Specimen collection Role of the Nurse Nurses often

Specimen collection Role of the Nurse

Nurses often assume the responsibility of specimen collection n Specimens consist Urine l Stool l Sputum l Wound drainage l Blood l

What about the client? Comfort n Privacy n Questions n Clear, concise directions n l NPO

The Nurse Check physician orders n Keep it Simple directions to client n Standard precautions n Label specimen n Timely n C&S to lab ASAP or refrigerated n Documentation n

Urine Specimen Random n Clean n Female ? Menses (make note) n Tested for: n n Specific gravity n p. H n Albumin n Glucose n Microscopic exam

Urine for C&S Culture = ? Bacteria growing n Sensitivity = which antibiotics are effective n Readings after 24; 48; 72 hrs. Midstream Urine Sterile Catheter Specimen (never from bag) n

Why a urine specimen for C&S n ? Urinary Tract Infection (UTI) Frequency l Urgency l Dysuria l Hematuria l Flank pain l Fever l Cloudy, malodorous urine l

Obtaining specimen Wash hands n Clean meatus, female front to back n Start stream, then stop, collect specimen n Aseptic technique n Bedpan/mexican hat n To lab 15 -20 min post collection n

Children Pediatric bags ( u Bag) n Never squeeze diaper n

Characteristics of Urine Color n Clarity n Odor n

Specimen Collection Random Specimens 1. § § Clean-not sterile Ordered for § § Urinalysis testing Measurement of specific gravity p. H Glucose levels

Urine specimen collection 2. Midstream Specimen v v v 3. Clean voided C&S 30 -60 mls urine Sterile Specimen v v Indwelling catheter Drainage bag

Urine collection 4. Timed urine specimens v v 2 -72 hr intervals (24 hr most common) Begin after urinating Note start time on container & requisition Collect all urine in timed period Post Reminder Signs

Indwelling Catheter n n n n Strict aseptic technique Only from Bag if Brand new Sampling Port? Clamp 30 min. prior Wash hands – Glove Cleanse port with alcohol swab Sterile needle To lab 30 min (may refridge 2 hrs)

Common Urine Lab Tests n Routine Urinalysis l l l n Specific Gravity l l n Examine within 2 hrs 1 st voided specimen in AM Reagent strip Concentration 1. 010 -1. 025 Urine glucose l l l Diabetics Reagent strips Double void

Measuring chemical properties of urine=Urinalysis Glucose n Ketones n Protein n Blood- hematuria n p. H n Specific gravity n Microscopic examination n

Stool Specimen Analysis of fecal material can detect pathological conditions ie: tumors, hemorrhage, infection n Tests OB l Pus l Ova & Parasites l

Fecal specimens ? Chemical preservatives n Medical aseptic technique n To lab on time n Labelling n Documentation Guaiac Test Colorectal cancer screening test FOBT Hemoccult slide test n

Fecal Characteristics n Color l melena Odor n Consistency n Frequency n Amount n Shape n Constituents n

Guaiac Test Single positive test result does not confirm bleeding or colorectal cancer. n Repeat test 3 X n Meat free, high residue diet n

Vaginal or Urethral Discharge Specimens Normally thin, nonpurulent, whitish or clear, small in amount n S&S STD’s, UTI n Not Delegated n Assess external genitalia n If STD record sexual history n Physician’s ordervaginal/urethral n

Blood Specimens Lab techs n ABG’s n Blood Glucose n

Respiratory Tract n Tests to determine abnormal cells or infection Throat cultures l Sputum specimens l Skin testing l Thoracentesis l

Nose, Throat Specimens n n n Upper respiratory/ throat infections Should Not be delegated Throat swabs l l l ac meal or 1 hr pc meal Wash hands, glove Tilt head backward “ah” ( if pharynx not visualized, tongue depressor, anterior 1/3 of tongue) Don’t contaminate

Throat cultures Oropharynx & tonsillar n Sterile swab n Culture determines pathogenic microorganisms n Sensitivity determines the antibiotics to which the microorganisms are sensitive or resistant n

Method for throat culture Insert swab into pharyngeal region n Reddened areas/ exudate n Gag reflex if client sitting and leaning forward slightly n Inform client re procedure n

Nose culture Blow nose, check nostril patency n Rotate Swab inflamed mucosa or exudate n Swab must advance into nasopharynx to ensure culture properly obtained n

Sputum specimens (3 major types) Ordered to identify organisms growing in sputum Ø C&S Ø AFB Ø 3 Ø consecutive, early am Cytology Ø Abnormal type Ø 3 early am lung cancer by cell

Sputum collection n n May be delegated Cough effectively Mucus from bronchus Not Saliva Record l l l Color Consistency Amount Odor Document date & time sent to lab.

Sputum collection n No mouthwash/toothpasteviability of microorganisms and alter culture results

Skin testing n Determines pulmonary diseases Bacterial l Fungal l Viral l Antigen injected intradermally Injection site circled Instructions not to wash site

Reading skin test Induration – palpable, elevated, hardened area around site. Edema and inflammation from antigen –antibiotic reaction. Measured in millimeters n Reddened flat areas are neg. The elderly freq. display false neg. or false positive TB skin test n

If positive TB test Complete history n Symptoms n risk factors Weight loss l Night sweats l Hemoptysis l Fatigue l Early am sputum for AFB Chest xray

Thoracentesis Insert needle through chest wall into pleural space Aspirate fluid • Diagnostic • Therapeutic • Biopsy

Gastric Secretions n NG tube

Cultures Culturette/swab n Wet/dry method n Nose, throat, wound n Review procedure manual & fill in requisitions.

Nursing Functions for Specimen Collection Explain procedure, gain client’s participation 2. Collect right amt. of specimen at the right time 3. Place specimen in correct container 4. Label container accurately (addressograph), plastic bag 1.

Nursing Functions for specimen collection 5. 6. 7. Complete lab. Req. Place the specimen in the appropriate place for pick up. Document/record specimen sent and anything unusual about the appearance of specimen

Blood glucose levels Capillary Puncture n Reduces Venipunctures n Clients can perform n Glucometers n Chemical reagent strip n Delegated to those instructed in skill if client’s condition stable n

Glucose monitoring Ordered ac, pc, hs, fasting, before insulin (sliding scale) n ? Risks for skin puncture n Assess area of skin n l Sides of fingers, toes, heels Client’s ability n Normal fasting Bld. Sugar 70 -120 mg/100 ml n

Glucose Monitoring n n n Wash hands, glove Client wash hands, warm water Follow instructions on meter Massage /milk finger or puncture site Antiseptic swab ( allow to dry completely) Wipe away first droplet of blood with tissue/cotton ball

Glucose Monitoring Dispose of lancet in sharps container n Wash hands n Check puncture site n l Can share reading with client Record results n Proceed as indicated by results n

The Value of Measurement 3 benefits to measuring progress and results ü Shows where we are now ü Tells if we are heading toward our goal ü Allows us to make improvements along the way

What we measure gets improved. Peter F. Drucker Heightens our awareness n Helps us focus on what we value and where we are going n Keeps us on track n Gives info what is happening along the way and enables us to continue or change depending on desired results n