

3 consecutive days.

C-reactive protein (CRP) CRP i t i f d i l t



• CRP is a protein found in serum or plasma at

elevated levels during a inflammatory

processes.

• CRP binds to part of the capsule of

Streptococcus pneumoniae. It is a sensitive

marker of acute and chronic inflammation andinfection, and in such cases is increased

several hundred-fold.

• Several recent studies have demonstrated

http://www.healthline.com/adamcontent/travelers-guide-to-avoiding-infectious-diseases

http://www.healthline.com/adamcontent/travelers-guide-to-avoiding-infectious-diseases



that CRP levels are useful in predicting the

risk for a thrombotic event (such as a blood

clot causing MI). These studies suggest that

a high-sensitivity assay for CRP be used that

is capable of measuring the very low level

normally found in serum (0.1 –2.5 mg/L).Heart patients who have persistent CRP

levels between 4 and 10 mg/L, with clinical

evidence of low-grade inflammation, shouldbe considered to be at increased risk for

thrombosis.

Normal Value

http://www.healthline.com/adamcontent/blood-clots













Normal Value

• C-reactive protein: According to the U.S.Food and Drug Administration, in healthy

people, reference values are below 5

mg/dL; in various diseases, this thresholdis often exceeded within four to eight

hours after an acute inflammatory event,

with CRP values reaching approximately20 –500 mg/dL.


http://www.healthline.com/galecontent/food-and-drug-administration















• It is believed that laboratory testing for plasma homocysteine levels can improve

the assessment of risk, particularly in

patients with a personal or family history of cardiovascular disease, but in whom the

well-established risk factors (smoking,

high blood cholesterol, high bloodpressure, physical inactivity, obesity, and

diabetes) do not exist.

Normal value

http://www.healthline.com/galecontent/cholesterol-test-1

http://www.healthline.com/adamcontent/obesity

http://www.healthline.com/adamcontent/diabetes

http://www.healthline.com/adamcontent/diabetes

http://www.healthline.com/adamcontent/obesity

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Normal value

• The normal fasting level for plasma is5 –15 micromol/L. Moderate,

intermediate, and severe

hyperhomocysteinemia refer to

concentrations between 16 and 30,

between 31 and 100, and less than

100 micromol/L, respectively.

Liver Function Test



Liver Function Test

• Liver function tests help detect,evaluate and monitor liver

disease or damage. Liver functiontests generally refer to a group of

blood tests that measure certain

enzymes or proteins in your blood.



• Liver function tests may be done for avariety of reasons. Liver function tests can

help screen for liver viruses such as

hepatitis. They can also help monitor theprogression of a disease like viral or

alcoholic hepatitis and determine how well

a treatment is working. Liver function testscan even measure the severity of a

disease, particularly if you have cirrhosis

— an irreversible scarring of the liver.



• LFTs include measurements of albumin,various liver enzymes (ALT, AST, GGT

and ALP), bilirubin, prothrombin time,

cholesterol and total protein. All of thesetests can be performed at the same time.



• The normal range of ALT levels isbetween 5 IU/L to 60 IU/L (International

Units per Liter). ALT levels in people with

HCV often rise and fall over time, soadditional testing such as HCV RNA, HCV

genotyping and a liver biopsy may be

needed to help determine the cause andextent of liver damage.



• Aspartate aminotransferase (AST). Thisenzyme, which plays a role in processing

proteins, is found in the liver, heart,

muscles, and kidneys. When the liver isinjured or inflamed, levels of AST in the

blood usually rise.

• Also known as serum glutamic oxaloacetictransaminase



• The normal range for AST levels inthe bloodstream are 5 IU/L to 43 IU/L.

Like ALT levels, AST levels in people

with HCV often vary over time andcan't be used to forecast disease

progression or specifically measure

liver damage.

• GGT and ALP are also called cholestatic liver



enzymes.

• Chloestasis is a term used for partial or fullblockage of the bile ducts. Bile ducts bring bile

from the liver into the gallbladder and the

intestines. Bile is a green fluid produced in liver

cells. Bile helps the body to break down fat,process cholesterol and get rid of toxins. If the

bile duct is inflamed or damaged, GGT and ALP

can get backed up and spill out from the liver into the bloodstream.

