Unit 4 Microbiology and Parasitology Lab Finals (PDF)

BACHELOR OF SCIENCE IN NURSING (BSN) CN 112L: Microbiology and Parasitology Laboratory - FINALS UNIT 4: ROLES of NURSES in DIAGNOSTIC TESTS Learning Objectives: On successful completion of this unit, you will be able to 1. Determine techniques of...

BACHELOR OF SCIENCE IN NURSING (BSN) CN 112L: Microbiology and Parasitology Laboratory - FINALS UNIT 4: ROLES of NURSES in DIAGNOSTIC TESTS Learning Objectives: On successful completion of this unit, you will be able to 1. Determine techniques of specimen collection ensuring quality specimens needed for accurate diagnosis 2. Describe the roles of the nurse related to diagnostic tests 3. Communicate clearly and briefly all relevant information in an organized manner both in oral and written form. 4. Assume responsibility for lifelong learning, own personal development and maintenance of professional and personal competence. 5. Apply ethical principles during specimen collection. 6. Perform proper nasal swabbing. Various types of specimens are collected depending on the signs and symptoms of the client. So if your client is experiencing a respiratory infection, then the specimen to be collected is the sputum of the patient. The specimen is an important specimen to make a diagnosis of the patient’s illness. In this case, the nurse then must be able to provide correct and complete instruction regarding the preparation and the steps in collecting a high-quality specimen, that is a good representative of a specimen that is taken by sampling, or gathered matter of a medical patient's tissue, fluid, or other material derived from the patient used for laboratory analysis to assist differential diagnosis or staging of a disease process. The patient might become anxious regarding the result of his diagnosis so to allay anxiety of the patient, the nurse must also be able to inform the patient regarding the steps involved in the diagnosis of an infectious disease. 1. Patient with symptoms of an infectious disease consults a clinician. 2. The clinician makes preliminary diagnosis and writes order for laboratory tests. 3. Appropriate specimen is collected and transported to the laboratory. - Nurses should be skillful in this step since they are the ones providing health education to patients regarding collection and transportation of specimen. Sometimes, nurses are the ones who collect the specimen and transport it to the laboratory 4. Specimen and patient data are entered into the laboratory computer or logbook 1|Page  Nurses must also be accurate in putting labels on the specimen container to prevent switching of specimen from one patient to another. Proper recording of data must also be done to prevent conflict between the laboratory personnel and nurses. 5. Specimen is examined macroscopically and microscopically 6. Preliminary or presumptive report may be issued 7. Specimen is cultured and incubated 8. Cultures are examined 9. Clinician interprets report and prescribes treatment 10. Patient outcome is monitored by clinician for success or failure. Nurses are important in this step as they are more in contact with the patient. The nursing process of assessing, diagnosing, planning, intervening, and evaluating is constantly done to the client. Nurses are responsible of updating the physicians on the current status of the client whether the treatment is a success or a failure. Since a nurse collaborates with the health team, specimens must be collected in a manner that does not jeopardize either the patient or the person (may be a medical technologist, respiratory therapist, doctor, or a nurse) collecting the specimen. Responsibilities Of Health Care Professionals In The Submission Of Specimens 1. Proper collaboration among the members of the health care team is important for proper diagnosis of infectious disease. 2. Based on assessment, appropriate clinical specimens must be obtained and appropriate diagnostic test must be requested. 3. Must select the appropriate specimen, collect it properly, and transport it properly to the laboratory. 4. During collection, extreme caution must be observed especially if it involves use of needles or coming in contact with HIV or Hepatitis B infected secretions. 5. Strictly adhere to the safety policies of standard precaution (Primary strategy for the prevention of health care-associated transmission of infectious agents between patients and health care personnel.) First, look into the differences of bacterial infections and viral infections. Bacteria and viruses can cause many common infections. But what are the differences between these two kinds of infectious 2|Page  organisms? Please use the table below: https://www.healthline.com/health/bacterial-vs-viral-infections CHARACTERISTICS BACTERIAL INFECTION VIRAL INFECTION BACTERIA VIRUS -larger than viruses -which is smaller/tinier than bacteria CAUSATIVE AGENT -able to reproduce by itself -cannot survive without a host. Need a living cell to reproduce - staphylococcus aureus, tubercle bacillus - HIV, hepatitis A virus, rhinovirus FEVER A bacterial illness notoriously A viral infection may or may not cause a cause a fever fever some are beneficial (normal Viruses are not beneficial. Most viruses flora). Helps in the digestion of cause diseases and specifically attacks BENEFITS food. cells like liver cells, respiratory system notoriously cells, blood cells -some viruses may be able to destroy brain tumors. - Ebola and Lassa chimeric viruses Can be useful in genetic engineering DURATION OF ILLNESS A bacterial illness commonly will Most viral illnesses last 2 to 10 days last longer than 10 days INFECTIONS/DISEASES Food poisoning, gastritis, ulcers, AIDS, common cold, influenza, chickenpox meningitis, pneumonia Antibiotics Vaccines like polio vaccine, measles vaccine -overuse