Specimen Collection

Objectives of Chapter 23 on Specimen Collections

  • Discuss nursing interventions in preparation for diagnostic exams.

  • Outline guidelines for effective specimen collection.

  • Explain appropriate specimen labeling.

  • Detail procedures for collecting sputum specimens.

  • Describe the electrocardiography (EKG) procedure.

Importance of Lab Tests

  • Facilitate healthcare diagnoses and monitor disease stages and activity.

  • Inform about response to therapies.

  • Clear explanations to patients improve cooperation during specimen collection.

Helpful Suffixes for Test Names

  • "iography": procedure producing an image (e.g., mammography).

  • "ogram": the resulting image from a test (e.g., mammogram).

  • "oscopy": visualization of body structures (e.g., colonoscopy).

  • "synthesis": puncturing a body cavity (e.g., thoracentesis).

General Guidelines for Specimen Collection

  • Always wear gloves when collecting any specimen.

  • Properly label all specimens with patient identification.

  • Collect specimens in designated containers.

  • Use aseptic technique to prevent contamination.

Urinalysis

  • Analyzes urine for pH, specific gravity, proteins, glucose, ketones, blood, WBCs.

  • Culture and Sensitivity: Diagnose/treat urinary tract infections (UTIs).

    • Culture: cultivates microorganisms in growth medium.

    • Sensitivity: determines antibiotic effectiveness.

Responsibility of the Nurse

  • Collect and label urine samples.

  • Ensure safe delivery to the lab.

  • Assess lab results.

  • Educate patients on proper collection techniques; avoid contamination from toilet paper or fecal matter.

Urine Specimen Types

  • Midstream Urine Specimen:

    • Initiate voiding and collect midstream.

    • Cleanse perineum before collection, front to back for females and circular for males.

  • Sterile Urine Specimen:

    • Insert a straight catheter into the bladder or collect from an indwelling catheter.

    • Never use urine from the drainage bag; must be sterile.

  • 24-Hour Urine Specimen:

    • Begin after discarding initial void.

    • Collect all urine for 24 hours and include last void.

Stool Specimen Collection

  • Used to detect infections, blood, and parasites.

  • Observe stool characteristics.

  • Collect with a specimen hat; keep urine and stool separate to avoid contamination.

Occult Blood Testing

  • Hemoccult Test:

    • Indicates presence of blood in stool.

    • Differentiate between bright red and black, tarry stool for location of bleeding.

  • Use of a tongue blade for transfer.

Gastric Secretions and Emesis

  • Test for occult blood in gastric contents indicates bleeding location.

    • Red/black coloration and coffee ground appearance signify bleeding sites.

Sputum Sample Collection

  • Deep lung secretions vs. saliva.

  • Best collected in the early morning.

  • Suction may be necessary for patients who cannot expectorate.

  • Educate on the importance of hydration to loosen secretions.

Wound Culture Collection

  • Assess for systemic infections through patient signs (fever, malaise).

  • Obtain specimens from inside the wound, avoiding old drainage.

Aerobic vs Anaerobic Specimens

  • Aerobic: surface wound secretions.

  • Anaerobic: aspirate from deeper in the wound.

Nose and Throat Specimen Collection

  • Obtain before starting antibiotic therapy to avoid contamination.

  • Throat Specimen: swab tonsillar area, avoiding oral structures.

  • Nose Specimen: check nostril patency, swab inflamed mucosa.

Venipuncture Procedure

  • Collect blood for nutritional, hematologic, metabolic status.

  • Use a hollow-bore needle and follow appropriate protocols.

Risk Factors for Venipuncture

  • Patients on anticoagulation, low platelet counts, or with vascular issues.

  • Special considerations for children; involve parents for support.

OSHA Safety Guidelines for Bloodborne Pathogens

  • Do not recap dirty needles, dispose of safely.

  • Report all needle stick injuries.

Blood Specimen Collection Methods

  • Draw samples using syringes or vacutainers.

  • Understand additives and the proper tube for each test.

EKG/ECG Procedure

  • Graphic representation of heart's electrical impulses.

  • Identify abnormalities in cardiac conduction.

  • Electrode placement and creating printed tracings.