PERINEAL-GENITAL CARE

 Also known as perineal care or pericare

 Part of bed bath
 Cleaning “private parts”
PURPOSES
1. To remove normal perineal secretions and odors
2. To promote client comfort
ASSESSMENT TERTIARY SYPHILIS
Assess for the presence of:  2 years after infection, the latest can be 20years.
 Irritation, excoriation, inflammation, swelling  The constituent ratio was about 30% in all
 Excessive discharge  Syphilis patients
 Odor; pain or discomfort  clinical characteristic of clinical characteristic of Secondary
 Urinary or fecal incontinence syphilis
 Recent rectal or perineal surgery  Slow-moving course of disease
 Indwelling catheter  Viscera skeleton central nervous system all canbe
SEXUALLY TRANSMISSIBLE DISEASES  Affected besides skin and membrana mucosa
PRIMARY SYPHILIS
 Caused by the treponema palidum.
 Mainly infected though sexual behaviour or placental infection.
 Organs all over the body can be affected.

SYPHILIS CONGENITA
 Syphilis congenital is acquired from a mother with early syphilis.
It is generally
 Believed that syphilis congenital rarely
 Occur
 Before 4 months in infants because
 Immune system has not fully developed
CLINICAL CHARACTERISTIC
 No sulcus chancer occurred, already in the second stage after
birth
 Early pathological changes are severe than acquired syphilis, but
SECONDARY SYPHILIS
later changes is lighter
 Clinical manifestation of secondary syphilis
 It is common that cardiovascular system affected , also in the
 Pleomorphism of the lesions: macula
eyes, ear, nose.
 Maculopapule, papule, scales usually occur
 It is common that physical development affected and skeleton
 In 3-4 weeks after extinction of hard chancre,
damaged.
 Precursory symptom includes low-grade fever
 Headache, nostalgia, neuralgia headache of four
 Limbs usually occur before eruption, last for 3-5
 Days, relieve after eruption

TREATMENT OF SYPHILIS
PRINCIPLE:
 early full dosage sufficient course. Penicillin is the best selection.
DETERMINE:
1. Perineal-genital hygiene practices
2. Self-care activities
3. If client is experiencing any discomfort in the perineal-genital
area
4. Obtain and prepare the necessary equipment and supplies
EQUIPMENT
 Perineal-genital care provided in conjunction with the bed bath:
1. Bath towel
2. Bath blanket
3. Clean gloves
4. Bath basin w/ water at 43˚c (110-115 ˚c)
5. Soap
6. Washcloth
PERFORMANCE
1. Prior to performing the procedure, introduce self and verify the
client’s identity using agency protocol. Explain to the client what you
are going to do, why it is necessary and how he and she can
cooperate, being particularly sensitive to any embarassment felt by
the client.
2. Perform hand hygiene and observe other appropriate infection
control procedures (e.g. Clean gloves).
3. Provide the client privacy by drawing the curtains around the bed
or closing the door to the room. Some agencies provide signs
indicating the need for privacy.
Rationale: hygiene is a personal matter.
4. Prepare the client:
 Fold the top bed linen to the foot of the bed and fold the gown
up to expose the genital area.
 Place a bath towel under the client’s hips.
Rationale: the bath towel prevents the bed from being soiled.
5. Position and drape the client and clean the upper inner thighs.
FOR FEMALES:
 Position the female in a back-lying position with the knees flexed
and spread well apart.
 Cover her body and legs with the bath blanket positioned so a
corner is at her head, the opposite corner of her feet, and the
other two on the sides. Drape the legs by tucking the bottom
corners of the bath blanket under the inner sides of the legs
Rationale: minimum exposure lessens embarrassment and helps to
provide warmth.
Put on gloves, wash and dry the upper inner thighs.
FOR MALES:
 Position the male client in a supine position with knees slightly
flexed and hips slightly externally rotated.
 Put on gloves, wash and dry the upper inner thighs.
6. Inspect the perineal area.
 Note particular areas of inflammation, excoriation, or swelling,
especially between the labia in females and the scrotal folds in
males.
 Also note excessive discharge or secretions from the orifices and
the presence of odors.
7. Wash and dry the perineal-genital area.
FOR FEMALES:
A. Wipes labia majora (outer) from front to back in downward motion
using clean surface of wash cloth for each swipe.
Rationale: secretions that tend to collect around the labia majora
facilitate bacterial growth.
B. Wipes labia minora (inner) from front to back in downward motion
using clean surface of wash cloth for each swipe.
C. Wipes down the center of the meatus from front to back. If
catheter is in place, cleans around catheter in circular fashion
 Using clean surface of wash cloth for each swipe.
