Hematology Values

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<p>Uric Acid test Interpretation Normal Resultsy y</p> <p>In men, 3.4 to 7 mg/dl (SI, 202 to 416 mol/L) In women, 2.3 to 6 mg/dl (SI, 143 to 357 mol/L)</p> <p>Abnormal Resultsy y</p> <p>y</p> <p>Increased uric acid levels may indicate gout or impaired kidney function. Levels may also rise in hjeart failure, glycogen storage disease (type I, von Gierkes disease), infection, hemolytic and sickle cell anemia, polycythemia, neoplasms, and psoriasis. Low uric acid levels may indicate defective tubular absorption (such as Fanconis syndrome) or acute hepatic atrophy.</p> <p>Interpretation Normal Resultsy y y</p> <p>Varying levels, depending on age and sex In men, 44 to 180 mg/dl (SI, 0.44 to 2.01 mmol/L) In women, 10 to 190 mg/dl (SI, 0.11 to 2.21 mmol/L)</p> <p>Abnormal Resultsy y y y</p> <p>An increased or decreased serum triglycerides level is abnormal; additional tests are required for a definitive diagnosis. A mild to moderate increase in serum triglyceride levels indicates biliary obstruction, diabetes mellitus, nephrotic syndrome, or over consumption of alcohol. Markedly increased levels without an identifiable cause reflect congenital hyperlipoproteinemia and necessitate lipoprotein phenotyping to confirm the diagnosis. Decresed serum triglyceride levels are rare and occur mainly in malnutrition and abetalipoproteinemia.</p> <p>As a qualitative analysis of urine levels of human chorionic gonadotropin (hCG), this test can detect pregnancy as early as 14 days after ovulation. A glycoprotein that is produced after conception, hCG prevents degeneration of the corpus luteum at the end of a normal menstrual cycle. During the first trimester, hCG levels rise steadily and rapidly, peaking around 10 weeks gestation, and subsequently taper off to less than 10% of peak levels. The most common and inexpensive method of evaluating qualitative and quantitative hCG levels is through</p> <p>hemagglutination inhibition of a urine sample. The serum hCG test (beta-subunit assay) is a more expensive alternative. Purposey y</p> <p>To detect and confirm pregnancy. To help diagnose hydatiform mole of hCG-secreting tumors, threatened abortion, or dead fetus.</p> <p>Procedure Patient Preparation 1. If appropriate, explain to the patient that the urine hCG test determines whether shes pregnant or determines the status of her pregnancy. 2. Alternatively, explain how the test functions as a screen for some types of cancer. 3. Tell the patient that she need not to restrict food but should restrict fluids for 8 hours before the test. 4. Inform the patient that the test requires a first-voided morning specimen or urine collection over a 24-hour period, depending on whether the test is qualitative or quantitative. 5. Notify the laboratory and physician of drugs the patient is taking that may affect test results; it may be necessary to restrict them. Implementation 1. For verification of pregnancy (qualitative analysis), collect a first-voided morning specimen. If this isnt possible, collect a random specimen. 2. For quantitative analysis of hCG, collect the patients urine over a 24-hour period in the appropriate container, discarding the first specimen and retaining the last. 3. Specify the date of the patients last menstrual period on the laboratory request. 4. Refrigerate the 24 hour specimen or keep it on ice during the collection period. 5. Be sure the test occurs at least 5 days after a missed period to avoid a false-negative result. Nursing Interventions 1. Instruct the patient to resume her usual diet and medications. Interpretation Normal Resultsy</p> <p>In a qualitative immunoassay analysis, results are negative (nonpregnant) or positive (pregnant) for hCG.</p> <p>y</p> <p>y</p> <p>In a qualitative analysis, urine hCG levels in the first trimester of a normal pregnancy may be as high as 500,000 IU/24 hours; in the second trimester, from 10,000 to 25,000 IU/24 hours. Measurable hCG levels dont normally appear in the urine of men or nonpregnant women.</p> <p>Abnormal Resultsy</p> <p>y</p> <p>During pregnancy, elevated urine hCG levels may indicate multiple pregnancy or erythoblastosis fetalis; depressed urine hCG levels may indicate threatened abortion or ectopic pregnancy. Measurable levels of hCG in men and nonpregnant women may indicate choriocarcinoma, ovarian or testicular tumors, melanoma, multiple myeloma, or gastric, hepatic, pancreatic or breast cancer.</p> <p>Interfering Factorsy y y</p> <p>Gross proteinuria (greater than 1g/24 hours), hematuria, or an elevated erythrocyte sedimentation rate (possible false-positive; depending on the laboratory method). Early pregnancy, ectopic pregnancy, or threatened abortion (possible false-positive). Phenothiazine (possible false negative or false positive)</p> <p>Complicationy</p> <p>None known.