• ALP metabolizes phosphorus and brings energy

to the body GGT brings oxygen to tissues

Causes of elevated ALP and GGT

l l



levels • Scarring of the bile ducts (called primary

biliary cirrhosis),

• Fatty liver (steatosis),

• sAlcoholic liver disease,

• Liver inflammation from medications and

certain herbs,

• Liver tumors,

• Gallstones or gall bladder problems.



• ALP (also called alkaline phosphatase) isfound in the bones, intestines, kidneys and

placenta as well as the liver. Abnormally

high ALP can have many causes other than liver damage, including: bone

disease, congestive heart failure, and

hyperthyroidism. A rise in ALP levels canindicate liver trouble if GGT levels are also

elevated. The normal range of ALP is from

30 IU/L to 115 IU/L.



• GGT (gamma-glutamyltranspeptidase) isfound in the liver. Obesity, PBC, heavy

drinking, fatty liver, and certain

medications or herbs that are toxic to theliver can cause GGT levels to rise the

normal range of GGT is from 5 IU/L to 80

IU/L.



• Bilirubin is a yellow fluid produced in theliver when worn-out red blood cells are

broken down. Bilirubin can leak out from

the liver into the bloodstream if the liver isdamaged. When bilirubin builds up, it can

cause jaundice - a yellowing of the eyes

and skin, dark urine and light coloredfeces



• Total bilirubin testing measures theamount of bilirubin in the bloodstream.

Normal total bilirubin levels range from

.20mg/dl to 1.50 (milligrams per deciliter).Direct bilirubin testing measures bilirubin

made in the liver. The normal level of

direct bilirubin range from .00 to .03 mg/dl



• Total protein testing (also called TP or serum total protein) measures the amount

of proteins in the bloodstream. Many

different things can cause abnormally highor low protein levels. A doctor may order

total protein testing to help diagnose

kidney or liver disease, blood cancer,malnutrition or abnormal body swelling.

Normal protein levels in the bloodstream

range from 6.5 to 8.2 grams per deciliter

• Albumin is a protein made in the liver. If



the liver is badly damaged, it can no

longer produce albumin. Albuminmaintains the amount of blood in the veins

and arteries. When albumin levels become

very low, fluid can leak out from the blood

vessels into nearby tissues, causing

swelling in the feet and ankles. Very low

levels of albumin may be a sign of liver

damage. The normal albumin range isfrom 3.9 grams/ deciliter to 5.0

grams/deciliter



• Prothrombin (also called factor II) is aprotein that helps to clot blood.

Prothrombin is made in the liver. A

prothrombin time test measures how muchtime it takes for a person's blood to clot.

The normal time needed for blood to clot is

between 10 and 15 seconds.



• Instruct patient to eat a diet lowin yellow food for 3 to 4 days

before the blood is drawn(bilirubin)

• Transport the specimen to

laboratory immediately

Lipoproteins Profile



Lipoproteins Profile• Lipoproteins are the "packages" in

which cholesterol and triglycerides

travel throughout the body. Measuring

the amount of cholesterol carried byeach type of lipoprotein helps

determine a person's risk for

cardiovascular disease (disease thataffects the heart and blood vessels,

also called CVD).



• Cholesterol and triglycerides are fat-likesubstances called lipids. Cholesterol is

used to build cell membranes and

hormones. The body makes cholesteroland gets it from food. Triglycerides provide

a major source of energy to the body

tissues. Both cholesterol and triglyceridesare vital to body function, but an excess of

either one, especially cholesterol, puts a

person at risk of cardiovascular disease.



• Because cholesterol and triglycerides can'tdissolve in watery liquid, they must be

transported by something that can

dissolve in blood serum. Lipoproteinscontain cholesterol and triglycerides at the

core and an outer layer of protein, called

apolipoprotein.



WHAT YOUR CHOLESTEROL

LEVELS MEANS

• Less than 200 mg/dL: Desirable



g

– If your LDL, HDL and triglyceride levels are

also at desirable levels and you have noother risk factors for heart disease, total

blood cholesterol below 200 mg/dL puts

you at relatively low risk of coronary heart

disease. Even with a low risk, however, it’s

still smart to eat a heart-healthy diet, get

regular physical activity and avoid tobacco

smoke. Have your cholesterol levelschecked every five years or as your doctor

recommends.

