The authors would like to thank all the users of the previous editions for
helping us identify what they like about this book as well as what might
improve its value. We want to continue this dialogue. As writers, it is our
desire to capture the interest of our readers, to provide essential information,
and to continue to improve the presentation of the material in the book and
ancillary products. We encourage our readers to provide feedback to the Web
site and to the company's sales professionals. Your feedback helps us modify
the material—to change with your changing needs. Several new monographs
have been added: urea breath test, anti-cyclic citrullinated peptide
antibodies, and fluorodeoxyglucose PET scan. Monographs have been
expanded to include additional information, for example: US OB biophysical
profile, amniotic fluid analysis, and creatinine/eGFR. Some monographs have
been combined to consolidate similar tests and a few less frequently used
tests have been condensed into a mini-monograph format that highlights
abbreviated test-specific facts, with the full monographs for those tests now
resident on the DavisPlus Web site (http://davisplus.fadavis.com). The names
of some test monographs have been changed to assist the reader in locating
them more easily. For example, the tests that relate to the complete blood
count have been renamed to begin with CBC, “test name” (CBC, hemaglobin;
CBC, red blood cell count; etc.), so they are grouped together alphabetically
in the text; the individual tests are also listed separately under their own
names in the index. All of these changes have been made in response to
feedback from our readers.
The authors have taken care to especially enhance four areas in this new
edition: pathophysiology that affects test results, patient safety, patient education,
and integration of related laboratory and diagnostic testing. First, the
result section has been expanded to include an explanation of increased or
decreased values, as many of you requested. Second, the authors appreciate
that nurses are the strongest patient advocates with a huge responsibility to
protect the safety of their patients, and we have observed student nurses in
clinical settings being interviewed by facility accreditation inspectors, so we
have integrated a number of reminders that parallel the Joint Commission’s
national patient safety goals. The pretest section reminds the nurse to positively
identify the patient before beginning a procedure, administering medications,
etc. The pretest section also addresses hand-off communication of
critical information. The third area of emphasis is that each monograph
coaches the student to focus on patient education and prepares the nurse to
anticipate and respond to a patient’s questions or concerns; from describing
the purpose of the procedure, addressing concerns about pain, understanding
the implications of the test results, and describing postprocedural care.
Various related Web sites for patient education have been included throughout
the book. And fourth, laboratory and diagnostic tests do not stand on
their own—all the pieces fit together to form a picture. The section at the end
of each monograph that lists related tests by modality has been changed to
integrate both laboratory and diagnostic tests. The authors thought it might be
more useful for a nurse to know what other tests might be ordered together—and all the related tests are listed alphabetically for ease of use.
To make sure that we remain on target with each revision, we submit
the manuscript to a thorough review process. Our reviewers look at the
manuscript from both the nursing perspective and the technical perspective,
and the insights they provide help mold every edition, but this edition’s
review was particularly extensive and rigorous. To see the full list of reviewers
who participated in the process, go to http://davisplus.fadavis.com.
Now—more about the details of this book—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 Tests—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 monographs. The tests and procedures are presented in this
book in alphabetical order by their complete name, allowing the user to locate
information quickly without having to first 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 procedure (e.g., nuclear medicine,
x-ray) is given.
• Reference Values for each monograph include age-specific and genderspecific
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:
• 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 body system tables where
correlated laboratory and diagnostic studies are alphabetically listed.
• 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.
• Reference to the specific body system tables of related laboratory and
diagnostic tests that might bear on a patient’s situation.
Color and icons have been used to facilitate locating critical information at
a glance. On the inside front and back covers is a full color chart describing
specific tube tops used for various blood tests and their recommended order
of draw.
The nursing process is evident throughout the laboratory and diagnostic
monographs. Within each phase of the testing procedure, the nurse has certain
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; a summary chart of transfusion reactions,
their signs and symptoms, associated laboratory findings, and potential nursing
interventions; an introduction to CLIA (Clinical Laboratory Improvement
Amendments) with an explanation of the different levels of testing 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.
This book is also about teaching. Additional educationally supportive
materials are provided for the instructor and student in an Instructor’s Guide,
available on the Instructor’s Resource Disk (CD) and posted to DavisPlus
(http://davisplus.fadavis.com). Organized by nursing curriculum, 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; new to this edition is the sensory, obstetric, an
nutrition coverage. 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.
Newly developed for this third edition is a robust collection of online
material for students and educators posted to the DavisPlus Web site
(http://davisplus.fadavis.com) including:
• a searchable library of mini-monographs for all the active tests included in
the text itself. The mini-monograph gives each test’s full name, synonyms/
acronyms, specimen type (laboratory tests) or area of application (diagnostic
tests), reference ranges or contrast, and results
• an archive of full monographs of retired tests that are referenced by minimonographs
in the text
• interactive drag and drop, quiz show, flash card, and multiple-choice
exercises
• a printable file of critical values
• a printable table of monograph template section titles matched to corresponding
national patient safety goals
• all the instructor and student material from the Instructor’s Resource Disk.
The authors hope that the changes and additions they’ve made to the book
and its CD- and Web-based ancillaries will reward users with an expanded
understanding of and appreciation for the place laboratory and diagnostic testing
holds in the provision of high-quality nursing care as well as made it easy
for instructors to integrate this important content in their curricula.