Labs, Diagnostic, ADPIE & QSEN

CMP

• what does the Comprehensive Metabolic Panel (CMP) monitor?

Monitors basic metabolic panel (BMP) values, liver function, and protein status.

CMP

• when is a CMP typically ordered?

For thorough evaluation of liver disease, malnutrition, or to review medication side effects.

CMP

• Albumin: normal range, and causes of increase/decrease

Normal: 3.5-5.0, Increased: dehydration. Decreased: liver disease, malnutrition

CMP

• Total Protein: normal range, and causes of increase/decrease

Normal; 6-8, Increased: chronic inflammation. Decreased: malnutrition

CMP

• ALT: normal range, and causes of increase/decrease

Normal: 7-56. Increased: liver injury, hepatitis, alcohol, medications. Decreased: chronic kidney disease, malnutrition

CMP

• AST: normal range, and causes of increase/decrease

Normal: 10-40. Increased: liver injury, hepatitis, alcohol, medications. Decreased: chronic kidney disease, malnutrition.

CMP

• ALT and AST are both classified as what type of lab value?

liver enzymes - elevations typically signal liver damage or injury

BMP

• what does the Basic Metabolic Panel (BMP/Chem 7) evaluate?

Metabolism, kidney function, fluid/electrolyte balance, and glucose levels

BMP

• BMP is a routine test for which patient populations?

Hypertension (HTN) clients and Congestive Heart Failure (CHF) clients

BMP

• Sodium (Na+): normal range, function, and increase/decrease causes

Normal: 135-145. Function: regulates fluid balance/neuro function. Increased: dehydration. Decreased: fluid overload, SIADH

BMP

• Potassium (K+): normal range, function, and increase/decrease causes

Normal: 3.5-5.0. Function: cardiac/muscle function. Increased: kidney failure, medications. Decreased: diuretics, GI loss

BMP

• Glucose: normal range, and increase/decrease causes

Normal: 60-100. Increased: diabetes, stress, steroids. Decreased: hypoglycemia, fasting

CBC

• what does a Complete Blood Count (CBC) monitor and detect?

Monitors RBCs, WBCs, and platelets. Detects conditions like infection, anemia, and hematological disorders.

CBC

• WBC: normal range and function

Normal: 4,500-11,000. Function: immune response/fights infection

CBC

• WBC: causes of increase and decrease

Increased: infection, stress, leukemia. Decreased: immunosuppression, bone marrow failure, some viral infection

CBC

• Platelets: normal range and function

Normal: 140,000-400,000. Function: helps with blood clotting

CBC

• what is thrombocytosis and what does it indicate?

increased platelets - indicates clotting risk and inflammation

CBC

• what is thrombocytopenia and what does it indicate?

decreased platelets - indicates bleeding risk

CBC

• Hemoglobin (Hgb): normal ranges (M/F) and function

M: 14-17, F: 12-16. Function: O2-carrying protein, part of RBCs

CBC

• Hematocrit (Hct): normal ranges (M/F) and what it measures

M: 42-52%, F: 36-48% Measures percentage of RBCs in blood

CBC

• Hgb/Hct: causes of increase and decrease

Increased: dehydration, polycythemia. Decreased: anemia, bleeding

Coagulation

• what does INR stand for, and what is used for?

International Normalized Ratio - a standardized PT used to monitor warfarin therapy

Coagulation

• INR: normal range and increased/decreased meaning

Normal: 0.8-1.2. Increased: high bleeding risk, blood too thin (excess warfarin, liver disease). Decreased: high clot risk, blood too thick (inadequate anti coagulation.

Coagulation

• PT (Prothrombin Time): what does it measure, and normal range?

measures time to clot. Normal: 11-13 secs

Coagulation

• PT: causes of prolonged (increased) and short (decreased) results

Prolonged: high bleeding risk - liver disease, vitamin K deficiency, warfarin effect. Short: high clot risk - hypercoagulable state (less common)

Coagulation

• PTT (Partial Thromboplastin Time): what does it measures, and normal range?

