LABORATORY TEST

- The physical and chemical alterations of the

body substances are evidenced through
abnormal values or results occurring in
laboratory test- values lying outside the
accepted normal range or limit for that
particular test.
- Clinical laboratory test results are often used
along with a thorough health history and
physical examination to provide essential data
needed by the physician to accurately diagnose
and manage a patients condition.
- It provides objective and quantitative
information regarding the status of body
conditions and functions.
- The number of laboratory tests ordered on a
patient will vary depending on the physicians
clinical impression
- When clinical signs and symptoms are vague, a
number of laboratory tests may be necessary to
provide a wide range of data on the overall
status of the patients body functions.
- The nurse must acquire both the knowledge
and skill in basic clinical laboratory methods and
techniques. It is important that the nurse have a
knowledge of those laboratory tests that are
performed most often, including the purpose of
the tests, how to perform them, the normal
value or range for each tests, any advance
patient preparation or special instructions.
PURPOSE OF LABORATORY TESTING
1. Laboratory tests are most frequently ordered by
the physician to assist in the diagnosis of
pathologic conditions
The physician may order laboratory tests for the
following reasons:
a. To confirm a clinical diagnosis
- Patients signs and symptoms may provide a
strong clinical diagnosis of a particular
condition, and the physician may order LT
simply to confirm that diagnosis. E.g. Diabetes
mellitus
b. To assist in the differential diagnosis of a
patients condition
- Two or more diseases may have similar signs
and symptoms
c. To obtain information regarding a patients
condition when there is not enough concrete
evidence to support a clinical diagnosis
- At times, the pt. may exhibit vague signs and
symptoms, and laboratory tests are ordered to
provide information on what may be causing
the pt.s problem
2. Laboratory testing may be performed to
evaluate the patients progress and to regulate
treatment
- Based on the lab results, the therapy may need
to be adjusted or further treatment prescribed.
3. Lab tests can also serve to establish each
patients baseline or normal level against which
future results can be compared.
4. Lab tests can also help prevent or reduce the
severity of disease by early detection of
abnormal finding.
5. Another reason for performing a lab test is its
requirement by state law.
- The statutes of most states require a gonorrhea
culture and serology for syphilis

GUIDELINES
1. Review the requirements for collection and
handling of the specimen
2. Assemble the equipment and supplies
3. Identify the patient and explain the
procedure
4. Collection of the specimen
5. Properly handle and store the specimen
with care
6. Submit the specimen to the laboratory for
testing

SERUM ELECTROLYTES LEVELS
Potassium (K+)
- Normal adult range 3.5- 5.0 meq/L
- Child range- SAME
Indications:
1. Increased K+ (Hyperkalemia)
- Acute renal disease
- Burns
- Crushing injuries
- Dehydration
- Salt substitute
- Too rapid infusion of IV solution containing
potassium (most common cause)
*Nursing considerations
- Restrict potassium intake
- Check cardiac monitor (increased contractility
of the heart)
2. Decreased K+ (HYpokalemia)
- Renal loss ( due to diuretics)
- Vomiting or diarrhea
*Nursing considerations
- Give foods rich in potassium
e.g bananas, oranges , raisins, seafood
- Observe ECG monitor if possible
Sodium (Na+)
- Normal adult range 135-145 meq/L
- Child range SAME
1. Increased level (Hypernatremia)
- Very high concentration of sodium in the
extracellular fluid
- Dehydration
- Vomiting or diarrhea
- Decreased water intake
- Renal failure-
- Ingestion of sodium chloride
*NC
- restriction of Na in diet
- weigh the ct. daily
- record of intake & output
- D/C drugs that causes fluid retention
Calcium (Ca++)
- Nomal serum level is 4.5- 5.8 meq/L
1. Increased level ( Hypecalcemia)
- Excess of Vit. D
- Hyperparathyroidism
- Cancer
*NC
Immobilization nursing considerations
- Limit dietary intake of Ca
- Avoid milk and milk products
2. Decreased level ( Hypocalcemia)
- Vit. D. deficiency
- Excessive laxatives
- Burns
- Hypothyroidism
*NC
- Monitor for tetany- major symptom of
hypocalcemia
- Monitor for positive Trousseaus test or
Chvosteks sign
- Administer oral calcium supplements
- give diet rich in calcium with vit. D

Magnesium (Mg++)
-Normal level 1.5-2.5 meq/L
1. Increased (Hypermagnesemia)
- Renal insufficiency
- Severe dehydration
- Leukemia
- Hypothyroidism
*NC
- Monitor for increased level which potentiate cardiac
effect
- Monitor for renal failure
2. Decreased (Hypomagnesia)
- Gastric drainage
- diarrhea
- impaired absorption
- Acute alcoholism
* NC
- Monitor daily ingestion of Mg+ and promote diet high
in magnesium
e.g. Nuts, green, vegetables, seafood
URINALYSIS
- Is a critical test for total evaluation of the renal
system and for indication of renal disease

