CHAPTER 22
Review of Laboratory Values and Diagnostic Tests
LEARNING OUTCOMES
Upon completion of this chapter, the nurse will:
1. Summarize the types of diagnostic and laboratory tests appropriate for reporting through telephonic care
2. Analyze ways to discuss the importance of diagnostic and laboratory tests with clients
3. Strategize approaches to enhance client adherence to diagnostic and laboratory testing regimens
IMPORTANCE OF LABORATORY AND DIAGNOSTIC TESTS
Diagnostic and laboratory testing is an integral part of telephonic nursing care. These tests are used to:
Identify participation in disease management programs
Evaluate compliance with the prescribed treatment plan
Analyze the impact of teaching interventions on client health status
This chapter is not to replace any diagnostic and laboratory textbooks but rather is intended to highlight diagnostic and laboratory tests that you might most frequently encounter when providing telephonic care.
TYPES OF DIAGNOSTIC TESTS
Generally, a client in a wellness program will not be scheduled or reporting the results of diagnostic testing unless a symptom or problem occurs. The types of tests prescribed for the client will be closely associated with a suspected disease process and used to either rule out a problem or confirm the diagnosis. The following table categorizes the types of diagnostic tests that you might need to explain when conducting telephonic care. Keep in mind when explaining a diagnostic test that the most basic language and terms should be used. The associated teaching column in the table provides suggestions to use when explaining the test.
Health Problem | Diagnostic Test | Associated Teaching |
Integumentary disorders | Biopsy | Takes a piece of the skin and tests it for infections |
Respiratory disorders | Pulmonary function tests | Checks to see how much obstruction or constriction is in the lungs |
| Bronchoscopy | Examines the lungs and breathing airway to check for obstructions/tumors or bleeding |
| Chest x-ray | Looks at the major structures in the chest in relation to the location of the lungs |
Cardiovascular disorders | EKG | Examines the electrical activity of the heart |
| Echocardiogram |
|
| Cardiac catheterization | Checks the arteries and other structures in the heart |
| Venogram/Doppler studies | Uses sound waves to check for any blood clots in the blood vessel |
| Stress/treadmill test | Determines the function of the heart during exercise |
Gastrointestinal (GI) disorders | Abdominal x-ray | Checks for any blockages or if there is free air in the bowel |
| Abdominal ultrasound | Checks the structures in the abdomen to include the pancreas, liver, and gallbladder for any blockages, stones, or masses |
| Endoscopy | Looks at the esophagus and the lining of the stomach to check for ulcers or tumors |
| Colonoscopy | Looks at the lining and structure of the colon to check for polyps, ulcers, or tumors |
| Upper GI/barium swallow | By drinking barium, the lining of the stomach and small intestine are examined for ulcers or blockages |
| Lower GI/barium enema | By using barium through an enema, the lining of the large intestine is examined for ulcers or blockages |
| Liver biopsy | Takes a small piece of the liver to check it for any problems with function |
Musculoskeletal disorders | X-rays | Looks for any breaks in the bones |
| CT scan/MRI | Looks for any problems within the bones like a mass/tumor |
| Arthroscopy | Looks at the structures associated with a joint for any breaks or tears in the tissue around the joint |
Neurologic disorders | Electromyogram/nerve conduction studies (EMGS/NCVs) | Checks the electrical activity generated by the nerves that feed the muscles |
Myelogram |
| |
| CT scan/MRI | Looks at the brain and spinal cord for any problems with blood flow, broken skull bones, broken spinal bones, and if there are any masses/tumors or bleeding |
Sensory disorders | Tonometry | Checks for the amount of pressure within the eyes |
| Audiometry | Tests for hearing |
Genitourinary disorders | CT scan of the kidneys | Checks for any problems with blood flow to the kidneys or if there are any masses/tumors/kidney stones |
| Cystoscopy | Looks directly at the bladder to check for any irritation or masses/tumors |
| Intravenous pyelogram | Injects dye to look at the kidneys and check for stones |
| Renal biopsy | Takes a piece of the kidney to check for a specific disease |
| Prostate biopsy | Takes a piece of the prostate to check for diseases |
| Prostate ultrasound | Checks to see the size of the prostate and if the enlargement is pressing on any other body tissues |
| Breast biopsy | Takes a piece of the breast tissue to check if a swelling/mass is cancerous |
| Breast ultrasound | Uses sound waves to look at a breast mass to see if it is solid or filled with fluid (cyst) |
| Laparoscopy | Looks at the organs in the (female) abdomen to check for location, swellings/masses, or blockages |
| Mammogram | Looks at the structures within the breasts to check for masses/tumors |
TYPES OF LABORATORY TESTS
The volume of laboratory tests that could be prescribed and reported on by the client receiving telephonic care can be quite lengthy. Oftentimes, the client is unaware of what is being tested and will ask you why something was being done. The following table provides a general list of laboratory tests that may be prescribed for the clients receiving telephonic care.
CLIENT ADHERENCE
No one likes to have blood drawn or have to place a small amount of body fluid into a cup. Scheduling for diagnostic tests can be a nightmare if work schedules need to be changed or there are issues with child care. But, ongoing diagnostic or laboratory testing is essential when evaluating the effectiveness of telephonic care.
Yes, having to collect specimens or arrive to an outpatient facility for testing is an inconvenience to the client, but the alternative could be hospitalization or surgery. Clients need to be encouraged to keep scheduled appointments for blood work, especially if medication dose adjustments will be made.
One of your many roles when contacting the clients is to:
Remind them to schedule a blood test
Keep an appointment for a blood test
Schedule a follow-up appointment with the health care provider to receive blood test results
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