liver disease
Terms Definitions
Red blood cell count (RBC) lab values
men 4.6 - 6.2
woman 4.2 - 5.4
child 3.2 - 5.2
White blood cell count lab values
adult 5000 - 10000
child 5000 - 13000
hemoglobin normal value
man 13-18
woman 12 - 16
child 11-12.5
hematocrit normal value
man 42 -50%
woman 40-48%
child 35-45%
what is hematocrit mean?
% of RBC's in a volume of blood
bleeding time lab.
Normal value
and what is it
measures duration of bleeding after standardized skin incision
1-9 minutes
partial thromboplastin time (PTT): what is it
normal range
monitors effectiveness of heparin therapy (detects coagulation disorders)
20 - 39 seconds
platelet count normal lab
100,000 - 400,000
prothrombin time (PT) lab
what is it
normal values
monitors effectiveness of Coumadin therapy (detects coagulation disorders)
9.5 - 12 seconds
sedimentation rate (ESR)
what is it?
normal lab values
speed at which RBC"s settle in well mixed venous blood
indicates inflammation
man 0-15 mm/h
woman 0-20 mm/h
glucose tolerance test
what is it?
normal values
measures ability of body to secrete insulin in response to hyperglycemia
fasting 60-110
1hr 190
2 hrs 140
3hrs 125
total cholesterol
what is it?
normal values?
evaluates tendency for atherosclerosis
overnight fast
optimal < 200
borderline 200 - 239
high >239
Low density lipoprotein (LDL) nad High density lipoprotein (HDL) tests
normal values?
determines whether elevated cholesterol elvels are caused by incr. LDL or HDL
LDL optimal < 139, borderline 140-160, high >160
HDL men 35-70
women 35-85
creatinine lab
normal values?
test of renal fxn
NPO 8 hrs
list meds pt is taking on lab slip
adult 0.6 - 1.5
child 0.4 - 1.2
infant 0.3 - 0.6
alkaline phosphate lab
normal values?
evaluates liver and bone fxn
NPO 8-12 hrs
List meds pt taking on lab slip
adult 30 -150 u/L
infant & adolescent up to 104
Creatinine Kinase (CK)
normal values?
used to dx MI
detected in blood 3-5 hrs
man 55-170
woman 30-135
child 0-70
serum albumin
normal values?
used to detect protein malnutrition
3.5 - 5.5 g/dL
BUN what & values
evaluates renal fxn
over 60 yrs 8 -20
Values affected by protein intake, tissue breakdown, fluid volume changes
alterations in pulse volume measured by placing a pneumatic cuff around the extremity at different levels, attached to monitor
oscillometry purpose
abnormal findings help pinpoint the level of arterial occlusion
skin temperature studies
palpate & compare skin warmth or coolness in opposing limbs
Use direct reading skin temp thermometers
Immerse 1 extremitiy in warm water and obesrve for other extremity to rise in temp. which should normally follow d/t reflex vasodilation
Place hot water bottel on abdomen and observe extremities for reflex incr. temperature
skin temperature studies purpose
coldness of one/both extremities at normal room temp implies poor circulation
angiography (arteriography)
contrast dye injected into the arteries and xray films are taken of the vascular tree
angiography (arteriograph) purpose
indicates abnormalities of blood flow d/t arterial obstruction or narrowing
exercise test for intermittent claudication
patient exercises until pain occurs
the lenght of time btwn start and pain onset is recorded
exercise test for intermittent claudication purpose
claudication w/ exercise indicates inabililty of damaged arteries to incr. blood flow needed for incr. tissue oxygenation
lumbar sympathetic block
local anesthetic is injected into sympathetic ganglia, temporarily blocking the sympathetic vasomotor nerve fibers supplying an ischemic limb
lumbar sympathetic block purpose
decreased limb pain & incr. temperature indicate that sympathectomy could improve circulation to the extremities
thrombi are identified as radiolucent areas in opaque filled veins
phlebography purpose
lack of filling of a vein is indicative of venous occlusion d/t thrombus
post test risk in lumbar sympathetic block
shock d/t movement of blood form vital organs to peripheral vessels
venous pressure measurements
venous occlusion in one leg causes venosu pressure to be higher in other leg
venous pressure measurements purpose
significant only in early stages of thrombophlebitis before collateral veins develop
isotope studies
fibrinogen labeled w/ radioactive iodine molecules make up a clot along with naturally occurring fibrinogen
radioactivity counts are increased over thrombi
isotope studies purpose
helpful in dx of early formation thrombi
ultrasonic flow detection
Doppler studies
electronic stethoscope that detects sound of blood flow
ultrasonic flow detection (doppler) purpose
indicates obstruction in blood flow in extremities
pulmonary fxn test purpose
detects impaired pulmonary fxn from person
breathing into a machine
No _____ 4 hrs before pulmonary fxn text
Arterial blood gasses
measuresments of tissue oxygenation, CO2 removal and acid-base balance
Evaluates pts being mechanically ventilated or with CV disease
how to obtain arterial blood
perform Allen's test (check for collateral circulation)
art blood is obtained in heparinized syringe
Must be unclotted
air bubbles can't be present in specimen
post arterial blood draw instructions for RN
apply pressure to site for 5 minutes to prevent hematoma (15 minutes for pt on anticoagulants)
send specimen on ice & occlude needle to avoid air in syringe
note on lab slip room air or O2 amount
purpose of Allen's test
tests for collateral circulation in hand (before radial art line insertion/blood draw)
elevate hand, make fist for 30 seconds
compress ulnar & radial arteries
release ulnar
blood flow should return within 7 seconds (hand unblanches)
means ulnar blood supply to hand is sufficent & its okay to prick/cannulate the radial
Lung scan (VQ scan) purpose
evaluates pulmonary perfusion when pulmonary infarction or space-occupying disorders are suspected
Lung scan (VQ scan) how is it done?
