Study Guide #26 Specimen Collection and Care of the Patient
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- Specimen Collection Techniques: Wound Specimen:
- Clean the site w/ sterile water or aline prior to wound specimen collection. Wear gloves and use cotton-tipped swab or syringe to collect as much drainage as possible. Have clean test tube or culture tube on clean paper towel. After swabbing center of wound site, grasp collection tube by holding it w/paper towel. Carefully insert swab w/out touching outside of tube. After secureing tube's top, transfer tube into bag for transport and the perform hand hygiend.
- Specimen Collection Techniques: Stool Specimen:
- Wearing glives, use clean cup with seal top (need not be sterile) and tongue blade to collect small amount of stool, approximately the size of a walnut. Place cup on clean paper towel in client's batheroom. Using tongue blade, collect needed amount of feces from clients' bedpan. Transfer feces to cup w/out touching cup's outside surface. Dispose of tongue blade, and place seal on cup. Transfer specimen into clean bag for transport. Remove gloves and perform hand hygiene.
- Specimen Colleciton Techniques: Urine Specimen:
- Wearing gloves, use syringe and sterile cup to collect 1-5 ml of urine. Place cup or tube on clean towl in client's bathroom. If client has a urinary catheter, use syringe to collect specimen. Have client follow procedure to obtain a clean voided specimen if not catheterized. Transfer urine into sterile container by injecting urine from syringe or pouring it from used collection cup. SEcure top of container and transfer specimen into clean, labeled bag for transport. Remove gloves and perform hand hygiene.
- If the infectious disease can be tansmitted directily form on person to another, it is a:
- communicable or contagious disease
- Infectious diseases such as hepatitis B or C become a reservoir fot pathogens in:
- blood
- The interval when a client manifests signs and symptoms specific to a type of infection is the:
- Illness stage
- The most effective way to break the chin of infection is by:
- Hand hygeine
- Afeter coming in contact w/infected clients, and after handling contaminated equipment or organic material, vistors are encouraged to:
- perform hand hygiene before eating or handling food.
- A client is isolated for pulmonary tuberculosis. The nurse notes the client seems to be angry, but he knows this is a normal response to isolation. The bes intervention is to:
- Explain the isolation procedures and provide meaningful stimulation.
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A gown should be worn when:
-the client's hygiene is poor.
-the client has AIDS or hepatitis
-the nurse is assisting w/medication administration
-blood/body fluids may get on the nurse's clothing from a task the nurse plans to perform - -blood/body fluids may get on the nurse's clothing from a task the nurse plans to perform.
- The nurse has redressed a client's wound and now plans to administer a medication to the client. It is important to:
- Remove gloves and perform hand hygiene before administering the medication
- When a nurse is perfomring a surgical hand hygiene, he must keep hands:
- above elbows
- To sterilize surgical instruments, parenteral solutions, and surgical dressings:
- An autoclave is used
- The normal adult uring output is:
- 1500-1600 ml/day
-
Renal alterations result from factors that cause injury dirction to the glomeruli or renal tubule, interfering w/their normal filtering, reabsorptive, and secretory funtions. Selected causes include:
-transfusion reactions
-dehydration
-he - Transfusion reactions
- Postrenal alterations result from obstrucction to the flow of urine in the urinary collecting system casued by:
- Blood clots
- The most common hospital-acquired (nosocomial) infecitons are:
- Urinary Tract
- Hospital acquired UTIs are often r/t poor hand washing and:
- improper catheter care
- The urine appears concentrated and cloudy b/c of the presence of wbc or:
- bacteria
- Some meidications change the color of urine. Pyridium colors the urine:
- Bright orange to rust
- To minimize noturia, clients should avoid fluids:
- 2 hours before bedtime
- Maintaining a Foley catheter drainage bag in the dependent position prevents:
- Urinary reflux
- When applying a condom catheter, it is important to secure the catheter in the penile shaft in such a manner that the catheter is:
- snug and secure, but does not cause consttriction to blood flow.
