1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 30 Collecting and Testing Specimens

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  Specimens (samples) are collected and tested to prevent, detect, and treat disease.  The doctor orders what specimen to collect and the test needed.  Most specimens are tested in the laboratory. All specimens sent to the laboratory require requisition slips. All specimens sent to the laboratory require requisition slips.  Some tests are done at the bedside.

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  URINE SPECIMENS  The random urine specimen The random urine specimen is collected for a routine urinalysis. The random urine specimen is collected for a routine urinalysis. It is collected any time during a 24-hour period. It is collected any time during a 24-hour period.

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  The midstream specimen (clean-voided specimen or clean-catch specimen) The perineal area is cleaned before collecting the specimen. The perineal area is cleaned before collecting the specimen. To collect the specimen: To collect the specimen:  The person starts to void into a receptacle.  The person stops the stream of urine.  A sterile specimen container is positioned.  The person voids into the container until the specimen is obtained.

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  The 24-hour urine specimen All urine voided during a 24-hour period is collected. All urine voided during a 24-hour period is collected. Urine is chilled on ice or refrigerated during this time. Urine is chilled on ice or refrigerated during this time. A preservative is added to the collection container for some tests. A preservative is added to the collection container for some tests. The person voids to begin the test with an empty bladder. The person voids to begin the test with an empty bladder.  Discard this voiding.  Save all voidings for the next 24 hours. The test is restarted if: The test is restarted if:  A voiding was not saved  Toilet tissue was discarded into the specimen  The specimen contains feces

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  The double-voided specimen (fresh-fractional urine specimen) The person voids twice. The person voids twice.  The first time the bladder is emptied of “stale” urine.  In 30 minutes, the person voids again. Fresh-fractional urine specimens are used to test urine for glucose and ketones. Fresh-fractional urine specimens are used to test urine for glucose and ketones.  To collect a urine specimen from an infant or a child who is not toilet-trained, a collection bag (“wee bag”) is applied over the urethra.

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  Testing urine Testing for pH Testing for pH  Urine pH measures whether urine is acidic or alkaline.  A routine urine specimen is needed. Testing for glucose and ketones Testing for glucose and ketones  The diabetic person may have sugar (glucose) in the urine.  The diabetic person may also have acetone (ketone bodies, ketones) in the urine.  Urine is tested for glucose and ketones.  The doctor uses the tests to make drug and diet decisions.  Double-voided specimens are best for these tests.

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8 Testing for blood Testing for blood  Injury and disease can cause hematuria (blood in the urine).  Sometimes blood is seen in the urine.  At other times, it is unseen (occult).  A routine urine specimen is needed. Using reagent strips Using reagent strips  Do not touch the test area on the strip.  Dip the strip into urine.  Compare the strip with the color chart on the bottle.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9 A stone (calculus) can develop in the kidney, ureter, or bladder. A stone (calculus) can develop in the kidney, ureter, or bladder.  Stones (calculi) vary in size.  Stones causing severe pain and urinary system damage may require surgical removal.  Some stones are passed through urine. –All of the person’s urine is strained. –Passed stones are sent to the laboratory.

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  STOOL SPECIMENS  Stools are checked and studied for blood, fat, microbes, worms, and other abnormal contents.  The stool specimen must not be contaminated with urine.  Some tests require a warm stool.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  Testing stools for blood Stools may contain blood for many reasons. Stools may contain blood for many reasons. Often blood is seen if it is low in the bowels. Often blood is seen if it is low in the bowels. Stools are black and tarry (melena) if there is bleeding in the stomach or upper gastrointestinal tract. Stools are black and tarry (melena) if there is bleeding in the stomach or upper gastrointestinal tract. Sometimes bleeding occurs in very small amounts and cannot be seen (occult blood). Sometimes bleeding occurs in very small amounts and cannot be seen (occult blood). When using occult blood test kits, follow the manufacturer’s instructions. When using occult blood test kits, follow the manufacturer’s instructions.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  SPUTUM SPECIMENS  Mucus from the respiratory system is called sputum when expectorated (expelled) through the mouth. Sputum is not saliva. Sputum is not saliva.  Sputum specimens are studied for blood, microbes, and abnormal cells.  The person coughs up sputum from the bronchi and trachea. It is easier to collect a specimen in the morning. It is easier to collect a specimen in the morning.

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  BLOOD GLUCOSE TESTING  Blood glucose testing is used for persons with diabetes. The doctor uses the results to regulate the person’s drugs and diet. The doctor uses the results to regulate the person’s drugs and diet.  Capillary blood is obtained through a skin puncture. A fingertip is the most common site for skin punctures. A fingertip is the most common site for skin punctures. The earlobe also is a site. The earlobe also is a site.

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  To perform a skin puncture: Inspect the site carefully. Inspect the site carefully.  Look for signs of trauma and skin breaks.  Avoid sites that are swollen, bruised, cyanotic, scarred, or calloused. Do not use the center, fleshy part of the fingertip. Do not use the center, fleshy part of the fingertip. Use the side toward the tip of the fingertip on the middle or ring finger. Use the side toward the tip of the fingertip on the middle or ring finger. A sterile lancet is used to puncture the skin. A sterile lancet is used to puncture the skin.  A glucose meter (glucometer) is used to measure blood glucose.  Many different glucose meters are available. Follow the manufacturer’s instructions. Follow the manufacturer’s instructions.