Chapter 14

1. Chapter 14 Laboratory Orders and Recording Telephoned Laboratory Results

2. Objectives • List the two general purposes of laboratory studies. • Name the three major laboratory divisions, and briefly state the purpose of each. • Name six studies performed in each of the three major laboratory divisions. • List five specimens that may be studied in the laboratory.

3. Objectives, continued • Describe the health unit coordinator’s responsibilities in sending specimens to the laboratory. • Name three methods of obtaining urine specimens. • List the four tests generally performed as part of electrolyte studies. • List five laboratory specimens that may require a written consent form.

4. Objectives, continued • Describe the procedure for requisitioning stat blood tests from the laboratory. • Name the procedure that must be performed to order blood (packed cells) for transfusion. • Describe the health unit coordinator’s responsibilities in an order for a 2-hr. PP. • Explain the difference between fasting and NPO.

5. Objectives, continued • Identify the laboratory department that would perform each of the tests that are marked with an asterisk. • Explain the procedure for ordering peak and trough drug levels. • Name three common urine chemistry tests (marked with an asterisk). • Describe how errors may be avoided in recording telephoned laboratory results.

6. Lesson 14.1

7. Two Purposes of Laboratory Studies • Diagnostic evaluation • Evaluation of treatment

8. Specimens Studied by Lab • Blood: collected by nurse or lab tech • Urine: collected by CNA • Stool: collected by nurse or CNA • Sputum: collected by nurse, CNA or respiratory tech • Wound drainage: collected by nurse or doctor • N/P smear: collected by nurse or doctor • Gastric washings: collected by nurse or doctor • Sweat: collected by lab tech

9. Various Specimen Containers

10. Specimens Collected by Invasive Procedures • Consent and Tray Needed SpecimenProcedure Bone marrow --------Sternal puncture/ bone marrow biopsy Spinal fluid (CSF) ------Lumbar puncture/ spinal tap Thoracic cavity --------Thoracentesis fluid

11. Specimens Collected by Invasive Procedures, continued • Consent and Tray Needed SpecimenProcedure Other cavity fluid-----Paracentesis Amniotic fluid----------Amniocentesis Cervical smear----------Pap smear (no consent needed)

12. Methods of Collecting Blood • Venipuncture (puncture into the vein) • Finger-stick (puncture into a capillary) • Peripheral arterial draw (artery)

13. Three Methods of Collecting Blood (Capillary, Venous, Arterial) From S Warekois R: Phlebotomy: Worktext and procedures manual, St. Louis, Saunders, 2001.

14. Three Methods of Collecting Urine • Voided • Clean catch – mid-stream • Catheterized (Clean catch and catheter specimens are sterile specimens)

15. Point-of-Care Testing • Laboratory tests that are collected and analyzed on the hospital nursing unit by nursing personnel include: • Electrolytes • Blood glucose • Hemoglobin, hematocrit • Coagulation studies (stat for PT) • ABGs may also be performed on the nursing unit

16. Point-of-Care Testing, continued Reagent-based tests may include: • HCG (pregnancy test) • ACT (activated clotting time) • CLO test (uses a biopsy specimen obtained in the endoscopy department to detect Helicobacter pylori (a bacterium indicated in ulcers of the gastrointestinal system)

17. Point-of-Care Testing, continued • Urine and blood for the presence of ketones and levels of glucose • Guaiacs, gastroccults, or hemoccults to detect occult (hidden) blood

18. Divisions Of Laboratory

19. A Downtime Requisition

20. Hematology • Study of physical properties of blood including blood cells and their appearance—tests related to clotting and bleeding disorders, and coagulation (clotting) studies to monitor patients on anticoagulant therapy • Bone marrow and spinal fluid also may be studied in hematology

21. Common Tests Ordered From Hematology • CBC (complete blood cell count) • WBC c diff • RBC • Hemoglobin and hematocrit (H & H) • Erythrocyte sedimentation rate (ESR) • Platelet count (plt ct) • PT and PTT • Bleeding time

22. Lesson 14.2

23. Chemistry • Study of chemical reactions occurring in living organisms • When a disease process occurs, the chemicals within the body fluids vary from the normal • Specimens studied include blood, urine, and CSF

24. Common Tests Ordered From Chemistry • Chemistry panels (CMP, BMP) • Blood sugars (glucose) FBS, RBS, 2hr PP • GTT (glucose tolerance test) 2 hr or 6 hr • Electrolytes (lytes) • Sodium (Na) • Potassium (K) • Chloride (Cl) • Carbon dioxide (CO2)

