1. Collecting and Testing Specimens
Chapter 28
Collecting and Testing Specimens
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2. Specimens
Specimens (samples) are collected and tested to prevent, detect, and treat disease.
The doctor orders what specimen to collect and the test needed.
All specimens sent to the laboratory require requisition slips.
Most specimens are tested in the laboratory. Some tests are done at the bedside.
The requisition slip has the person’s identifying information and the test ordered.
The specimen container is labeled according to center policy.
Review Box 28-1 on p. 466.
Review Teamwork and Time Management: Collecting and Testing Specimens on p. 465.
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3. Urine Specimens Urine specimens are collected for urine tests.
The random urine specimen
The random urine specimen is collected for a routine urinalysis.
No special measures are needed.
Many people can collect the specimen themselves.
Weak and very ill persons need help.
Review Delegation Guidelines: Urine Specimens on p. 466 in the textbook.
Review Promoting Safety and Comfort: Urine Specimens on p. 466 in the textbook.
The random urine specimen is collected anytime during a 24-hour period.
Review the Collecting a Random Urine Specimen procedure on pp
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4. The Clean-Catch Specimen
The midstream specimen (clean-voided specimen or clean-catch specimen)
The perineal area is cleaned before collecting the specimen.
Sterile gloves are needed.
A sterile specimen container is needed.
To collect the specimen:
The person starts to void into a receptacle.
Then the person stops the stream of urine.
A sterile specimen container is positioned.
The person voids into the container until the specimen is obtained.
You may need to position and hold the specimen container in place after the person starts to void.
Cleansing the perineal area reduces the number of microbes in the urethral area.
Stopping the stream of urine is hard for many people. You may need to position and hold the specimen container in place after the person starts to void (Fig. 28-2, p. 468).
Pour about 120 mL (milliliters) (4 oz [ounces]) into the specimen container.
Review Focus on Communication: The Midstream Specimen on p. 468.
Review the Collecting a Midstream Specimen procedure on pp
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5. The 24-Hour Urine The 24-hour urine specimen
All urine voided during a 24-hour period is collected.
Urine is chilled on ice or refrigerated during this time.
A preservative is added to the collection container for some tests.
The person voids to begin the test with an empty bladder.
Discard this voiding.
Save all voidings for the next 24 hours.
The person and nursing staff must clearly understand the procedure and the test period.
The test is re-started if:
A voiding was not saved.
Toilet tissue was discarded into the specimen.
The specimen contains feces.
Review Promoting Safety and Comfort: The 24-Hour Urine Specimen on p. 469.
Review the Collecting a 24-Hour Urine Specimen procedure on p. 470.
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6. Urine Testing Testing urine
Urine pH measures if urine is acidic or alkaline.
Normal pH is 4.6 to 8.0.
A routine urine specimen is needed.
Testing for glucose and ketones
These tests are usually done 30 minutes before each meal and at bedtime (four times each day).
The doctor uses the test to make drug and diet decisions.
Double-voided specimens are best for these tests.
Testing for blood
Sometimes blood is seen in the urine.
At other times it is unseen (occult).
The nurse may ask you to do simple urine tests.
Glucosuria or glycosuria means sugar (glucos, glycos) in the urine (uria). The diabetic person may also have ketones (ketone bodies, acetone) in the urine. These substances appear in urine from the rapid breakdown of fat for energy. The body uses fat for energy if it cannot use sugar. Urine is also tested for ketones.
Injury and disease can cause hematuria. It means blood (hemat) in the urine (uria).
Review Teamwork and Time Management: Testing Urine on p. 471.
Review Delegation Guidelines: Testing Urine on p. 471.
Review Promoting Safety and Comfort: Testing Urine on p. 471.
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7. Urine Testing (Cont’d)
Using reagent strips
Do not touch the test area on the strip.
Dip the strip into the urine.
Compare the strip with the color chart on the bottle.
Follow the manufacturer’s instructions.
Straining urine
A stone (calculus) can develop in the kidney, ureter, or bladder.
Stones can vary in size.
Stones causing severe pain and urinary system damage may require surgical removal.
Some stones are passed through urine.
Reagent strips (dipsticks) have sections that change color when they react with urine (Fig. 28-3, p. 471).
Review Promoting Safety and Comfort: Using Reagent Strips on p. 471.
Review the Testing Urine With Reagent Strips procedure on p. 472.
Review the Straining Urine procedure on p. 473.
The person drinks 8 to 12 glasses of water a day to help pass the stone. Expect the person to void in large amounts.
All urine is strained. Passed stones are sent to the lab.
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8. Stool Specimens Stools are studied for: Blood Fat Microbes Worms
Other abnormal contents
The stool specimen must not be contaminated with urine.
The person uses one receptacle for voiding and another for a bowel movement (BM).
Some tests require a warm stool. The specimen is taken at once to the storage area for transport to the laboratory.
