Specimen collection Role of the Nurse

Specimen collection Role of the Nurse

Nurses often assume the responsibility of specimen collection

* Specimens consist
o Urine
o Stool
o Sputum
o Wound drainage
o Blood

What about the client?

* Comfort
* Privacy
* Questions
* Clear, concise directions
o NPO

The Nurse

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

Urine Specimen

* Random
* Clean
* Female ? Menses (make note)
* Tested for:
+ Specific gravity
+ pH
+ Albumin
+ Glucose
+ Microscopic exam

Urine for C&S

* Culture = ? Bacteria growing
* Sensitivity = which antibiotics are effective
* Readings after 24; 48; 72 hrs.

Midstream Urine

Sterile Catheter Specimen

(never from bag)

Why a urine specimen for C&S

* ? Urinary Tract Infection (UTI)
o Frequency
o Urgency
o Dysuria
o Hematuria
o Flank pain
o Fever
o Cloudy, malodorous urine

Obtaining specimen

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

Children

* Pediatric bags ( u Bag)
* Never squeeze diaper

Characteristics of Urine

* Color
* Clarity
* Odor

Specimen Collection

* Random Specimens
o Clean-not sterile
o Ordered for
+ Urinalysis testing
+ Measurement of specific gravity
+ pH
+ Glucose levels

Urine specimen collection

* Midstream Specimen
o Clean voided
o C&S
o 30-60 mls urine
* Sterile Specimen
o Indwelling catheter
o Drainage bag

Urine collection

* Timed urine specimens
o 2-72 hr intervals (24hr most common)
o Begin after urinating
o Note start time on container & requisition
o Collect all urine in timed period

Post Reminder Signs

Indwelling Catheter

* 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 2hrs)

Common Urine Lab Tests

* Routine Urinalysis
o Examine within 2hrs
o 1st voided specimen in AM
o Reagent strip
* Specific Gravity
o Concentration
o 1.010-1.025
* Urine glucose
o Diabetics
o Reagent strips
o Double void

Measuring chemical properties of urine=Urinalysis

* Glucose
* Ketones
* Protein
* Blood- hematuria
* pH
* Specific gravity
* Microscopic examination

Stool Specimen

Analysis of fecal material can detect pathological conditions ie: tumors, hemorrhage, infection

* Tests
o OB
o Pus
o Ova & Parasites

Fecal specimens

* ? Chemical preservatives
* Medical aseptic technique
* To lab on time
* Labelling
* Documentation

Guaiac Test

Colorectal cancer screening test

FOBT

Hemoccult slide test

Fecal Characteristics

* Color
o melena
* Odor
* Consistency
* Frequency
* Amount
* Shape
* Constituents

Guaiac Test

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

Vaginal or Urethral Discharge Specimens

* Normally thin, nonpurulent, whitish or clear, small in amount
* S&S STD’s, UTI
* Not Delegated
* Assess external genitalia
* If STD record sexual history
* Physician’s order- vaginal/urethral

Blood Specimens

* Lab techs
* ABG’s
* Blood Glucose

Respiratory Tract

* Tests to determine abnormal cells or infection
o Throat cultures
o Sputum specimens
o Skin testing
o Thoracentesis

Nose, Throat Specimens

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

Throat cultures

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

Method for throat culture

* Insert swab into pharyngeal region
* Reddened areas/ exudate
* Gag reflex if client sitting and leaning forward slightly
* Inform client re procedure

Nose culture

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

Sputum specimens (3 major types)

Ordered to identify organisms growing in sputum

* C&S
* AFB
o 3 consecutive, early am
* Cytology
o Abnormal lung cancer by cell type
o 3 early am

Sputum collection

* May be delegated
* Cough effectively
* Mucus from bronchus
* Not Saliva
* Record
o Color
o Consistency
o Amount
o Odor
o Document date & time sent to lab.

Sputum collection

* No mouthwash/toothpaste-

viability of microorganisms and alter culture results

Skin testing

* Determines pulmonary diseases
o Bacterial
o Fungal
o Viral

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
* Reddened flat areas are neg.

The elderly freq. display false neg. or false positive TB skin test

If positive TB test

* Complete history risk factors
* Symptoms
o Weight loss
o Night sweats
o Hemoptysis
o Fatigue

Early am sputum for AFB

Chest xray

Thoracentesis

Insert needle through chest wall into pleural space

Aspirate fluid

* Diagnostic
* Therapeutic
* Biopsy

Gastric Secretions

* NG tube

Cultures

* Culturette/swab
* Wet/dry method
* Nose, throat, wound



Review procedure manual & fill in requisitions.

Nursing Functions for Specimen Collection

* Explain procedure, gain client’s participation
* Collect right amt. of specimen at the right time
* Place specimen in correct container
* Label container accurately

(addressograph), plastic bag

Nursing Functions for specimen collection

* 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
* Reduces Venipunctures
* Clients can perform
* Glucometers
* Chemical reagent strip
* Delegated to those instructed in skill if client’s condition stable

Glucose monitoring

* Ordered ac, pc, hs, fasting, before insulin (sliding scale)
* ? Risks for skin puncture
* Assess area of skin
o Sides of fingers, toes, heels
* Client’s ability
* Normal fasting Bld. Sugar

70-120 mg/100ml

Glucose Monitoring

* 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
* Wash hands
* Check puncture site
o Can share reading with client
* Record results
* Proceed as indicated by results

The Value of Measurement

3 benefits to measuring progress and results

* Shows where we are now
* Tells if we are heading toward our goal
* Allows us to make improvements along the way

What we measure gets improved. Peter F. Drucker

* Heightens our awareness
* Helps us focus on what we value and where we are going
* Keeps us on track
* Gives info what is happening along the way and enables us to continue or change depending on desired results


Specimen collection Role of the Nurse.ppt