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Specimen collection Role of the Nurse. Nurses often assume the responsibility of specimen collection Specimens consist Specimens consist Urine Urine Stool.

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Presentation on theme: "Specimen collection Role of the Nurse. Nurses often assume the responsibility of specimen collection Specimens consist Specimens consist Urine Urine Stool."— Presentation transcript:

1 Specimen collection Role of the Nurse

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

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

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

5 Urine Specimen Random Random Clean Clean Female ? Menses (make note) Female ? Menses (make note) Tested for: Tested for: Specific gravity Specific gravity pH pH Albumin Albumin Glucose Glucose Microscopic exam Microscopic exam

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

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

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

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

10 Characteristics of Urine Color Color Clarity Clarity Odor Odor

11 Specimen Collection 1. Random Specimens  Clean-not sterile  Ordered for  Urinalysis testing  Measurement of specific gravity  pH  Glucose levels

12 Urine specimen collection 2. Midstream Specimen  Clean voided  C&S  mls urine 3. Sterile Specimen  Indwelling catheter  Drainage bag

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

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

15 Common Urine Lab Tests Routine Urinalysis Routine Urinalysis Examine within 2hrs Examine within 2hrs 1 st voided specimen in AM 1 st voided specimen in AM Reagent strip Reagent strip Specific Gravity Specific Gravity Concentration Concentration Urine glucose Urine glucose Diabetics Diabetics Reagent strips Reagent strips Double void Double void

16 Measuring chemical properties of urine=Urinalysis Glucose Glucose Ketones Ketones Protein Protein Blood- hematuria Blood- hematuria pH pH Specific gravity Specific gravity Microscopic examination Microscopic examination

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

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

19 Fecal Characteristics Color Color melena melena Odor Odor Consistency Consistency Frequency Frequency Amount Amount Shape Shape Constituents Constituents

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

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

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

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

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

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

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

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

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

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

30 Sputum collection No mouthwash/toothpaste- No mouthwash/toothpaste- viability of microorganisms and alter culture results viability of microorganisms and alter culture results

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

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

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

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

35 Gastric Secretions NG tube NG tube

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

37 Nursing Functions for Specimen Collection 1. 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 (addressograph), plastic bag

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

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

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

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

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

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

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


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