Chapter 52: Specimen Collection

Keeping Intake and Output Records Indicator of nutritional and fluid balance. Order is given to “record food and fluid intake” or “I&O + calorie count.” Over 24 hours, a person’s normal fluid I&O will be approximately the same, or balanced. Amounts recorded for I&O are measured in milliliters (mL).

Fluid Intake and Output All fluids consumed through the gastrointestinal (GI) system Fluids taken as part of intravenous (IV) therapy or total parenteral nutrition (TPN) *Count ice as 50% water intake Fluid output Includes all fluids excreted from the body by any means Maintain IV fluids record

I&O record

Specimen Hat

Collecting Specimens and Samples Label specimen containers with client name prior to collection. Observe standard precautions. Collect each sample according to facility protocol. Observe sterile technique for sample collection. Place all specimens in biohazard bags. Document the procedure; notify provider of results.

Measuring Urine Specific Gravity An indicator of the concentration of urine as compared with pure water Measured with a urinometer or hydrometer *Normal range 1.010 (dilute) to 1.025 (highly concentrated)

Disorders Associated with Low/High Urine Specific Gravity Low specific gravity Diabetes insipidus Excessive use of diuretic medications Dehydration or tissue fluid retention (edema) Low or high specific gravity Kidney disorder

Specimen Collection Laboratory study of samples of body fluids provide health status. Follow agency protocols for specimen collection to ensure accuracy and consistency in test results. Always wear clean gloves when collecting specimens of urine, stool, sputum, wound drainage, or blood. Perform thorough and consistent handwashing before and after any contact with clients and their specimens.

The Urine Specimen: Information Obtained Client’s recovery or decline Assessment of kidney and/or liver status Presence of legal and illegal drugs Pregnancy Identification of specific disease-causing organisms

Collecting Urine Specimens Urinalysis: components of urine are identified Single-voided urine specimen *done to determine the efficiency of the kidneys or examine the urine for abnormalities Clean-catch or midstream urine specimen 24-hour urine specimen *store all specimens on ice or in a specimen refrigerator during the 24 hour collection period unless otherwise specified

Collecting Urine Specimens Fractional urine specimen *6 hour segments In some cases, such as when doing drug testing, an observed urine specimen must be obtained Initiating a kidney stone prevention program

An Indwelling Catheter Take care not to allow the collecting bag to be elevated above the level of the bladder Obtaining a one-time catheterized urine specimen Residual urine volume Strict sterile technique 40% of all nosocomial infections are related to infections of the urinary tract

The Stool Specimen Tested for *Occult blood (Hemoccult or Hematest brand methods or guaiac tests) *usually specimens are collected on 3 separate days *Ova and parasites (O&P)

The Sputum Specimen Highly contaminated. Treat with caution. *sputum collects in the airways during the night and often is more easily expelled by coughing in the early morning *first morning specimen is most accurate Dispose paper tissues used by client as per agency protocol. Wear gloves when handling tissues and sputum specimens and when providing any nursing care, if the client is coughing up sputum. Goggles and a mask or a full face shield may be necessary.

The Sputum Specimen (cont.) Document use of aerosolized medications Order to measure sputum Collect sputum in a graduated specimen container Weigh the specimen

Collecting Other Specimens Throat culture Nasal swab Nasopharyngeal swab