of antibiotics results to antibiotic resistance like the Viruses do not respond to antibiotics TREATMENT multi-drug resistant tuberculosis Preventing transmission and control of transmission of bacterial and viral infections Certain bacteria and viruses are transmitted through close contact between people. Several situations increase such contacts, including the following: Living or working with other people Sharing items Giving care to a person Frequenting public areas 3|Page There are a number of measures that you can take to prevent the spread of bacteria and viruses HOW DO BACTERIA and VIRUSES CAUSE DISEASE? Ability of the bacteria and viruses to cause a disease depends on the virulence of the bacteria or the virus. VIRULENCE OF BACTERIA and VIRUSES Virulence is described as an ability of an organism to infect the host and cause a disease. Virulence factors are the molecules that assist the bacterium and virus colonize the host at the cellular level. The membrane associated virulence factors aid the bacterium in adhesion and evasion of the host cell. Virulence factors are molecules produced by bacteria, viruses, fungi, and protozoa that add to their effectiveness and enable them to achieve the following: colonization of a niche in the host (this includes attachment to cells) Immune-evasion which refers to the evasion of the host's immune response. A. ROLES OF NURSES RELATED TO DIAGNOSTIC TESTING: INTEGUMENTARY Intact skin is a type of nonspecific host defense mechanism, serving as a physical barrier. It is part of the body’s first line of defense. Very few pathogens can penetrate intact skin. Clinical specimen Skin specimen, wound secretions Disease in Review : MPOX Mpox (previously known as Monkeypox) is a zoonotic viral infection caused by the Mpox virus, which is an orthopox virus in the same genus as Smallpox. Mpox was a relatively unknown infection until early 2022, at which time human-to-human transmission began to occur more frequently, leading to an exponential increase in number of cases. Transmission began to take place between humans, either via direct, indirect or vertical transmission. Once the Mpox virus is exposed to an individual, it uses particular membrane proteins on it’s surface to bind to and infiltrate into host cells. One of the first places it enters is the lymph nodes, and then will enter into the blood leading to the initial viremia stage of infection. The virus will eventually lead to symptoms after an approximately 4-21 day incubation period. Symptoms involve a flu-like prodromal stage of infection, with subsequent pox-like rash that occurs with vesicles and pustules. Symptom onset correlates with a secondary viremia leading to 1 to 2 days of prodromal symptoms such as fever and lymphadenopathy before lesions appear. Infected patients may be contagious at this time. Lesions start in the oropharynx and then appear on the skin. Serum antibodies are often detectable by the time lesions appear. 4|Page  Historical clues for mpox infection, such as recent travel to endemic areas, interaction with wild animals imported from endemic areas, and providing care to an infected animal or human, help build a differential diagnosis, but clinical features are critical. Initial symptoms include fever, headache, myalgia, fatigue, and lymphadenopathy, a key differentiating feature of mpox from smallpox. After 1 to 2 days, mucosal lesions develop in the mouth, closely followed by skin lesions of the face and extremities (including palms and soles), and are centrifugally concentrated. The rash may or may not spread to the rest of the body, and the total number of lesions may vary from a small amount to thousands. Over the following 2 to 4 weeks, the lesions evolve in 1 to 2-day increments through macular, papular, vesicular, and pustular phases. Lesions change synchronously and are characterized as a firm, deep-seated, and 2 to 10 mm in size. Lesions remain in the pustular phase for 5 to 7 days before crusts begin to form. Crusts form and desquamate over the subsequent 7 to 14 days, and the condition resolves around 3 to 4 weeks after symptom onset in most cases. Patients are no longer considered infectious after all crusts fall off. Different reports have suggested that the MSM population is at particular risk in the present outbreak. The predominant clinical features include vesicular, umbilicated, and pseudo-pustular lesions on the skin, fever, weakness, tiredness, headache, and regional lymphadenopathy. The genital or perianal area is commonly involved and has lesion clustering, which is thought to be due to the sexual nature of transmission. Eventually, skin lesions will resolve over the course of weeks in most patients; however, in patients with immunocompromise they can have issues with complications of Mpox, including eye issues, septicemia and encephalitis. 5|Page 6|Page 7|Page 8|Page 9|Page Preliminary actions of nurses prior to collection of specimens Consider that all clinical specimens may contain potentially infectious agents or organisms. Take precautions when handling specimens suspected or confirmed positive for Monkeypox virus. 