www.pdflobby.com www.pdflobby.com ROUTINE BLOOD TESTING Many laboratory tests include the direction to perform routine blood testing The protocol for those tests is presented here and is crossreferenced within the many tests requiring them Before • Follow proper patient identification protocols to avoid wrong patient events Usually name and date of birth are used as two identifiers Explain the procedure to the patient Tell the patient if fasting is necessary (Fasting is most commonly required with glucose and lipid studies.) If fasting is required, instruct the patient not to consume any food or fluids Only water is permitted Fasting requirements usually vary from to 12 hours Instruct the patient to continue taking medications unless told otherwise by the health-care provider During • Collect the blood in a properly color-coded test tube (Table A, p xiv), which indicates the presence or absence of additives Tube stopper colors may vary with different manufacturers If uncertain, verify with the laboratory After • Apply pressure or a pressure dressing to the venipuncture site • Assess the site for bleeding = Patient teaching www.pdflobby.com ROUTINE URINE TESTING Many laboratory tests include the direction to perform routine urine testing The protocol for those tests is presented here and is crossreferenced within the many tests requiring them Before • Follow proper patient identification protocols to avoid wrong patient events Usually, name and date of birth are used as two identifiers Explain the procedure to the patient Inform the patient if food or fluid restrictions are needed During Random, fresh, or spot specimen Instruct the patient to urinate into an appropriate nonsterile container 24-hour specimen Begin the 24-hour collection by discarding the first specimen Collect all urine voided during the next 24 hours Show the patient where to store the urine Keep the urine on ice or refrigerated during the collection period Foley bags are kept in a basin of ice Some collections require a preservative Check with the laboratory Post the hours for the urine collection in a prominent place to prevent accidentally discarding a specimen Instruct the patient to void before defecating so that urine is not contaminated by stool Remind the patient not to put toilet paper in the urine collection container Collect the last specimen as close as possible to the end of the 24-hour period Add this urine to the collection After • Transport the specimen promptly to the laboratory = Patient teaching www.pdflobby.com COMMON REFERENCE RANGES FOR HEALTHY ADULTS (NOTE: These values are generalizations Each laboratory has specific ranges.) Blood Count/Hematology Page WBC: 5-10 × 109/L 974 RBC: 4.7 6.1 ì 106/àL; Hemoglobin: 14-18 g/dL; 4.2-5.4 ì 106/àL 770 12-16 g/dL 488 Hematocrit: 40%-52%; 36%-47% 485 Platelets: 150-400 × 109/L 706 Prothrombin time (PT): 11-12.5 sec 753 International normalized ratio (INR): 0.8-1.1 753 Activated partial thromboplastin time (APTT): 30-40 sec 681 Glycosylated hemoglobin: 4%-5.9% 471 Electrolytes and Gastrointestinal, Renal, and Liver Function Sodium: 136-145 mEq/L 835 Potassium: 3.5-5 mEq/L 724 Chloride: 98-106 mEq/L 233 CO2 content (bicarbonate): 23-30 mEq/L 197 Blood urea nitrogen (BUN): 10-20 mg/dL 155 Creatinine: 0.5-1.1 mg/dL 301 Glucose: 74-106 mg/dL 462 Calcium: 9-10.5 mg/dL 189 Amylase: 60-120 U/L 56 Lipase: 0-160 U/L 562 Protein (total): 6.4-8.3 g/dL 476 Albumin: 3.5-5 g/dL 476 Bilirubin (total): 0.3-1 mg/dL 137 Bilirubin (direct): 0.1-0.3 mg/dL 137 Alkaline phosphatase (ALP): 30-120 U/L 29 Alanine aminotransferase (ALT): 4-36 U/L 21 Aspartate aminotransferase (AST): 0-35 U/L 125 Gamma-glutamyl transpeptidase (GGT): 8-38 U/L 435 Lipids Triglycerides: 40-180 mg/dL 908 Total cholesterol: < 200 mg/dL 235 High-density lipoproteins (HDL): > 45 mg/dL; > 55 mg/dL 565 Low-density lipoproteins (LDL): < 130 mg/dL 565 www.pdflobby.com MOSBY’S DIAGNOSTIC AND LABORATORY TEST REFERENCE Fourteenth Edition Kathleen Deska Pagana, PhD, RN Professor Emeritus Department of Nursing Lycoming College Williamsport, Pennsylvania President, Pagana Keynotes & Presentations http://www.KathleenPagana.com Timothy J Pagana, MD, FACS Medical Director Emeritus The Kathryn Candor Lundy Breast Health Center Susquehanna Health System Williamsport, Pennsylvania Theresa Noel Pagana, MD, FAAEM Emergency Medicine Physician Virtua Voorhees Hospital Voorhees, New Jersey www.pdflobby.com 3251 Riverport Lane St Louis, Missouri 63043 MOSBY'S DIAGNOSTIC AND LABORATORY TEST REFERENCE, FOURTEENTH EDITION ISBN: 978-0-323-60969-2 Copyright © 2019 by Elsevier, Inc All rights reserved Previous editions copyrighted 2017, 2015, 2013, 2011, 2009, 2007, 2005, 2003, 2001, 1999, 1997, 1995, 1992 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notices Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein Library of Congress Control Number: 2018952399 Senior Content Strategist: Yvonne Alexopoulos Content Development Manager: Lisa P Newton Senior Content Development Specialist: Tina Kaemmerer Publishing Services Manager: Deepthi Unni Project Manager: Janish Ashwin Paul Design Direction: Renee Duenow Printed in United States Last digit is the print number: 9 8 7 6 5 4 3 2 1 www.pdflobby.com With love and adoration, we dedicate this book to our grandchildren: Ella Marie Gaul Jocelyn Elizabeth Gaul Timothy William Gaul Justin Aquinas Gaul Juliana Kathleen Pericci Luke Michael Pericci John Henry Bullen V Hunter Timothy Bullen —KDP, TJP Thanks for your love and support, John Bullen IV —TNP www.pdflobby.com reviewers Brenda Barnes, BS, MS, PhD Director, Medical Lab Science Program; Director, EdD Health Professions Education Program; Professor Allen College-UnityPoint Health Waterloo, Iowa Peter Miskin, RN, DHSc Adjunct Assistant Professor Samuel Merritt University, Peninsula Learning Center San Mateo, California Tammy R Dean, RN, BSN Program Director The Prince William County School of Practical Nursing Manassas, Virginia Jessica Massengill, MHA-Edu, BSN, RN Coordinator of Health Sciences Tennessee College of Applied Technology-Harriman Harriman, Tennessee Sue Ellen Edrington, MSN, RN Assistant Professor