IV injection iodinated radioactive dye
High level of radioactivity in areas of good perfusion; low levels of radioactivity in areas that are obstructed
Vent. Scan: radioactive gas inhaled, should be equal distribuition of gas
sputum analysis purpose
ID cause of pulmonary infxn
ID abnormal lung cells
sputum analysis preperation
encourage fluid intake night before
instruct to rinse mouth w/ water
do not brush teeth, eat or use mouthwash before test
use sterile container
ultrasonic/heat nebulizer treatment 10-15 " prior aids in collection
collect early am if possible
bronchoscopy purpose
allows visualization of layrnx, trachea & mainstem bronchi
possible to obtain tissue biopsy, appy meds, aspirate secretions for lab, aspirate mucus plug causing airway obstruction or remove aspirated foreign objects
bronchoscopy preperations
maintain NPO 6 hrs before
inspect mouth for infx
administer premeds-valium, versed, demerol, atropine
remove dentures
prepare client for sore throat after procedure
post bronchoscopy nursing care
site/lie on side
remain NPO until gag reflex returns
Observe for resp. difficulties
thoracentesis purpose
aspiration of fluid/air from pleural space
To obtain specimen for analysis, relieve lung compression, obtain lung tissue for biopsy or instill meds into pleural space
thoracentesis prep
shave area around needle insertion site
postion pt sittin gw/ arms on pillows on over bed table or lying on side
expect stinging sensation w/ injection of anesthesia (local)
NO MORE THAN 1000 ml fluid removed at one time
post thoracentesis: sterile or non sterile dressing?
sterile dressing
chest x ray purpose
to ID abnormalities such as foreign bodies, fluid, infiltrates, tumors
lung biopsy purpose
removal of lung tissue for culture or cytology
lung biopsy prep
position pt same as thoracentesis
have pt hold breath in midexpiration
performed with fluoroscopic monitoring
what diagnostic test is performed directly after a lung biopsy?
