Chapter 52: Specimen Collection

Information from Samples: Body fluids and feces can provide significant insights into a person's health status.
Types of Specimens Collected: Common specimens include urine, stool, sputum, and blood.
Measurement and Observation: Healthcare professionals must measure or observe specific characteristics of these specimens.
Protocols to Follow:
- Labeling: Ensure all specimen containers are correctly labeled.
- Standard Precautions: Adhere to established safety protocols to prevent contamination.
- Sterile Technique: Observe appropriate sterile techniques during specimen collection.
- Biohazard Bags: Place specimens in designated biohazard bags to prevent exposure.
- Documentation: Document the entire procedure and promptly notify the provider of any results.

Health Indicators: Urine specimens can provide significant information regarding:
- Kidney and/or liver health
- Presence of substances (both legal and illegal drugs)
- Pregnancy status
- Identification of specific disease-causing organisms or conditions.

Nutritional and Fluid Balance: Monitoring intake and output (I&O) records is crucial for assessing a patient's nutritional and hydration status.
Daily Balance: Normally, a person’s fluid intake should approximately equal their output over a 24-hour period. Significant discrepancies can be life-threatening.
Guiding Provider's Decisions: These records assist providers in making informed decisions regarding patient management.
Documentation Methods: I&O fluids can be documented automatically by computer systems.

Procedure Orders: Specify orders such as “record food and fluid intake” or “I&O + calorie count” for tracking.
Nurse Responsibilities: Each nurse is responsible for accurate documentation using either computerized or paper methods.
Measurement Units: Amounts are usually recorded in milliliters (mL).
Fluid Intake Includes: Items such as gelatin (Jello), ice, popsicles, thin cereals, broth, tube feedings, and intravenous (IV) fluids.
Output Includes: Documented outputs include vomitus, bleeding, chest tube drainage, thoracentesis, paracentesis, nasogastric suction, and urine. Special attention should also be given to documenting instances of diaphoresis.

Daily Intake and Output Worksheet: Document intake and output for a patient, including items consumed and measures recorded in milliliters.

Client Name: Jane Doe
Client Record Number: 3987624
Date: 5/15/17
Physician: Dr. Smith
Unit/Room Number: 8763
- General Measures: Include measures for common intake item sizes (e.g., 1 oz = 30 mL, 8 oz. water glass = 240 mL).
- Input and Output Examples: Detailed tracking of fluids taken and emitted, as well as any medications involved.

Definition: All fluids consumed through the gastrointestinal (GI) tract, including those taken as part of IV therapy or total parenteral nutrition (TPN), must be documented.
Measurement Guidelines: Use graduated containers for accurate assessments and follow established facility policies regarding bedside water pitchers.

Definition: Output includes all fluids excreted from the body by any means. This encompasses:
- Wound drainage
- Emesis (vomiting)
- Bleeding
- Watery diarrhea
- NG suction returns.
Documentation: Identify the source of output, and if weighing outputs, remember that 1 mg of weight is equivalent to 1 mL of fluid. Appropriate equipment must be used for accurate collection and measurement.

Purpose: An indicator of urine concentration and hydration status, typically part of a routine urinalysis.
Equipment: May require a urinometer for measurements.
Normal Range: The specific gravity of urine typically falls within 1.010 to 1.025.
- Values greater than 1.025 can indicate dehydration or edema.
- Values less than 1.010 may point to diabetes insipidus or excessive diuretic use.

Urinalysis: Identify normal/abnormal components, obtained at treatment initiation and repeated if necessary. Helps determine the presence of legal/illegal drugs, pregnancy, and infection indicators.
Types of Urine Specimens:
- Single-voided urine specimen
- Clean-catch or midstream urine specimen
- Observed urine specimen for drug testing
- 24-hour urine collection
- Fractional urine specimen for kidney stone prevention.

Precautions: Ensure the collecting bag remains below bladder level. Only use blunt-tipped cannulas or needleless systems for complications.
Technique: Employ strict sterile technique when acquiring a one-time catheterized urine specimen.

Purpose: Stool specimens provide insights into the gastrointestinal system and accessory organs and are tested for:
- Occult blood (using Hemoccult or Hematest methods, or guaiac tests)
- Ova and parasites (O&P).

For infants with diarrhea, place soiled diapers in a biohazard bag for laboratory submission. For formed stool, use a tongue blade to collect a sample in a specimen container.
False-Positive Guaiac Tests: Certain food consumption may yield false positives, hence avoid acetylsalicylic acid or non-steroidal anti-inflammatory drugs (NSAIDs) three days prior to testing. Multiple separate-day collections may be needed.

Diagnostic Purpose: Sputum specimens are used to rule out tuberculosis and other bacterial, fungal, and viral infections. Handle samples with care due to contamination risks.
Collection Timeline: Often collected over three consecutive days. The best time to obtain sputum is immediately upon waking, before the client eats, uses mouthwash, or brushes teeth.

Preparation: Clear nose and throat, rinse mouth with water, breathe deeply, and cough to obtain a deep specimen. Sputum can also be collected with nasotracheal suction.
Safety: Follow Standard Precautions, covering the container to avoid contamination. Document aerosolized medication usage and use graduated containers for collection.

General Procedures: Follow Standard Precautions, use appropriate personal protective equipment (PPE), and maintain sterile techniques when collecting specimens such as throat cultures, nasal swabs, or nasopharyngeal swabs.

Is the following statement true or false? "Before giving fluids to a client, the nurse must find out if the client is on I&O."
- Answer: True. A nurse must verify if the client is on I&O before administering fluids, as adjustments must be made according to the established procedures in the facility.

Is the following statement true or false? "False-positive results may occur with guaiac tests."
- Answer: True. False positives can occur due to consumption of high amounts of rare red meat or specific foods, and patients should avoid excessive vitamin C or NSAID use leading up to the tests.