Specimen Collection[1]
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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