</p> <p>Direct laryngoscopy allows visualization of the larynx by the use of a fiberoptic endoscope or laryngoscope passed through the mouth or nose and pharynx and larynx. Its indicated for any condition requiring direct visualization or specimen samples for diagnosis, such as in patients with strong gag reflexes resulting from anatomic abnormalities and in those who have had no response to short-term therapy for symptoms of pharyngeal or laryngeal disease, such as chronic hoarseness, stridor, and hemoptysis. Secretions or tissue may be removed during this procedure for further study. The test is usually contraindicated in patients with epiglottitis, but it may be performed on them in an operating room with resuscitative equipment. Purpose of Direct Laryngoscopyy y y y</p> <p>To detect lesions, strictures, or foreign bodies. To remove benign lesions or foreign bodies from the larynx. To help diagnose laryngeal or upper airway abnormalities. To examine the larynx when indirect laryngoscopy is inadequate.</p> <p>Direct Laryngoscopy Procedure</p> <p>Preparation 1. 2. 3. 4. 5. 6. 7. Make sure the patient has signed an appropriate consent form. Note and report all allergies. Check the patients history for hypersensitivity to the anesthetic. Instruct the patient to fast for 6 to 8 hours before the test. Give the patient a sedative to help him relax and a drug to reduce secretions. Give a general or local anesthetic to numb the gag reflex. Explain that the study takes about 30 minutes; it takes longer if minor surgery is performed as part of the procedure.</p> <p>Implementation 1. The patient is assisted into the supine position. 2. A general anesthetic is given, or the mouth or nose and throat are sprayed with local anesthetic. 3. The laryngoscope is inserted through the mouth. 4. The larynx is examined for abnormalities. 5. Specimens may be collected for further study. 6. Minor surgery (polyp removal) may occur at this time. Nursing Interventions 1. Place the conscious patient in semi-Fowlers position. Place the unconscious patient on his side with his head slightly elevated to prevent aspiration. 2. Check the patients vital signs according to facility protocol, or every 15 minutes until the patient is stable and then every 30 minutes for 2 hours, every hour for the next 4 hours, and then every 4 hours for 24 hours. 3. Immediately report to the practitioner any adverse reaction to the anesthetic or sedative such as tachycardia, palpitations, hypertension, euphoria, excitation, and rapid, deep aspirations. 4. Apply an ice collar per institution protocol to minimize laryngeal edema. 5. Provide an emesis basin, and instruct the patient to spit out saliva rather than swallow it. 6. Observe sputum for blood, and report excessive bleeding immediately. 7. Instruct the patient to refrain from clearing his throat and coughing to prevent hemorrhaging at the biopsy site. 8. Advise the patient to avoid smoking until his vital signs are stable and theres no evidence of comlications. 9. Immediately report subcutaneous crepitus around the patients face and neck, which may indicate tracheal perforation. 10. Listen to the patients neck with a stethoscope for signs of stridor and airway obstruction. Interpretation Normal Results</p> <p>y</p> <p>No inflammation, lesions, strictures, or foreign bodies are found.</p> <p>Abnormal Resultsy y y y</p> <p>Combine with the results of a biopsy, abnormal lesions suggest possible laryngeal cancer or benign lesions. Narrowing suggests stricture. Inflammation suggests possible laryngeal edema secondary to radiation or tumor. Asynchronous vocal cords suggest possible vocal cord dysfunction</p> <p>Fecal occult blood test is also known as stool occult blood test, hemoccult test, guiaic smear test, gFOBT, or occult blood test. Fecal occult blood is detected by microscopic analysis or by chemical tests for hemoglobin, such as the guiaic test. Normally, stools contain small amounts of blood (2-2.5 mL/day); therefore, test for occult blood detect quantities larger than this. Testing is indicated when clinical symptoms and preliminary blood studies suggest GI bleeding. Additional tests are required to pinpoint the origin of the bleeding. Purposey y</p> <p>To detect gastro intestinal bleeding. To aid in the early diagnosis of colorectal cancer.</p> <p>Procedure Preparation 1. Explain the patient that this test detects abnormal GI bleeding. 2. Instruct the patient to maintain a high-fiber diet and to refrain from eating red meats, turnips, and horseradish for 48 to 72 hours before the test as well as throughout the collection period. 3. Tell the patient that the test usually requires three fecal specimens but that sometimes only one sample is needed. 4. Instruct the patient to avoid contaminating the fecal specimen with toilet tissue or urine. 5. Notify the laboratory and physician of drugs the patient is taking that may affect test results; it may be necessary to restrict them. If the patient must continue using this drugs, note this on the laboratory request. Implementation 1. Collect three fecal specimens or a random fecal specimen. 