Davis’s Comprehensive Manual of Laboratory and Diagnostic Tests with Nursing Implications
Davis’s Comprehensive Manual of Laboratory and Diagnostic Tests with Nursing Implications, Tenth Edition
Copyright © 2023 by F. A. Davis Company. All rights reserved.
Unbound™ mobile platform © 2000-2023 Unbound Medicine, Inc. All rights reserved.
Anne M. Van Leeuwen, MA, BS, MT (ASCP)
Mickey L. Bladh, RN, MSN
Inspiration springs from Passion. . . . Passion is born from unconstrained love, commitment, and a vision no one else can own.
Lynda—my best friend and an extraordinarily gifted nurse—thank you, I could not have done this without your love, strong support, and belief in me. My gratitude to Mom, Dad, Adele, Gram . . . all my family and friends, for I am truly blessed by your humor and faith. A huge hug for my daughters, Sarah and Margaret—I love you very much. To my puppies, Maggie, Taylor, Emma, Zoe, Sophie, Gracie, and Lola for their endless and unconditional love. Many thanks to my friend and wonderful coauthor Mickey; to all the folks at F.A. Davis, especially Rob and Julia, for their guidance, support, and great ideas. Very special thanks to Lisa Houck, publisher, for her friendship, excellent direction, and unwavering encouragement. Lisa believed in this book and in me from the time I was a fledgling author and the book was a work in progress; thank you from the bottom of my heart and for ten wonderful editions. A warm welcome and thank you to Suzanne Czehut Toppy, publisher, who helped guide this 10th edition through its final steps into print; we look forward to working with you on future editions.
Anne M. Van Leeuwen, MA, BS, MT (ASCP)
Medical Laboratory Scientist & Independent Author
An eternity of searching would never have provided me with a man more loving and supportive than my husband, Eric. He is the sunshine in my soul, and I will be forever grateful for the blessing of his presence in my life. I am grateful to my five children, Eric, Anni, Phillip, Mari, and Melissa, for the privilege of being their mom; always remember that you are limited only by your imagination and willingness to try. To my darling grandchildren, watching you grow up always reminds me of the joy of discovery. Life is a gift, and the trick is not to focus on its troubles but to enjoy the ride, remember to dance in the rain. To Anne, a forever friend who saw in me the potential to spread my wings, thanks for your patience and guidance, and thanks to Lynda for the miracle of finding me. Thanks to those at F.A. Davis for your kind support. Lastly, to my late beloved parents, thanks with hugs and kisses.
Mickey L. Bladh, RN, MSN
Nurse Educator & Author
Hacienda Heights, California
Our thanks to all those in the health-care profession and beyond who have provided essential and loving support during the unprecedented pandemic. You are greatly appreciated!
We are so grateful to all the people who have helped us make this book possible. We thank our readers for allowing us this important opportunity to touch their lives. Our goal has always been to assist each individual to find a way to blend emotional and intellectual intelligence into a competent and compassionate approach to patient care. We are also thankful for our association with the F.A. Davis Company. We value and appreciate the efforts of all the people associated with F.A. Davis because without their hard work, this publication could not succeed. We recognize all the wonderful people in leadership, the editors, freelance consultants, designers, IT gurus, and digital applications developers, as well as those in sales & marketing, distribution, and finance. We have a deep appreciation for the Davis Educational Consultants. They are tasked with being our voice. Their exceptional ability to communicate is what actually brings our book to the market. We would like to give special acknowledgment to the outstanding publishing professionals who were our core support team throughout the development of this edition:
Lisa Houck, Publisher
Robert Allen, Manager, Content Architecture
Julia Curcio, Senior Content Project Manager
Alison Enright, Digital Asset and eBook Manager
Elaine Finefrock, Curriculum Support Manager
Carolyn O’Brien, Art & Design Manager
Jaclyn White, Senior Marketing Manager
Sharon Y. Lee, Production Manager
Laboratory and diagnostic testing. The words themselves often conjure up cold and impersonal images of needles, specimens lined up in collection containers, and high-tech electronic equipment. But they do not stand alone. They are tied to, bound with, and tell of health or disease in the blood and tissue of a person. Laboratory and diagnostic studies augment the health-care provider’s assessment of the quality of an individual’s physical being. Test results guide the plans and interventions geared toward strengthening life’s quality and endurance. Beyond the pounding noise of the MRI, the cold steel of the x-ray table, the sting of the needle, the invasive collection of fluids and tissue, and the probing and inspection is the gathering of evidence that supports the healthcare provider’s ability to discern the course of a disease and the progression of its treatment. Laboratory and diagnostic data must be viewed with thought and compassion, however, as well as with microscopes and machines. We must remember that behind the specimen and test result is the person from whom it came, a person who is someone’s son, daughter, mother, father, husband, wife, or friend.
