9. Specimen Collection.docx

**SPECIMEN COLLECTION** **Learning Outcomes** After completing this topic students will be able to: 1. Discuss the nursing responsibility for specimen collection. 2. Explain the rationale for the collection of each type of specimen. 3. Describe how to collect stool specimens. 4. Compare an...

**SPECIMEN COLLECTION** **Learning Outcomes** After completing this topic students will be able to: 1. Discuss the nursing responsibility for specimen collection. 2. Explain the rationale for the collection of each type of specimen. 3. Describe how to collect stool specimens. 4. Compare and contrast the different types of urine specimens. 5. Describe how to collect sputum and throat specimens. 6. Verbalize and demonstrate the steps used in: i. Obtaining a capillary blood specimen to measure blood glucose. ii. Collecting a urine specimen for culture and sensitivity by clean catch. A. **INTRODUCTION** - Diagnostic and laboratory tests -- to provide information about clients. B. **DIAGNOSTIC TESTING** 1. Pre-test Assessment - Focus on client preparation - Assessment and data collection (e.g., biologic, psychological, sociological, cultural and spiritual) assist nurse in determine communication and teaching strategies - Important to know if the pt is pregnant, because special precaution may be necessary or the test may need to postponed due to pregnant - Need to know what equipment/supplies are needed for specific test - Common question; - What type of sample will be needed and how will it be collected? - Does the client need to stop oral intake for a certain number of hours prior to the test? - Does the test include administration of dye (contrast media) and, if so, is it injected or swallowed? - Are fluids restricted or forced? - Are meds given or withheld? - How long is the test? - Is a concerned form required? - Answers these types of questions can avoid costly mistake and reduce inconvenience to all the healthcare team - Laboratory act as resources information 2. Intra-test - Focus on specimen collection and performing /assisting with certain diagnostic test - Nurses use the standard precautions and sterile technique - During the procedure, nurse provides emotional and physical support while monitoring (e.g., vital signs, pulse oximetry, ECG) - Nurse ensures correct labelling, storage, and transportation of the specimen to avoid invalid test results 3. Post-test - Focus on nursing care of the client and follow-up activities and observations - Nurse compares the previous and current test results and modifies nursing intervention as needed - Report the result to appropriate team members - The National Patient Safety Goals Identify the importance of reporting critical results of test and diagnostic procedures  C. **MEASURE CAPILLARY BLOOD GLUCOSE** - To measure -- current blood glucose level a. Responsibility - Clean the site with antiseptic and dry completely before prick - Capillary blood specimen -- obtained from lateral aspect or side of the finger in adults b. Skills: i. Purpose ii. Assessment iii. Planning iv. Equipment v. Implementation vi. Evaluation  D. **SPECIMEN COLLECTION AND TESTING** a. **Responsibilities** i. Provide client comfort, privacy, and safety ii. Explain the purpose iii. Practice aseptic technique and correct procedure iv. Note relevant information : medication affect results v. Transport specimen -- promptly vi. Report abnormal -- finding 1. **Stool Specimens** a. **Purpose;** i. To determine presence -- occult blood ii. To analyze -- dietary products & digestive secretion. Eg; excessive fat; decreased bile iii. To detect -- ova & parasites iv. To detect -- bacteria / viruses b. **Instruction to give;** i. Defecate in a clean bedpan/ bedside commode ii. Do not contaminate -- specimen : urine/ menstrual discharge iii. Void before -- specimen collection iv. Do not place toilet tissue -- bedpan after defecation v. Send specimen immediately vi. Amount @ 2.5 cm / 1 in or 15 -30mls 2. **Urine Specimens** a. **Clean voided urine specimen** i. To collect -- clean voided specimen for routine urinalysis, clean-catch or midstream urine specimens for urine culture ii. First voided specimen -- morning iii. Amount -- 10mL urine iv. Specimen must be free -- fecal contamination v. Discard -- toilet tissue vi. Put the lid lightly -- container vii. Clean contaminated area -- disinfectant b. **Skill** i. Purpose ii. Assessment