• 200 –239 mg/dL: Borderline-High Risk

– If your total cholesterol falls between 200 and

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– If your total cholesterol falls between 200 and

239 mg/dL, your doctor will evaluate your levels

of LDL (bad) cholesterol, HDL (good)cholesterol and triglycerides. It's possible to

have borderline-high total cholesterol numbers

with normal levels of LDL (bad) cholesterolbalanced by high HDL (good) cholesterol. Make

lifestyle changes, including eating a heart-

healthy diet, getting regular physical activity

and avoiding tobacco smoke. Depending onyour LDL (bad) cholesterol levels and your

other risk factors, you may also need

medication

• 240 mg/dL and over: High Risk People who have a total cholesterol level of


































240 mg/dL or more typically have twice the risk

of coronary heart disease as people whosecholesterol level is desirable (200 mg/dL). If

your test didn’t show your LDL cholesterol,

HDL cholesterol and triglycerides, your doctor

should order a fasting profile. You need

cholesterol-regulating medication, make

lifestyle changes, including eating a heart-

healthy diet, getting regular physical activity and avoiding tobacco smoke.

Your HDL (Good) Cholesterol Level


































( )

• With HDL (good) cholesterol, higher levelsare better. Low HDL cholesterol (less than

40 mg/dL for men, less than 50 mg/dL for

women) puts you at higher risk for heart

disease. In the average man, HDL

cholesterol levels range from 40 to 50

mg/dL. In the average woman, they range

from 50 to 60 mg/dL. An HDL cholesterolof 60 mg/dL or higher gives some

protection against heart disease.

• Smoking, being overweight and being

sedentary can all result in lower HDL



y

cholesterol. To raise your HDL level, avoid

tobacco smoke, maintain a healthy weight and get at least 30 –60 minutes of physical

activity more days than not.

• People with high blood triglyceridesusually also have lower HDL cholesterol

and a higher risk of heart attack and

stroke. Progesterone, anabolic steroidsand male sex hormones (testosterone)

also lower HDL cholesterol levels. Female

sex hormones raise HDL cholesterol levels

Your LDL (Bad) Cholesterol Level























• The lower your LDL cholesterol,

the lower your risk of heart

attack and stroke. In fact, it's a

better gauge of risk than totalblood cholesterol.

• In general, LDL levels fall into these

categories:



categories:

– LDL Cholesterol Levels – Less than 100 mg/dL- Optimal

– 100 to 129 mg/dL - Near Optimal/ Above

Optimal – 130 to 159 mg/dL - Borderline High

– 160 to 189 mg/dL -High

– 190 mg/dL and above - Very High

Your Triglyceride Level



g y

• Triglyceride is a form of fat.People with high triglycerides

often have a high total cholesterol

level, including high LDL (bad)

cholesterol and low HDL (good)

cholesterol levels.



• Your triglyceride level will fall into one of these categories:

• Normal: less than 150 mg/dL

• Borderline-High: 150 –199 mg/dL

• High: 200 –499 mg/dL

• Very High: 500 mg/dL

• Many people have high triglyceride levels

due to being overweight/obese physical



due to being overweight/obese, physical

inactivity, cigarette smoking, excessalcohol consumption and/or a diet very

high in carbohydrates (60 percent of more

of calories). High triglycerides are a

lifestyle-related risk factor; however,underlying diseases or genetic disorders

can be the cause.

• The main therapy to reduce triglyceridelevels is to change your lifestyle.

• Sometimes, medication is needed in

Nursing considerations











g

• The patient must fast for 12 hours before

the test, eating nothing and drinking only

water.

• The person should not have alcohol for 24

hours before the test.

• There should be a stable diet (free of

high cholesterol foods the night before the

test

• No illnesses occurring in the preceding

two weeks.

Glucose StudiesA blood glucose test measures the amount



• A blood glucose test measures the amount

of a type of sugar, called glucose, in your blood.

• Glucose comes from carbohydrate foods.

It is the main source of energy used by thebody.

• Insulin is a hormone that helps your body's

cells use the glucose.

• Insulin is produced in the pancreas and

released into the blood when the amount

of glucose in the blood rises.

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• Normally, our blood glucose levelsincrease slightly after we eat. This

increase causes our pancreas to release

insulin so that our blood glucose levels donot get too high.

• Blood glucose levels that remain high over

time can damage your eyes, kidneys,nerves, and blood vessels.

