| A | B |
|---|
| Serum albumin and total protein | 3.5–5.0 g/dL. / 6.0–8.0 g/dL Used to assess general nutritional status and liver function. Requires no special precautions or fasting. Levels are lower during pregnancy or prolonged bed rest. |
| Serologic H.pylori testing | No detectable antibody Positive result indicates presence of antibodies to this bacteria; may or may not indicate current infection. No special precautions or fasting required. |
| Stool specimen for ova and parasites | None present Used to detect the presence of infective organisms. Avoid contamination of the specimen with urine,use a clean bedpan or collection device; instruct client to avoid mixing stool with urine or toilet tissue. |
| Stool for occult blood | None Used to assess for gastrointesti- nal (GI) bleeding Requires a single,random stool specimen. Client may be advised to refrain from eating meats,poultry,and fish for 2–3 days before the test. |
| Fecal fat | Neutral fat:less than 50 globules/HPF Fatty acids:less than 100 globules/HPF Used to confirm steatorrhea (impaired fat absorption) Requires either random stool specimen or 24–72 hour stool specimen. Client may be instructed to eat a high-fat diet for 3 days before testing. |
| Liver Function Tests Alanine aminotrans- ferase (ALT or SGPT) Aspartate amino- transferase (AST or SGOT) Alkaline phos- phatase (ALP) Gamma-glutamyl- transferase (GGT), Serum bilirubin, Urobilinogen (Urine) | Used to assess liver function, evaluate clients with jaundice, and detect liver disease such as hepatitis,alcoholic cirrhosis. Fasting is required for the bilirubin; samples for other liver function studies may be drawn without fasting.Water is permitted. |
| Urobilinogen (Urine) | Random:negative 2-h specimen:0.3–1.0 Ehrlich units 24-h:0.5–4.0 mg/24 h (Ehrlich units/24 h) Used as a sensitive indicator of liver damage,hemolysis,or severe infections. No food or fluid restriction required. May require a 2-hour or 24-hour urine specimen (see Box 28-3 on page 734) |
| Pancreatic Function Tests:Urine amylase | 24–37 units/12 hUsed to help diagnose pancreatitis. Requires a 2-hour or 24-hour urine specimen. No food or fluid restrictions necessary |
| Pancreatic Function Tests:Serum amylase, Serum lipase, Urine amylase | Adult:60–160 units/L, Adult:20–180 units/L. Elderly:slightly higher, Used to assess pancreatic and salivary gland function and to monitor treatment of pancreatitis. |
| Gastric analysis | Used to assess hydrochloric acid secretion and for the presence of H.pylori in the stomach.The sample is collected via nasogastric tube or during endoscopy.A drug to stimulate gastric acid secretion may be given during the test. Food, fluids, smoking, chewing gum, and some drugs are withheld for 8–12 hours before the test. Insert a naso- gastric tube per institutional procedure and collect samples as ordered. Observe for and take precautions to prevent aspiration during tube insertion or during the test. Inform the client about possible discomfort with tube insertion, the length of the test, and the procedure itself. |
| Urea breath test | Used to detect infection with H.pylori bacte- ria.Radio-tagged urea is administered orally.If H.pylori is present,exhaled ammo- nia and carbon dioxide can be measured. Food and fluids are withheld for 4 hours before the test.Instruct to avoid using antacids,bismuth sulfate, antibiotics,and omeprazole (Prilosec) for 2 weeks before testing. |
| Ambulatory pH monitoring | Used to diagnose gastrointestinal reflux.A pH electrode inserted through the nose into the esophagus is connected to a data recorder worn on the belt.Recorded data are later analyzed by computer. Teach per protocol about caring for the electrode and data recorder. |
| Esophageal acidity,acid perfusion (Bernstein test) | Used to measure esophageal acidity and identify gastric acid reflux. Food and fluids are withheld for 8 to 12 hours before the test. Place the client in high Fowler’s position. For the esophageal acidity test,a catheter with a pH probe is inserted through the nose into the esophagus. The probe is secured and connected to a recorder.The client records symptoms and activities for a 24-hour period. For the acid perfusion test,a catheter is inserted through the nose into the esophagus.Dilute hydrochloric acid is instilled through the catheter until the client devel- ops pain; normal saline is then is instilled. |
| Esophageal manometry | Measures pressures of the esophageal sphincters and esophageal peristalsis. Food and fluids are withheld for 8 hours before testing; some medications may be withheld as well.Gagging may occur during tube insertion;instruct the client to breathe through the mouth to control.The test takes about an hour to complete. |