1. Specific gravity: Normal Value: 1.010-1.025
- Indicates the ability of the kidney to
concentrate or dilute urine
- SG: (greater than 1.030) indicates fluid
depletion- dehydration, vomiting/diarrhea
- SG: (less than 1.010) indicates fluid excess-
overhydartion
- Renal failure: SG constant at 1.010
- SG can be measured using a refractometer or a
urinometer
2. Urine PH: NV: 4.5- 8.0
- PH is the symbol for the logarithm of the
reciprocal of the hydrogen ion concentration
- The lower the number, the higher the acidity of
the urine
- Lower than 6 is acidic urine, the higher than 7 is
alkaline urine
- Acidic urine: may reflect renal TB, PKU, pyrexia,
acidosis
- Alkaline urine: suggest UTI, metabolic or
respiratory alkalosis, drug influence or a
vegetarian diet
3. Color: Straw or light yellow, light amber, amber
- The color of the urine is due to the presence of
a yellow pigment called urochrome, produced
by the breakdown of hemoglobin
4. Odor: Faintly Aromatic
5. Appearance: Clear or transparent
- Cloudiness on a freshly voided urine may be d/t
the presence of bacteria, pus,blood, fat, yeast,
sperm or fecal contaminations.
6. Protein: Negative or zero
- High in amount of protein: Proteinuria
- Usually common to those who have renal
diseases
7. Glucose: Negative or zero
- If the glucose concentration in the blood
becomes too high, the kidney is unable to re
absorb all of it back in the blood, the renal
threshold is exceeded, and glucose is spilled in
the urine known as glycosuria
8. Ketones: Negative or zero
- Excessive amount of ketone bodies begin
appearing in the urine known as ketonuria
- Ketonuria can lead to DM, starvation
9. Red blood cells: 0- 3
- If RC is present, may indicate disease of kidney
or urinary tract,
- May also indicate bleeding somewhere along
the urinary tract and the source of hemorrhage
must be determined
10. WBC: 0-4
- Presence of leukocytes in the urine known as
leukocyturia accompanies inflammation of the
kidneys and the lower urinary tract.
11. Crystals: Negative or zero
- Abnormal crystals found include leucine,
tyrosine, cystine and cholesterol.
12. Parasites: none
- May be present in the urine sediment as a
contaminant from fecal or vaginal material
13. Yeast cells: none
- Presence of yeast cell in the urine of a fem ale
pt are usually a vaginal infection known
as candidiasis




HEMATOLOGICAL TESTS
- Hematology involves the study of blood, including the morphologic appearance, function and diseases of the
blood and blood- forming tissues.
NAME OF TEST
AND SPECIMEN
REQUIREMENT
ABBREV
I-ATION
PURPOSE NORMAL
RANGE
INCREASED WITH DECREASED WITH
1.White blood
cell count
WBC Used to
assist in
the
diagnosis
and
prognosis
of disease
5,000-10,00/
cu mm
Leukocytosis
-Acute infections (
appendicitis,
chicken pox,
diphtheria,
meningitis,
pneumonia,
smallpox, )
- Leukemia
- Malignant disease
Leukopenia
-Viral infections,
bone marrow
depression,
infectious
hepatitis, cirrhosis
2.Red blood cell
count
RBC Used to
assist in
the
diagnosis
of anemia
&
polycythe
mia
M: 5-6
million/cu
mm
F: 4-5
million/ cu
mm
Polycythemia vera
- Severe
diarrhea
- Dehydration
- Acute
poisoning
severe
burns
- Anemia
- Leukemia

3.Differential
white blood cell
count
Diff Used to
assist in
the
diagnosis
and
prognosis
of disease
-Neutrophils:
50-70%
-Eosiniphils:
1-4%
-Basophils:
0-1%
-
Lymphocytes
20-35%
-Monocytes
3-8%
Neutrophilia
-acute bacterial
infection
-parasitic infections
-liver disease
Eosinophilia
-Allergic conditions
- parasitic infections
- Lung and bone
cancer
Basophilia
-Leukemia
-Chronic
inflammation
- Hemolytic anemia
Lymphocytosis
-Acute & chonic
infections
Monocytosis
-Viral infections
-Cirrhosis
Bacterial & parasitic
infections
Neutropenia
-Acute viral
infections
- Blood diseases
- hormone
diseases
Eosinopenia
-congestive heart
failure
-Aplastic and
pernicious anemia
Basopenia
-Acute allergic
reactions
-Steroid therapy
Lymphopenia
-Cardiac failure
-Leukemia
Monocytopenia
-Prednisone
treatment
- Hairy cell
leukemia
Hemoglobin Hgb Used to
screen for
the
presence &
severity of
anemia
and to
monitor
the pt,s
response
to
treatment
for anemia
M:14-
18g/100ml
F: 12-
16g/100ml
Severe burns, COPD,
Congestive heart
failure
Anemia, Cirrhosis,
severe
hemorrhage,
leukemia
Hematocrit Hct,
HCT
Assists in
the
diagnosis
and
M: 37-47%
F: 40-54%
Severe dehydration,
shock, severe burns
Anemia, leukemia,
cirrhosis
evaluation
of anemia


Prothrombin
time
PT Used to
screen for
the
presence
of
coagulatio
n d/o and
to regulate
treatment
of patients
on oral
anticoagul
ant
therapy
11-16 sec Thrombocytosis
Vit. K deficiency,
Hemmorrhagic
disease of a
newborn, liver
disease,
anticoagulant
therapy,
Thrombocytopeni
a
Diuretics,
pulmonary
embolism,vit. K
therapy
Erythrocyte
sedimentation
rate
ESR Used as a
non-
specific
test for
connective
tissue
diseases,
malignancy
and
infectious
disease.
Also to
evaluate
the
progress of
inflammat
ory
diseases
M: <50 yr
0-15 mm/hr
50yr 0-20
mm/hr
F: <50 yr
0-20 mm/hr
50 yr 0-30
mm/hr
Collagen diseases,
infections,
inflammatory
diseases, carcinoma,
cell or tissur
destruction,
rheumatoid arthritis
Sickle cell anemia,
congestive heart
failure
Platelet count Assists in
the
evaluation
of bleeding
d/o that
occur with
liver
disease,
thrombocy
topenia
2000,000-
400,000/ cu
mm
Thrombocytosis
Cancer, leukemia,
Rheumatoid
arthritis, trauma
Thrombocytopenia
Pernicious anemia,
aplastic anemia,
hemolytic anemia,
pneumonia,
infection, bone
marrow-
depressant drugs










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RDRR 06 DG