25. Common Tests Ordered From Chemistry, continued Cholesterol • Triglycerides • Cardiac enzymes • CK (CPK) and CK-MB • LDH • AST (SGOT) • Troponin • Bilirubin • Creatinine • Blood urea nitrogen (BUN)

26. Common Panels Ordered From Chemistry • Electrolytes • Basic metabolic panel (BMP) • Comprehensive metabolic panel (CMP) • Lipid panel • Hepatic function panel

27. Common Laboratory Panels

28. Tests that Require Fasting(Unless Ordered Otherwise by Doctor) • FBS • GTT • Some chem profiles/panels • Cholesterol • Triglycerides • Fe c TIBC

29. Toxicology • Scientific study of poisons, their detection, their effects, and methods of treatment for conditions they produce • Tests for detecting drug abuse and for monitoring drug usage also are performed in toxicology • Special consents, handling, and labeling may be required

30. Common Tests Ordered From Toxicology • Levels of certain medications the patient is receiving may be monitored by doing a peak and trough • Peak levels are useful when testing for toxicity • Trough levels are useful for demonstrating a satisfactory therapeutic level

31. Peak and Trough Levels of a Medication

32. Common Medications for Peak and/or Trough Levels from Toxicology • Antibiotics that may be monitored include: • Amikacin • Gentamicin • Kanamycin • Tobramycin • Other medication levels may include: • Dilantin (random) • Digoxin (random) • Prograf (trough level)

33. Microbiology • Study of the organisms that cause disease • Includes bacteriology, mycology, virology and parasitology • Specimens may include urine, stool, sputum, wound drainage, eye/ear drainage, etc.

34. Common Tests Ordered From Microbiology • Cultures (viral, fungal) • Culture and sensitivity (C & S) • Aerobic • Anaerobic • AFB culture • C. diff culture Cultures may be done on blood, urine, stool, sputum, wound drainage, and ear, nose, throat drainage

35. Serology • Study of antibodies and antigens in body fluids to detect the presence and intensity of a current infection • Also may be used to detect a previous infection or exposure to an organism • Study of autoimmune diseases

36. Common Tests Ordered From Serology • RPR- dx of syphilis • CEA- dx and tx of types of cancer • CMV- dx of cytomegalovirus • HIV- dx of AIDS virus • RSV- respiratory syncytial virus • Monospot- dx of mononucleosis • RA factor- dx of rheumatoid arthritis • HBAg- dx of hepatitis B

37. Blood Bank • Stores, types, and cross-matches blood and blood products for transfusion • Permission or refusal for transfusion signed by patient • Must be labeled properly • Blood types include: • A: may receive types A or O • B: may receive types B or O • AB: may receive types A, B, AB, or O • O: may only receive type O

38. Common Orders for Blood Bank • Type and screen • Type and crossmatch for packed cells • Platelets • Plasma • Washed cells • Cryoprecipitates • Other tests include Coombs test to determine anti-Rh antibodies in serum of pregnant women before delivery

39. Urinalysis • The physical, chemical, and microscopic examination of the urine • May be a voided, clean catch, or cath specimen

40. Common Tests Ordered From Urinalysis • UA • Study of urine for color, clarity, pH (degree of acidity or alkalinity), specific gravity (degree of concentration), protein (albumin), glucose, blood, bilirubin, and urobilinogen; viewed microscopically for organisms, intact cells, and crystals • Urine reflex • Urine is tested; if certain parameters met, a culture will be performed

41. Pathology Department • Under direction of a pathologist • Study of biopsies, tissue, and other specimens to determine disease and changes in the body

42. Common Tests Ordered From Pathology • Study of tissue and organs to determine changes caused by disease; determination of cancer

43. Cytology • Study of cells obtained from body tissues and body fluids to determine cell type and to detect cancer or a precancerous condition

44. Common Tests Ordered From Cytology • Biopsy specimens • Pap smear • To determine the presence of cancer

45. Recording Laboratory Results • The HUC records laboratory results received via telephone on a telephone laboratory report sheet. • Laboratory results may also be sent to the unit via the computer. HUC may print them on the unit printer. • Results from an outside laboratory may be faxed to the nursing unit.

46. Recording Laboratory Results, continued • The HUC should report the values to the patient’s nurse, who may request the results to be called in to the doctor’s office. • Stat and/or abnormal laboratory test results are communicated verbally or by telephone to the doctor by the HUC or nurse.

47. Recording Laboratory Results, continued To avoid errors: • Always read the laboratory values you have recorded back to the person in the laboratory. • Always have the person you are communicating to in the doctor’s office repeat his or her recorded values back to you. • Place the written report on the patient’s chart in a timely manner.

48. Telephoned Laboratory Results Form