This book is written to help health-care providers in their understanding and interpretation of laboratory and diagnostic procedures and their outcomes. Just as important, it is dedicated to all health-care professionals who experience the wonders in the science of laboratory and diagnostic testing, performed and interpreted in a caring and efficient manner.
The authors continue to enhance and update four main areas in this new edition: organization of the content, pathophysiology that affects test results, patient safety, and patient/family education with expected patient outcomes.
Organization of the content: Time is a precious commodity. The content in the 10th edition puts the “need to know” information at the top of each study, in the order we imagine readers might prioritize what they need to know. Also, closely related studies are combined under a single title to maintain a smaller book size without affecting the number of studies included in the book. A new feature in the 10th edition is the highlighting of a small subset of laboratory studies labeled with the words “Core Study” in the main title. The authors hope that by identifying these core studies, students will have a place to begin—first learning about the tests they will encounter most often. References to related studies throughout the manual will help readers further connect the dots as
they become involved in investigating the bigger picture. Portability is another important feature of a comprehensive reference book. To that end, repetitive content from the individual studies has been consolidated in Laboratory/Diagnostic Procedural Checklist for Students and Appendix A: Patient Preparation and Specimen Collection.
There are three appendices associated with this 10th edition that address important topics related to patient/family education and expected patient outcomes:
• Appendix B: Skin Assessment for Infection, Hematoma, and Pressure Damage—The skin assessment appendix outlines the ways that laboratory procedures (specimen procurement) and diagnostic procedures (patient positioning) can cause skin complications. Appendix B also describes the studies used to predict risk for, identify, or monitor therapy administered for skin complications.
• Appendix C: Current Trends in Health Care: Nurses should be informed regarding potential and newly developed technology; they or their patients may be introduced to these technologies in the course of their health care. Examples of approved and developing applications of technology specific to health care are presented in this appendix.
• Appendix D: The Human Microbiome: Patient Care Considerations for Nurses—The microbiome appendix is intended to provide some basic information regarding the human microbiome, how it affects our health, and potential nursing implications. The content also offers a review of terminology regarding genetics and molecular test methods used to gather genetic information. Last, the microbiome appendix highlights the nurse’s unique and significant role in antimicrobial stewardship programs.
The summarized reference tables for critical findings are available in Appendices E and F on FADavis.com.
Pathophysiology that affects test results: The Potential Diagnosis section includes explanations of increased or decreased laboratory values to assist in associating pathophysiology with study findings. The authors present a range of age-specific reference normal laboratory values for the neonatal, pediatric, adult, and older adult populations. It should be mentioned that standardized information for the complexity of neonatal, pediatric, and older adult populations is difficult to document. Studies to establish normal ranges for neonates and pediatric patients are limited in number—it is understandable that parents would be reluctant to have their children participate in such studies, especially those involving blood tests. Neonates and pediatric patients are not “little adults,” as has so often been said. Their organ systems are not fully developed and continue to mature over time, which can change the definition of a “normal” finding, incrementally, over time. Evaluating laboratory findings in older adults is also a challenging task. Older adults often have complex health situations. Laboratory values may be increased or decreased in older adults due to the sole or combined effects of malnutrition, alcohol use, medications, and the presence of multiple chronic or acute diseases with or without muted symptoms. It is believed that changes in older adult laboratory findings occur in waves at certain points as we advance in age, rather than in steady increments over time.
Patient safety: The authors appreciate that nurses are the strongest patient advocates with a huge responsibility to protect the safety of their patients, and we have observed student nurses in clinical settings being interviewed by facility accreditation inspectors, so we have updated reminders for a variety of safety topics. Examples include information related to positive patient identification; hand-off communication of critical information; proper timing of diagnostic procedures; rescheduling of specimen collection for therapeutic drug monitoring; use of evidence-based practices for prevention of surgical site infections; descriptions of study-related complications and how to avoid them;
adverse drug reactions and how to avoid them; the nurse’s role in the process of obtaining an informed written patient consent before providing care, treatment, or services; information regarding the move to track or limit exposure to radiation from imaging studies for adults; and the Image Gently campaign for pediatric patients who undergo diagnostic studies that utilize radiation.
Patient/family education with expected patient outcomes: The fourth area of emphasis coaches the nurse in providing patient education and provides examples for the nurse to anticipate and respond to a patient’s questions or concerns. Elements of this area include the following:
• Describing the purpose of the procedure
• Study-specific patient preparation
• Addressing concerns about pain
• Understanding potential nursing problems in conjunction with the implications of the test results
• Potential treatment considerations with related patient/family education
• Describing postprocedural care and expected patient outcomes
• Summing up with a Clinical Judgement statement that embraces critical thinking and clinical reasoning to help students/instructors/nurses focus on patient management and related teaching/learning needs
Related Web sites for patient education are included throughout the book to provide additional educational resources for the patient and the nurse.