D. Washes inner thighs from proximal to distal.
 For menstruating women and client with indwelling catheters,
use clean wipes. Take a clean wipe for each stroke.
Rationale: using separate quarters of the washcloth or new wipes
prevents the transmission of microorganisms from one area to the
other. Wipe from the area of least contamination (the pubis) to that
of greatest (the rectum).
8. Rinse the area well. You may place the client on a bedpan and use
a periwash or solution bottle to pour warm water over the area. Dry
the perineum thoroughly, paying particular attention to the folds
between the labia.
Rationale: moisture supports the growth of microorganisms.
FOR MALES:
7. Wash and dry the penis, using firm strokes.
A. If the client is uncircumscribed, retract the prepuce (foreskin) to
expose the glans penis (the tip of the penis).
Rationale: retracting the foreskin is necessary to remove the
smegma (thick, cheesy secretion) that collects under the foreskin
prevents constriction of the peis, which may cause edema).
B. Washes around the urinary meatus in a circular motion, using clean
surface of wash cloth for each stroke and around the head of penis in
circular motion.
C. Washes down shaft of penis toward the thighs changing wash cloth
position with each stroke.
D. Wash and dry the scrotum from front to back. The posterior folds
of the scrotum may need to be cleaned when the buttocks are
cleaned.
Rationale: the scrotum tends to be more soiled than the penis
because of its proximity to the rectum; thus it is usually cleaned
after the penis.
E. Washes the inner thighs
F. Rinses with clean wash cloth or peri-bottle using warm water in
same sequence as the wash.
G. Dries with clean towel in the same sequence.
H. Replace foreskin, as appropriate.
8. Inspect perineal orifices for intactness.
 Inspect particularly around the urethra in clients with in-dwelling
catheters.
Rationale: a catheter may cause excoriation around the urethra.
9. Turns patient on side to wash anus from front to back and dry.
 Assist the client to turn onto the side facing away from you.
 Pay particular attention to the anal area and posterior folds of
the scrotum in males. Clean the anus with toilet tissue before
washing it, if necessary.
 Dry the area well.
 For postdelivery or menstruating females, apply a perineal pad
as needed from front to back.
Rationale: this prevents contamination of the vagina and urethra
from the anal area.
10. Document any unusual findings such as redness, excoriation, skin
breakdown, discharge or drainage, and any localized areas of
tenderness
PERINEAL CARE
 Involves thorough cleansing of the client’s external genitalia,
anal area and surrounding skin
 “peri-care” or “perineal-genital” care
 Involves washing the external genitalia with soap & water or
with water alone or in combination with any commercially
prepared periwash
 Can be delegated to nursing assistive personnel
 Carried out as part of the patients bath or as a separate
procedure
 Perineal area is conducive to the growth of pathogenic organism
because it is warm, moist, and is not well ventilated
 Cleanliness is essential to prevent bad odor & promote comfort
PURPOSES
 To prevent or eliminate infection, odor and promote healing
 Remove secretions
 Provide comfort
PRINCIPLES
 To clean the perineum from the cleanest to the less clean area
 Follow standard precautions
 Maintain patient’s privacy
PATIENTS WHO NEED FREQUENT PERINEAL CARE
 Who are unable to do self care
 Patients with genito-urinary tract infections
 With fecal & urinary incontinence
 An indwelling foley catheter
 Who are recovering from rectal or genital surgery or childbirth
 Patients with excessive vaginal drainage
 Patients with injury and ulcers
 Uncircumcised males
 Morbid obesity
ASSESS PRESENCE OF
 Irritation, excoriation, inflammation, swelling
 Excessive discharge
 Odor; pain or fecal incontinence
 Recent rectal or perineal surgery
 Indwelling catheter
DETERMINE
1. Perineal-genital hygiene practices
2. Self-care abilities
EQUIPMENT
1. Bath towel
2. Bath blanket
3. Clean gloves
4. Bath basin with water at 43° C (110-115° C)
5. Soap and soap dish
6. Washcloth
7. Toiletry items – toilet tissue or diaper wipes
8. Water proof pad
9. Bed pan
10. Cotton balls/swabs
ASSESSMENT SKILLS
1. Assemble equipment
 Avoid interruptions during procedure
 Carry out procedure organized and systematic
 Saves time and energy
2. Explain procedure to the client
 To gain cooperation from the client
 Lessen anxiety
3. Wash hands and done gloves
 To deter transfer of microorganisms
 Provide the client privacy by drawing the curtains around the
bed or closing the door to the room
Rationale: hygiene is a personal matter
 Position and drape the client
 Help patient assume dorsal recumbent position
 Note restrictions or limitations in patient’s positioning
 Place a water proof pad under the client’s hips
Rationale: prevent soiling of the bed sheet
 Drape patient with a blanket placed in a shape of diamond
Rationale: minimum exposure lessens embarrassment and helps to
provide warmth
 Fold the top linen to the foot of the bed and fold the gown up.
