1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 30 Collecting and Testing Specimens

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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.

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. No special measures are needed. No special measures are needed.  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. Sterile gloves are needed. Sterile gloves are needed. A sterile specimen container is needed. A sterile specimen container is needed.

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. Save all voidings for the next 24 hours.

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. The first time the bladder is emptied of “stale” urine. In 30 minutes the person voids again. 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.

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Testing urine Urine pH measures if urine is acidic or alkaline. 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 Testing for glucose and ketones  These tests are usually done 30 minutes before each meal and at bedtime.  The doctor uses the test to make drug and diet decisions.  Double-voided specimens are best for these tests. Testing for blood Testing for blood  Sometimes blood is seen in the urine.  At other times it is unseen (occult).  A routine urine specimen is needed.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Using reagent strips Dip the strip into urine. Dip the strip into urine. Compare the strip with the color chart on the bottle. Compare the strip with the color chart on the bottle. Follow the manufacturer’s instructions. Follow the manufacturer’s instructions.  Straining urine A stone (calculus) can develop in the kidney, ureter, or bladder. A stone (calculus) can develop in the kidney, ureter, or bladder. Some stones are passed through urine. Some stones are passed through urine.

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  STOOL SPECIMENS  Stools are studied for: Blood Blood Fat Fat Microbes Microbes Worms Worms Other abnormal contents Other abnormal contents  The stool specimen must not be contaminated with urine.

14. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Testing stools for blood Often blood is seen if bleeding is low in the bowels. 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. 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). Sometimes bleeding occurs in very small amounts and cannot be seen (occult blood). The test is often done to screen for colon cancer. The test is often done to screen for colon cancer.

16. Slide 16 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. 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. Coughing is easier after postural drainage. The nurse or respiratory therapist does postural drainage. The nurse or respiratory therapist does postural drainage.

18. Slide 18 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. Doing so promotes independence and helps reduce embarrassment.