Review Box 28-1 on p. 466.
Review Focus on Communication: Stool Specimens on p. 474.
Review Delegation Guidelines: Stool Specimens on p. 474.
Review Promoting Safety and Comfort: Spool Specimens on p. 474.
Review the Collecting a Stool Specimen procedure on p. 475.
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9. Testing Stools for Blood
When internal bleeding is suspected, stools are checked for blood.
Testing stools for blood
Often blood is seen if bleeding is low in the bowels.
Stools are black and tarry (melena) if there is bleeding in the stomach or upper GI tract.
Sometimes bleeding occurs in very small amounts and cannot be seen (occult blood).
The test is often done to screen for colon cancer.
Ulcers, colon cancer, and hemorrhoids are common causes of blood in stool.
Occult blood test kits vary. Follow the manufacturer’s instructions.
Review Delegation Guidelines: Testing Stools for Blood on p. 476.
Review Promoting Safety and Comfort: Testing Stools for Blood on p. 476.
Review the Testing a Stool Specimen for Blood procedure on p. 477.
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10. Sputum Specimens
Sputum specimens are studied for blood, microbes, and abnormal cells.
The person coughs up sputum from the bronchi and trachea.
It is easier to collect a specimen in the morning.
Older persons may lack the strength to cough up sputum.
Coughing is easier after postural drainage.
The nurse or respiratory therapist does postural drainage.
Sputum is not saliva. Saliva (“spit”) is a thin, clear liquid produced by the salivary glands in the mouth.
Coughing up sputum that contains blood is called hemoptysis.
Coughing up sputum is often painful and hard to do.
To collect a specimen, follow the rule in Box 28-1, p Also, have the person rinse the mouth with water. Rinsing decreases saliva and removes food particles.
Mouthwash is not used. It destroys some of the microbes in the mouth.
Review Delegation Guidelines: Sputum Specimens on p. 478.
Review Promoting Safety and Comfort: Sputum Specimens on p. 478.
Review the Collecting a Sputum Specimen procedure on p. 479.
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11. Blood Glucose Testing (Cont’d)
Blood glucose testing is used for persons with diabetes.
Capillary blood is obtained through a skin puncture.
You use a sterile, disposable lancet to puncture the skin.
A glucose meter (glucometer) measures blood glucose.
The doctor uses the results to regulate the person’s medications and diet.
A drop of blood is collected. A fingertip (Fig , p. 480) is the most common site for skin punctures. This provides easy access and clothing is not removed. With some meters, you can use the forearm, thigh, or fleshy part of the hand.
The person feels a brief, sharp pinch when you use the lancet (Fig , p. 480), which is a short, pointed blade. Discomfort is brief.
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12. Blood Glucose Testing (Cont’d)
To perform a skin puncture:
Inspect the site carefully. Look for signs of trauma and skin breaks.
Do not use sites that are swollen, bruised, cyanotic (bluish color), scarred, or calloused.
Do not use the center, fleshy part of the fingertip.
Use the side toward the tip of the middle or ring finger.
You apply a drop of blood to a reagent strip.
Then you insert the strip into the glucose meter.
The blood glucose level appears on the screen.
Many types of glucose meters are available.
Follow the manufacturer’s instructions.
Calluses often form over frequently used areas, such as the tips of the thumbs and index fingers. Therefore thumbs and index fingers are not good skin puncture sites.
The lancet punctures but does not cut the skin. The lancet is inside a protective cover. Do not touch the blade. Discard it into the sharps container after use.
Review Teamwork and Time Management: Blood Glucose Testing on p. 480.
Review Delegation Guidelines: Blood Glucose Testing on p. 480.
Review Promoting Safety and Comfort: Blood Glucose Testing on p. 480.
Review Box 28-2 on p. 481.
Review Measuring Blood Glucose procedure on pp
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13. Quality of Life
Promote comfort by explaining the procedure to the person.
Some people can collect their own urine and sputum specimens.
Doing so promotes independence and helps reduce embarrassment.
Show the person the specimen container and how it is used.
Ask the person where to place the container so the person knows where to find it.
You must collect and test specimens on the right person. Otherwise one or more persons could suffer harm. Before collecting or testing a specimen, carefully identify the person. Check the identification (ID) bracelet against the laboratory requisition slip or assignment sheet. Compare all information, not just the person’s name.
Some centers require placing the collection date, collection time, and collector’s name or initials on the container. This promotes safety. Follow center policy for labeling specimens.
Always act professionally. Do not say things that may embarrass the person.
Specimen collection embarrasses many people. To promote comfort and privacy:
Politely ask visitors to leave the room.
Close doors, the privacy curtain, and window coverings.
Leave the room if it is safe to do so. If you cannot leave, explain this to the person.
Place the specimen container in a paper bag or wrap it in a paper towel or washcloth so others do not see the specimen.
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