procedure/testing steps

eye irrigation

1. check med solution 3 times

2. warm water in basin 98.6 F or 37 C and put solution bottle in there

3. position patient supine or sitting

4. hand hygiene + gloves

5. drape shoulder of eye side

6. head to side and hold basin tightly agaist side of face

7. hold upper and lower lid apart

8. squeeze bottle from 1 inch above from inner to outer canthus

9. wipe eye with gauze, give towel, do finishing stuff

eye installation

• check med 3 times

• seat in supine or sitting

• tilt head up

• look up or to side

• pull lower eyelid down

• place amount of drops

• have patient close and roll eyes around

• give tissue and finish

ear irrigations

• warm solution in basin of 98.6F water

• pour solution into ear wash bottle

• check for the 3rd time

• sit patient and waterproof drape over shoulder

• use otoscope to see anything

• put solution on gauze and cleanse outer ear

• tilt head to side of irrigation and hold basin under

• hold tip of tubing in left hand and bottle in right

• position tip to top of ear canal within the ear

• spray moderately without letting tubing bend

• STOP if dizzy, discomfort, pain

• finish

• insert cotton ball loosely in ear

• put waterproof drape on exam table and lie on side for 15 min

• dry ear with gauze and inspect with otoscope

• Have provider check ear

• finish up

spirometry test

measures max volume in duration of time = forced vital capacity

• calibrate spirometer

• connect mouth piece to tubing but keep wrapper on

• confirm pre procedure stuff was done

  • No heavy meals 2 hrs before

  • no smoking in last 8 hrs,

  • no inhaler use or bronchodilators in 4 hrs

  • no strenuous activity 

  • Loose clothing

• measure height and weight

• sitting in chair —> straight back and feet on floor

• enter body demographics into database

  • height, weight, name, age, race, sex, medical record number

• give nose clips

• position head to chin lifted slightly and neck extended

• press start

• have them take a really deep breath

• place tube in mouth

• blow hard and keep going —> give encouragement

• remove nose clips and allow to rest

• review recording and observe signs of struggle

• repeat 2 more times

• notify provider if not able to complete all tests

• should be between 80-120

peak flow test

• position patient to standing or erect in chair with feet on floor if not able

• remove restrictive clothing or items in mouth

• set meter to bottom

• connect mouth piece (dont touch area that goes into mouth)

• have patient practice hold

• Relax 

• Heavy deep breath and blow as hard and fast as you can

• Give time to rest and look at meter result

• Move marker to bottom again

• Repeat 2 more times

teach patient breast self exam steps

• explain procedure and answer questions

• have them choose a monthly date that they will remember not during period

• visual exam instructions

  • Look at breasts in mirror with hands on hips

  • Inspect for changes in color, shape, contour, dimpling

  • Check nipple for rash or drainage

• palpation instructions

  • Lie down and place arm on breasts side behind head

  • Palpate breast using pads of 3 middle fingers

  • Make dime size circular motions to assess each area of breast 

  • Light, medium, then firm pressure to each part

  • Move across tissue from armpit to sternum in vertical zig zag

urinalysis

• PPE

  • Fluid impermeable lab coat, eye wear, gloves

• perform control test

• bring urine to room temp

  • but don’t let sit for over hour at room temp

  • should be about 30-50 mL

• swirl and fill to 12 mL in centrifuge tube, ¾ full. label

• Examine and record color and odor transparency

  • Common ranges from pale to dark amber

  • Record abnormal order

    • Ammonia, sweet, foul

  • Assess transparency

    • Hold it against white paper with dark print

    • Terms: clear, slightly cloudy, cloudy, turbid (cloudy with clumps)

• Gather supplies

  • Sample, test strips, paper towels, clinical analyzer

• Turn on analyzer

  • Select strip test

  • Enter patient info and ur info

• Remove test strip from bottle and avoid touching other strips and testing area on strip. Cover lid

• Select start button and immediately dip strip into urine

• Place strip on side on paper towel and blot within 8 seconds of pressing start

• Place it facing up on channel of analyzer and it will bring it into the machine

