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Fundamentals in Nursing (Notes)
Laboratory and Diagnostic Examination
Fundamentals in Nursing (Notes)

Laboratory and Diagnostic Examination

Urine Specimen

1. Clean-Catch mid-stream urine specimen for routine urinalysis, culture and sensitivity test

  1. Best time to collect is in the morning, first voided urine
  2. Provide sterile container
  3. Do perineal care before collection of the urine
  4. Discard the first flow of urine
  5. Label the specimen properly
  6. Send the specimen immediately to the laboratory
  7. Document the time of specimen collection and transport to the lab.
  8. Document the appearance, odor, and usual characteristics of the specimen.

2. 24-hour urine specimen

  1. Discard the first voided urine.
  2. Collect all specimens thereafter until the following day
  3. Soak the specimen in a container with ice
  4. Add preservative as ordered according to hospital policy

3. Second-Voided urine – required to assess glucose level and for the presence of albumen in the urine.

  1. Discard the first urine
  2. Give the patient a glass of water to drink
  3. After few minutes, ask the patient to void

4. Catheterized urine specimen

  1. Clamp the catheter for 30 min to 1 hour to allow urine to accumulate in the bladder and adequate specimen can be collected.
  2. Clamping the drainage tube and emptying the urine into a container are contraindicated after a genitourinary surgery.
Stool Specimen

1. Fecalysis – to assess gross appearance of stool and presence of ova or parasite

  1. Secure a sterile specimen container
  2. Ask the pt. to defecate into a clean, dry bed pan or a portable commode.
  3. Instruct client not to contaminate the specimen with urine or toilet paper (urine inhibits bacterial growth and paper towel contain bismuth which interfere with the test result.

2. Stool culture and sensitivity test

  • To assess specific etiologic agent causing gastroenteritis and bacterial sensitivity to various antibiotics.

3. Fecal Occult blood test

  • Are valuable test for detecting occult blood (hidden) which may be present in colo-rectal cancer, detecting melena stool
  1. Hematest– (an Orthotolidin reagent tablet)
  2. Hemoccult slide– (filter paper impregnated with guaiac)
    • *Both test produces blue reaction id occult blood lost exceeds 5 ml in 24 hours.
  3. Colocare – a newer test, requires no smear
Instructions
  1. Advise client to avoid ingestion of red meat for 3 days
  2. Patient is advice on a high residue diet
  3. Avoid dark food and bismuth compound
  4. If client is on iron therapy, inform the MD
  5. Make sure the stool in not contaminated with urine, soap solution or toilet paper
  6. Test sample from several portion of the stool.
Venipuncture
Pointers
  1. Never collect a venous sample from the arm or a leg that is already being use d for I.V therapy or blood administration because it mat affect the result.
  2. Never collect venous sample from an infectious site because it may introduce pathogens into the vascular system
  3. Never collect blood from an edematous area, AV shunt, site of previous hematoma, or vascular injury.
  4. Don’t wipe off the povidine-iodine with alcohol because alcohol cancels the effect of povidine iodine.
  5. If the patient has a clotting disorder or is receiving anticoagulant coagulant therapy, maintain pressure on the site for at least 5 min after withdrawing the needle.
Arterial puncture for ABG test
  1. Before arterial puncture, perform Allen’s test first.
  2. If the patient is receiving oxygen, make sure that the patient’s therapy has been underway for at least 15 min before collecting arterial sample
  3. Be sure to indicate on the laboratory request slip the amount and type of oxygen therapy the patient is having.
  4. If the patient has just received a nebulizer treatment, wait about 20 minutes before collecting the sample.
Blood specimen
  1. No fasting for the following tests:
    • CBC, Hgb, Hct, clotting studies, enzyme studies, serum electrolytes
  2. Fasting is required:
    • FBS, BUN, Creatinine, serum lipid (cholesterol, triglyceride)
Sputum Specimen

1. Gross appearance of the sputum

  1. Collect early in the morning
  2. Use sterile container
  3. Rinse the mount with plain water before collection of the specimen
  4. Instruct the patient to hack-up sputum

2. Sputum culture and sensitivity test

  1. Use sterile container
  2. Collect specimen before the first dose of antibiotic

3. Acid-Fast Bacilli

  1. To assess presence of active pulmonary tuberculosis
  2. Collect sputum in three consecutive mornings

4. Cytologic sputum exam

  1. To assess for presence of abnormal or cancer cells.

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