Specimen collectionSpecimen collection

Role of the NurseRole of the Nurse

Nurses often assume the Nurses often assume the responsibility of specimen responsibility of specimen collectioncollection Specimens consist Specimens consist

UrineUrine StoolStool SputumSputum Wound drainageWound drainage BloodBlood

What about the client?What about the client?

ComfortComfort PrivacyPrivacy Questions Questions Clear, concise directionsClear, concise directions

NPONPO

The NurseThe Nurse

Check physician ordersCheck physician orders Keep it Simple directions to Keep it Simple directions to

clientclient Standard precautionsStandard precautions Label specimenLabel specimen TimelyTimely C&S to lab ASAP or refrigeratedC&S to lab ASAP or refrigerated Documentation Documentation

Urine SpecimenUrine Specimen

RandomRandom CleanClean Female ? Menses (make note)Female ? Menses (make note) Tested for:Tested for:

Specific gravitySpecific gravity pHpH AlbuminAlbumin GlucoseGlucose Microscopic examMicroscopic exam

Urine for C&SUrine for C&S

Culture = ? Bacteria growingCulture = ? Bacteria growing Sensitivity = which antibiotics Sensitivity = which antibiotics

are effectiveare effective Readings after 24; 48; 72 hrs.Readings after 24; 48; 72 hrs.

Midstream UrineMidstream Urine

Sterile Catheter SpecimenSterile Catheter Specimen

(never from bag)(never from bag)

Why a urine specimen for Why a urine specimen for C&SC&S

? Urinary Tract Infection (UTI)? Urinary Tract Infection (UTI) FrequencyFrequency UrgencyUrgency DysuriaDysuria HematuriaHematuria Flank painFlank pain FeverFever Cloudy, malodorous urineCloudy, malodorous urine

Obtaining specimenObtaining specimen

Wash handsWash hands Clean meatus, female front to Clean meatus, female front to

backback Start stream, then stop, collect Start stream, then stop, collect

specimenspecimen Aseptic techniqueAseptic technique Bedpan/mexican hatBedpan/mexican hat To lab 15-20min post collection To lab 15-20min post collection

ChildrenChildren

Pediatric bags ( u Bag)Pediatric bags ( u Bag) Never squeeze diaperNever squeeze diaper

Characteristics of UrineCharacteristics of Urine

ColorColor ClarityClarity OdorOdor

Specimen CollectionSpecimen Collection

1.1. Random SpecimensRandom Specimens Clean-not sterileClean-not sterile Ordered forOrdered for

Urinalysis testingUrinalysis testing Measurement of specific gravityMeasurement of specific gravity pHpH Glucose levelsGlucose levels

Urine specimen collectionUrine specimen collection

2.2. Midstream SpecimenMidstream Specimen Clean voidedClean voided C&SC&S 30-60 mls urine30-60 mls urine

3.3. Sterile SpecimenSterile Specimen Indwelling catheterIndwelling catheter Drainage bagDrainage bag

Urine collectionUrine collection

4.4. Timed urine specimensTimed urine specimens 2-72 hr intervals (24hr most 2-72 hr intervals (24hr most

common)common) Begin after urinatingBegin after urinating Note start time on container & Note start time on container &

requisitionrequisition Collect all urine in timed periodCollect all urine in timed period

Post Reminder SignsPost Reminder Signs

Indwelling CatheterIndwelling Catheter

Strict aseptic techniqueStrict aseptic technique Only from Bag if Brand newOnly from Bag if Brand new Sampling Port?Sampling Port? Clamp 30 min. priorClamp 30 min. prior Wash hands – GloveWash hands – Glove Cleanse port with alcohol swabCleanse port with alcohol swab Sterile needleSterile needle To lab 30 min (may refridge 2hrs)To lab 30 min (may refridge 2hrs)

Common Urine Lab TestsCommon Urine Lab Tests

Routine UrinalysisRoutine Urinalysis Examine within 2hrsExamine within 2hrs 11stst voided specimen in AM voided specimen in AM Reagent stripReagent strip

Specific GravitySpecific Gravity ConcentrationConcentration 1.010-1.0251.010-1.025

Urine glucoseUrine glucose DiabeticsDiabetics Reagent stripsReagent strips Double voidDouble void

Measuring chemical Measuring chemical properties of urine=Urinalysisproperties of urine=Urinalysis

GlucoseGlucose KetonesKetones ProteinProtein Blood- hematuriaBlood- hematuria pHpH Specific gravitySpecific gravity Microscopic examinationMicroscopic examination

