Testing and laboratory procedures

Clinical Laboratory Improvement Amendments (CLIA)

Federal standards that regulate laboratory testing, handling, and processing

Random urine:

A urine specimen collected in a clean container for screening purposes; no preparation is required

Clean-catch midstream:

a urine specimen that is collected in the middle of the urinary stream in a sterile container after perineal cleaning

What is the most common collected specimen in ambulatory care setting

urine

First morning specimen:

the patient collects the first specimen of the morning in a clean container. This specimen is more concentrated and used for pregnancy testing, or when other analytes (proteins, nitrites) need to be evaluated

Clean-Catch midstream

the patient performs perineal cleaning using moist wipes, begins to urinates, and then collects the specimen midstream in a sterile urine container. This specimen is used for cultures or when a nonctomtaimined specim is desired.

24-hour:

this method uses a container with preservatives. The patient discards the first morning specimen and collects all specimens for the next 24 hr, including the first void of the second day. This type of collection is important in quantitative analysis of components such as protein when analyzing kidney function

Catheterized collection:

this method is used when a sterile urine sample is needed or if patients are unable to provide a specimen on their own. It involves insertion of a sterile tube through the urethra into the bladder. This procedure is performed by the provider or nurse, with the medical assistant preparing the patient and assisting.

Quantitative:

analysis that identifies quantity or actual number counts

Fecal Occult Blood:

evaluation of a stool specimen for hidden blood

What does a fecal occult blood test require:

a stool specimen collection to screen for the presence of blood, which can indicate a disease process or gastrointestinal bleeding

Why are correct patient instructions imperative?

to ensure that false positive do not occur

Before collection specimen, patients should avoid food and medication for how many days?

3

What is the tape test used for?

detect pinworms

What are stool specimens for:

collected for parasites or to evaluate for bacterial infections

What does the ova and parasites test detect:

presence of parasites and their eggs

What are sputum specimens collected in?

sterile containers

What is important in obtaining a sputum specimen?

patient to produce deep, producitve cough

When are sputum specimens best collected?

in the early morning before eating or drinking

What should patients avoid prior to sputum collection?

mouthwash

Where are specimens for cultures collected in?

always sterile containers

What happens if the specimen is not properly collected?

the identification of the causative agent will not occur and proper treatment cannot be started

What are the 5 reminders for specimen collection?

-collect the specimen at appropriate time

-collect the specimen from the site of suspected infection

-minimize transport time to a reference lab

-collect the appropriate quantity

-use the appropriate containers and label them accordingly

What does the FDA require:

that all testing meet federal guidelines and determines the complexity of the tests performed in the laboratory

Qualitative:

analysis that identifies quality or characteristics of components such as size, shape, and maturity of cells; typically reported as positive or negative

Pregnancy testing:

urine is screened for the presence of human chorionic gonadotropin antibodies

Rapid streptococcus testing:

throat swabs are obtained to screen for Group A streptococcus

Dipstick, tablet, or multi-stick urinalysis:

The urinalysis is a screening tool for analytes that are excreted in the urine

Hemoglobin:

a machine is used to screen for the oxygen-carrying protein in whole blood, performed using capillary blood from a fingerstick

Spun hematocrit

Fingerstick collection of blood in microcapillary tubes is centrifuged and evaluated for the percentage of red blood cells

Blood glucose:

whole blood is analyzed in a glucometer for quantitative glucose level and is a screening test for diabetes, performed using capillary blood from a finger stick

Hemoglobin A1c

This capillary blood test shows diabetes control over an approximate 3 month period

Cholesterol testing:

Lipids are evaluated using capillary blood

Helicobacter pylori:

a blood sample screens for H. pylori, which is the main cause of gastric ulcers

Mononucleosis screening:

this screening tool tests for the presence of the Epstein-Barr virus in capillary blood

Nasal smear for influenza types A and B

This screening is a qualitative test for influenza antigens using a swab that is inserted into the nostril

Drug testing:

Substances can be detected in urine and blood samples

Fecal Occult Blood:

this test is performed to screen for hidden blood in the stool

The CLIA was established in 1988 to:

ensure quality of diagnostic testing through laboratory regulations

How many designations are there for laboratory testing based on complexity?

