1. Stool, Gastric, Sputum and Throat Cultures PN 103

2. Stool cultures  What are the reasons to obtain a stool culture?  How is a culture obtained?  What does the nurse do with the culture once it is obtained?  What is the pathophysiology of constipation and diarrhea?

3. Stool cultures  Stool cultures are obtained after an MD/NP order is given secondary to signs and symptoms of an abnormal gastrointestinal process  Detects the presence of bacteria, parasites and/or bleeding  -observed for stool amount, color, consistency and presence of fats

4. Stool cultures  See FON, pps.499-500  -Inform the patient that a stools specimen is needed -Carry out the collection in a manner that will not cause stress or make the patient feel hurried or embarrassed -When the specimen is obtained, correctly label the container for the proper test -if a stool specimen is for ova and parasites (o & p),obtain an appropriate container with a special solution

5. Stool cultures  http://www.youtube.com/watch?v=oFQo 0E3N1F8 http://www.youtube.com/watch?v=oFQo 0E3N1F8

6. Hemoccult stool  Blood in urine or feces is abnormal  Bright red blood in the stool -blood is fresh and is from the lower GI system, rectum or anus  Black, tarry and malodorous stool -old, blood and is from the esophagus or upper GI system

7. Hemoccult stool  Occult blood -blood that is not visible and can only be detected microscopically

8. Hemoccult stool  Testing is usually done on the nursing unit and results are called into the HCP http://www.youtube.com/watch?v=IGPVlo 2bNmQ http://www.youtube.com/watch?v=IGPVlo 2bNmQ

9. Hemoccult stool  Black  Melena, Blood in stool (usually from upper GI tract)  Esophageal Variances, Mallory-Weiss tear, Bleeding stomach or duodenal ulcer, Gastritis, Trauma, Bowel ischemia, Vascular malformation   Black licorice, iron, lead, bismuth medicines (Pepto-Bismol), blueberries Cleanse your liver & colon  Reduce aspirin/Ibuprofen  Reduce alcohol use  Tarry   Blood in stool which has been exposed to digestion   Esophageal Variances, Mallory-Weiss tear, Bleeding stomach or duodenal ulcer, Gastritis, Trauma, Bowel ischemia, Vascular malformation  Black licorice, iron, lead, bismuth medicines (Pepto-Bismol), blueberries, exposed to digestive juices Cleanse your liver & colon  Reduce aspirin/Ibuprofen  Reduce alcohol use

11. Hemoccult stool  Maroon   Hematochezi, Blood in stool (usually from lower GI tract)  Diverticulitis, Vascular malformation, Intestinal Infection (including parasites), Irritable Bowel Syndrome (IBS), Tumors, Polyps, Colon Cancer, Ulcers, Gastritis, Esophageal Variances  Red colored gelatin, popsicles, Kool-Aid, tomato juice, soup, beets. Cleanse your liver & colon  Reduce aspirin/Ibuprofen  Reduce alcohol use  Red   Blood in stool from very late in GI tract  Hemorrhoids, Anal fissures, Ulcers, Polyps,  Red colored gelatin, popsicles, Kool-Aid, tomato juice, soup, beets. Cleanse your liver & colon  Reduce aspirin/Ibuprofen  Reduce alcohol use

12. Hemoccult stool  Orange   Transit time of stool is too fast, not sufficiently exposed to bile during digestion.  Low bile salt production, Consumption of medications containing beta-carotene or aluminum hydroxide, obstructed or diseased liver  Carrots, Sweet potatoes, kale, spinach, turnip greens, winter squash, collard greens, cilantro, thyme, artificial orange food coloring Cleanse your liver & colon  Reduce aspirin/Ibuprofen  Reduce alcohol use  Yellow   Possible malfunction of digestive system  Gilbert's Syndrome, malabsorption, parasite infection, pancreatic cancer  Carrots, Sweet potatoes, artificial yellow food coloring Digestive Enzymes  Cleanse your liver & colon  Reduce aspirin/Ibuprofen  Reduce alcohol use

