Laboratory and diagnostic studies are essential components of a complete patient
assessment. Examined in conjunction with an individual’s history and physical examination,
laboratory and diagnostic data provide clues about health status. Nurses
are increasingly expected to integrate an understanding of laboratory and diagnostic procedures
and expected outcomes in assessment, planning, implementation, and evaluation of
nursing care. The data help develop and support nursing diagnoses, interventions, and
outcomes.
Nurses may interface with laboratory and diagnostic testing on several levels,
including:
• Interacting with patients and families of patients undergoing diagnostic tests
or procedures, and providing pretest, intratest, and post-test information and
support
• Maintaining quality control to prevent or eliminate problems that may interfere
with the accuracy and reliability of test results
• Ensuring completion of testing in a timely and accurate manner
• Collaborating with other health care professionals in interpreting findings as
they relate to planning and implementing total patient care
• Communicating significant alterations in test outcomes to other appropriate
health care team members
• Coordinating interdisciplinary efforts
Whether the nurse’s role at each level is direct or indirect, the underlying responsibility
to the patient, family, and community remains the same.
This book is a reference for nurses, nursing students, and other health care professionals.
It is useful as a clinical tool as well as a supportive text to supplement clinical
courses. It guides the nurse in planning what needs to be assessed, monitored, treated,
and taught regarding pretest requirements, intratest procedures, and post-test care. It
can be used by nursing students at all levels as a textbook in theory classes, integrating
laboratory and diagnostic data as one aspect of nursing care; by practicing nurses, to
update information; and in clinical settings as a quick reference. Designed for use in
academic and clinical settings, Davis’s Comprehensive Handbook of Laboratory and
Diagnostic Procedures—with Nursing Implications provides the user with a comprehensive
reference that allows easy access to information about laboratory and diagnostic
tests and procedures. A general overview of how all the tests and procedures included
in this book relate to body systems can be found in tables at the end of the mono-
ABOUT THIS BOOK
vii
graphs. All tests and procedures are listed in alphabetical order by their complete
name, allowing the user to locate information quickly without having to place tests in
a specific category or body system. Each monograph is presented in a consistent format
for easy identification of specific information at a glance. The following information
is provided for each laboratory and diagnostic test:
• Test Name for each monograph is given as a commonly used designation, and
all test monographs in the book are organized in alphabetical order by name.
• Synonyms/Acronyms for each test are listed where appropriate.
• Specimen Type includes the amount of specimen usually collected and, where
appropriate, the type of collection tube or container commonly recommended.
Specimen requirements vary from laboratory to laboratory. The
amount of specimen collected is usually more than what is minimally
required so that additional specimen is available, if needed, for repeat testing
(quality control failure, dilutions, or confirmation of unexpected results). In
the case of diagnostic tests, the type of test procedure (e.g., nuclear medicine,
x-ray) is given.
• Reference Values for each monograph include age-specific and gender-specific
variations, when indicated. It is important to give consideration to the
normal variation of laboratory values over the life span and across cultures;
sometimes what might be considered an abnormal value in one circumstance
is actually what is expected in another. Reference values for laboratory tests
are given in conventional and standard international (SI) units. The factor
used to convert conventional to SI units is also given. Because laboratory
values can vary by method, each laboratory reference range is listed along
with the associated methodology.
• Description & Rationale of the study’s purpose and insight into how and why
the test results can affect health are included.
• Indications are a list of what the test is used for in terms of assessment, evaluation,
monitoring, screening, identifying, or assisting in the diagnosis of a
clinical condition.
• Results present a list of conditions in which values may be increased or
decreased and, in some cases, an explanation of variations that may be
encountered.
• Critical Values, or findings that may be life-threatening or for which particular
concern may be indicated, are given along with age span considerations
where applicable. This section also includes signs and symptoms associated
with a critical value as well as possible nursing interventions.
• Interfering Factors are substances or circumstances that may influence the
results of the test, rendering the results invalid or unreliable. Knowledge of
interfering factors is an important aspect of quality assurance and includes
pharmaceuticals, foods, natural and additive therapies, timing of test in relation
to other tests or procedures, collection site, handling of specimen, and
underlying patient conditions.
• Nursing Implications and Procedure provides an outline of pretest, intratest,
and post-test concerns.
• Pretest section addresses the need to:
viii About This Book
• Obtain pertinent clinical, laboratory, dietary, and therapeutic history of
the patient, especially as it pertains to comparison of previous test
results, preparation for the test, and identification of potentially interfering
factors.
• Understand the interrelationship between various body systems. In this
section, the reader is informed of the body systems that may be involved
in the study of interest and is referred to system tables where related
studies are alphabetically cross-referenced.
• Explain the requirements and restrictions related to the procedure as well
as what to expect; provide the education necessary for the patient to be
properly informed.
• Anticipate and allay patient concerns or anxieties.
• Provide for patient safety.
• Intratest section can be used in a quality control assessment by the nurse or as
a guide to the nurse who may be called on to participate in specimen collection
or perform preparatory procedures and gives:
• Specific directions for specimen collection and test performance.
• Important information such as patient sensation and expected duration
of the procedure.
• Precautions to be taken by the nurse and patient.
• Post-test section provides guidelines regarding:
• Specific monitoring and therapeutic measures that should be performed
after the procedure (e.g., maintaining bed rest, obtaining vital signs to
compare with baseline values, signs and symptoms of complications).
• Specific instructions for the patient and family, such as when to resume
usual diet, medications, and activity.
• General nutritional guidelines related to excess or deficit as well as
common food sources for dietary replacement.
• Indications for interventions from public health representatives or for
special counseling related to test outcomes.
• Indications for follow-up testing that may be required within specific
time frames.
• Related tests for consideration and evaluation, an alphabetical listing of
related laboratory and/or diagnostic tests that is intended to provoke a
deeper and broader investigation of multiple pieces of information; the
tests provide related data that, when combined, can form a more
complete picture of health or illness.
Color and icons have been used to facilitate locating critical information at a glance.
The nursing process is evident throughout the laboratory and diagnostic monographs.
Within each phase of the testing procedure, the nurse has certain potential
roles and responsibilities. These should be evident in reading each monograph.
Information provided in the appendices includes a summary of specimen collection
procedures and materials, describing specific tube tops used for various blood tests and
their recommended order of draw; a summary chart of transfusion reactions, their
signs and symptoms, associated laboratory findings, and potential nursing interventions;
an introduction to CLIA with an explanantion of the different levels of testing
About This Book ix
complexity; a summary chart that details suggested approaches to persons at various
developmental stages to assist the provider in facilitating cooperation and understanding;
a list of some of the herbs and nutraceuticals that have been associated with
adverse clinical reactions or have been associated with drug interactions related to the
affected body system; and guidelines for Standard and Universal Precautions.
Finally, additional supportive materials are provided for the instructor and student
in an Instructor’s Guide. Presentations and case studies with emphasis on laboratory and
diagnostic test–related information and nursing implications have been developed for
selected conditions and body systems. Open-ended and NCLEX-type, multiple-choice questions are provided as well as suggested critical thinking activities. This supplemental
material will aid the instructor in integrating laboratory and diagnostic materials in assessment and clinical courses and provide examples of activities to enhance student learning.