Advanced Fundamentals
Concept Preparation
Chapter 24
1. What is the normal preparation for a patient for a patient having blood
chemistries drawn at 8:00 am?
NPO for 12 hrs
2. Elderly patients who are kept NPO for testing are at greater risk for
what problem, more so than a young adult.
Dehydration because body fluid balance is not stable like young people
3. The Hematology section of laboratory testing is dedicated to
evaluation of:
The study of blood and its components CBC blood count provides
information about anemia etc
4. What is an H & H, and why is it done?
Hemoglobin and hematocrit it is to measure of whether somebody has
anemia or a low blood count red blood cells
5. What is a platelet count and why is it done?
Platelet count is the measure of how many platelets a person has
circulating in there plasma and it is to see if the are at risk for bleeding or
clotting
6. What platelet count result indicate a serious risk for bleeding
(hemorrhage)
20,000 mm3
Pg 410. Normal platelet count is 150-400 millimeters of blood cubed
7. What two blood tests are important indicators of kidney function?
Bun and CR – when they are elevated ther is kidney damage or decreased
in kidney function
8. What is evaluated in the Cytology section of the laboratory?
Cytology assess tissue samples looking for cancer cells
A few other things are assessed : Sarcoid
9. What blood tests are ordered to monitor patients who are on
anticoagulant therapy?
PT and INR
10.
List the steps in obtaining a blood sugar with an Accucheck
devices?
1. Wash and dry your hands (nurse) don gloves. Cleanse chosen
fingertip with alcohol swab keep fingers separated
2.
3. Turn on the meter and prepare a test strip and needle
4. Choose your spot—don't check from the same finger all the time.
Using the side of the fingertip may be less painful than the pads.
5. Prepare the lancing device then lance your fingertip
6. Wipe away first blood with clean cotton ball squeeze for a second
drop
7. Touch and hold the test strip opening to the drop until it has absorbed
enough blood to begin the test. Clean finger with a clean cotton ball
with pressure
8. View your test result and take the proper steps if your blood sugar is
high or low,
9. Discard the used lancet properly.
10.
Document results
11.
While doing a finger stick blood sugar, what is the reason for
wiping away the first drop of blood?
The first fluid that comes from the fingerstick is serious fluid which
can dilute the sample and give a false or inaccurate reading. Wipe it
away and milk the finger for the second sample of blood
12.
What is the range for a normal fasting blood sugar?
70-100mg/dL is normal FBS
13.
What is a urine analysis (UA) and what can be understood by
doing such a test?
Pg 411. This is a simple basic urine test color clarity assess whether there
is RBC in urine. WBC Ketones
This done use a urine dipstick
14.
What is the reason why a Urine for Culture and Sensitivity
(C & S) would be ordered for a patient?
To assess for UTI
15.
What are 2 other names for Urine for C & S?
Clean catch and midstream catch
16.
What can be determined by doing a urine for C & S?
such as liver disease, kidney disease and diabetes, and to
diagnose urinary tract infections (UTIs).
17.
What are steps in the procedure for a Urine C & S that the
nurse will teach his/her patient?
Cleanse urinary meatus
Using a sterile specimen cup
No touching patient to begin
Patient to begin urination and urinate small amount then catch the rest of
the urine midstream
Label and send to lab
18.
Describe the procedure for obtaining a 24 hr urine test and why
it is performed?
Say the test is start 10 am
The patient emptes their bladder and this flushed away ( not kept)
Then the test begins
Every Urination for the next 24hrs is transferred into a very large
specimen container that is kept on ice in a basin in the bathroom
At 10 am the next day whatever urine is in the patients bladder is
Kept and put into the container
Label and send to lab
19.
What is a cystoscopy and why is it done?
-Surgical procedural test sterile fiberoptic scope is advanced up through the
urinary meatus and ureters of the bladder
-Tissue samples are taken9 snipped and retrieved and they are sent to the
cytology section looking for cancer
-Cystoscopy can also be use to instill medication targeted chemo and
targeted antibiotics
20.
What is a Pulmonary Function Test, and why is it done?
PFTS assess the function of the lungs used to evaluate patients with
COPD asthma and other lung disease. Measure expiratory and inspiratory
volumes help diagnosis and treatment of lung disease
21.
What types of procedures require an informed consent
document to be complete by the physician and patient? (list 3
examples)
Any procedure that is invasive that enters the body through an orifice
or incision
Cystoscopy
Endoscopy
Thorocentesis
Biopsies
Angiogram
Cardiac catheterization
22.
For the following aspiration procedures listed in question (2226), list reasons why the procedure is done, any preparation for the
test, positioning of the patient, post-test instructions (patient
teaching):
Vital signs
Lumbar Puncture- Spinal tap done for detecting meningitis leukemia.
Positioning: lateral recumbent position or sitting position, lateral recumbent position A
lumbar puncture (spinal tap) may be done to:
Post

Collect cerebrospinal fluid to check for infections, inflammation or other
diseases

Measure the pressure of cerebrospinal fluid

Inject spinal anesthetics, chemotherapy drugs or other medications

Inject dye (myelography) or radioactive substances (cisternography) into
cerebrospinal fluid to make diagnostic images of the fluid's flow
headache Back discomfort or pain Bleeding. Brainstem herniation
Pre :
Try to increase your fluid intake (such as water and juice) for the two days
leading up
 you may be asked to change into a gown.
 All patients can take their prescribed medications as usual blood thinners.
 must have an adult driver accompany you so they can drive you home
after the procedure.
23.
Thoracentesis
It’s used to test the fluid for infection or other illnesses and to relieve
chest pressure that makes it tough to breathe infection. Cancer. I
Symptom relief.

