A Manual of Laboratory and Diagnostic Tests 7th edition (July 2003): By Frances T Fischbach RN, BSN, MSN By Lippincott Williams & Wilkins Publishers

A Manual of Laboratory and Diagnostic Tests CONTENTS Editors Contributors Dedication Preface Acknowledgments Diagnostic Testing Blood Studies; Hematology and Coagulation Urine Studies Stool Studies Cerebrospinal Fluid Studies Chemistry Studies Microbiologic Studies Immunodiagnostic Studies Nuclear Medicine Studies X-Ray Studies Cytologic, Histologic, and Genetic Studies Endoscopic Studies Ultrasound Studies Pulmonary Function, Arterial Blood Gases (ABGs), and Electrolyte Studies Prenatal Diagnosis and Tests of Fetal Well-Being Special Systems, Organ Functions, and Postmortem Studies Appendix A Standard/Universal Precautions Appendix B Latex and Rubber Allergy Precautions Appendix C Sedation and Analgesia Precautions Appendix D Conversions From Conventional to Systéme International (SI) Units Appendix E Guidelines for Specimen Transport and Storage Appendix F Vitamins in Human Nutrition Appendix G Minerals in Human Nutrition Appendix H Examples of Forms Appendix I Panic or Critical Values Appendix J Effects of the Most Commonly Used Drugs on Frequently Ordered Laboratory Tests (Blood, “Whole” Plasma, Serum, Stool, and Urine) Appendix K Protocols for Hair, Nails, Saliva, Sputum, and Breath Specimen Collection Appendix L Protocols for Evidentiary Specimen Collection in Criminal or Forensic Cases Contributors Corrinne Strandell, RN, BSN, MSN, PhD Nursing Research, Home Care and Rehabilitation Specialist, West Allis, WI Bernice Gestout DeBoer, RN, BSN, CPAN Parish Nurse, Covenant Health Care, Milwaukee, WI Mary Pat Haas Schmidt, BS, MT Manager, Laboratory Services, Pre-insurance testing; Instructor, Medical technology, Waukesha, WI Jean Schultz, ES, RT, RD, MS Director of Ultrasound and Radiology Education, St. Luke's Medical Center, Milwaukee, WI Patricia Pomohac, MT (ASCP) Supervisor, Diagnostic Immunology, Department of Pathology, United Regional Medical Services, Inc., Milwaukee, WI Teresa Friedel Abrams, RN, BSN, MSN Geriatric Nurse Specialist, Menomonee Falls Health Care Center, Menomonee Falls, WI Carol Colasacco, CT (ASCP), CMIAC Cytotechnologist, Department of Pathology, Fletcher Allen Health Care, Burlington, VT Emma Felder, RN, BSN, MSN, PhD Professor Emeritus, Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI Ann Shafranski Fischbach, RN, BSN Occupational Health; Case Manager, Johnson Controls, Milwaukee, WI Bonnie Grahn, RN, CIC Infection Control Coordinator, Froedtert Memorial Lutheran Hospital, Milwaukee, WI Roger Groth Ophthalmic Technologist, Eye Institute, Froedtert Memorial Lutheran Hospital, Milwaukee, WI Gary Hoffman Manager, Laboratory for Newborn Screening, State of Wisconsin, Madison, WI Karen Kehl, PhD Assistant Professor-Pathology, Children's Hospital of Wisconsin, Milwaukee, WI Susan Kirkpatrick, MS Genetic Counselor, Waisman Center, Madison, WI Stanley F. Lo, PhD Assistant Professor-Pathology, Children's Hospital of Wisconsin, Milwaukee, WI Lynn Mehlberg, ES, CNMT Director, Quality Assurance-Imaging Department, St. Luke's Medical Center, Milwaukee, WI Deborah B. Martin, RN, BSN Community Health Nurse, Baltimore City Health Department, Maternal and Infant Program Field Office, Baltimore, MD Lorraine Meisner, PhD Cytogenetics, State Laboratory of Hygiene, Madison, WI Christine Naczek, MT (ASCP) Manager, Blood Banking and Pre-Transfusion Testing, Department of Pathology, United Regional Medical Services, Inc., Milwaukee, WI Anne Witkowiak Nezworski, RN, BSN Maternity and Newborn Specialist, Sacred Heart Hospital, Eau Claire, WI Joseph Nezworski, ES, RN, BSN Chief Deputy Medical Examiner, Eau Claire County, Eau Claire, WI Richard Nuccio, BA, MA, MBA, CNMT, RT (ASCP) Global Products, General Electric Medical Systems, Milwaukee, WI Annette O'Gorman, RN, ESN, MSNCS Family Nurse Practitioner, EM Care S.C., Milwaukee, WI Tracey Ryan, RD Chief Clinical Dietitian, Froedtert Memorial Lutheran Hospital, Milwaukee, WI Julie Saavedra, RN, BA, BSN, CGRN Nursing Manager, Department of Endoscopy, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL John Shalkham Program Director for School of Cytotechnology, State Laboratory of Hygiene, Clinical Assistant Professor–Department of Pathology, University of Wisconsin, Madison, WI Eleanor C. Simms, RNC, BSN Specialist, Nursing Student Enrichment Program, Coppin State College, Helene Fuld School of Nursing, Baltimore, MD Nancy A. Staszak, RN, BSN, CCRN Education Coordinator-QA & Staff Development, Froedtert Memorial Lutheran Hospital, Milwaukee, WI Frank G. Steffel, BS, CNMT Program Director-Nuclear Medicine Technology, Department of Radiology, Froedtert Memorial Lutheran Hospital, Milwaukee, WI Rosalie Wilson Steiner, RN, BSN, MSN, PhD Community Health Specialist, Milwaukee, WI Thudung Tieu QA/Safety Coordinator, United Dynacare Laboratories, Milwaukee, WI Jean M. Trione, RPh Clinical Specialist, Wausau Hospital, Wausau, WI Beverly Wheeler, RN, BSN, MSN, CS Cardiology; Cardiothoracic Nurse Specialistm, National Naval Medical Center, Bethesda, MD Michael Zacharisen, MD Assistant Professor-Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI To Michael, Mary, Paul, and Margaret