What advice should the nurse give to the patient collecting a urine sample for urinalysis?
The most important step in the recovery of pathogenic organisms responsible for infectious disease is the proper specimen collection, processing and handling by you, the healthcare professional. It is one way of knowing about the patient’s health status by identifying pathogens and analyzing urine, blood, sputum, and feces. One of the many responsibilities assigned to us, as nurses, is to collect and label specimen for analysis and to ensure their delivery to the lab. And knowing the proper way of gathering specimen is necessary for self-protection and to prevent the spread of disease. Show
Objectives
Concepts of Specimen Collection
Importance of Specimen CollectionThe following could affect the hospital’s reimbursement under recent healthcare reform laws and regulations:
Specimen collection is also key to patient’s satisfaction and poor collection practice can lead to:
Poor specimen collection may also affect nurses professionally and personally by:
Nurses’ Roles in Specimen Collection
1. Throat Swab CultureA throat swab culture is a laboratory diagnostic test that evaluates for the presence of a bacterial or fungal infection in the throat. It is done to isolate and identify any pathogens, which may be medium. A sample of mucus and secretions from the back of the throat is collected on a cotton-tipped applicator and applied to a slide or a special cup that allows infections to grow. These infections can include strep throat, pneumonia, tonsillitis, whooping cough, and meningitis. Purpose Throat swab culture is done to detect the presence of organisms in the throat that could cause infection. For instance, the presence of group A streptococcus bacteria in your throat is a key sign that you may have strep throat. Supplies and Equipment The supplies and equipment required to obtain a sample for throat culture are:
Procedure
10. The sample is then taken to the laboratory for culture. 2. Sputum Specimen and CultureA sputum specimen is a sample of material expelled from the respiratory passages taken for laboratory analysis to determine the presence of pathogens. A specimen of mucus from the lungs expectorated through the mouth or obtained via tracheal suctioning with an in-line trap or bronchoscope. Specimens are often taken for three consecutive days because it is difficult for the patient to cough up enough sputum at one time, and an organism may be missed if only one culture is done. Purpose A sputum specimen is obtained for culture to identify the microorganism responsible for lung infections; identify cancer cells shed by lung tumors; or aid in the diagnosis and management of occupational lung diseases. Supplies and Equipment Supplies and equipment required to collect a sputum specimen are:
Preparation To prepare your patient, have him drink enough fluids on the night before the test, provided that he’s not on a fluid restriction. The additional intake will further increase sputum production overnight and assure that you’ll get a good sample. For best results, obtain the sample first thing in the morning. If you can’t obtain the sample before the patient has breakfast, though, wait at least an hour after he’s eaten before trying. Before you begin, describe the procedure to him. Ten to 15 ml of sputum is typically needed for laboratory analysis. A specimen will be rejected by the laboratory if it contains excessive numbers of epithelial cells from the mouth or throat or if it fails to show adequate numbers of neutrophils on gram staining. If the patient cannot cough up a specimen, the respiratory therapist can use sputum induction techniques such as heated aerosol (nebulization), followed in some instances by postural drainage and percussion. Procedure
3. Stool Specimen and CultureA stool culture is the process of growing or culturing organisms existing in feces to see if any of them cause disease. The most common is the ova and parasites test, a microscopic examination of feces for detecting parasites such as amoebas or worms. Stools specimen are often tested for blood. Guaiac or HemOccult test may be done in the laboratory but are sometimes done at the nursing station to test a stool for occult blood. Purpose Stool cultures play an important role in understanding and treating intestinal illness. It can confirm the presence of harmful bacteria. It may also show what treatments may work to kill an invasive organism. If no dangerous bacteria are present in the stool culture but symptoms still exist, other explanations like irritable bowel syndrome, a parasitic infection, or other diagnosis can be explored. Supplies and Equipment
Procedure
3.1. Guaiac Fecal Occult Blood Test (gFOBT)The stool guaiac test finds hidden (occult) blood in the stool (bowel movement). It is the most common form of fecal occult blood test (FOBT) in use today. Purpose This test uses guaiac as reagent to detect the presence of occult blood (blood that appears from a nonspecific source, with obscure signs and symptoms), which is not visible. Supplies and Equipment
Preparation Do not allow the patient to eat red meat, any blood-containing food, cantaloupe, uncooked broccoli, turnip, radish, or horseradish for 3 days prior to the test. The patient may need to stop taking medicines that can interfere with the test. These include vitamin C and nonsteroidal anti inflammatory medicines such as ibuprofen and aspirin. However, never let the patient stop such medication without consulting the physician. There is no discomfort when the test is done since it only involves normal bowel function. Procedure