Different types of blood glucose

tests



tests

• Fasting blood sugar (FBS) measures blood glucose after

you have not eaten for at least8 hours. It often is the first test

done to check for diabetes.

Normal Values• N.V. – 70 – 110 mg/dL

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• If your fasting blood glucose level measures in

the range of 100 mg/dL (5.5 mmol/L) to 125mg/dL (6.9 mmol/L), you are considered to have

prediabetes (impaired fasting glucose), and you

have an increased chance of getting diabetes.

• A fasting glucose level below 40 mg/dL (2.2

mmol/L) in women or below 50 mg/dL (2.8

mmol/L) in men that is accompanied by

symptoms of hypoglycemia may mean you havean insulinoma, a tumor that produces abnormally

high amounts of insulin.

Nursing Consideration

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http://www.webmd.com/hw-popup/hypoglycemia

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• For a fasting blood sugar test, do noteat or drink anything other than water

for at least 8 hours before the blood

sample is taken.

• If you have diabetes, you may be

asked to wait until you have had your

blood tested before taking your

morning dose of insulin or diabetes

medication.



• 2-hour postprandial bloodsugar measures blood

glucose exactly 2 hours after you eat a meal.

• N.V. - 70 –145 mg/dL (lessthan 7.9 mmol/L)




• For a 2-hour postprandial test, eat a mealexactly 2 hours before the blood sample is

taken.

• Random blood sugar (RBS) measures

bl d l dl f h l t

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blood glucose regardless of when you last

ate. Several random measurements maybe taken throughout the day.

• Random testing is useful because glucose

levels in healthy people do not vary widelythroughout the day.

• Blood glucose levels that vary widely may

indicate a problem.• This test is also called a casual blood

glucose test.



• N.V. - 70 –125 mg/dL (less than 7.0mmol/L)

• No special preparation is required before

having a random blood sugar test.



• Oral glucose tolerance test is used todiagnose prediabetes and diabetes. An

oral glucose tolerance test is a series of

blood glucose measurements taken after you drink a sweet liquid that contains

glucose. This test is commonly used to

diagnose diabetes that occurs during

pregnancy (gestational diabetes).


http://www.webmd.com/hw-popup/gestational-diabetes--(dupe)

http://www.webmd.com/hw-popup/gestational-diabetes--(dupe)




Nursing Considerations• Instruct the client to eat a high carbohydrate

( / ) f f



(200 – 300 mg/dL) diet for 3 days before the

test.• Instruct the client to avoid alcohol, coffee, and

smoking for 36 hours before the test.

• Instruct the client to fast for 10 to 16 hoursbefore the test

• Instruct the client to avoid strenuous exercise

for 8 hours before and after the test.• Withhold morning insulin or oral hypoglycemic

meds.



• Instruct the client that the test will take 3 to5 hours, requires intravenous or oral

administration of glucose, and multiple

blood samples.

Glycosylated hemoglobin



• Glycosylated hemoglobin is blood

glucose bound to hemoglobin.

• Hemoglobin A1 c (Glycosylated

hemoglobin A) is a reflection of howwell blood glucose levels have been

controlled for up to 4 months

Normal Values



• Values are expressed as a percentage of the total hemoglobin

– Diabetic with good control: 7.5% or less

– Diabetic with fair control: 7.6% to 8.9% – Diabetic with poor control: 9% or greater




• Fasting is not required before the test.

• The American Diabetes Association (ADA) criteria for diagnosing diabetes are met when any of the following

results have been repeated on at least two different

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http://www.webmd.com/hw-popup/criteria-for-diagnosing-diabetes



results have been repeated on at least two different

days:

– A fasting blood glucose level is 126 mg/dL (7.0 mmol/L) or

higher.

– A 2-hour oral glucose tolerance test result is 200 mg/dL

(11.1 mmol/L) or higher. For more information, see the

medical test Oral Glucose Tolerance Test.

– Symptoms of diabetes are present and a random blood

glucose test is 200 mg/dL (11.1 mmol/L) or higher.

Symptoms of diabetes include increased thirst and frequent

urination (especially at night), unexplained increase in

tit l i d i ht l f ti ti

http://www.webmd.com/baby/oral-glucose-tolerance-test

http://www.webmd.com/baby/oral-glucose-tolerance-test

common diagnolastic procedures

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