Measures clotting time of plasma; monitors heparin therapy & bleeding disorders. Normal: 21-35 secs

Coagulation

• PTT: causes of prolonged (increased) and short (decreased) results

Prolonged: high bleeding risk - heparin therapy, clotting factor deficiencies. Short: high clot risk - possible hypercoagulable state

Coagulation

• which coagulation test monitors warfarin? Which monitors heparin?

Warfarin → PT/INR. Heparin → PTT

Imaging

• what does a CT scan visualize and detect?

Visualizes organs, bones, blood vessels. Detects injuries, trauma, bleeding, and other abnormalities

Imaging

• CT Scan: list 4 key preparation steps

1) Verify allergies (iodine, contrast, shellfish), premedicate if needed.

2) Assess renal function (BUN, creatine)

3) NPO - no solids day of study, clear liquids up to 2 hrs prior

4) Obtain informed consent (contraindicated in pregnancy

Imaging

• CT Scan: special considerations for diabetic patients and those on Metformin

Diabetes: notify radiology, schedule morning exam. Metformin: consult provider - may need to hold before/after scan

Imaging

• CT Scan: aftercare priorities

Monitor for contrast reactions/sensitivity, assess IV site (irritation, infection, bruising), observe for sedation effects until resolved

Imaging

• X-ray: what is it, and key prep/aftercare points?

Uses small amount of radiation, quick and noninvasive. Prep: remove metal objects, notify tech if pregnant. Aftercare: resume regular activity, typically no dietary restrictions

Imaging

• MRI: what does it use to create detailed images?

A superconducting magnet and radiofrequency signals to produce detailed anatomic views of tissue

Imaging

• MRI: what is an absolute contraindication and why?

Metal/implants (clips, pacemakers, pumps, cochlear implants) - contraindicated due to the strong magnetic field

Imaging

• MRI: other preparation considerations besides metal screening

Assess need for sedation (claustrophobia, inability to lie still), avoid in pregnancy (risk to fetus), obtain informed consent

Imaging

• MRI: aftercare priorities

Monitor for contrast reactions (if used), assess injection site, monitor until sedation wears off to prevent injury

Imaging

• Ultrasound: how does it work, and what is the prep requirement?

Uses ultrasound waves to visualize organs via a small transducer against the skin. Prep: NPO for a minimum of 8 hrs

Imaging

• Ultrasound: aftercare

Resume diet unless contraindicated by the specific test

Imaging

• Barium Study: what is it and how is it performed?

A series of radiographs examining the large intestines after rectal instillation of barium sulfate

Imaging

• Barium Study: prep steps and contraindications to screen for

Obtain informed consent, complete bowel prep and dietary restrictions. Review history for contraindications: ulcerative colitis, active GI bleed

Imaging

• Barium Study: aftercare and what to report

Encourage fluids, expect light-colored stools, use prescribed laxatives, promote rest (fatigue). Report if barium not passed within 2 days

Endoscopy

• what is an endoscope, and what is endoscopy used for?

A thin, flexible tube with a light and tiny camera. Used to diagnose GI problems, take tissue biopsies, and treat conditions (e.g., removing polyps, stopping bleeding)

Endoscopy

• gastroscopy (upper endoscopy): what does it examine?

esophagus, stomach, and upper small intestine

Endoscopy

• colonoscopy: what does it examine?

the large intestine/colon

Endoscopy

• bronchoscopy: what does it examine?

airways and lungs

Endoscopy

• cystoscopy: what does it examine?

bladder

Endoscopy

• endoscopy: preparation steps

NPO 6-8 hrs (prevents aspiration); bowel prep if colonoscopy (clear liquids + laxatives); hold/adjust anticoagulants & diabetes meds; consent + allergy/history check; start IV for sedation