Position : You sit on a bed or on the edge of a chair or bed. Your head and
arms rest on a table.
Pre


Stop taking medications after a certain time.
Have someone drive you home after the procedure. blood pressure
and use a small device on your finger to measure your blood
oxygen level. They’ll use imaging (X-ray, ultrasound or CT scan)
Post




X-ray or ultrasound of your lungs.
watch your vital signs until it’s OK for you to leave.
You might cough for up to an hour after thoracentesis.
Your provider usually sends the drained fluid to a lab.

24.
Paracentesis
Procedure to remove fluid ( peritoneal fluid) from the abdomen
through a slender needle




Diagnose an infection
Check for certain types of cancer
Relieve pressure in the abdomen
Improve kidney, bowel or respiratory function
Positioning: while you lie on your back or while sitting up
Pre:
our doctor will meet with you to discuss any allergies to medications or
anesthesia and talk about what medications you are currently taking. If you
have any bleeding problems or are taking blood thinners, nonsteroidal antiinflammatory drugs (NSAIDs), or aspirin, you may have to stop taking those
medications for a short time.
everal tests that can be done using the abdominal fluid that has been removed.
Post Reducing salt intake. Limiting your liquids.
25.
Liver Biopsy
A liver biopsy is a test that takes a sample of tissue from the liver for examination.
Positioning : lie on your back with your right hand under your head. You need to stay as
still as you can.
Pre:




Bleeding problems
Drug allergies
Medicines you are taking including herbs, supplements, or medicines you bought
without a prescription
Whether you are pregnant

The biopsy also helps detect:




Cancer
Infections
The cause of abnormal levels of liver enzymes that have been found in blood
tests
The cause of an unexplained liver enlargement
Post:
avoid lifting more than 10 pounds and avoid strenuous physical activity. Do not swim or take a tub bath
for 7-10 days after your biopsy or until your biopsy site is healed. foods like plain rice, toast and yogurt •
Drink plenty of fluids
26.
Bone Marrow Biopsy
Position- prone or lateral decubitus position
Many conditions — including blood disorders and some cancers —
require a bone marrow biopsy to confirm a suspected diagnosis.
Stage cancer Evaluate or diagnose a condition: Monitor treatment
progress: allogeneic stem cell transplant.
PRE:
you may need to fast (no food or drink) the night before. You’ll need to
arrange for someone to drive you home.
Your provider should have detailed information about your medical
history and current medications.
AFTER



Take a nonprescription pain reliever to help with pain or
discomfort.
Avoid exercise or any strenuous physical activity for at least 24
hours.
Keep your wound dry for at least 24 hours.
27.
What is the pre-procedure patient instructions for a female
patient who is scheduled for an abdominal (uterine) ultrasound?
They are to drink 1 liter of water 1 hour before the procedure and hold in
their bladder until the test is over
The full bladder pushes the uterus and the other organs closer to the
abdominal wall making it more clear for view with the ultrasound waves
28.
How does the Ultrasound test work?
Utrasonic waves to through the patients skin depending the location
this is using a transducer and conductive jelly. Images created by the
ultrasonic waves are transferred onto the computer screen and can
be captured in a video or picture
29.
What is another term for the term X-Ray?
Fluroscopy
30.
What preparation and teaching is required for a patient who is
having an MRI done?
a. The environment: MRI room usually darkened cold
b. The patient: because of the large magnets patient are not
allowed to wear metal jewelry inplants such surgical clips
prosthesis pacemaker piercing
31.
When a patient is undergoing an Electroencephalogram (EEG),
why are they sometimes asked to hyperventilate? (see pg 430 &
PowerPoint)
Hyperventilate because it causes the brain waves to become more
pronounced and easier to read on the waveform reading sheet.
32.
What patient teaching would you carry out for a patient who is
going to have a Cardiac Stress Test? (i.e. what to expect, clothing to
wear, food intake, smoking, caffeine)
Wear loose comfortable clothing
No caffeine for 24 hrs before
No smoking before test
Light breakfast
33.
When a patient undergoes a Cardiac Catheterization what is
being evaluated?
Hearth rhythm EKG under stress
If patient does poorly and EKG shows signs of problems under stress it is
an indicator that the patient likely has coronary artery sdiseas CAD
If the patient does poorly they are usually scheduled for a more invasive
cardiac catherization
34.
Post angiography or cardiac cath. patients require immediate
and ongoing assessment of the ___Catheeter insection site looking
signs of bleeding ____________, to prevent potential hemorrhage.
35.
What would the nurse teach her patient who is about to go to
the X-Ray Department? What to expect in that environment? And
how can the nurse make the patient more comfortable in this
experience?
Xray dept is
Cold
Dark
The technician will have leave their momentarily
So we can send xtra blankets we can warm them that will be dark
36.
In a case where a patient may have a test requiring the
injection of a radio-opaque dye, it is very important for the nurse to
check with the patient regarding allergies to what?
If a patient states they are allergice to shellfish they are likely to have
serious allergic reaction to dye if injected
Many of the dyes have iodine in them shellfish has iodine in them
37.
What are the pre-procedure instructions that you will give your
patient who is scheduled for a colonoscopy?
On clear liquids 24hrs
No red or purple drinks can be confused with blood
No after midnight
The evening before the test they drink strong laxatives
Around 5am hey drink strong laxatives
38.
What can patients expect, post-colonoscopy, while having a
bowel movement.
There may be slight bleeding reassure patient that this is expected
39.
Since the patient undergoing a colonoscopy has the induction
of diarrhea as a cleansing prep, what are two important electrolytes
that the physician may order labs to check levels?
Potassium K
Sodium NA
40.
What position is a female position put in for a pelvic exam?
Lithotomy position