10 | P a g e  Timely communication between clinical and laboratory staff is essential to minimize the risk of laboratory transmission when handling and testing specimens from patients with possible mpox. Label specimens accordingly and alert the receiving laboratory to ensure that specimens are appropriately handled. Correct handling and storage of specimens during transportation are essential for accurate diagnostic testing. Skin lesion material (swabs of lesion surface, exudate, or lesion crusts) is the recommended specimen type for mpox testing. Contact the laboratory testing facility to determine their specific requirements e.g. accepted specimen types. Unroofing or aspiration of lesions (or otherwise using sharp instruments for mpox testing) is not necessary, nor recommended, due to the risk for sharps injury. Collecting and Handling Specimens for Mpox Testing Wear recommended personal protective equipment when collecting specimens. Only sterile, synthetic swabs (including but not limited to polyester, nylon, or Dacron) with plastic, wood, or thin aluminum (wire) shafts should be used to collect suspected or confirmed mpox specimens for diagnostic testing. Do not use cotton swabs. Procedures and materials used for collecting specimens may vary depending on the phase of the rash (e.g., swabs from lesion surface or crust from healing lesion). Collect two swabs from each lesion, preferably from different locations on the body or from lesions that differ in appearance (e.g., a pair of swabs for each lesion with a total of 2-3 lesions). Vigorously swab each lesion, avoiding contamination of gloved hands, to ensure adequate viral DNA is collected. Unroofing or aspiration of lesions (or otherwise using sharp instruments for mpox testing) before swabbing is not necessary, nor recommended due to the risk for sharps injury. Place swabs from lesions, crusts, and exudate in separate tubes. Roles in the submission of clinical specimens Transport of clinical specimens. The type of acceptable specimen (dry swab or wet swab in transport media) for diagnostic testing may vary depending on the laboratory. Contact the appropriate laboratory facility to determine the specimen types accepted. At CDC, only dry swabs or swabs in viral transport media (VTM) from lesions, or lesion crusts are currently accepted for testing. Swabs in media designated for bacterial preservation may cause PCR inhibition and are not recommended. 11 | P a g e Labelling: ensure positive specimen identification and optimum integrity of a patient's specimen using 2 identifiers and the specimen information. Clearly label the specimen container with the patient identifiers and include the appropriate specimen information prior to collecting the specimen. Identifiers must be visible, and labels cannot cover the identifiers. Patient identifiers should include at least 2 of the following: 1. Patient name (full first and last name, no initials) 2. Patient date of birth (MM/DD/YYYY) 3. Patient sex assigned at birth 4. A unique ID generated at the time of collection (e.g., a medical record number). A State Public Health Lab ID does not satisfy the requirement Specimen information should include but is not limited to: Collection site (e.g., left arm, upper left groin, right cheek, etc.) Collection date Specimen type Contact the laboratory facility if additional information is required on the label. When accessioning specimens, confirm the specimen has been collected correctly from the individual being tested. Storage After specimen collection, store specimens in sterile leak-proof containers. Use a durable container for the required shipping and temperature conditions. Glass containers are not recommended. If testing occurs at an external laboratory, contact the appropriate laboratory facility to determine specimen storage requirements. For testing at CDC, if specimen testing does not occur promptly after specimen collection, refrigerate (2-8°C) or freeze (-20°C or lower) the specimens until testing occurs. Dry swabs, swabs in VTM, or lesion crust(s) that are stored at 2-8°C can be tested up to 7 days from collection. Swab specimens in VTM and lesion crust(s) that are stored frozen (-20°C or lower) can be tested up to 30 days from collection whereas dry swabs that are stored frozen (-20°C or lower) can be tested up to 60 days from collection. For additional information regarding specimens shipped to CDC, see Requirements for Shipping Specimens to CDC. When preparing specimens for shipment, consider individually bagging specimens so that if a leak does occur, it does not cause the rejection of all specimens. Ship specimens on dry ice, if available. Do not ship specimens at room temperature. 12 | P a g e Scabies § Scabies is the second most common cause of disability among skin diseases in the Philippines as of 2019. § Scabies is an infectious skin condition which can spread from person to person through close physical contact. Resembling an eczema, the infection is caused by mites burrowed beneath the skin which results in itchiness and the occurrence of pimple-like rashes. § Scabies is contagious and can spread quickly through close person-to-person contact in a family, child care group, school class, nursing home or prison. Because scabies spreads so easily, health care providers often recommend treating the entire family or any close contacts. 13 | P a g e Scabies is an itchy skin rash caused by a tiny burrowing (obligate parasitic lifestyle) mite called Sarcoptes scabiei. Intense itching occurs in the area where the mite burrows. The need to scratch may be stronger at night. 14 | P a g e SYMPTOMS 5. Itching, often severe and usually worse at night 6. Thin, wavy tunnels made up of tiny blisters or bumps on the skin 15 | P a g e TREATMENT Scabies is easily treated. Medicated skin creams (E.G. Permethrin) or pills kill the mites that cause scabies and their eggs. But itching may not stop for many weeks after treatment. Belongings treated daily: 1. clothes, beddings best treated best to eliminate the mites with washing machine with heated water for at least 50C for at least 10 minutes; or 2. frozen -10C for 5 hours; or 3. sealing it on a plastic bag 2 up to 8 days to make sure mites are dead. DIAGNOSIS: Multiple (four or more) lesions should be scraped from each patient, with scraping sufficient to cause bleeding. The skin scrapings are then transferred to a slide and viewed under a microscope. The presence of mites, eggs, or mite faecal material confirms the diagnosis. 16 | P a g e