3

What is the most common designation of ambulatory care and is the lowest level of complexity

CLIA-waived

What test are considered nonwaived:

Moderate-and High-complexity

Provider-performed microscopy procedure:

a CLIA term for microscopic examinations that require the expertise of a physician or mid level proivder qualified in micrsocpic examination; falls under CLIA's moderate compelxity category

Commission on office laboratory accreditation (COLA)

an independent firm that provides accreditation for laboratories and has a goal of meeting CLIA standards

quality assurance:

policies and procedures to maximize patient safety and ensure reliability related to laboratory testing

Quality control:

measures incorporated to maximize reliability and accuracy of results while recognizing and eliminated errors in testing

Forced expiratory volume:

the amount of air that can be forcibly exhaled

Radioallergosorbent test (RAST)

A blood test used to detect antibodies associated with allergens

Ishihara test:

A set of templates with patterns or numbers embedded within them to test for color blindness

Tympanometry:

The process of recording the movement of the tympanic membrane through pressure variances in the external ear canal

Critical value:

A laboratory result that is outside of the established reference range and presents potential health risks to a patient

Hyperopia

difficult seeing things up close; farsightedness

Myopia

difficult seeing things far away; nearsightedness

Presbyopia:

a gradual, age-related loss of they eyes' ability to focus actively on nearby objects

Chain of custody:

A series of processes and procedures used to ensure security and accuracy

Panel:

a group of tests that are connected to one particular body system; profile

Controls:

specific tools used in the laboratory with a known result, used to compare with results of a patient sample to confirm validity of the test and specimen

What information is required when labeling specimens;

-patients name

-date and time of collection

-patients DOB

-providers name

-initials of person collecting specimen

What are the safety measures when transporting non blood specimens:

padding and protection from leakage

-when transported via mail, use a biohazard identification on the outside of the package

How to use a near vision acuity chart:

Ask patients to read printed materials 14 to 16 inches away from eyes without corrective lenses, testing each eye separately and then together. The result is the level at which the patient reads the smallest print clearly.

Normal adult hearing:

Should hear up to 25 decibels

Normal child hearing

Should hear up to 15 decibels

Catheterized urine collection:

Nurse or provider inserts a sterile tube through the urethra into the bladder.

How to perform a tape test:

Provide parents with slide with a piece of tape. Tape is placed over child's anus before getting up in the morning, then back on slide

Tympanometry

The process of recording the movement of the tympanic membrane through pressure variances in the external ear canal

What are the two most common noninvasive methods:

spirometry and peak flow meter testing

What can the peak flow test:

monitor lung function in the home, especially for patients who have chronic respiratory diseases such as asthma

What does the peak flow meter measure:

the forced expiratory volume, which indicated the effectiveness of airflow out of the lungs

Spirometry:

An automated test that produces graphic result

How should the patient take a spirometry test:

-wear loose clothing

-sit in an upright or standing position

-breath through the mouth

-pursing the lips around mouthpiece

What should the patient do during the spirometry test to reduce breathing resistance?

the patient should lift the chin slightly and extend the neck

What is required in pretest preparation:

-no large meals 2 hours before the test

-no smoking 1hr before test

-discontinuing the use of bronchodilators or other breathing therapies for at least 6hrs before the test

How to take the Peak Flow test

-wear nonrestrictive clothing

-begin with marker at the bottom of the scale on the meter

-upright or standing position, take a deep breath and blow out the mouth

-record the \# where the marker is located

-repeat test 2-3 times

Challenge testing is used to:

detect specific allergies, such as food allergies

What happens during food challenges test

the patient receives increasing amounts of food suspected of causing an allergy

What test requires a blood draw, but safer regarding avoiding a potential allergic reaction

Radioallergosorbent

What can be indetified as an allergen

if a wheal becomes infected with induration (raised, hard area)

The \_____the wheal, the more significant the allergy

larger

Where is skin testing usually performed

forearm or the back

how far do patients stand from a chart at eye level during a distance vision test:

20 feet

How many items can a patient miss and still pass that line during an eye test?

one

what is normal vision:

20/20