Specimen collection

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Specimen collection

• Role of the Nurse

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Nurses often assume the responsibility of
specimen collection

• Specimens consist
• Urine
• Stool
• Sputum
• Wound drainage
• Blood

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What about the client?

• Comfort
• Privacy
• Questions
• Clear, concise directions
• NPO

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The Nurse

• Check physician orders
• Keep it Simple directions to client
• Standard precautions
• Label specimen
• Timely
• CS to lab ASAP or refrigerated
• Documentation

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Respiratory Tract

• Tests to determine abnormal cells or infection
• Throat cultures
• Sputum specimens
• Skin testing
• Thoracentesis

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Nose, Throat Specimens

• Upper respiratory/ throat infections
• Should Not be delegated
• Throat swabs
• ac meal or 1 hr pc meal
• Wash hands, glove
• Tilt head backward
• ah ( if pharynx not visualized, tongue
  depressor, anterior 1/3 of tongue)
• Dont contaminate

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Throat cultures

• Oropharynx tonsillar
• Sterile swab
• Culture determines pathogenic microorganisms
• Sensitivity determines the antibiotics to which
  the microorganisms are sensitive or resistant

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Method for throat culture

• Insert swab into pharyngeal region
• Reddened areas/ exudate
• Gag reflex if client sitting and leaning
  forward slightly
• Inform client re procedure

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Nose culture

• Blow nose, check nostril patency
• Rotate Swab inflamed mucosa or exudate
• Swab must advance into nasopharynx to ensure
  culture properly obtained

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Sputum specimens (3 major types)

• Ordered to identify organisms growing in sputum
• CS
• AFB
• 3 consecutive, early am
• Cytology
• Abnormal lung cancer by cell type
• 3 early am

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Sputum collection

• May be delegated
• Cough effectively
• Mucus from bronchus
• Not Saliva
• Record
• Color
• Consistency
• Amount
• Odor
• Document date time sent to lab.

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Sputum collection

• No mouthwash/toothpaste-
• viability of microorganisms and alter
  culture results

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Skin testing

• Determines pulmonary diseases
• Bacterial
• Fungal
• Viral
• Antigen injected intradermally
• Injection site circled
• Instructions not to wash site

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Reading skin test

• Induration palpable, elevated, hardened area
  around site. Edema and inflammation from antigen
  antibiotic reaction. Measured in millimeters
• Reddened flat areas are neg.
• The elderly freq. display false neg. or false
  positive TB skin test

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If positive TB test

• Complete history risk factors
• Symptoms
• Weight loss
• Night sweats
• Hemoptysis
• Fatigue
• Early am sputum for AFB
• Chest xray

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Thoracentesis

• Insert needle through chest wall into pleural
  space
• Aspirate fluid
• Diagnostic
• Therapeutic
• Biopsy

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SPUTUM COLLECTION
Sputum containers
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SPUTUM COLLECTION
Isolated chambers for sputum expectoration
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SPUTUM COLLECTION
Sputum suction from lung
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WASTE MANAGEMENT
Be careful !
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Gastric Secretions

• NG tube

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Gastric Secretions

• NG tube

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Cultures

• Culturette/swab
• Wet/dry method
• Nose, throat, wound
• Review procedure manual fill in requisitions.

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WOUND SPECIMEN
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Cultures

• Culturette/swab
• Wet/dry method
• Nose, throat, wound
• Review procedure manual fill in requisitions.

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Nursing Functions for Specimen Collection

• Explain procedure, gain clients participation
• Collect right amt. of specimen at the right time
• Place specimen in correct container
• Label container accurately
• (addressograph), plastic bag

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Nursing Functions for specimen collection

1. Complete lab. Req.
2. Place the specimen in the appropriate place for
   pick up.
3. Document/record specimen sent and anything
   unusual about the appearance of specimen

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Blood glucose levels

• Capillary Puncture
• Reduces Venipunctures
• Clients can perform
• Glucometers
• Chemical reagent strip
• Delegated to those instructed in skill if
  clients condition stable

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Glucose monitoring

• Ordered ac, pc, hs, fasting, before insulin
  (sliding scale)
• ? Risks for skin puncture
• Assess area of skin
• Sides of fingers, toes, heels
• Clients ability
• Normal fasting Bld. Sugar
• 70-120 mg/100ml

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Glucose Monitoring

• Wash hands, glove
• Client wash hands, warm water
• Follow instructions on meter
• Massage /milk finger or puncture site
• Antiseptic swab ( allow to dry completely)
• Wipe away first droplet of blood with
  tissue/cotton ball

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Glucose Monitoring

• Dispose of lancet in sharps container
• Wash hands
• Check puncture site
• Can share reading with client
• Record results
• Proceed as indicated by results

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The Value of Measurement

• 3 benefits to measuring progress and results
• Shows where we are now
• Tells if we are heading toward our goal
• Allows us to make improvements along the way

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INCENTIVE SPIROMETRY

• Incentive Spirometry is designed to mimic natural
  sighing or yawning by encouraging you to take
  slow, deep breaths. A device called an Incentive
  Spirometer is used to provide information about
  your inspiratory effort. When you lie in bed for
  a long time, after surgery, or if are having a
  lot of pain, you tend to take shallow breaths and
  not cough as often as needed. By inhaling deeply,
  you help mobilize secretions and open up areas of
  the lungs that may have become collapsed. Try to
  do at least ten breaths every hour on your
  Incentive Spirometer.

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Incentive Spirometry
Volume-dependant spirometer
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Incentive Spirometry
flow-dependant spirometer
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Incentive Spirometry
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Incentive Spirometry
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Incentive Spirometry
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Incentive Spirometry

• Slide the yellow Patient Goal Indicator to the
  volume level (ml) prescribed by your clinician.

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Incentive Spirometry

• With you lips off the mouthpiece, exhale
  completely. Then close your lips tightly around
  the mouthpiece.
•  
• Inhale slowly. Keep the small yellow coach as
  close to the happy face as you can.

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Incentive Spirometry

• Inhale as deeply as you can. When you can't
  inhale any more, hold your breath for 6 seconds
  and note the highest level the top of the yellow
  piston reaches. Try to reach your prescribed
  goal.
• Repeat as many times as prescribed. Keep a record
  of your progress.

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Bike Incentive Spirometry
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Incentive Spirometry
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Turn Cough
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Turn Cough
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Turn Cough
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Breath Deep and dont Cough ???
You have a choice !