1. Chapter 28 Collecting and Testing Specimens All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

2. Specimens   Specimens (samples) are collected and tested to prevent, detect, and treat disease.   The doctor orders what specimen to collect and the test needed.   All specimens sent to the laboratory require requisition slips. 2 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

3. Urine Specimens   Urine specimens are collected for urine tests.   The random urine specimen   The random urine specimen is collected for a routine urinalysis.   No special measures are needed.   Many people can collect the specimen themselves.   Weak and very ill persons need help. 3 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

4. The Clean-Catch Specimen   The midstream specimen (clean-voided specimen or clean-catch specimen)   The perineal area is cleaned before collecting the specimen.   Sterile gloves are needed.   A sterile specimen container is needed.   To collect the specimen:   The person starts to void into a receptacle.   Then the person stops the stream of urine.   A sterile specimen container is positioned.   The person voids into the container until the specimen is obtained.   You may need to position and hold the specimen container in place after the person starts to void. 4 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

5. The 24-Hour Urine   The 24-hour urine specimen   All urine voided during a 24-hour period is collected.   Urine is chilled on ice or refrigerated during this time.   A preservative is added to the collection container for some tests.   The person voids to begin the test with an empty bladder. Discard this voiding.   Save all voidings for the next 24 hours. 5 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

6. Urine Testing   Testing urine   Urine pH measures if urine is acidic or alkaline. Normal pH is 4.6 to 8.0. A routine urine specimen is needed.   Testing for glucose and ketones These tests are usually done 30 minutes before each meal and at bedtime (four times each day). The doctor uses the test to make drug and diet decisions. Double-voided specimens are best for these tests.   Testing for blood Sometimes blood is seen in the urine. At other times it is unseen (occult). A routine urine specimen is needed. 6 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

7. Urine Testing (Cont’d)   Using reagent strips   Do not touch the test area on the strip.   Dip the strip into the urine.   Compare the strip with the color chart on the bottle.   Follow the manufacturer’s instructions.   Straining urine   A stone (calculus) can develop in the kidney, ureter, or bladder.   Stones can vary in size.   Stones causing severe pain and urinary system damage may require surgical removal.   Some stones are passed through urine. 7 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

8. Stool Specimens   Stools are studied for:   Blood   Fat   Microbes   Worms   Other abnormal contents   The stool specimen must not be contaminated with urine. 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

9. Testing Stools for Blood   When internal bleeding is suspected, stools are checked for blood.   Testing stools for blood   Often blood is seen if bleeding is low in the bowels.   Stools are black and tarry (melena) if there is bleeding in the stomach or upper GI tract.   Sometimes bleeding occurs in very small amounts and cannot be seen (occult blood).   The test is often done to screen for colon cancer. 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

10. Sputum Specimens   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.   Older persons may lack the strength to cough up sputum.   Coughing is easier after postural drainage.   The nurse or respiratory therapist does postural drainage. 10 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

11. Blood Glucose Testing (Cont’d)   Blood glucose testing is used for persons with diabetes.   Capillary blood is obtained through a skin puncture.   You use a sterile, disposable lancet to puncture the skin.   A glucose meter (glucometer) measures blood glucose. 11 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

12. Blood Glucose Testing (Cont’d)   To perform a skin puncture:   Inspect the site carefully. Look for signs of trauma and skin breaks.   Do not use sites that are swollen, bruised, cyanotic (bluish color), scarred, or calloused.   Do not use the center, fleshy part of the fingertip.   Use the side toward the tip of the middle or ring finger.   You apply a drop of blood to a reagent strip.   Then you insert the strip into the glucose meter.   The blood glucose level appears on the screen.   Many types of glucose meters are available.   Follow the manufacturer’s instructions. 12 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

13. Quality of Life   Promote comfort by explaining the procedure to the person.   Some people can collect their own urine and sputum specimens.   Doing so promotes independence and helps reduce embarrassment.   Show the person the specimen container and how it is used.   Ask the person where to place the container so the person knows where to find it. 13 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.