• Put in color and clarity of urine on analyzer

• Print or upload results

• Clean unit

• Dispose of test strips in biohazard and follow guidelines for urine disposal

throat specimen

• perform controls

• put on PPE

  • lab coat, new gloves, and new face mask and eyewear

• open swab

• adjust light source (pen) to see in throat

• Position patient

  • Adjust position to sitting or fowlers

  • Tell them to tilt head back and stick tongue out

• Have them say ahhh while depressing tongue with depressor in non dominant

  • Elevates uvula to prevent gagging

• swab areas

  • Don't touch lips, teeth, tongue, cheeks

  • Swab each side of back of throat in circular motions

  • Swab tonsillar pillars

  • Swab reddened areas or pus pockets

• storage

  • onsite testing

    • put back in wrapper and label wrapper

  • transport

    • put in sterile container and transport medium with label

• patient verify label

nasopharyngeal specimen

• PPE

  • Lab coat, face mask, goggles/shield, gloves

• Position

  • Head back

  • Sitting or semi fowlers

• Open rayon swab

  • Verify that it is for nasopharynx collection

• Insertion

  • Hold it at scoreline (line on handle of it)

  • Insert in nostril parallel to palate

  • Slowly push forward until you feel soft resistance

    • Near anterior ear

• Gently rotate it without pushing more forward for 10-15 sec

  • Let it stay in place for few more seconds to absorb

• Remove slowly

• Repeat in other nostril if required

• Put swab in transport container with medium and break off handle at scoreline

• Tightly replace cap

• place label and patient verify

fecal blood

• General testing instructions for patient

  • No cleaning chemicals in toilet

  • Urinate first then flush toilet

  • Take out tissue paper from kit and allow it to float in toilet

    • Or give patient collection hat for stool to fall in

  • 3 cards for 3 bowel movements over different days

    • Label 1 card with date/time before BM

    • Cards have 2 boxes for smearing

    • Cards fold

  • Take sample of stool with spatula provided

  • Smear onto 1 box on card

  • Take sample from different section on stool and smear onto second box

  • Wrap spatula in toilet paper and throw away

  • Close card and place in envelop and store in cool dark place

  • Don’t refrigerate. Bigger stool samples can be refrigerated for 24 hrs before

  • Repeat for next 2 BM

  • Mail samples back

• Give patient with written directions too

• Testing steps

  • Gather supplies

  • Hand hygiene and gloves

  • Check exp date on developer and make sure its stored right

  • Perform test

    • Place cards on stable clean surface and open

    • Put 1-2 drops of developer on each box on the card

    • Put 1 drop on the control box on the card

      • Make sure they turn the correct colors

    • Read test within proper timeframe, 1- 4 min

  • Results

    • Negative is no color change

    • Positive if blue color appears

  • Dispose test in regular trash can

human chorionic gonadotropin test

• get 30-50 mL of first of the day urine

• do control tests

• Remove test cassette from pouch

  • Don’t touch testing area of it

• Add urine to sample well

  • Use transfer pipette

  • Add 3 drops

  • Put pipette in biohazard after

• Read results

  • Wait recommended time (3-5)

clean catch midstream cleaning instructions

• Female instructions

  • Wash hands

  • Open 1 towelette and place on wrapper

  • Open lid of cup and put inside facing up on paper towel

  • Spread vaginal lips with non dominant hands all the way through

  • Use dominant hand to clean one side of urinary meatus front to back

  • The second towel do other side. Third on middle

  • keep lips spread

  • Pee a small amount of urine into toilet

  • Put specimen container underneath not touching inside with fingers

  • Fill halfway then remove

  • Let go of labias and finish peeing

  • Attach lid back

  • Wash hands and place specimen in designated area

• Male instructions

  • Wash hands

  • Open towelette and place on counter with container

  • Place lid facing up on counter

  • Expose penis and retract foreskin if uncircumcised

  • Clean one side of tip and opening. Repeat other side with other. Clean urethra opening with third

  • Pee a little into toilet

  • Place cup until half full

  • Remove and finish peeing

drug test differences

• Drug test safeguards to do

  • Check bathroom before hand

  • Send sample to lab day of collection

  • Verify temperature within 4 minutes of collecting

    • Would be 98-100 F

  • Make sure patient does not flush toilet

  • Collect 30-45 mL

  • Seal lid in front of patient

    • So they know no tampering happened

tests that capillary puncture

• glucose

• hemoglobin A1C

• hematocrit

• mononucleosis

• H pylori

Capillary tube draw order

• Blood gases

• EDTA tube

• Additive tubes

• Serum tubes

tips for capillary puncture

• stick perpendicular to finger whirls

• wipe first drop away with blood unless its for prothrombin time

• lower finger downward and put gentle pressure to get drop

  • but dont squeeze