Lift lower edge of the bath blanket and expose the perineum.
Fold lower corner of the bath blanket up between the patient’s
legs onto the abdomen and lower hip
 Wash and dry patient’s upper thighs with a bath mitt
FEMALE
1. Wipe labia majora (outer) from front to back in downward motion
using clean surface of wash cloth for each swipe.
Rationale: secretions that tend to collect around the labia majora
facilitate bacterial growth.
 Use non dominant hand to gently retract labia from thigh, with
dominant hand wash carefully in skin folds. Wipe in the
direction from perineum to rectum repeat on the other side
with separate section of the bath mitt. Rinse and dry
thoroughly
Rationale: skin folds may contain body secretions that harbour
microorganisms. Wiping from front to back reduces chance of
transmitting fecal organisms to urinary meatus
2. Wipes labia minora (inner) from front to back in downward motion
using clean surface of wash cloth for each swipe.
3. Wipes down the center of the meatus from front to back. If
catheter is in place, cleans around catheter in circular fashion
• Using clean surface of wash cloth for each swipe.
4. Washes inner thighs from proximal to distal.
 Gently separate labia with non dominant hand to expose
urethral meatus and vaginal orifice. With dominant hand, wash
downward from pubic area towards the rectum in one smooth
stroke. Clean thoroughly around labia minora, clitoris and
vaginal orifice
 For menstruating women or patient with IFC, clean with cotton
balls, take a clean wipe for each stroke
 Avoid placing tension on indwelling catheter if present and clean
are thoroughly
 Rationale: using separate quarters of the washcloth or new
wipes prevents the transmission of microorganisms from one
area to the other. Wipe from the area of least contamination
(the pubis) to that of greatest (the rectum).
4. Wash inner thighs from proximal to distal
5. Rinse with warm tepid water using pour from peri bottle if available
 May use bedpan and pour warm water
6. Remove bed pan if one is used
7. Turn the patient on side to dry anal area thoroughly
 Assist the client to turn onto the side facing away from you
 Separate the client’s buttocks and clean the anus with toilet
tissue if necessary to remove fecal matters before washing it
 Dry the area well
 For postpartum or menstruating females, apply genital pad as
needed from front to back. This prevents contamination of the
vagina and urethra from the anal area
 Apply skin care to the area according to the need of doctor’s
order
 Observe perineal area for any irritations, redness or drainage
that persisted after hygiene
 Remove soiled gloves and discard in proper receptacle. Raise
side raise before leaving bedside. Perform hand hygiene
 Document the procedure, describing the client’s skin condition
(redness, excoriation, skin breakdown, discharge or drainage
and any localized areas or tenderness) and tolerance to the
care, sign the chart
MALE
PREPARATION
 Help patient in supine position. note any restriction or mobility
 Fold lower half of bath blanket to expose upper thighs. Wash and
dry thighs
 Cover thighs with bath blanket. Raise bath blanket up to expose
the genitalia
 Gently raise penis and place bath towel underneath
1. Retract foreskin if uncircumcised
 If the client is uncircumcised, retract the prepuce (foreskin) to
expose the glans penis (the tip of the penis)
Rationale: retracting the foreskin is necessary to remove the smegma
(thich, cheesy secretion) that collects under the foreskin prevents
constriction of the peis, which may cause edema)
2. Wash around the urinary meatus in circular motion, using clean
surface of wash cloth for each stroke and around the head of penis in
circular motion
 Using circular motion, clean from meatus outward. Discard wash
cloth and repeat with clean cloth until penis is clean. Rinse and
dry gently.
 Direction of cleaning moves from area of least contamination to
area of most contamination preventing microorganisms from
entering the urethra
3. Wash down shaft of penis toward the thighs changing wash cloth
position with each stroke
4. Wash scrotum – front to back
 Wash and dry the scrotum from front to back. The posterior folds
of the scrotum may need to be cleaned when the buttocks are
cleaned
Rationale: the scrotum tends to be more soiled than the penis
because of its proximity to the rectum; thus it is usually cleaned after
the penis
5. Wash the inner thighs
6. Rinse with clean wash cloth or peri-bottle using warm water in
same sequence as the wash
7. Dries with clean towel in the same sequence
8. Replace foreskin, as appropriate
 Return the foreskin to its natural position. This is extremely
important in patients with decreased sensation in their lower
extremities
Rationale: tightening of the foreskin around shaft of penis causes
local edema and discomfort. Patients with reduced sensation do not
feel tightening of the foreskin
9. Turn patient on side to wash anus from front to back and dry
 Assist the client to turn onto the side facing away from you
 Pay particular attention to the anal area and posterior folds of
the scrotum in males. Separate the client’s buttocks and clean
the anus with toilet tissue if necessary to remove fecal matters
before washing it
 Dry the area well
 Observe perineal area for any irritations, redness or drainage
that persisted after hygieneRemove soiled gloves and discard
in proper receptacle. Raise side raise before leaving bedside.
