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Unit 18 Lab Skills J.J. Nelson RN

Unit 18 lab skills

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Page 1: Unit 18 lab skills

Unit 18 Lab Skills

J.J. Nelson RN

Page 2: Unit 18 lab skills

Clinical Laboratory Improvement Amendments (CLIA) test

TESTS GRANTED WAIVED STATUS UNDER CLIA This list includes updates from Change Request 7435 CPT CODE(S) TEST NAME MANUFACTURER USE

81002 Dipstick or tablet reagent urinalysis – non-automated for bilirubin, glucose, hemoglobin, ketone, leukocytes, nitrite, pH, protein, specific gravity, and urobilinogen Various Screening of urine to monitor/diagnose various diseases/conditions, such as diabetes, the state of the kidney or urinary tract, and urinary tract infections

81025 Urine pregnancy tests by visual color comparison Various Diagnosis of pregnancy 82272 Fecal occult blood Various Detection of blood in feces from whatever cause, benign or

malignant (colorectal cancer screening) 82962 Blood glucose by glucose monitoring devices cleared by the FDA for home use Various

Monitoring of blood glucose levels 83026 Hemoglobin by copper sulfate – non-automated Various Monitors hemoglobin level in blood

84830 Ovulation tests by visual color comparison for human luteinizing hormone Various Detection of ovulation (optimal for conception)

85013 Blood count; spun microhematocrit Various Screen for anemia 85651 Erythrocyte sedimentation rate – non-automated Various Nonspecific screening test for

inflammatory activity, increased for majority of infections, and most cases of carcinoma and leukemia INFLUENZA NASO-PHARYNGEAL

THERE ARE MORE BUT THESE ARE THE MOST COMMON

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Characteristics of urine

Volume - polyuria. oliguria, anuria

Color- straw coloredPale or colorless=dilute urine

Dark yellow, orange brown=concentrated urine

Beer brown=bilirubin or bile

Cloudy red=RBC

Clear red=hgb, increased RBC destruction

Transparency (turbidity or clarity)Cloudy=mucus, pus, WBC, or old specimen

Milky=fats,lipids

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Urine Characteristic cont.

Odor – faint or no odor

pH - High acid=starvation, diarrhea, diabetes

Alkaline=infection, renal failure, old specimen, vegetarian diet

Specific Gravity Bacteria Nitrates

Albumin- RBC Glucose

Acetones (ketones) WBC

Blood- Bilirubin

Pus- Urobilogen

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Urinalysis

Physical

Chemical

Microscopic

FRESH SPECIMEN IS NEEDED FOR ACCURATE RESULTS.Examination within one hour of collection or refrigerate specimen

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What standard precautions?

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Reagent Strips (Dipsticks)

Note:

*Expiration date

*Store cool, dry dark area

*Close immediately

*Do not touch pads

*Consider bottle contaminated!!!

*That includes in classroom!!!

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Notice where the strip handle is located and the time requirement for each pad. Brand names may vary with time and pad locations.

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Quality Control Checks

Quality control procedures should be performed with each new lot of reagent strips, and as often as required by the laboratory's (office) procedure.

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Automated strip readers

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TERMS

Albuminuria

Proteinuria

Hematuria

Pyuria

Bilirubinuria

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CHARTING

Take care not to contaminate the written lab slip.

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Blood Test 18:3 & 18:10

Skin puncture (capillaries) Venipuncture Arterial puncture

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Skin Puncture

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Remember-

Do not use thumb and index finger Check sites for edema, callouses, scars or open

areas. Use warm site and do not milk Automatic lancet for individual use only Wipe away first drop Let patient help with gauze Perform standard precautions

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BLOOD GLUCOSE MONITORING

FBS 80-120mg/dl of blood Hgb A1C amount of glucose attached to hgb Keep strip bottle closed tightly. Check expiration date on strips Calibrate Glucometer with each new bottle of

strips (with chip and low sugar solution) Completely fill strip as recommended

by manufacturer Record in meter memory and in diary. Disinfect area

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CHARTING

Outpatient’s chart in diary

Inpatients. You chart date,time, “Pt.instructed on use of blood glucose monitor. Pt verbalized understanding”, Blood Glucose number, “from location”, signature and title

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PATIENT EDUCATIONPATIENT EDUCATION

Unit 18J.J. Nelson RN,CMA

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Glucose tests

FBS-fasting (in Chem Panel or Complete Metabolic Panel)

Hgb A1C -nonfastingGTT (2-6 hours)-fasting &

multiple blood drawsUrine-glucose is abnormal in

urine

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STOOL SPECIMENS Hemoccult-use card Stool for O&P-special

bottle with mark to fill to.

Stool for C&S-special bottle with mark to fill to.

Do not contaminate with urine of blood (menses)

URINE

Routine UA Urine C&S-

midstream, clean catch, sterile cup

24 hour specimen

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FASTING LABS

LIPID PANELSCEMISTRIES

(CHEM 6/CHEM PANELS)

Phenylketonuria• multiple tests in addition to PKU e.g. thyroid

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SPUTUM SPECIMEN

Not saliva Deep from lungs.

(may use nebulizer)

Sterile container No smoking prior

to test

Cardiac Test• EKG• Echocardiogram• Stress Test (exercise or chemical); take cardiac meds, wear exercise cloths• Holter Monitor-24 hour recording….need good electrode attachment. Avoid microwaves, Record in diary and use “event button”.

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Holter Monitor

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MEDICAL IMAGING

ULTRASOUNDS –• Abdominal is NPO• Fetal and Pelvic drink 24-30 ounces noncarbonated

fluid 45 min -1 hour before exam

•MRI- MAGNETIC RESONANCE IMAGING• Patient must be metal free• Claustrophobia may be medicated• Very noisy• Must lay very still, in tight quarters

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MEDICAL IMAGING CONT.

X-Rays=radiationRisk for pregnant women. (Neg. HCG)UGI-NPO, swallow barium. FluoroscopySMALL BOWEL- Laxative day before

exam, NPO and same as UGIBARIUM ENEMA- CL diet evening meal

before, NPO, Laxatives prior, barium is injected into rectum. Must also follow up with laxatives)

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X-Rays continued

Angiogram NPO prior to testIVP- Iodine is used in injection. Ask about

sea food allergies. NPO, Laxatives IV.Voiding Cystogram uses catheter and

fluoroscopyMammogram No deo, lotion powder. Wear

clothes to make breast accessibleCT scan ABD and brain require contrast

media and NPO for 4 hours prior to test

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CT SCAN MRI

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SCOPES

COLONOSCOPY SIGMOIDOSCOPY

• Light-liquid diet day before

• NPO after MN

• Enemas/laxatives night before and in am

• Biopsies can cause some rectal bleeding

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EEG (Electroencephalogram)

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ALLERGY SKIN TEST Multiple scratches or

punctures Not take allergy meds

for at least 24 hours Must lie still May cause red, itching

areas

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