| Paracentesis | An invasive procedure used to detect bleeding,contamination,or infection in the peritoneal cavity. Withhold food and fluids as directed before the test. Explain that local anesthesia will be used,so it should not be painful; pressure will be felt,however,when the needle is inserted into the abdomen,.Obtain baseline weight and vital signs.Instruct to void immediately before the test.Position seated with feet supported. Place a dressing over the puncture wound and moni- tor vital signs and wound drainage after the proce- dure.Label specimens and send with completed requisitions to the laboratory. |
| Ultrasonography Abdominal ultrasound Gallbladder ultrasound Liver echogram | Echoes from high-frequency sound waves are used to detect and evaluate abdominal disorders,detect masses,and screen for abdominal aneurysms.Can detect gall- stones and evaluate gallbladder emptying. Noninvasive. Often performed at the client’s bedside.Food and fluids are withheld for 8 hours before the exam;cleansing enemas or other bowel preparation may be ordered. Advise the client that this test is not painful and gener- ally is completed in 30 minutes or less |
| Abdominal x-ray (flat plate of the abdomen) | Used to evaluate abdominal pain,detect fluid collections,organ enlargement or rupture, masses,obstruction,or foreign bodies. No fasting or contrast media is required for this x-ray. |
| Upper GI series (barium swallow,upper GI with small bowel follow-through) | Uses contrast media (barium),fluoroscopy, and still pictures to assess the structure and peristalsis of the esophagus,stom- ach,and upper small intestine. Food,fluids,and smoking are restricted for 8 hours before the exam.Advise the client that the test requires sev- eral hours to complete and to bring reading or other materials to pass time.Tell the client that the barium is instilled through a weighted tube inserted into the small bowel;some discomfort may occur with insertion of the tube.Advise to increase fluid intake for 24 to 48 hours after the test to promote barium elimination. Advise the client that stool will be chalky white for up to 3 days after the exam.When both an upper GI series and a barium enema are required,the barium enema is scheduled 1 to 2 days before the upper GI to prevent interference with evaluation by retained barium. Monitor for barium excretion after the exam. |
| Oral cholecystogram | Uses orally ingested contrast media to detect stones or deformity of the gall- bladder and to assess its ability to con- centrate and excrete bile. Assess for allergy to iodine,seafood,or other contrast media.Fat intake is restricted the evening before the test.Schedule before barium enema if ordered; may be scheduled on the same day as an upper GI series. |
| CT scans | Specialized radiographic procedures produce computer-generated images with signifi- cantly more detail than standard x-rays.May be done with or without contrast media. If contrast is used, inquire about allergies (to iodine and seafood in particular),and ensure that the client is well hydrated to reduce the risk of kidney damage. |
| Colonoscopy, sigmoidoscopy | Visual examination of the large intestine from the anus to the ileocecal valve (or,in a sig- moidoscopy,the descending colon).Used as a screening examination to detect colorec- tal cancer and to evaluate chronic constipa- tion,diarrhea,persistent bleeding,abdomi- nal pain.Polyps may be removed during the procedure and tissue samples taken. Bowel preparation with cathartics and limited food intake occurs 24–48 hours before the exam.Conscious sedation is used during the procedure.Instruct the client to report any abdominal pain,chills,fever,rectal bleeding,or purulent discharge after the procedure.If a polyp has been removed,advise to avoid high-fiber foods for 1 to 2 days and heavy lifting for 7 days. |
| Capsule endoscopy | Uses a wireless camera inside a capsule that is swallowed.The camera takes multiple pictures as it travels through the digestive tract.These pictures are transmitted to a recorder on a belt worn around the waist. Capsule endoscopy allows visual inspec- tion of the small intestine,which generally is inaccessible during other endoscopic procedures. A laxative may be ordered for bowel preparation before the procedure.Instruct the client to avoid eating and taking medications (except as ordered by the physician) for at least 12 hours before capsule endoscopy and to limit fluids to sips of clear water.Clear liquids may be resumed 2 hours after swallowing the capsule,and solid foods 4 hours after swallowing the capsule.The proce- dure lasts approximately 8 hours or until the capsule is expelled during a bowel movement.The camera does not need to be retrieved and can safely be flushed away |
| Endoscopic retrograde cholangiopancreatography | Combines endoscopic and x-ray procedures to evaluate the pancreatic,hepatic, common bile ducts,ampulla of Vater, and gallbladder. Food and fluids are withheld for at least 8 hours before the exam.A local anesthetic and conscious sedation are used.Care is similar to that provided a client undergoing upper endoscopy. |