Laboratory and diagnostic studies are essential components of a complete patient assessment. Examined in conjunction with an individual’s history and physical examination, laboratory studies and diagnostic data provide clues about health status. Nurses are increasingly expected to integrate an understanding of laboratory and diagnostic procedures and expected outcomes in assessment, planning, implementation, and evaluation of nursing care. The data help develop and support nursing diagnoses, interventions, and outcomes.
Nurses may interface with laboratory and diagnostic testing on several levels, including the following:
• Interacting with patients and families of patients undergoing diagnostic tests or procedures, and providing pretest, intratest, and posttest information and support
• Maintaining quality control to prevent or eliminate problems that may interfere with the accuracy and reliability of test results
• Providing education and emotional support at the point of care
• Ensuring completion of testing in a timely and accurate manner
• Collaborating with other health-care professionals in interpreting findings as they relate to planning and implementing total patient care
• Communicating significant alterations in test outcomes to appropriate health-care team members
• Coordinating interdisciplinary efforts
Whether the nurse’s role at each level is direct or indirect, the underlying responsibility to the patient, family, and community remains the same.
The authors hope that the changes and additions made to the book will reward users with an expanded understanding of and appreciation for the place laboratory and diagnostic testing holds in the provision of high-quality nursing care and will make it easy for instructors to integrate this important content in their curricula. The authors would like to thank all the users of the previous editions for helping us identify what they like about this book as well as what might improve its value to them. We want to continue this dialogue. As authors, it is our desire to capture the interest of our readers, to provide essential information, and to continue to improve the presentation of the material in the book and ancillary products. We encourage our readers to provide feedback to the F.A. Davis Web site and to the publisher’s sales professionals.
Your feedback helps us modify the material—to change with your changing needs.
• The authors recognize that preferences for the use of specific medical terminology may vary by institution. Much of the terminology used in this Handbook is sourced from Taber’s Cyclopedic Medical Dictionary.
• The definition, implementation, and interpretation of national guidelines for the treatment of various medical conditions changes as new information and new technology emerge. The publication of updated information may at times be contentious among the professional institutions that offer either support or dissent for the proposed changes. This can cause confusion when a patient asks questions about how their condition will be identified and managed. The authors believe that the most important discussion about health care occurs between the patient and the patient’s health-care provider(s). Although the individual studies may point out various screening tests used to identify a disease, the authors often refer the reader to Websites maintained by nationally recognized authorities on specific topics that reflect the most current information and recommendations for screening, diagnosis, and treatment.
• Most institutions have established policies, protocols, and interdisciplinary teams that provide for efficient and effective patient care within the appropriate scope of practice. It is not our intention that the actual duties a nurse may perform be misunderstood by way of misinterpreted inferences in writing style, but the information prepared by the authors considers that specific limitations are understood by the licensed professionals and other team members involved in patient care activities and that the desired outcomes are achieved by order of the appropriate health-care provider.
Notices and Disclaimers
Davis’s Comprehensive Manual of Laboratory and Diagnostic Tests with Nursing Implications, 10th Edition (the "Content") is a publication of 2023 by F. A. Davis Company ("PUBLISHER"), and copyright © 2023 by F. A. Davis Company.
The Unbound™ handheld platform is copyright © 2000-2023 Unbound Medicine, Inc. All rights reserved.
The user is receiving only a limited right to use the Content and Unbound Platform (jointly referred to as the "Service") for user’s own internal or personal use. The user may not reproduce, forward, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the Service or in any way commingle the Service with other third party content, without PUBLISHER’s or Unbound Medicine’s consent.
Disclaimer of Warranties
THE SERVICE IS PROVIDED ON AN "AS IS" BASIS. NEITHER PUBLISHER, UNBOUND MEDICINE NOR ITS LICENSORS MAKE ANY GUARANTEES OR WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE AS TO THE SERVICE OR THE INFORMATION THEREIN OR ANY WARRANTIES AS TO THE ACCURACY, COMPLETENESS, CURRENTNESS, OR RESULTS TO BE OBTAINED FROM, ACCESSING OR USING THE SERVICE, OR ANY MATERIAL REFERENCED IN SUCH SERVICE OR ANY INFORMATION ENTERED INTO THE SERVICE BY USERS OR OTHER PERSONS AND/OR ANY MATERIAL AVAILABLE ON OR THAT CAN BE ACCESSED THROUGH THE SERVICE (INCLUDING VIA ANY HYPERLINK OR OTHERWISE) OR AS TO NON-INFRINGEMENT OF THIRD PARTY RIGHTS. ANY WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, ARE DISCLAIMED. ANY MATERIAL OR DATA OBTAINED THROUGH USE OF THE SERVICE IS AT YOUR OWN DISCRETION AND RISK AND USER UNDERSTANDS THAT IT WILL BE SOLELY RESPONSIBLE FOR ANY RESULTING DAMAGE TO ITS COMPUTER SYSTEM OR LOSS OF DATA.
