NF2 Module 6

Diagnostic Values & Specimen Collection

Diagnostic tests
1. Diagnosis/Prognosis
o Guide treatment choice
2. Baseline Data
3. Monitor Response
4. Screening
Culture & Sensitivity
Culture = identifies presence of pathogens (bacterial, fungal)
Sensitivity = identifies antibiotic to best treat identified pathogen
Types of samples collected for C&S
• Sputum • CSF • Tip of
• Fluid from • Stool catheters/drains
surgically inserted • Cervical (urinary and
drains • Blood central)
• Urine • Wounds swabs

Must be collected using sterile technique to avoid contamination of sample

Sputum collection
 The sputum should be the result of a deep
cough, not saliva
 The patient should cough the sputum
directly into the sterile container
 Collect an early morning specimen BEFORE
breakfast

Don Appropriate PPE

Cytology: to identify abnormal cancer and different types of cancer cells

Urine collection types

1. Random specimen or urinalysis
 Collected in a clean specimen cup
 Can be collected during normal voiding, from an in-dwelling catheter or a urinary
diversion
 E.g., Routine urinalysis, urine electrolytes
2. Clean-voided or midstream specimen
 Collected in a sterile specimen cup
 If the patient has an indwelling catheter, aseptic technique used
 Culture & Sensitivity
3. Timed urine specimen
 Collected in a clean container and transferred to a large collection container, usually kept
on ice in patient's bathroom
 2, 12, or 24-hour urine for creatinine clearance, protein, cortical steroids/hormones

Complete Blood Count (CBC)

 Erythrocytes  Coagulation studies
 RBC ratios  Liver enzymes
 WBC differential  Total Serum Protein
 Platelets  Electrolytes
CBC: Erythrocytes
 Red Blood Cells (RBC)/Erythrocytes
o Carry oxygen through the body and filter the carbon dioxide from the body
back to the lungs.
o Low erythrocytes o High erythrocytes
 Anemia  Dehydration
 Leukemia  High altitudes
 Hemorrhage  Polycythemia/
 Renal failure sever diarrhea

CBC: Red blood cell ratios

 Hematocrit (Hct)
o represents the % of RBCs in the total blood volume
 Low
o low levels of iron or other condition
 High
o sign of dehydration or other condition
 Hemoglobin (Hgb)
o binds to oxygen. Hgb value provides an indication of the blood’s ability to
carry oxygen throughout the body.

CBC: WBC differential

 White Blood Cells (WBC)/Leukocytes
o help fight infection
o If high, there may be inflammation or infection in the body
o There are 5 main types of leukocytes:
1. NEVER - Neutrophils: first line of defense against acute bacterial
infections
2. LET - Lymphocytes: chronic infections/viral
3. MONKEYS - Monocytes: acute infections/chronic inflammation
4. EAT - Eosinophils: allergic reactions
5. BANANAS - Basophils: hypothyroidism, myeloproliferative diseases
CBC: Platelets
 Platelet/thrombocytes
o Major role in clotting; when bleeding occurs, the platelets swell, clump together, and
form a sticky plug that helps stop the bleeding.
 High = risk for clotting (stroke, MI)
 Low = risk for bleeding (hemorrhage)
Plasma
the liquid portion of blood, which contains/carries to the body:
 Clotting factors  Hormones
 Enzymes  Electrolytes
 Proteins
Coagulation studies
 Coagulation tests measure how long your blood takes to clot.
 Patients who may need coagulation tests are:
o Patients with or at risk of deep vein thrombosis, pulmonary embolism,
myocardial infarction, atrial fibrillation, and undergoing dialysis
o Patients on anticoagulants (warfarin, heparin, clotting factor inhibitors)
 Activated Partial Thromboplastin Time (aPTT)
o Increased in patients on heparin therapy, hemophilia, liver disease, and
deficiency of certain clotting factors because the blood takes longer to clot in
these patients
o Normal PTT is 60-70 seconds
 Prothrombin Time (PT)/International Normalize Ratio (INR)
o Increased in patients with liver disease, warfarin therapy, vitamin K deficiency,
and deficiency of certain clotting factors (different than aPTT) because the blood
takes longer to clot in these patients
o INR is calculated from PT, measures how well the blood-thinning medication
warfarin (Coumadin®) is working to prevent blood clots
o Normal INR is 0.8-1.2, INR for a patient on coumadin 2-3
o If a patient is anticoagulated, then the target INR will be above normal
range because we want to avoid the blood clotting too easily (contraindication
for surgery)
 D-Dimer
o Increased in patients with clotting disorders.

You may need this test if:

- You have symptoms of a bleeding or clotting disorder
- You have liver disease
- You are taking Warfarin (PT/INR) or heparin (PTT)

Potter et al., 2019, p. 1433

Liver enzymes
 Liver function tests measure the levels of specific enzymes and proteins in the blood
which can indicate liver damage.
 Alanine transaminase (ALT) Normal ange 17-63 UI/L
o Increased ALT levels can be a sign of liver damage
 Aspartate aminotransferase (AST), Normal range 15-37 UI/L
o Increased AST levels may indicate problems with the liver or muscles
 Alkaline phosphatase (ALP), Normal range 50-136 IU/L
 Increased ALP indicates liver disease or certain bone disorders

 Bilirubin
 o Found in bile and processed by the liver, it is a yellow-coloured waste product
from RBC breakdown
o Bilirubin build up causes jaundice to patients

Total serum protein

 Protein in the plasma is the most significant factor that determines the oncotic
pressure within the intravascular space.
o If there is an imbalance in the amount of protein in the blood, fluid shifts and
imbalances will ultimately follow
 Total serum protein measures the total protein in the total blood volume (primarily
albumin and globulin) and provides an albumin/globulin (A/G) ratio.
 Albumin
o Large protein made in the liver that maintains colloidal osmotic pressure carries
medicine and hormones throughout the body; helps with tissue growth and
healing.
 Globulin
o a group of proteins that help fight infection and transport nutrients.

Electrolytes
 Sodium:
o The most abundant cation in extracellular fluid
o Exerts the greatest influence on the extracellular fluid osmotic concentration and
water balance
o Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
 Potassium:
o The major electrolyte and principal cation in the intracellular compartment.
o Regulates many metabolic activities and is necessary for glycogen deposits in the
liver and skeletal muscle, transmission and conduction of nerve impulses, normal
cardiac conduction, and skeletal and smooth muscle contraction.
 Calcium:
o Stored in bone, plasma, and body cells (99% located in bone)
o Necessary for bone and teeth formation, blood clotting, hormone secretion,
cell membrane integrity, cardiac conduction, transmission of nerve impulses,
and muscle contraction.
 Magnesium:
o The second most abundant intracellular ion.
o Essential for intracellular activities (i.e., enzyme reactions), bone structure
and neuromuscular function.

Read Table 40-4: p. 1023 Electrolyte imbalance, causes, and signs and symptoms

Sending specimens to lab

What information needs to be included on the specimen container?
  client identification  type of specimen collected (on
 specimen source requisition)
 date and time of collection  healthcare professional signature
Critical lab results
 The lab will identify and alert healthcare providers about critical high and critical low lab
values
 **To be reported as soon as the result is available**
 Critical values/results
o Vary from the normal range
o Have the potential to be life-threatening
o Provide information to determine appropriate corrective action

Critical Testing in the Community

if-lab-tc-cal-stat-testing-calgary.pdf (albertahealthservices.ca)