1. Collecting and Testing Specimens
Chapter 31
Collecting and Testing Specimens

2. Specimens
Ordered by doctors, specimens (samples) are collected and tested to prevent, detect, and treat disease.
Most specimens are tested in the laboratory.
All specimens sent to the laboratory require requisition slips.
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 agency policy.
When collecting specimens, follow the rules in Box 31-1 on p. 541 in the Textbook.
Review the Teamwork and Time Management: Collecting and Testing Specimens Box on p. 541 in the Textbook.

3. Urine Specimens Urine specimens are collected for urine tests.
Random urine specimen is used for a routine urinalysis (UA).
It is collected any time during a 24-hour period.
Many people can collect the specimen themselves.
Weak and very ill persons need help.
Follow the rules in Box 31-1 on p. 541 in the Textbook.
Review the Delegation Guidelines: Urine Specimens Box on p. 541 in the Textbook.
Review the Promoting Safety and Comfort: Urine Specimens Box on p. 541 in the Textbook.

4. Urine Specimens (cont’d)
Midstream specimen (clean-voided specimen or clean-catch specimen)
The perineal area is cleaned before collecting the specimen.
To collect the specimen:
The person starts to void into a device.
The person stops the urine stream.
A sterile specimen container is positioned.
The person voids into the container until the specimen is obtained.
Cleaning the perineal area before collecting the specimen reduces the number of microbes in the urethral area.
Stopping the urine stream is hard for many people. You may need to position and hold the specimen container in place after the person starts to void.
Review the Focus on Communication: The Midstream Specimen Box on p. 543 in the Textbook.

5. Urine Specimens (cont’d)
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 test is restarted if:
A voiding was not saved.
Toilet tissue was discarded into the specimen.
The specimen contains stool.
The person and nursing staff must clearly understand the procedure and the test period.
Review the Promoting Safety and Comfort: The 24-Hour Urine Specimen Box on p. 544 in the Textbook.

6. Urine Specimens (cont’d)
To collect a urine specimen from an infant or a child who is not toilet- trained, a collection bag (“wee bag”) is applied over the urethra.
Voiding on request is hard for toilet-trained toddlers and young children.
Potty chairs and specimen pans are useful.
Remember to use terms the child understands.
To collect specimens from infants and children, a parent or another staff member assists if the child is upset.
The nurse may ask you to give the child water or other fluids when a urine specimen is needed. Usually the child needs to void about 30 minutes after drinking fluids.

7. Urine Specimens (cont’d)
The doctor orders the type and frequency of urine tests. The nurse may ask you to do these simple urine tests.
Testing for pH
Urine pH measures if urine is acidic or alkaline.
A random urine specimen is needed.
Testing for glucose and ketones
The diabetic person may have sugar (glucose) in the urine and ketones in the urine.
Tests for glucose and ketones are usually done 4 times a day—30 minutes before each meal and at bedtime.
The doctor uses the test to make drug and diet decisions.
Changes in normal pH occur from illness, food, and drugs.
Glucosuria or glycosuria means sugar in the urine.
Ketones (ketone bodies, acetone) are substances that appear in urine from the rapid breakdown of fat for energy. The body uses fat for energy if it cannot use sugar.

8. Urine Specimens (cont’d)
Testing for blood
Injury and disease can cause hematuria (blood in the urine).
Sometimes blood is seen in the urine.
At other times, it is unseen (occult).
A random urine specimen is needed.
Using reagent strips
Do not touch the test area on the strip.
Dip the strip into urine.
Compare the strip with the color chart on the bottle.
Reagent strips (dipsticks) are used to test urine. They have sections that change color when they react with urine.
Review the Teamwork and Time Management: Testing Urine Box on p. 548 in the Textbook.
Review the Delegation Guidelines: Testing Urine Box on p. 548 in the Textbook.
Review the Promoting Safety and Comfort: Testing Urine Box on p. 548 in the Textbook.