MEDICINE IS AN EVER-CHANGING SCIENCE. AS NEW RESEARCH AND CLINICAL EXPERIENCE BROADEN OUT KNOWLEDGE, CHANGES IN TREATMENT AND DRUG THERAPY ARE REQUIRED. IN VIEW OF THE POSSIBILITY OF HUMAN ERROR OR CHANGES IN MEDICAL SCIENCES, NEITHER PUBLISHER, UNBOUND MEDICINE NOR ITS LICENSORS WARRANTS THAT THE INFORMATION CONTAINED IN THE SERVICE IS IN EVERY RESPECT ACCURATE OR COMPLETE, AND THEY ARE NOT RESPONSIBLE FOR ANY ERRORS OR OMISSIONS OR THE RESULTS OBTAINED FROM THE USE OF SUCH INFORMATION. USERS ARE ENCOURAGED TO CONFIRM THE INFORMATION CONTAINED IN THE SERVICE WITH OTHER SOURCES. FOR EXAMPLE, AND IN PARTICULAR, USERS ARE ADVISED TO CHECK THE PRODUCT INFORMATION SHEET INCLUDED IN THE PACKAGE OF EACH DRUG THEY PLAN TO ADMINISTER TO BE CERTAIN THAT THE INFORMATION CONTAINED IN THE PUBLISHER CONTENT IS ACCURATE AND THAT CHANGES HAVE NOT BEEN MADE IN THE RECOMMENDED DOSE OR IN THE CONTRAINDICATIONS FOR ADMINISTRATION. THIS RECOMMENDATION IS PARTICULARLY IMPORTANT IN CONNECTION WITH NEW OR INFREQUENTLY USED DRUGS. NEITHER PUBLISHER NOR ITS LICENSORS SHALL BE LIABLE TO SUBSCRIBER OR TO ANY USER OR ANYONE ELSE FOR ANY INACCURACY, DELAY, INTERRUPTION IN SERVICE, ERROR OR OMISSION, REGARDLESS OF CAUSE, OR FOR ANY DAMAGES RESULTING THEREFROM.
Limitation of Liability
IN NO EVENT WILL PUBLISHER, UNBOUND MEDICINE OR ITS LICENSORS, BE LIABLE FOR ANY INDIRECT, SPECIAL OR CONSEQUENTIAL DAMAGES, INCLUDING BUT NOT LIMITED TO, LOST TIME, LOST MONEY, LOST PROFITS OR GOOD WILL, WHETHER IN CONTRACT, TORT, STRICT LIABILITY OR OTHERWISE, AND WHETHER OR NOT SUCH DAMAGES ARE FORESEEN OR UNFORESEEN ARISING FROM OR RELATING TO: (i) YOUR USE OF THE SERVICE OR USE OF THE SERVICE THROUGH YOUR ACCOUNT BY ANYONE ELSE; (ii) THE COST OF PROCUREMENT OF SUBSTITUTE DATA, INFORMATION OR SERVICES; (iii) UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA; OR (iv) ANY OTHER MATTER RELATING TO THE SERVICE. UNBOUND’S TOTAL CUMULATIVE LIABILITY TO YOU AND ANYONE WHO USES THE SERVICE THROUGH YOUR ACCOUNT, FOR ANY AND ALL CLAIMS UNDER ANY THEORY OF LAW, WILL NOT EXCEED THE UNUSED PORTION OF FEES PAID FOR THE SERVICE. IF, NOTWITHSTANDING THE OTHER TERMS OF THIS AGREEMENT, UNBOUND SHOULD HAVE ANY LIABILITY TO YOU OR ANY THIRD PARTY FOR ANY LOSS, HARM OR DAMAGE, YOU AND UNBOUND AGREE THAT SUCH LIABILITY SHALL UNDER NO CIRCUMSTANCES EXCEED THE LESSER OF $1,000 OR THE FEES YOU PAID US DURING THE THREE (3) MONTHS IMMEDIATELY PRECEDING THE DAY THE ACT OR OMISSION OCCURRED THAT GAVE RISE TO YOUR CLAIM. YOU AND UNBOUND AGREE THAT THE FOREGOING LIMITATION OF LIABILITY IS AN AGREED ALLOCATION OF RISK BETWEEN YOU AND US AND REFLECTS THE FEES, IF ANY, UNBOUND CHARGE YOU TO USE THE SITE AND THE SERVICES. YOU ACKNOWLEDGE THAT ABSENT YOUR AGREEMENT TO THIS LIMITATION OF LIABILITY, UNBOUND WOULD NOT PROVIDE THE SITE OR SERVICES TO YOU.