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Online Companion: Fundamentals of Nursing Standards and Practice 2E
Chapter Summary
The fascinating subject
of diagnostic testing and its uses in clinical situations is presented in Chapter
28. The data obtained from the client presenting symptoms, from the history
and from the physical examination determine the need for diagnostic testing.
The primary focus of the nurse is teaching the client and family about the procedures
involved in diagnostic testing, the steps to be taken in preparation for the
specific test, and the care that will follow the procedure. Protocols that use
the nursing process for the care of the client before, during, and after diagnostic
testing are presented in the chapter. The major themes of nursing care in diagnostic
testing include increasing the client's understanding and participation in the
testing, decreasing the client's anxiety and discomfort, monitoring vital signs
and airway function, using standard precautions or surgical asepsis as appropriate
and documenting the client's responses. The scheduling and sequencing of laboratory
tests is an important function of the nurse. Nurses are often the first to know
the results of laboratory studies and they need to know the purpose and normal
test values of laboratory tests. Blood can be collected for laboratory tests
in several ways: venipuncture, arterial puncture, capillary puncture and via
centrally placed venous lines. Each of the methods is an invasive procedure
and requires the use of standard precautions to prevent the spread of blood-borne
organisms such as HIV. Strict surgical aseptic technique is used when a blood
sample is obtained from the client. The nurse is involved in collecting specimens
of urine, stool, sputum, and wound drainage. The procedures for these, the type
of asepsis used in their collection and the proper handling of specimens is
described in the chapter.
The second part of the Chapter 28 details the various types of diagnostic studies,
indications for their use and the significance of the data obtained from each
test. The composition of blood is studied to provide data on a variety of health
problems. Abnormal blood cell counts, the concentration of electrolytes and
glucose, elevated levels of blood enzymes such as cholesterol provide critical
information about the client's physiologic functioning. Internal organ structure
and function can be studied by radiologic tests. The chest x-ray is the most
common radiologic study and can provide diagnostic evidence for lesions of the
lung, inflammation of lung tissue, bone deformities of the rib and sternum,
and diaphragmatic hernia. Computed tomography is the radiologic scanning of
the body with x-ray beams that transmit data to a computer that creates multidimensional
images of internal structures. Contrast medium, given orally, rectally or into
a blood vessel, is used in a variety of studies that provide detailed visualization
of internal organ functioning. Deep body structures can be visualized by the
ultrasound, a study that uses high-frequency sound waves that travel thought
body tissue and are reflected back to an instrument that converts electrical
energy to sound waves and records them. Magnetic resonance imaging (MRI) uses
radiowaves and a strong magnetic field to make continuous cross-sectional images
of the body. The MRI reveals lesions and changes in the body's organs, tissues,
vascular and skeletal structures. The electrical activity of the heart, brain,
and skeletal muscles can be transmitted to an oscilloscope and printed on graphic
paper for study as in an electrocardiogram. The use of a scope instrument to
visualize a body organ or cavity is endoscopy. The types of endoscopic procedures
are described in a table in Chapter 28. A needle is used to gain entry into
body organs from which a specimen can be withdrawn for study. Cerebrospinal
fluid (CSF) is obtained from the subarachnoid space in this way in a procedure
called lumbar puncture.
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