Stool SpecimenStool Specimen

Analysis of fecal material can Analysis of fecal material can detect pathological conditions ie: detect pathological conditions ie: tumors, hemorrhage, infection tumors, hemorrhage, infection

TestsTests OBOB PusPus Ova & ParasitesOva & Parasites

Fecal specimensFecal specimens

? Chemical preservatives? Chemical preservatives Medical aseptic techniqueMedical aseptic technique To lab on time To lab on time LabellingLabelling DocumentationDocumentationGuaiac TestGuaiac TestColorectal cancer screening testColorectal cancer screening testFOBTFOBTHemoccult slide testHemoccult slide test

Fecal CharacteristicsFecal Characteristics

ColorColor melenamelena

OdorOdor ConsistencyConsistency FrequencyFrequency AmountAmount ShapeShape Constituents Constituents

Guaiac TestGuaiac Test

Single positive test result does Single positive test result does not confirm bleeding or not confirm bleeding or colorectal cancer.colorectal cancer.

Repeat test 3XRepeat test 3X Meat free, high residue dietMeat free, high residue diet

Vaginal or Urethral Discharge Vaginal or Urethral Discharge SpecimensSpecimens

Normally thin, nonpurulent, Normally thin, nonpurulent, whitish or clear, small in amountwhitish or clear, small in amount

S&S STD’s, UTIS&S STD’s, UTI Not DelegatedNot Delegated Assess external genitaliaAssess external genitalia If STD record sexual historyIf STD record sexual history Physician’s order- Physician’s order-

vaginal/urethralvaginal/urethral

Blood SpecimensBlood Specimens

Lab techsLab techs ABG’sABG’s Blood GlucoseBlood Glucose

Respiratory TractRespiratory Tract

Tests to determine abnormal Tests to determine abnormal cells or infectioncells or infection Throat culturesThroat cultures Sputum specimensSputum specimens Skin testingSkin testing Thoracentesis Thoracentesis

Nose, Throat SpecimensNose, Throat Specimens

Upper respiratory/ throat infectionsUpper respiratory/ throat infections Should Should NotNot be delegated be delegated Throat swabsThroat swabs

ac meal or 1 hr pc meal ac meal or 1 hr pc meal Wash hands, gloveWash hands, glove Tilt head backwardTilt head backward ““ah” ( if pharynx not visualized, tongue ah” ( if pharynx not visualized, tongue

depressor, anterior 1/3 of tongue)depressor, anterior 1/3 of tongue) Don’t contaminateDon’t contaminate

Throat culturesThroat cultures

Oropharynx & tonsillarOropharynx & tonsillar Sterile swabSterile swab Culture determines pathogenic Culture determines pathogenic

microorganismsmicroorganisms Sensitivity determines the Sensitivity determines the

antibiotics to which the antibiotics to which the microorganisms are sensitive or microorganisms are sensitive or resistant resistant

Method for throat cultureMethod for throat culture

Insert swab into pharyngeal Insert swab into pharyngeal regionregion

Reddened areas/ exudateReddened areas/ exudate Gag reflex if client sitting Gag reflex if client sitting

and leaning forward slightlyand leaning forward slightly Inform client re procedure Inform client re procedure

Nose cultureNose culture

Blow nose, check nostril Blow nose, check nostril patencypatency

Rotate Swab inflamed mucosa Rotate Swab inflamed mucosa or exudateor exudate

Swab must advance into Swab must advance into nasopharynx to ensure culture nasopharynx to ensure culture properly obtainedproperly obtained

Sputum specimens (3 major Sputum specimens (3 major types)types)

Ordered to identify organisms Ordered to identify organisms growing in sputumgrowing in sputum

C&SC&S AFBAFB

3 consecutive, early am3 consecutive, early am Cytology Cytology

Abnormal lung cancer by cell Abnormal lung cancer by cell typetype

3 early am3 early am

Sputum collectionSputum collection

May be delegatedMay be delegated Cough effectivelyCough effectively Mucus from bronchusMucus from bronchus Not SalivaNot Saliva RecordRecord

ColorColor ConsistencyConsistency AmountAmount Odor Odor Document date & time sent to lab.Document date & time sent to lab.