- Most nutrients & electrolytes are absorbed in the:
- small intestine
- During the nursing assessment the client reveals that he has diarrhea & cramping every time he has ice cream. He attributes this to the cold nature of the food. However, the nurse begins to suspect that these symptoms might be associated with:
- lactose intolerance
- The nures is assessing a 55yo client who is in the clinic for a routine physical. The nurse instructs the cleint to obtain fecal occult blood testing (FOBT):
- as part of a routine examination for colon cancer
- These agents decrease intestinal muscle tone to slow passage of feces:
- antidiarrheal opiate agents
- Diarrhea that occurs w/a fecal impaction is the result of:
- seepage of stool around the impaciton
- a cleaning enema is ordered for a 55yo client before intestinal surgery. The maximum amount given is:
- 750-1000 ml
- During the enema the client begins to c/o pain. The nurse notes blood in the return fluid and rectal bleeding. The nurse's actions are to:
- Stop the instillation and obtain VS
- ONe of the greatest problems in caring for a client w/an NG tube is:
- Maintaining comfort
- The stool discharged forn an ostomy is called:
- effluent
- A nurse trained to care for ostomy clients is an:
- Enterostomal therapist
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The middle portion of voiding is collected for a culture and sensitivity b/c:
1. the urine has more bacteria
2. the initital stream flushes the urethral orifice and meatus of any resident bacteria.
3. it gives the client more time to be pr - 2-the initial stream flusches the urethral orifice and meatus of any resident bacteria
- How much urnie is needed for a culture & sensitivity specimen?
- 40-60 ml
- When obtaining a timed urine collection the nurse:
- discards the first urine specimen
- A sterile urine specimen form an indwelling catheter is obtained from:
- The sterile self-sealing specimen port on the catheter
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Which of the following is not necessary to observe and document when obtaining urine form an indwelling catheter?
1. characteristic of urine
2. patency of the urinary drainage system
3. patient discomfort
4. total output - total output
- Glucose present in the urine may be indicative of:
- diabetes
- A double voided specimen is used for testing urine for glucose. A double voided specimen:
- is a procedure to obtain fresh urine
- A stool for guaiac test for:
- Parasites
- Which foods can alter the results of a stool for occult blood?
- tomatoes
- Gastroccult testing could help to reveal bleeding in the:
- stomach, esophagus
- Gastric secretions can be obtained rom:
- NG, nasoenteral tube
- When obtaining a nasal or throat collection, it is preferred to have the client:
- sitting upright or at a 45-degree angle
- When obtaining a throat culture, the nurse should swab the:
- Tonsillar area
- The ampule at the end of the culture tube should be:
- crushed
- When obtaining a urethral discharge culture, the genital area for both m/f clients should be observed for:
- redness, swelling, and discharge
- Sterile sputum specimens are collectd by:
- Tracheal suctioning
- How long is it necessary to wait after a meal before collecting a sputum specimen?
- 1-2 hours
- When obtaining a wound culture sample the nurse should collect the sample form:
- new drainage (exudate)
- Aerobic organisms commonly grow in:
- superficial wounds exposed to the air
- Clients w/the following medical history are at greater risk for complications form venipuncture:
- polycythemia
- Before performing a venipuncture, ask the client to open and close his/her fist several times. This helps to:
- Facilitate distention of veins
- Patent and healthy veins:
- are inelastic and rebound when palpated
- When performing a venipuncture, the nurse should release the tourniquet:
- after the blood sample is obtained
- For blood obtained by syringe, the one-handed technique is used to trnafer the blood specimen to the laboratory tube. This helps to:
- prevent needle-stick injury
- Skin puncture sites for obtaining a glucose level are:
- sides of the fingers, toes, heels
- AFter a capillary stick (finger stick) is performed:
- wipe away the first droplet of blood with alcohol
- Diagnostic data helps to evaluate the success or failure of both...
- nursing and medical interventions
- When teaching a client, you should keep information...
-
1. concise and to the point
2. clear
3. to meet the needs of the client--need to assess these needs - How can you teach?
-
1. one on one
2. as a group
3. assisted by audiovisual aides - When teaching you should...
-
-teach at a pace that compliments the client's learning
-have information repeated/restated as needed
-provide return demonstration when applicable
-allow for questions & voicing of concerns - Before the test the nurse needs to...
