1. Chapter 52:
Specimen Collection

2. 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).

3. 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

4. I&O record

5. Specimen Hat

6. 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.

7. 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 (highly concentrated)

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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)

15. 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.

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

17. Collecting Other Specimens
Throat culture
Nasal swab
Nasopharyngeal swab