FRANCES TALASKA FISCHBACH, RN, BSN, MSN Associate Clinical Professor of Nursing Department of Health Restoration School of Nursing University of Wisconsin-Milwaukee Milwaukee, Wisconsin; Associate Professor of Nursing (Ret) School of Nursing University of Wisconsin-Milwaukee Milwaukee, Wisconsin MARSHALL BARNETT DUNNING, III, BS, MS, PHD Associate Professor of Medicine Department of Medicine Division of Pulmonary/Critical Care Medicine Medical College of Wisconsin, Milwaukee Wisconsin; Director Pulmonary Diagnostic Laboratory Froedtert Memorial Lutheran Hospital Milwaukee, Wisconsin QUINCY MCDONALD Acquisitions Editor SHARON NOWAK/MARIE RIM Editorial Assistant DEBRA SCHIFF Senior Production Editor HELEN EWAN Senior Production Manager ERIKA KORS Managing Editor / Production CAROLYN O'BRIEN Art Director BJ CRIM Design WILLIAM ALBERTI Manufacturing Manager ALEXANDRA NICKERSON Indexer PURPOSE The purpose of A Manual of Laboratory and Diagnostic Tests, in this Seventh edition, is to promote the delivery of safe, effective, and informed care for patients undergoing diagnostic tests and procedures and also to provide the clinician and student with a unique resource. This comprehensive manual provides a foundation for understanding the relatively simple to the most highly complex diagnostic tests that are delivered to varied populations in varied settings. It describes the clinician's role in providing effective diagnostic services in depth, through affording the necessary information for quality care planning, individualized patient assessment, analysis of patient needs, appropriate interventions, patient education, patient follow-up, and timely outcome evaluation. Potential risks and complications of diagnostic testing mandate that proper test protocols, interfering factors, follow-up testing, and collaboration among those involved in the testing process be a significant part of the information included in this text. ORGANIZATION This book is organized into 16 chapters and 12 appendices. Chapter 1 outlines the clinician's role in diagnostic testing and includes interventions for safe, effective, informed pre-, intra-, and posttest care. This chapter includes a Patient's Bill of Rights and Responsibilities, a model for the role of the clinical team in providing diagnostic care and services, test environments, reimbursement for diagnostic services, and the importance of communication as key to desired outcomes. The intratest section is expanded to include information about collaborative approaches facilitating family presence during invasive procedures, risk management, the collection, handling, and transport of specimens, infection control, controlling pain, comfort measures, administration of drugs and solutions, monitoring fluid intake and loss, using required equipment kits and supplies, properly positioning the patient for the procedure, managing the environment, and patient monitoring. The reader is referred back to Chapter 1, Diagnostic Testing, throughout the text for information about the clinician's role and diagnostic services. Chapter 2, Chapter 3, Chapter 4, Chapter 5, Chapter 6, Chapter 7, Chapter 8, Chapter 9, Chapter 10, Chapter 11, Chapter 12, Chapter 13, Chapter 14, Chapter 15 and Chapter 16 focus upon specific categories that include: Chapter 2: Blood Studies Chapter 3: Urine Studies Chapter 4: Stool Studies Chapter 5: Cerebrospinal Fluid Studies Chapter 6: Chemistry Studies Chapter 7: Microbiologic Studies Chapter 8: Immunodiagnostic Studies Chapter 9: Nuclear Medicine Studies Chapter 10: X-ray Studies Chapter 11: Cytology, Histology, and Genetic Studies Chapter 12: Endoscopic Studies Chapter 13: Ultrasound Studies Chapter 14: Pulmonary Function and Blood Gas Studies Chapter 15: Prenatal Diagnosis and Tests of Fetal Well-Being Chapter 16: Special Systems, Organ Functions, and Postmortem Studies CHAPTER CONTENT AND FEATURES Background rationale Test purpose Interfering factors Description of the procedure protocol and time frames and test completion Reference ranges and normal values, expectations Patient involvement (eg, history of signs and symptoms, body position, breathing instructions, electrode placement, compliance issues, patient right to refuse testing) Method of specimen collection (biohazard guidelines), handling, and transportation Clinical implications with interpretation of abnormal findings, unexpected outcomes, and disease patterns Interventions for pretest patient preparation (medications, fasting), explanation of benefits and risks, intratest patient care (appropriate monitoring, conscious sedation), and posttest patient aftercare (includes monitoring, explanation of further testing and treatment modalities) Special features integrated into the format include: The clinician's role in providing diagnostic services. Clinical Alerts and Education Alerts that signal special cautions. Specific guidelines listed for each test phase. Expected outcomes with evidence-based patient expectations and reference ranges as defined by the specialty. A user-friendly format of the text to support easy information retrieval. Both conventional and SI units are listed and, where possible, age-related reference values are also listed as a component of normal reference