Endoscopy

• endoscopy: immediate aftercare monitoring

Monitor VS, LOC, and O2 until awake; NPO until gag reflex returns (for upper endoscopy)

Endoscopy

• endoscopy: diet advancement and activity restriction after sedation

start clear liquids → advance diet as tolerated. No driving for 24 hrs after sedation

Endoscopy

• endoscopy: what symptoms are expected (normal) afterward?

bloating, gas, sore throat

Endoscopy

• endoscopy: which 4 symptoms must be reported immediately

severe abdominal pain, fever, bleeding (vomit or stool), chest pain or breathing issues

Stool Testing

• what does stool/fecal testing evaluate, and what can it detect?

Evaluates GI function. Detects infection (bacteria like Salmonella/ C. diff, parasites, viruses), blood (visible or occult), and fat content (malabsorption/steatorrhea)

Stool Testing

• stool sample collection: why have the client void first?

to prevent urine contamination of the stool specimen

Stool Testing

• stool sample collection: container and technique rules

Collect in a hat or designated container; avoid toilet paper in the specimen; notify staff promptly when specimen is available

Stool Testing

• stool sample collection: required specimen amount

1 mL of formed stool OR 30 mL of liquid stool, including any visible blood, mucus, or pus

Stool Testing

• FOBT: what does it stand for and how does it work?

Fecal Occult Blood Test (guaiac-based) - detects peroxidase activity of blood in stool

Stool Testing

• FIT: what does it stand for and how does it work?

Fecal immunochemical Test - more specific to human blood; the preferred test

Stool Testing

• FOBT vs FIT: which requires dietary restrictions, and what are they?

FOBT requires restrictions: avoid red meat (false +), avoid vitamin C (false -), avoid NSAIDs (can cause bleeding). FIT has NO diet restrictions - key difference

Stool Testing

• why is occult blood testing done? (2 main reasons)

Screen for colorectal cancer; detect GI bleeding (ulcers, polyps, inflammation)

Urinalysis

• what does a urinalysis (UA) assess?

Kidney function, hydration status, infection, and metabolic disorders

Urinalysis

• UA: what does the appearance evaluation look at?

color and clarity

Urinalysis

• UA dipstick: what does specific gravity indicate?

hydration status

Urinalysis

• UA dipstick: what does glucose in urine indicate?

diabetes

Urinalysis

• UA dipstick: what does protein in urine indicate?

kidney damage

Urinalysis

• UA dipstick: what do ketones in urine indicate?

starvation or diabetic ketoacidosis (DKA)

Urinalysis

• UA dipstick: what does blood in urine indicate?

bleeding

Urinalysis

• UA dipstick: what do leukocyte esterase & nitrites indicate?

infection

Urinalysis

• UA microscopic exam: what is checked for?

RBCs, WBCs, bacteria, crystals, and casts

Urinalysis

• Midstream/clean catch: what is its purpose?

to reduce contamination, especially important for UTI testing

Urinalysis

• midstream/clean catch: list the collection steps in order

1) cleanse area (front to back for females)

2) start urinating into the toilet

3) collect midstream urine in sterile cup

4) finishing voiding in toilet

Urinalysis

• midstream/clean catch: what is the key point about first and last urine?

The first and last urine discarded - only the midstream portion is collected and used

Urinalysis

• sterile specimen collection: when is it used?

When true sterility is required or contamination must be completely avoided - confirmed UTI diagnosis, critically ill patients, or when clean-catch is unreliable

Urinalysis

• catheterized specimen: where should it be obtained from?

From a sterile catheter or sampling port - NEVER from the drainage bag

Urinalysis

• straight catheterization (in-&-out)

a direct sterile bladder urine sample

ADPIE

• define the Nursing Process

a systematic, cyclic, and continuous method that directs the nurse, with patient participation, to accomplish goals (Taylor Table)

ADPIE

• what does ADPIE stand for?

assessment, diagnosis, planning, implementation, evaluation

ADPIE

• ADPIE - A: what does this step involve?