Perform hand hygiene
 Document the procedure, describing the client’s skin condition
(redness, excoriation, skin breakdown, discharge or drainage
and any localized areas or tenderness) and tolerance to the
care, sign the chart
APPLYING A WEE BAG
 For children who are too young to collect a urine specimen,
pediatric urine specimen collections bags with skin adhesive may
be used. This lecture is intended to aid you in applying, removing
and handling the urine specimen collected from an infant or
young child.
Before you begin:
 The skin area must be clean and dry. A mild soap and water is
recommended.
 Avoid oils, baby powders and lotion soaps that may leave a
residue on the skin and interfere with the adhesive’s ability to
stick to your child’s skin.
PROCEDURE
Clean the area:
1. Remove the infant’s diaper and separate their legs to clean the
area.
2. For females: Always clean from front to back.
 Clean one side of the opening where urine comes out then the
other side followed by cleaning down the center.
 Throw away the used cleaning cloth and allow the area to air dry.
3. For males:
 Clean the end of the penis.
 If the child has foreskin, pull it back and clean the end of the
penis. Be sure to clean the opening where the urine comes out.
 Throw away the used cleaning cloth(s) and allow the area to air
dry.
PROCEDURE IN ATTACHING THE WEE BAG
1. Pinch the center of the white paper backing on the urine bag
enough to make a crease.
2. Peel off the paper sticker to expose the adhesive around the
opening of the bag.
3. Attach the urine bag to your infant’s body using these steps:
A. For females:
a) Place the bottom (creased) part of the adhesive area on the skin
between the rectum and the opening to the vagina.
b) The excess bag should be pointing down towards the infant’s
feet.
c) Apply the bag by firmly pressing the adhesive from bottom to
top, and to the skin around the vagina.
B. For males:
a) Carefully place the penis into the bag.
b) Place the bottom (creased) part of the adhesive on the skin
between the rectum and the scrotum.
c) The excess bag should be pointing down towards the infant’s
feet.
d) Apply the bag by pressing firmly on the adhesive from bottom to
top and to the skin surrounding the scrotum.
PROCEDURE ON COLLECTING THE URINE SAMPLE:
1. Reapply the diaper over the bag. Ensure that the bag is not being
pulled by the diaper as this could break the seal.
Collecting the urine sample:
2. Once your child has urinated into the bag, slowly peel off the bag
to avoid spilling the urine.
 Keep the collection bag upright until able to pour the urine into
the sterile urine container provided to you by the laboratory.
 Empty the contents of the collection bag into the sterile urine
container and screw the lid on tightly so it does not leak.
Do not place the pediatric urine bag itself into the urine
container for transport to the laboratory.
3. Label the urine collection container with the following information:
a) The infant’s full name (first and last name);
b) Date of Birth;
c) Date and time of collection; and
d) Name of ordering provider.
4. Specimens that are contaminated with fecal matter will not be
accepted for testing and will require recollection of the specimen.
 If your child’s diaper contains feces after urination,
contamination is highly likely. Please discard this urine specimen
and reapply a second clean collection bag to obtain another
urine specimen.
Adhesive removal:
 An adhesive removal product should not be used on the sensitive
skin of an infant. Consult your provider with any concerns
regarding adhesive removal.
 Deliver the container to the laboratory as soon as possible after
completion of the collection. If the urine cannot be delivered to
the laboratory within 1-2 hours, it needs to be refrigerated.
Urine refrigerated for more than 24 hours cannot be used for
culture and will be rejected by the laboratory.
URINE SPECIMEN COLLECTION
 A 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:
IMPORTANT NURSING ACTION
 Label the container
RANDOM SPECIMEN
 Can be taken any time of the day
MORNING SAMPLE
 Collect the urine in the morning; urine is more concentrated
CLEAN CATCH MED STREAM
 Use for culture; to check for microbial susceptibility
24 HOUR URINE
 Quantitative and qualitative sample
PROSPANGAL
 Taken 2 hours after meal; for glucose monitoring
SUPRAPUBIC ASPIRE
 Make a use of syringe; prepare abdomen and apply antiseptic
solutio
COLOR
 Normal urine color ranges from pale yellow to deep amber in
color, depending on the concentration of the urine.