Sputum collectionSputum collection

No mouthwash/toothpaste- No mouthwash/toothpaste-

viability of microorganisms viability of microorganisms and alter culture resultsand alter culture results

Skin testingSkin testing

Determines pulmonary diseasesDetermines pulmonary diseases BacterialBacterial FungalFungal ViralViral

Antigen injected intradermallyAntigen injected intradermally

Injection site circled Injection site circled

Instructions not to wash site Instructions not to wash site

Reading skin testReading skin test

Induration – palpable, elevated, Induration – palpable, elevated, hardened area around site. hardened area around site. Edema and inflammation from Edema and inflammation from antigen –antibiotic reaction. antigen –antibiotic reaction. Measured in millimetersMeasured in millimeters

Reddened Reddened flatflat areas are neg. areas are neg.

The elderly freq. display false neg. The elderly freq. display false neg. or false positive TB skin testor false positive TB skin test

If positive TB testIf positive TB test

Complete history risk Complete history risk factorsfactors

SymptomsSymptoms Weight lossWeight loss Night sweatsNight sweats HemoptysisHemoptysis FatigueFatigue

Early am sputum for AFBEarly am sputum for AFBChest xrayChest xray

ThoracentesisThoracentesis

Insert needle through chest wall Insert needle through chest wall into pleural space into pleural space

Aspirate fluidAspirate fluid• DiagnosticDiagnostic• TherapeuticTherapeutic• BiopsyBiopsy

Gastric SecretionsGastric Secretions

NG tubeNG tube

CulturesCultures

Culturette/swabCulturette/swab Wet/dry methodWet/dry method Nose, throat, woundNose, throat, wound

Review procedure manual & fill Review procedure manual & fill in requisitions.in requisitions.

Nursing Functions for Nursing Functions for Specimen CollectionSpecimen Collection

1.1. Explain procedure, gain Explain procedure, gain client’s participationclient’s participation

2.2. Collect right amt. of specimen Collect right amt. of specimen at the right timeat the right time

3.3. Place specimen in correct Place specimen in correct container container

4.4. Label container accurately Label container accurately

(addressograph), plastic bag(addressograph), plastic bag

Nursing Functions for Nursing Functions for specimen collectionspecimen collection

5.5. Complete lab. Req.Complete lab. Req.

6.6. Place the specimen in the Place the specimen in the appropriate place for pick up.appropriate place for pick up.

7.7. Document/record specimen Document/record specimen sent and anything unusual sent and anything unusual about the appearance of about the appearance of specimenspecimen

Blood glucose levelsBlood glucose levels

Capillary PunctureCapillary Puncture Reduces VenipuncturesReduces Venipunctures Clients can performClients can perform Glucometers Glucometers Chemical reagent stripChemical reagent strip Delegated to those instructed in Delegated to those instructed in

skill if client’s condition stableskill if client’s condition stable

Glucose monitoringGlucose monitoring

Ordered ac, pc, hs, fasting, Ordered ac, pc, hs, fasting, before insulin (sliding scale)before insulin (sliding scale)

? Risks for skin puncture? Risks for skin puncture Assess area of skinAssess area of skin

Sides of fingers, toes, heelsSides of fingers, toes, heels Client’s abilityClient’s ability Normal fasting Bld. Sugar Normal fasting Bld. Sugar 70-120 mg/100ml 70-120 mg/100ml

Glucose MonitoringGlucose Monitoring

Wash hands, Wash hands, gloveglove Client wash hands, warm waterClient wash hands, warm water Follow instructions on meterFollow instructions on meter Massage /milk finger or puncture siteMassage /milk finger or puncture site Antiseptic swab ( allow to dry Antiseptic swab ( allow to dry

completely)completely) Wipe away first droplet of blood with Wipe away first droplet of blood with

tissue/cotton balltissue/cotton ball

Glucose MonitoringGlucose Monitoring

Dispose of lancet in sharps Dispose of lancet in sharps containercontainer

Wash handsWash hands Check puncture siteCheck puncture site

Can share reading with clientCan share reading with client Record resultsRecord results Proceed as indicated by resultsProceed as indicated by results

The Value of MeasurementThe Value of Measurement

3 benefits to measuring progress 3 benefits to measuring progress and resultsand results

Shows where we are nowShows where we are now Tells if we are heading toward Tells if we are heading toward

our goalour goal Allows us to make Allows us to make

improvements along the wayimprovements along the way

What we measure gets What we measure gets improved. improved. Peter F. DruckerPeter F. Drucker

Heightens our awarenessHeightens our awareness Helps us focus on what we Helps us focus on what we

value and where we are goingvalue and where we are going Keeps us on trackKeeps us on track Gives info what is happening Gives info what is happening

along the way and enables us to along the way and enables us to continue or change depending continue or change depending on desired resultson desired results