iii. Planning iv. Equipment v. Implementation vi. Evaluation   **TIME URINE SPECIMEN / 24 hours urine collection** - Period of time : 1-2 hrs to 24 hrs to collect urine 1. **Purpose;** i. To assess -- ability -- kidney ii. To determine disorder -- glucose metabolism for DM pt iii. To determine levels -- specific constituents -- eg; albumin, amylase, creatinine, urobilinogen, or certain hormone (estriol/corticosteroids) iv. Obtain -- specimen container v. Provide -- clean receptacle -- collect urine vi. Post signs -- client's chart vii. At the start -- collection period -- client void & discard -- urine viii. Save all urine produced ix. At the end -- collection period, instruct -- to completely empty -- bladder and save x. Record collection -- specimen, time started & completed **URINE TESTING** - Tests : specific gravity, pH, presence of -- glucose, ketones, protein, occult blood **Principle** - Dip end of specimen reagent strip in to urine for 2 sec - Remove excess urine by tapping the strip against the specimen container rim - Wait for exactly 30 sec - Compare its colour with the colour chart on the test strip container - Ignore color changes that occur after 30 sec **SPUTUM SPECIMENS** **1. PURPOSE** i. For culture and sensitivity -- identify a specific microorganism & drug sensitivities. ii. For cytology to identify the origin, structure, function, and pathology of cells. Specimens -- cytology often require serial collection of three earlymorning specimens and are tested to identify cancer in the lung and its specific cell type. iii. For Acid-fast bacillus (AFB), which also requires serial collection, often for 3 consecutive days, to identify the presence of tuberculosis (TB). iv. To assess -- effectiveness of therapy. **2. Responsibility** i. Offer mouth care -- specimen will not -- contaminated with microorganisms from -- mouth. ii. Ask -- client to breathe deeply & cough up 4 to 10 mL -- sputum. iii. Wear gloves & PPE - suspected TB iv. Ensure sputum does not contact -- outside container. (Disinfect if contaminated ) iv. Offer mouthwash following sputum collection vi. Label & transport -- specimen -- immediately -- laboratory. v. Document -- client chart ( amount, color, consistency: thick, tenacious, watery; hemoptysis, odor, **THROAT CULTURE** A sample -- collected from -- mucosa of -- oropharynx & tonsillar region using a culture swab **The Basic Guidelines For Specimen Collection** - Specimens need to be collected at the best time possible, such as early morning sputum for AFB culture. - Use appropriate collection devices like sterile, leak-proof specimen containers for collecting samples. - Expiration dates need to be checked before inoculating collection device. - Fill out the test request form fully and label the specimen properly. - Maintain an appropriate time between collection of the specimen and delivery to the lab. **The Role of Nurses in Specimen Collection:** - Ensuring appropriate collection of samples - Precise sample identification - Making sure all selected supplies are suitable for collection - Timely transfer of specimen to the lab - Patient interaction **Common Specimen Collections:** 1. **Throat swab culture** To check the presence of a bacteria or fungal infection in the throat, a diagnostic test called a throat swab culture is conducted. In this test, a sample of mucus is collected on a cotton-tipped applicator and is placed on a special cup that allows infections to dwell. Common infections include pneumonia, whooping cough, and tonsilitis 2. **Sputum specimen and culture** In this laboratory analysis, a sample of material is expelled from the respiratory passages to determine pathogen presence. It generally takes a good 2-3 days to collect the specimen, as it is very difficult for a patient to cough up enough sputum at one time 3. **Stool specimen and culture** Stool cultures include the process of growing organisms existing in the feces to identify any disease-causing bacteria. The most common is the parasites and ova test to detect the presence of parasites such as amoebas or worms. 4. **Urine specimen and culture** Physical, chemical and microscopic examination of urine is referred to as urinalysis. It generally involves a number of tests to analyze various compounds thoroughly that pass through the urine. The color, density, and odor of the urine are all considered to reveal the individual's health status