2. Obtain specimens from two different areas of each fecal specimen. Hematest 1. Use a wooden applicator to smear a bit of the fecal specimen on the filter paper supplied with the kit. Or, after performing a digital rectal examination, wipe the finger you used</p> <p>for the examination on a square of the filter paper. Place the filter paper with the fecal smear on a glass plate. 2. Remove a reagent tablet from the bottle and immediately replace the cap tightly. Place the tablet in the center of the fecal smear on the filter paper. Add 1 drop of water to the tablet, and allow it to soak in for 5 to 10 seconds. Add a second drop, letting it run from the tablet onto the specimen and filter paper. 3. After 2 minutes, the filter paper will turn blue if the test result is positive. Dont read the color that appears on the tablet itself or develops on the filter paper after the 2-minute period. Note the results and discard the filter paper. Remove and discard your gloves and wash your hands thoroughly. Hematocrit test 1. Open the flap on the side pack and use a wooden applicator to apply a thin smear of the fecal specimen to the guiaic-impregnated filter paper exposed in a box. Apply a second smear from another part of the specimen to the filter paper exposed in box B. 2. Let the specimen dry for 3 to 5 minutes. Open the flap at the near of the slide package and place 2 drops of hematocrit developing solution on the paper over each smear. A positive result yields a blue reaction in 30 to 60 seconds. Record the results and discard the slide package. Remove and discard your gloves and wash your hands thoroughly. Instant-View Fecal Occult Blood Test 1. Add a fecal sample to the collection tube. Shake it to mix the sample with the extraction buffer, and then dispose 4 drops into the sample well of the cassette. 2. Results will appear on the test region and the control region of the cassette in 5 to 10 minutes, indicating whether the hemoglobin level is &gt; 0.05 pg/ml of feces. Nursing Interventions 1. Send the specimen to the laboratory or perform the test immediately, depending on which test is used. 2. Inform the patient that he may resume his usual diet and medications as ordered. 3. Single digital office-based test may not be as accurate as serial home collected test. Interpretations Normal Resultsy</p> <p>Less than 2.5 ml of blood in feces, resulting in a green reaction.</p> <p>Abnormal Resultsy</p> <p>GI bleeding, this may result from many disorders, such as varices, a peptic ulcer, carcinoma, ulcerative colitis, dysentery, hemorrhagic disease.</p> <p>Interfering Factorsy y y y y y</p> <p>Failure to observe pretest reactions. Failure to test the specimen immediately or to send it to the laboratory immediately after collection. Bromides, colchicines, indomethacin, iron preparation, phenylbutazone, rauwolfia derivatives, and steroids (possible increase from GI blood loss). Ascorbic acid (false-negative, even with significant bleeding). Ingestion of 2 to 5 ml of blood (for example, from bleeding gums). Active bleeding from hemorrhoids (possible false-positive results).</p> <p>Electromyography (EMG) is the recording of electrical activity of selected skeletal muscle groups at rest and during voluntary contraction. In this test, a needle electrode is inserted percutaneously into a muscle. The muscles electrical discharge (or motor unit potential) is then measured and displayed on an oscilloscope screen. Purposey y y y</p> <p>To aid in differentiating between primary muscle disorders, such as the muscular dystrophies, and secondary disorders. To help assess diseases characterized by central neuronal degeneration such as ALS. To help diagnose neuromascular disorders such as myasthenia gravis. To help diagnose radiculopathies.</p> <p>Procedure Preparation 1. Make sure the patient has signed an appropriate consent form. 2. Note and report all allergies. 3. Check for and note drugs that may interfere with test results such as cholinergics, anticholinergics, anticoagulants, and skeletal muscle relaxants. 4. Tell the patient he need not restrict food and fluids before the test but that it may be necessary to restrict cigarettes, coffee, tea, and cola for 2 to 3 hours beforehand. 5. Warn the patient that he might experience some discomfort as a needle is inserted into selected muscles. 6. Explain that the test takes at least 1 hour. Implementation 1. 2. 3. 4. The patient is positioned in a way that relaxes the muscle to be rested. Needle electrodes are quickly inserted into the selected muscle. A metal plate lies under the patient to serve as a reference electrode. The resulting electrical signal is recorded during rest and contraction, amplified 1 million times, and displayed on an oscilloscope or computer screen.</p> <p>5. Lead wires are usually attached to an audio-amplifier so that voltage fluctuations within the muscle are audible. Nursing Interventions 1. Assess the patients pain level. If the patient experiences residual pain, apply warm compresses and administer prescribed analgesics. 2. Tell the patient that he may resume his usual medications as ordered. 3. Monitor the patient for signs and symptoms of infection at the needle electrode sites. 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