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

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 No mouthwash/toothpaste- viability of microorganisms and alter culture results n

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 risk factors n Symptoms n 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

SPUTUM COLLECTION Sputum containers

SPUTUM COLLECTION Isolated chambers for sputum expectoration

SPUTUM COLLECTION Sputum suction from lung

WASTE MANAGEMENT Be careful !

Gastric Secretions n NG tube

Gastric Secretions n NG tube

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

WOUND SPECIMEN

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

INCENTIVE SPIROMETRY Incentive Spirometry is designed to mimic natural sighing or yawning by encouraging you to take slow, deep breaths. A device called an Incentive Spirometer is used to provide information about your inspiratory effort. When you lie in bed for a long time, after surgery, or if are having a lot of pain, you tend to take shallow breaths and not cough as often as needed. By inhaling deeply, you help mobilize secretions and open up areas of the lungs that may have become collapsed. Try to do at least ten breaths every hour on your Incentive Spirometer.

Incentive Spirometry Volume-dependant spirometer

Incentive Spirometry flow-dependant spirometer

Incentive Spirometry

Incentive Spirometry

Incentive Spirometry

Incentive Spirometry 1. Slide the yellow Patient Goal Indicator to the volume level (ml) prescribed by your clinician.

Incentive Spirometry With you lips off the mouthpiece, exhale completely. Then close your lips tightly around the mouthpiece. n n Inhale slowly. Keep the small yellow coach as close to the happy face as you can. n

Incentive Spirometry n n Inhale as deeply as you can. When you can't inhale any more, hold your breath for 6 seconds and note the highest level the top of the yellow piston reaches. Try to reach your prescribed goal. Repeat as many times as prescribed. Keep a record of your progress.

Bike Incentive Spirometry

Incentive Spirometry

Turn & Cough

Turn & Cough

Turn & Cough

Breath Deep and don’t Cough You have a choice !