-
-inform the client of the test
-teach about test
-proper preperation
-consent signed as appropriate
-gather equipment
-answer questions
-be supportive - During the test, the nurse needs to...
-
-assist the client
-assist the physician
-assist allied health personnel
-provide/gather additional equipment
-inform/support client during the test - After the test, the nurse needs to...
-
-provide any follow-up care
-assist client--comfort, safety, support
-clean up
-deliver specimens prn to appropriate place
-document - Ethical/Legal Considerations...
-
-must be informed of the test and implications
-provide consent form w/implied understanding of benefits & risks
-privacy
-confidentiality
-awareness of any procedure that is experimenta
-timely reporting of test results & implications of those results - What are blood specimens?
-
-complete blood count (CBC)
-fasting blood sugar (FBS)
-Cholesterol
-Electolytes (lytes)
-Blood urea nitrogen (BUN) - What is a CBC?
- complete blood count, which includes Hgb, RBC, RBC indices, WBC, WBC differential, platelet count, mean platelet volume (MPV)
- What is fasting blood sugar?
- FBS-usually fast from after midnight
- What is electrolytes?
- lytes-includes K+, Na+, Cl-, etc.; usually fasting but doesn't have to
- What are urine specimens?
-
-Urinalysis
-urine cultures and senistivty - What is urinalysis?
- use steril container, prefer mid-stream urine
- What is Urine culture and sensitivity?
- Urine C&S-use sterile container, mid-stream urine
- chest x-ray
- CXR
- kidneys, ureters, bladder
- KUB
- cervical spine
- c-spine
- electocardiogram
- EKG, ECG
- What are reasons for urine specimen collection?
-
-gives us data that can tell us about our client's health
-means to assess for abnormalities
-method to evaluate treatment - Wht are the nursing repsponsibilities for urine collection?
-
-instruct client about urine collection techniques
-obtain a speciment from the client
-utilize standard precautions when handling urine specimens - What are the nursing responsibilities for stool specimens?
-
-instruct client on specimen collection
-obtain specimen
-label specimen
-ensure specimen is transported to lab in a timely manner
-document specimen collection - Step one: Stool specimen collection:
- have client void first to avoid mixing urine with stool specimen
- Step two: Stool specimen collection:
- use a clean bedpan or commode
- Step three: stool specimen collection:
- defecate into the required container rather than toilet to avoid contamination with water and dirty toilet bowl
- Step four: stool specimen collection:
- do not place toilet tissue into bedpan or speimen container b/c can contaminate specimen
- Step five: stool specimen collection:
- have client notify nurse when specimen is collected
- Step six: stool specimen collection:
- place specimen in collection container using tongue blades while wearing gloves
- Step seven: stool specimen collection:
- need approximately 1" of formed stool or 15-30 ml or liquid stool
- Step eight: stool specimen collection:
- if blood, pus, mucus or parasites are noted in part of stool, include these in the lab specimen
- Step nine: stool specimen collection:
- send specimen to lab immediately
- Step ten: stool specimen collection:
- document collect of specimen, description of stool, and that it was sent to lab
- What are the types of stool specimens?
-
-timed
-pinworms
-culture & sensitivity/ova & parasites
-stool for occult blood - What is timed stool specimens?
- collection of stool each time client defecates during a specified time period.
- What is pinworms stool specimen?
- When you place a piece of clear tape directly over the anal opening at night and remove in morning before client defecates.
- What is Culture & sensitivity/ova & parasites stool specimen?
- checking for excessive growth of bacteria and fungi; must be placed in sterile collection container
- What is stool occult blood?
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-check for blood in feces
-stool may be tested on the unit or in the lab depending on the agency
-instruct client to defecate in a container, avoiding getting urine or toilet paper in the collection container; using a tongue blade, place specimen on test card, and send to lab/apply developing solution & observe (blue color=positive for blood) - What are false positive results when Stool for occult blood?
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-red meat, poultry, fish
-raw fruits & vegetables
-iron supplements
-vitamin C
-aspirin
-NSAIDs (nonsteroidal anti-inflammatory)
-steroids