chest x ray to check for pneumothorax
computed tomography purpose
provides three dimensional assessment of lungs and thorax
Magnetic resonance imaging (MRI) purpose
provides detailed pictures of body structures
MRI prep
assess for clausterphobia
remove all metal jewelry and metal objects
ask if pt has metal implanted stuff (pacemaker, clips)
rotate pulse ox site every ____ to prevent _____
4 hrs, skin irritation
stress test purpose
assess CV response to increased workload
stress test: how its done
patient walks on treadmill, pedals bike, or climbs stairs
EKG monitored before, during and after test
ultrasound echocardiogram purpose
noninvasive sound waves used to determine cardiac structures
cardiac catheterization purpose
usually used w/ angiography
introduction of catheter into chambers of the heart to evaluate ventricular fxn and obtain chamber pressures
cardiac catheterization prep
NPO 8-12 hrs
signed permit
empty bladder
check pulse
explain that client may feel heat, palpitations, desire to cough when dye injected
post cardiac cath nursing considerations
extremity straight 6-8 hrs bedrest
Check pulses, sensation, bleeding at insertion site q 30 min x 3 hrs
cerbral angiography purpose
ID's aneurysms vascular malformations, narrowed vessels
Cerebral angiography prep
explain: lie flat, dye injected into femoral art., fluroscopy & radiologic films taken after injection
well hydrated
skin prep, chosen shaven site
mark peripheral pulses
may feel warmth & metalic taste when dye injected
cerebral angiography post test nursing care
neuro assess q 15-30" until vitals stable
keep bed flat 12-14 hrs
check puncture site q hour
immobilize site 6-8 hrs
force fluids
lumbar puncture purpose
insertion of needle into subarachnoid space to obtain specimen, relieve pressur e, inject dye or meds
lumbar puncture position
position lateral recumbent fetal posiiton at edge of bed
post lumbar puncture nursing consideration
flat 2-3 hrs
encouarge PO fluids to 3000 ml
electroencephalogram (EEG) purpose
records electrical activity of brain
EEG prep
tranquilizer and stimulant meds held for 24-48 hrs pre EEG (including caffeinne, tea, cigarettes cola)
may be asked to hyperventilate 3-4 minutes, watch bright flashing light
meals not withheld
kept awake night before test
echoencephalography purpose
evaluates brain structure through sound waves
CT (computed tomograph) purpose
detects hemorrhage, infarction, abscesses, tumors
CT (computed tomography) prep
immobile during exam
contrast dye may be used
myelogram purpose
visualizes spinal column and subarachnoid space
myelogram prep
NPO 4-6 hrs before
obtain allergy hx
phenothiazines, CNS depressants and stimulants withheld 48 hrs prior
table will be moved to various positions during test
myelogram post nursing caring
when metrizamide water soluble dye used, head should be elevated 30-45 degrees for 3 hrs
encourage fluids
assess for distended bladder
neuro assessments q 2-4 hrs
PET (positron emission tomography) purpose
used to assess metabolic and physiological fxn of brain; dx stroke, brain tumor, epilepsy, Parkinson's disase, head injury
PET (positron emission tomography) prep
client inhales/injected with radioactive substances then scanned
may expereince dizziness, headache
teach relaxation techniques
Pigment studies purpose
parameters of hepatic ability to conjugate and excrete bilirubin
abnormal in liver and gallbladder disorders, (e.g. w/ jaundice)
direct bilirubin increase in obstruction
Pigment studies prep
fast 4 hrs
Pigment studies normal values
serum bilirubin direct 0 - 0.3
total 0 - 0.9
urine bilirubin total 0
Over _____% of the parenchyma of the liver may be damaged before a liver function test becomes abnormal
Serum albumin r/t liver disease
proteins are produced by the liver
levels may diminish in hepatic disease
severely decr. albumin results in generalized edema
normal serum albumin
3.5 - 5.5
effects of liver disease on PT/PTT
may be prolonged in hepatic disease
In liver disease, PTT prolonged d/t lack of vitamin K
liver enzymes test
with damaged liver cells, liver enzymes are released into the bloodstream (AST, ALT, LDH)
normal AST, ALT , LDH levels
AST 10 -40 units
ALT 5 - 35 units
LDH 100 - 225 units
blood ammonia (arterial) purpose
liver converts ammonia to urea
with liver disease, ammonia levels rise
normal ammonia levels
15- 40 mcg/dL
purpose of abdominal xray of liver
determines gross liver size
purpose of liver scan
to demonstrate size, shape of liver, visualize scar tissue, cysts, or tumors; use radiopaque dye
Question liver scan pt about what before procedure
seafood allergy (iodine allergy)
Cholecystogram and Cholangriography (purpose)
for gallbladder and bile duct visualization; radiopaque material injected direclty into biliary tree
Cholecystogram and Cholangiography prep
fat free dinner evening before exam
ingestion of dye in tablet form (iodine allergy)
NPO after dye ingestion
Xrays, followed by ingestion of high fat meal, followed by further xrays
Celiac axis arteriography purpose
for liver and pancreas visualization; uses contrast media of organic iodine
(allergy alert!)
Splenoportogram (splenic portal venography) purpose
to determine adequacy of portal blood flow; uses contrast media of organic iodine
liver biopsy position
supine lateral with upper arms elevated
liver biopsy prep
vitamin K IM
NPO morning of (6 hrs)
asked to hold breath 5-10 seconds
post liver biopsy care
position on right side 2-3 hrs
check clotting times, platelets, hematrocrit
Report complains of SEVERE abd pain IMMEDIATELY (perforation of bile duct!)