Leighton School of Nursing Marian University Indianapolis, Indiana Lorraine Kelley, DNP, RN Nursing Instructor Pensacola State College Cantonment, Florida Marilyn Kelly, RN, LNC Health Sciences Instructor Discovery Community College Nanaimo, British Columbia, Canada iv Flora Sayson Instructor, Nursing College of Southern Nevada Las Vegas, Nevada Shopha Tserotas, MS, RN Coordinator, Weekend Program Assistant Clinical Professor Texas Woman's University Dallas, Texas www.pdflobby.com preface The 14th edition of Mosby’s Diagnostic and Laboratory Test Reference provides the user with an up-to-date, essential reference that allows easy access to clinically relevant laboratory and diagnostic tests A unique feature of this handbook is its consistent format, which allows for quick reference without sacrificing the depth of detail necessary for a thorough understanding of diagnostic and laboratory testing All tests begin on a new page and are listed in alphabetical order by their complete names The alphabetical format is a strong feature of the book; it allows the user to locate tests quickly without first having to place them in an appropriate category or body system The User’s Guide to Test Preparation and Procedures section outlines the responsibilities of health-care providers to ensure that the tests are accurately and safely performed Use of this guide should eliminate the need for test repetition resulting from problems with patient preparation, test procedures, or collection techniques Information on radiation exposure and risks has been added Every feature of this book is designed to provide pertinent information in a sequence that best simulates priorities in the clinical setting The following information is provided, wherever applicable, for effective diagnostic and laboratory testing: • Name of test Tests are listed by their complete names A complete list of abbreviations and alternate test names follows each main entry • Type of test This section identifies whether the test is, for example, an x-ray procedure, ultrasound, nuclear scan, blood test, urine test, sputum test, or microscopic examination of tissue This section helps the reader identify the source of the laboratory specimen or location of the diagnostic procedure • Normal findings Where applicable, normal values are listed for the infant, child, adult, and elderly person Also, where appropriate, values are separated into male and female It is important to realize that normal ranges of laboratory tests vary from institution to institution This variability is even more obvious among the various laboratory textbooks For this reason, we have deliberately chosen not to add a table of normal values as an appendix, and we encourage the user to check the normal values at the institution where the test is performed This should be relatively easy because laboratory reports include normal values Results are given in both conventional units and the International System of Units (SI units) where possible v www.pdflobby.com vi preface • Possible critical values These values give an indication of results that are well outside the normal range These results require health-care provider notification and usually result in some type of intervention The Joint Commission is looking at the timely and reliable communication of critical laboratory values as one of its patient safety goals • Test explanation and related physiology This section provides a concise yet comprehensive description of each test It includes fundamental information about the test itself, specific indications for the test, how the test is performed, what disease or disorder the various results may show, how it will affect the patient or client, and relevant pathophysiology that will enhance understanding of the test • Contraindications These data are crucial because they alert health-care providers to patients to whom the test should not be administered Patients highlighted in this section frequently include those who are pregnant, are allergic to iodinated or contrast dyes, or have bleeding disorders • Potential complications This section alerts the user to potential problems that necessitate astute assessments and interventions For example, if a potential complication is renal failure, the implication may be to hydrate the patient before the test and force fluids after the test A typical potential complication for many x-ray procedures is allergy to iodinated dye Patient symptoms and appropriate interventions are described in detail • Interfering factors This section contains pertinent information because many factors can invalidate the test or make the test results unreliable An important feature is the inclusion of drugs that can interfere with test results Drugs that increase or decrease test values are always listed at the end of this section for consistency and quick access A drug symbol ( ) is used to emphasize these drug interferences • Procedure and patient care This section emphasizes the role of nurses and other health-care providers in diagnostic and laboratory testing by addressing psychosocial and physiologic interventions Patient teaching priorities are noted with a special icon ( ) to highlight information to be communicated to patients For quick access to essential information, this section is divided into before, during, and after time sequences ◦ Before This section addresses the need to explain the procedure and to allay patient concerns or anxieties If patient consent is usually required, this is listed as a bulleted item ... The 14th edition of Mosby’s Diagnostic and Laboratory Test Reference provides the user with an up-to-date, essential reference that allows easy access to clinically relevant laboratory and diagnostic. .. effective diagnostic and laboratory testing: • Name of test Tests are listed by their complete names A complete list of abbreviations and alternate test names follows each main entry • Type of test. .. Routine urine testing, inside front cover Common reference ranges, inside front cover List of figures, x User’s guide to test preparation and procedures, xi Diagnostic and laboratory tests, Tests presented