4. Urine Specimen and CultureA urinalysis (UA), also known as routine and microscopy (R&M), is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds that pass through the urine. It has been a useful tool of diagnosis since the earliest days of medicine. The color, density, and odor of urine can reveal much about the state of health of an individual. Urine is assessed first for its physical appearance: Color Normal urine color ranges from pale yellow to deep amber in color, depending on the concentration of the urine. The amount and kinds of waste in the urine make it lighter or darker. Pigments and other compounds in certain foods and medications may change the color of urine. Blood in the urine colors it; if the amount of blood in the urine is great, the urine will be red. During a flare-up of chronic nephritis, the small number of red blood cells present in the urine give it a smoky appearance. Odor Urine normally doesn’t have a very strong smell. When urine stands, decomposition from bacterial activity gives it an ammonia-like odor. Consumption of certain foods, such as beets or asparagus can impart a characteristic odor to urine. UTI may also take on a foul-smelling odor. Refrigerate the urine sample if it is not to be examined at once. 4.1. Random Urine SampleA sample of urine collected at any time of the day. This type of specimen is most convenient to obtain. Purpose This type of sample may be used to detect the presence of various substances in the urine at one particular point in the day. Often, no special handling is required with these samples. Supplies and Equipment
Procedure
4.2. Midstream “Clean-Catch” Urine SpecimenMidstream “clean-catch” urine collection is the most common method of obtaining urine specimens from adults, particularly men. This method allows a specimen, which is not contaminated from external sources to be obtained without catheterization. It is important to follow the “clean-catch” protocol in order to have accurate results from an uncontaminated sample. Purpose The clean-catch urine method is used to prevent germs from the penis or vagina from getting into a urine sample. It is a method of collecting a urine sample for various tests, including urinalysis, cytology, and urine culture. Supplies and Equipment
Preparation Explain to the patient that this kind of urine collection involves first voiding approximately one half of the urine into the toilet, urinal, or bedpan, then collecting a portion of midstream urine in a sterile container, and allowing the rest to be pass into the toilet. Discuss that this is done to detect the presence or absence of infecting organisms and, therefore, must be free from contaminating matter that may be present on the external genital areas. Procedure For female patients:
For male patients:
Note: If the urine sample is being taken from an infant, the clean-catch kit consists of a plastic bag with a sticky strip on one end that fits over the baby’s genital area, as well as a sterile container. Use the same cleaning methods and the plastic bags for collecting the urine. Pour the urine into the sterile container. 4.3. Timed Urine Specimens (2-Hour, 4-Hour, 24-Hour)For many urine chemistry procedures the specimen of choice is 24-hour urine. A 24-hour urine collection is performed by collecting a person’s urine in a special container over a 24-hour period. It always begins with an empty bladder so that the urine collected is not “left over” from previous hours. This specimen shows the total amounts of wastes the kidneys are eliminating and the amount of each. Purpose A 24-hour urine collection is noninvasive (the skin is not pierced). It is used to assess kidney (renal) function and detects disease. Supplies and Equipment
Preparation The test does not require anything other than normal urination. There are no risks involved. Generally, the patient will be given one or more containers to collect and store urine over a 24-hour time period. Procedure
Example: Begin collecting the 24-hour urine specimen by voiding at 7:00 am and discarding the urine. Collect all urine voided during the next 24 hours. At 7:00 am the next morning, void and add the urine to the collection container. Keep the collection container refrigerated until delivery to the laboratory. 4.4. Pregnancy Urine TestA pregnancy test measures a hormone in the body called human chorionic gonadotropin (HCG), a hormone produced during pregnancy. This hormone can be detected in small amounts in both the urine and the blood of a pregnant woman as early as 10 days after conception. Purpose Urine HCG tests are a common method of determining if a woman is pregnant. The best time to test for pregnancy is after the woman miss her period. Supplies and Equipment
Preparation Allow patient to wait one to two weeks after her first missed period to get the most accurate results. Note: Irregular periods or miscalculations of when a period is due can affect the test. According to the FDA, 10 to 20 percent of pregnant women may not detect their pregnancy by testing on what they believe to be the first day of their first missed period. Procedure
5. Blood CulturesA blood culture is a fairly routine test that identifies a disease-causing organism in the blood, especially in patients who have temperatures that is higher than normal, for an unknown reason. The test is relatively simple for the patient and involves a simple blood draw. Purpose A blood culture is being done to determine which specific organism or bacteria is causing the problem and how best to combat it. Supplies and Equipment Supplies and equipment required for a blood culture are:
Preparation The test requires little preparation for the patient. The patient will be asked what kind of medications he is taking, including prescriptions and nutritional supplements. The patient may be asked to stop taking certain medications that may alter the blood culture results. Procedure
The role of nurses in collecting, labeling, and ensuring the timely and proper delivery of specimens to the laboratory plays a very important thing in the hospital setting. With this, nurses should be knowledgeable enough about the hospital’s policy and procedures for specimen collection. However, nurses should not only possess the right knowledge, but as well as the skill and understanding in performing necessary procedures in accordance with the organization’s protocols, policies, and guidelines. What precautions should be taken before urine sample?How do you prepare for the test?. Before the test, don't eat foods that can change the colour of your urine. Examples of these include blackberries, beets, and rhubarb.. Don't do heavy exercise before the test.. Tell your doctor ALL the medicines and natural health products you take.. How would a nurse prepare for a urinalysis test?Wash hands prior to collecting sample. Patient should clean the urethral meatus with proprietary sterile wipes in a downward motion, front to back. Pass a small amount of urine into the toilet and then collect a midstream specimen into the sterile container, and then finish passing urine into the toilet.
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