stomach/esophagus endoscopy purpose
visualization of esophagus and/or stomach by means of lighted, flexible fiberoptic tube introduced through the mouth to the stomach to determine presence of ulcerations, tumors or obtain tissue or fluid samples
endoscopy prep/post
NPO 8 hrs
numbness in throat d/t local anesthesia (spray/gargle)
maintain NPO 'til gag reflex returns
sigmoidoscopy/proctoscopy purpose
direct visualization of the sigmoid colon, rectum and anal canal
sigmoidoscopy/protoscopy prep
laxative night before and enema/supp. in morning of procedure
NPO at midnight
colonoscopy purpose
direct visualization of the colon; used as a diagnostic aid; removes foreign bodies, polyps, or tissue for biopsy
colonscopy prep
clear liquid diet 24-72 hrs before
cathartic in evening for 2 days prior
enema morning of
Golytely lavage solution to cleanse bowel
gastric aspirate purpose
aspiration of gastric contents to evaluate for presence of abnormal constituents such as blood, abnormal bacteria, abnormal pH or malignant cells
gastric aspirate prep/procedure
NPO before test
NG tube passed, stomach contents aspirated
Histamine sometimes used to stimulate HCL secretion
Guaiac tests 4 presence blood
gastric pH normal range
pH <4
Upper GI series barium swallow purpose
ingestion of barium sulfate to determine patency and size of esophagus, size and condition of gastric walls, patency of pyloric valve and rate of passage to small bowel
Upper GI series prep
NPO after midnight
stool will be light colored after test (white)
Lower GI series barium enema purpose
instillation of barium (radiopaque substance) into colon via rectum for fluroscopy, xrays to view tumors, polyps, strictures, ulcerations, inflammation or obstructions of colon
Lower GI series prep
low residue diet 1-2 days
clear liquid diet and laxative evening before test
cleasning eneams until clear morning of test
Paracentesis purpose
needle aspiration of fluid in abdominal cavity used for diagnostic examination of ascitic fluid and treatment of massive ascites resistant to other therapies
Paracentesis prep
pt in semi Fowler's or sitting upright on edge of bed
empty bladder prior to procedure (to avoid perforation)
culdoscopy purpose
visualization of ovaries, fallopian tubes uterus, via lighted tube inserted into vagina and through cul-de-sac
culdoscopy prep/post
knee chest position
local anesthesia
position on abdomen after procedure
obesrve for vaginal bleeding
no douching/sex 2 wks
colposcopy purpose
similar to pelvic exam
colposcopy prep
performed between menstrual periods
takes 20 minutes
lithotomy position
cervix is washed with dilute aceitic acid
laparoscopy purpose
visualization of pelvic cavity through an incision beneath the umbilicus to view structures
laparoscopy prep/post
CO2 introduced to enhance visualization
general anesthesia
foley inserted for bladder decompression
out of bed after procedure, regular diet
Cervical biopsy purpose
sample tissue taken to ID unusual cells
cervical biopsy prep/post
no anesthesia used
may have cramping sensation
no sex/douching/swimming 3 days
urinalysis purpose
detect kidney abnormalities
urinalysis prep
save first am specimen
overnight specimen is more concentrated
normal urine pH
normal urine specific gravity
1.010 - 1.030
urine culture & sensitivity purpose
ID bacteria in urine
normal urine culture
< 100,000 colonies/ml
cystometrogram purpose
test of muscle tone (bladder)
cystometrogram prep
foley catheter
instillation of saline may cause feeling of pressure
Creatinine clearance purpose
evaluate renal fxn
creatinine clearance prep
24 hr urine collection
blood drawn for creatinine level at end of urine collection
calculate creat. clearnace with urine flow rate and serum creat. numbers
normal creatinine serum
1.67 -2.5
BUN purpose
evalute renal fxn
BUN prep
values affected by protein intake, tissue breakdown, fluid volume changes
normal BUN
over 60 yrs, 8-20
cystoscopy purpose
direct visualization by cystoscope of bladder and urethra
cystoscopy prep/post
bowel prep
force fluids
deep breath to relieve discomfort
urine usually pink tinged post
Abd. or pelvic pain indicates TRAUMA!
antimicrobial prophylaxis
cystourethrogram purpose
x ray study of bladder and urethra
cystourethrogram prep
radiopque dye injected
patient voids, xray taken during voiding
intravenous pyelogram (IVP) purpose
provides x ray visualization of kidneys, ureters and bladder
intravenous pyelogram (IVP) prep
bowel prep
NPO after midnight
check allergies to shellfish/iodine/chocolate, eggs, milk
burning/salty taste may occur during dye injection
xrays taken at intervals
renal scan purpose
evaluation of kidneys
renal scan prep
radioactive isotope injected IV
measured by radioactivity counter
fluids forced before procedure
ultrasound (renal) purpose
images of renal structures obtained via sound waves
ultrasound (renal) prep
non invasive
full bladder required
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