Collection, validation, and communication of patient data. Obtain/establish baseline data. Document accurately, completely, concisely, factually, and in a timely manner.

ADPIE

• ADPIE - D: what does this step involve?

Analysis of data to identify strengths and health problems nurses can address. Involves clinical judgement; focuses on the patient’s human response to disease (not to disease itself). Establishes nurse accountability

ADPIE

• ADPIE - P: what does this step involve?

Setting SMART goals (specific, measurable, attainable, relevant, time-bound). Prioritizing care, including patient input, and adjusting as the patient’s condition changes. Includes short-term vs long-term goals

ADPIE

• what does SMART stand for in goal planning?

specific, measurable, attainable, relevant, time-bound

ADPIE

• ADPIE - I: what does this step involve?

Preforming nursing interventions - includes direct care (e.g., wound care) and indirect care (e.g., coordination of services). Requires clinical judgement and knowledge within the nursing scope of practice.

ADPIE

• ADPIE - E: what does this step involve?

Measuring the extent to which the patient met goals (met/partially met/ not met). Reassessing, and deciding whether to modify or terminate the plan, or collaborate with others.

ADPIE

• what three words describe the overall nature of the nursing process?

systematic, cyclic, and continuous

Diagnosis Types

• what is the difference between a medical diagnosis and a nursing diagnosis?

A medical diagnosis names the disease. A nursing diagnosis describes the patient’s individual response to that disease.

Diagnosis Types

• Medical diagnosis: Pneumonia - what nursing problems might be identified?

Difficulty breathing, low O2 levels, fatigue

Diagnosis Types

• Medical diagnosis: Congestive Heart Failure (CHF) - what nursing problems might be identified?

Fluid build-up causing swelling, shortness of breath, activity intolerance

Diagnosis Types

• Medical diagnosis: Diabetes Mellitus - what nursing problems might be identified?

unstable blood sugar, possible poor wound healing, need for self-care education

Diagnosis Types

• Medical diagnosis: Hip Fracture - what nursing problems might be identified?

Limited mobility, pain, complications, from immobility (e.g., blood clot, skin breakdown)

Critical Thinking

• define critical thinking in nursing

Self-guided, self-disciplined thinking that requires intentional focus and work. It can be learned and improved upon.

Critical Thinking

• list at least 5 behaviors that demonstrate critical thinking

Question info instead of accepting it at face value; analyze data and look for patterns; recognize when something doesn’t make sense; consider multiple possible explanations; avoid assumptions and reflect before acting; weigh options and anticipate outcomes; adapt approach to the individual patient; use both evidence and experience; continuously monitor and adjust thinking

Critical Thinking

• define clinical reasoning

The use of the Nursing Process (systematic, cyclic, unending) powered by knowledge, skills, and attitudes

Critical Thinking

• clinical reasoning: what does the “knowledge” component ask?

what do I know/understand

Critical Thinking

• clinical reasoning: what does the “skills” component ask?

can I do this correctly?

Critical Thinking

• clinical reasoning: what does the “attitudes” component ask?

am I caring and safe?

Critical Thinking

• define clinical judgement per Tanner’s Model

The skill of recognizing cues, generating/weighing hypotheses, taking action, and evaluating outcomes for a satisfactory clinical result (Tanner’s model)

Critical Thinking

• what theory/model is referenced alongside Tanner’s for clinical judgement development (see syllabus)?

Benner’s Novice to Expert model

CJMM

• what does CJMM stand for and what is it used for?

clinical judgement measurement model - it is also the framework used to measure clinical judgement on the NCLEX

CJMM

• Tanner’s CJMM - ‘noticing’: describe this phase

Initial grasp of the situation. Involve focused observation, recognizing deviations from expected patterns, and info seeking

CJMM

• Tanner’s CJMM - ‘interpreting’: describe this phase

Attributing meaning to data through multiple reasoning patterns. Involves making sense of data and prioritizing data.