9. Urine Specimens (cont’d)
Straining urine
A stone (calculus) can develop in the kidney, ureter, or bladder.
Stones (calculi) vary in size.
Stones causing severe pain and urinary system damage may require removal by medical or surgical procedures.
Some stones pass through urine.
All of the person’s urine is strained.
Passed stones are sent to the laboratory.
Stones can be as small as grains of sand, pearl-size, or larger.
The person drinks 8 to 12 glasses of water a day to help pass the stone. Expect the person to void in large amounts.

10. Stool Specimens
Stools are studied for fat, microbes, worms, blood, and other abnormal contents.
Bleeding may occur in very small amounts
Stools are tested for occult (hidden) blood.
Stools are tested for occult blood to screen for colon cancer and other digestive disorders.
Occult blood test kits vary. Follow manufacturer’s instructions.
Urine must not contaminate the stool specimen.
The person uses one device for voiding and another for a BM.
Some tests require a warm stool.
The specimen is taken at once to the laboratory or storage area.
Often, blood is seen if bleeding is low in the bowels. Stools are black and tarry from bleeding in the stomach or upper gastro-intestinal tract. Melena is a black, tarry stool.
Follow the rules in Box 31-1 on p. 541 in the Textbook.
Review the Focus on Children and Older Persons: Stool Specimens Box on p. 550 in the Textbook.
Review the Focus on Communication: Stool Specimens Box on p. 550 in the Textbook.
Review the Delegation Guidelines: Stool Specimens Box on p. 551 in the Textbook.
Review the Promoting Safety and Comfort: Stool Specimens Box on p. 551 in the Textbook.

11. Sputum Specimens
Mucus from the respiratory system is called sputum when expectorated (expelled) through the mouth.
Sputum is not saliva.
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.
Saliva (“spit”) is a thin, clear liquid produced by the salivary glands in the mouth.
Coughing up sputum is often painful and hard to do. Morning specimens are easier due to secretions that collect in the trachea and bronchi during sleep. They are coughed up on awakening.
To collect a specimen, follow the rules in Box 31-1 on p. 514 in the Textbook.
Have the person rinse the mouth with water. Mouthwash is not used.
Review the Focus on Children and Older Persons: Sputum Specimens Box on p. 553 in the Textbook.
Review the Delegation Guidelines: Sputum Specimens Box on p. 554 in the Textbook.
Review the Promoting Safety and Comfort: Sputum Specimens Box on p. 554 in the Textbook.

12. Blood Glucose Testing
Blood glucose testing is used for persons with diabetes.
The doctor uses the results to regulate the person’s drugs and diet.
Capillary blood is obtained through a skin puncture.
A drop of blood is collected.
A fingertip is the most common site for skin punctures.
The fingertip provides easy access and clothing is not removed.
See Figures and on p. 555 in the Textbook.

13. Blood Glucose Testing (cont’d)
To perform a skin puncture:
Inspect the puncture site carefully for signs of trauma and skin breaks.
Do not use swollen, bruised, cyanotic, scarred, or calloused skin.
Use the side toward the tip of the middle or ring finger.
You use a sterile, disposable lancet to puncture the skin.
The person feels a brief, sharp pinch.
Swollen, bruised, cyanotic (bluish colored), scarred, or calloused sites have poor blood flow.
A callus is a thick, hardened area on the skin. Calluses often form over frequently used areas, such as the tips of the thumbs and index fingers. Thumbs and index fingers are not good skin puncture sites.
Do not use the center, fleshy part of the fingertip. The site has many nerve endings, making punctures painful.
A lancet is a short, pointed blade that punctures but does not cut the skin. It is inside a protective cover.
You do not touch the blade.
Discard it into the sharps container after use.

14. Blood Glucose Testing (cont’d)
Using a reagent strip, a glucometer (glucose meter) measures blood glucose.
You apply a drop of blood to a reagent strip.
The blood glucose level appears on the screen.
Many types of glucometers are available.
You learn to use your agency’s device.
Always follow the manufacturer’s instructions.
Review the Teamwork and Time Management: Blood Glucose Testing Box on p. 556 in the Textbook.
Review the Delegation Guidelines: Blood Glucose Testing Box on p. 556 in the Textbook.
Review the Promoting Safety and Comfort: Blood Glucose Testing Box on p. 556 in the Textbook.
Follow the rules in Box 31-2 on p. 556 in the Textbook.