values. Numerous examples of test values and clinical considerations for newborn, infant, child, adolescent, and older adult groups where appropriate. A bibliography at the end of each chapter representing a composite of selected references from various disciplines and directs the clinician to information available beyond the scope of this book. Extensive appendices providing the clinician with additional data for everyday practice. Current, complete, and accurate content, which has been compiled from various multidisciplinary sources, then carefully scrutinized and continually reevaluated. NEW INFORMATION IN THE SEVENTH EDITION The addition of many new tests and methodologies includes: Newborn screening for inherited disease Updated Pap smears and protocols for further testing Cytokines Metabolic autopsy Tissue (histology) biopsies and predictive markers for treatment response Tests for bone disease Tests for heart disease, congestive and acute MI disease Microbiological testing, bioterrorism agents, detecting food poisoning, anthrax, plague, and hemorrhagic fever Breast diagnostic and prognostic markers Fetal predictive tests of abnormal development Breath tests for ulcers, alcohol, lactose, etc. Fertility tests Expanded scope of magnetic resonance (MRI) scans Expanded scope of sleep/sleepiness studies in newborns, children, older adults New nuclear tumor and infection scans PET scans combined with CT spiral imaging and ultrasound Ductal lavage for determining Gail Index for breast cancer risk New sentinel node localization LEEP GYN procedure Eye tests for retinal disorders, macular degeneration, visual acuity, and glaucoma Expanded content on keeping records of diagnostic tests, use of proper forms, and standardized patient reports Panels of multiple tests (e.g., metabolic syndrome, syndrome X) within Chapter 6 Chemistry Tests The appendices are completely revised and contain many additions. For example, Appendix D offers information regarding collection of saliva, breath, nail, sputum, and hair specimens. Appendix H provides examples of commonly used forms and infrequently used forms (videotaping, refusal). Appendix L deals with guidelines for collecting evidentiary specimens. Revised chapters include changes in the clinician's role and reflect current laboratory and diagnostic practice standards. Throughout the text, a greater emphasis is placed upon communication skills and collaboration between patients, their significant others, and health professionals from diverse disciplines. When clinicians see patients in the context of what the patient and loved ones are experiencing (ie, situational needs, expectations, previous experiences, and the environment in which they live), only then can they offer meaningful support and care. When patients believe the clinician is on their side, they have an increased sense of control. Identifying with the patient's point of view leads to a more profound level of communication. CURRENT DEVELOPMENTS IN LABORATORY AND DIAGNOSTIC TESTING New technologies foster new scientific modalities for patient assessment and clinical interventions. Thus, the clinician is provided a greater understanding of the long chain of events from diagnosis through treatment and outcomes. In a brief span of years, new technologies have introduced greatly improved developments in total body and brain x-ray scanners; digital and enhanced imaging; magnetic resonance (MR); positron emission tomography (PET) scanners, combination scans such as PET and CT to diagnose cancer and infections; greatly enhanced ultrasound and nuclear medicine procedures; genetic mutation studies; new tests for cancer; new cancer markers for diagnosis and prognosis; sleep disorders tests; technology for fetal testing before birth, and postmortem testing after death. Many new technologies are faster, more patient-friendly, more comfortable, and provide an equivalent or higher degree of accuracy (ie, HIV or hepatitis detection, monitoring for drug abuse or managing therapeutic drug levels). Saliva and breath testing is gaining ground as a mirror of body function and emotional, hormonal, immune, and neurologic status, as well as providing clues about faulty metabolism. Noninvasive and minimally invasive testing, (ie, need only one drop of blood, nail and hair clippings), which is better suited for testing in environments such as the workplace, private home, and other nontraditional health care settings such as churches, is made possible by better collection methods and standardized collection techniques. Newest diagnostic lab technologies include hand-held nucleic acid detectors for specific bacteria and viruses, hand-held miniaturized chip-based DNA analyzers, reagentless diagnostics that introduce the sample (hand, finger, ear lobe, etc.) to magnetic fields, and magnetic resonance spectroscopy (MRS). Non-invasive and minimally invasive diagnostics include infrared light to estimate glucose, rapid oral screen for HIV, proteinomics, functional and molecular techniques. Managed care and its drive for control of costs for diagnostic services exerts a tremendous effect on consumers' ability to access testing services care. This results in mixed access to services, depending upon approval or denial of coverage.