13. Hemoccult stool  Green   Transit time of stool is too fast, not sufficiently exposed to bile during digestion  Low bile salt production, Obstructed or diseased liver  Green leafy vegetables, dark purple/green food coloring, foods containing chlorophyll Digestive Enzymes  Cleanse your liver & colon  Reduce aspirin/Ibuprofen  Reduce alcohol use  Clay   Stool is not being properly exposed to bile during digestion.  Malabsorption, Hepatitis, Gallbladder disorders  High amounts of fatty foods Digestive Enzymes  Cleanse your liver & colon  Reduce aspirin/Ibuprofen  Reduce alcohol use

14. Stool collection for ova and parasites (O & P)  Microscopic examination for parasites -If specimen is not refrigerated, it must be tested in the laboratory 3 hours after the specimen was obtained -If the specimen is able to be refrigerated or has a preservative in the collection bottle, it can be tested 2-3 days after it is collected

16. Constipation/Diarrhea  Constipation and diarrhea are usually the main signs of a GI disturbance -usually when a stool sample is ordered What is constipation? http://www.youtube.com/watch?v=BmVTO 99QXFc What causes constipation? http://www.youtube.com/watch?v=nBGqh 0Qv3_c

17. Constipation/Diarrhea  What is diarrhea?  http://www.youtube.com/watch?v=nFLYl WL-aAE http://www.youtube.com/watch?v=nFLYl WL-aAE  What causes diarrhea?  http://www.youtube.com/watch?v=3AFD rfG0B9s http://www.youtube.com/watch?v=3AFD rfG0B9s

18. Gastroccult testing  Gastric secretion testing for blood -esophagus, stomach, small or large intestine -can either be emesis or obtained via nasal-gastric (N/G) suctioning See FON pps. 501-502, Skill 19-8

19. Throat culture  Obtained if a patient has signs/symptoms of an upper respiratory or sinus infection  Always obtain cultures before an antibiotic is started -If the patient is already on antibiotics before the culture is taken, document this on the lab requisition slip

20. Throat culture  The patient may experience discomfort while having the culture obtained secondary toe the heightened sensitivity of the mucosal membranes - may cause gagging -collect a throat culture at least 1 hour after eating to reduce the risk of vomiting

21. Throat culture  Assess the condition of the of the oral cavity/posterior pharynx  Assess for complaints of a sore throat  Assess for systemic indications of infection, including fever, chills and malaise

22. Throat culture  See FON, pg. 506  http://www.youtube.com/watch?v=0pzI0 ZgcC3M http://www.youtube.com/watch?v=0pzI0 ZgcC3M  Rapid strep test  http://www.youtube.com/watch?v=Hl6vIt Gt4qQ http://www.youtube.com/watch?v=Hl6vIt Gt4qQ

23. Sputum culture  Purpose is to obtain sputum from the lung -sputum contains mucous, cellular debris, microorganisms and occasionally blood or pus  Must be obtained from deep in the bronchial tree -not oral mucous/saliva -possible contamination of food

24. Sputum culture  Early morning is the best time for collection secondary to the patient’s respiratory passages have not cleared.  Tests include: -culture and sensitivity (C & S) -culture bacteria -cytology -abnormal cell structure/pathology -acid fast bacilli (AFB) -tuberculosis

25. Sputum culture  Patient may require to be suctioned if unable to expectorate  Suctioning can sometimes provoke coughing which has the potential to induce vomiting and constriction of the pharyngeal, laryngeal or bronchial muscles  -may also stimulate the vagal nerve fibers which can result in cardiac dysrhythmias and increased intracranial pressure

26. Sputum culture  Explain the procedure to the patient  Instruct the patient on drinking extra fluids the night before the test to help loosen up secretions and make it easier for the patient to expectorate for the specimen  See FON pg. 503  http://www.youtube.com/watch?v=Nyqr 7_JmBok http://www.youtube.com/watch?v=Nyqr 7_JmBok