 Dark yellow – dehydrated
 Red – identify if client is menstruated
 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.
1. Explain the procedure
• as careful instructions increase likelihood of proper specimen
collection.
2. Cleans with towelletes.
Female:
a. Hold Labia apart and cleanse one side with towellete with one
downward stroke toward the rectum- then discard
b. Clean the other side of the labia in the same manner- discard
towellete
c. Clean center of vulva – discard towellete.
Male- They may be given clean urinal
a. Hold penis in upward position and retract foreskin. Replaced
foreskin after specimen is collected
b. Allow first urinary flow to escape. First portion of the urine
washes out urethra and contains debris
3. Allow patient to finish voiding. Do not collect part of urine flow
4. Peel back protective safety label and push gray top tube into
recessed channel in cup lid within 15 – 20 minutes of voiding. Hold
until flow stops. Gray top tube is used for urine culture only.
5. Remove gray top tube and invert several times to dissolve
preservative
6. Use a red top conical bottle if further test are needed.
7. Reseal label on cup lid
8. Label each test tube and attaches pik-up slip and send to laboratory

Color code for specimen tube:
RANDOM CLEAN CATCH & MID STREAM URINE COLLECTION
• A sample of urine collected at any time of the day. This type of
specimen is most convenient to obtain.
• Midstream “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
• 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.
• 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 (RANDOM CLEAN CATCH)
• Clean, dry container with lid
• Cotton ball or towelette
• Laboratory request form
SUPPLIES AND EQUIPMENT (MIDSTREAM)
• Sterile specimen cup
• Zephiran, a soap solution, or three antiseptic towelettes
• Three cotton balls (to use with zephiran or soap solution)
• Laboratory request form
PROCEDURE
FEMALE COLLECTION:
• Wash hands thoroughly with soap and water
• Dry with paper towel.
• Washes vulva, wiping from front to back using antiseptic skin
towellete
• Discard towellete
• Instruct client to void first portion of urine into the toilet.
• Then instruct client to void midstream portion into a sterile
container
• Make sure that the inside part of the container is not touched
• Stop collection when container is about half full, than complete
the void into the toilet
• Screw cap on container
• Wash hand
• Send the sample to lab personnel
MALE COLLECTION:
• Wash hands thoroughly with soap and water
• Dry with paper towel.
• Pull back foreskin, if uncircumcised and skin clean glans of penis
with antiseptic towellete
• Void first portion of urine into the toilet and void the midstream
portion into the urine container, Do not touch the inside of the
container.
• Screw cap on container.
• Wash hands
• Give sample to personnel.
• Document in the chart and follow up results
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
• Large, clean bottle with cap or stopper
• Measuring graduate
• Bedpan or urinal
• Refrigerated storage area
• Gloves
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
1. Label the bottle with patient identifying information, the date, and
time the collection begins and ends.
2. Instruct the patient to urinate, flush down the urine down the toilet
when he gets up in the morning.
3. Afterward, tell the patient to collect the rest of his urine in the
special bottle for the next 24 hours, storing it in a cool environment.
It can be kept cool in the refrigerator or on ice in a cooler.
4. Instruct the patient to drink adequate fluids during the collection
period.
5. Emphasize proper hand hygiene before and after each collection.
Record each amount on the intake and output (I&O) sheet.
6. Exactly 24-hours after beginning the collection, ask the patient to
void. This will complete the specimen collection.
7. Instruct the patient to continue to keep the collection container
refrigerated until transfer to laboratory.
8. Send the bottle and laboratory request form to the lab.
• 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.
PREGNANCY URINE TEST
• A 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
• Only a urine specimen cup is required.
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
1. Advise the patient to use the test the first time she urinate after
waking up. As this urine is the most concentrated, it will contain the
highest hCG levels of the day. Urine will become more diluted as the
patient drink liquids, so hCG levels may be harder to measure later in
the day.
2. Label the specimen cup with the patient’s identifying information,
complete a laboratory request form requesting an HCG test and send
both to the lab.
3. Only the physician or a registered nurse should tell the patient the
results of the test.
CLEAN CATCH URINE COLLECTION
1. Explain the procedure to the client
2. Assemble equipment:
3. Wash Hands thoroughly
4. Provide privacy
5. Instruct client how to collect the specimen
6. Direct or assist client to the bathroom
FEMALE CLIENT:
7. Clean the perineal area from front to back and use towelette once
only
MALE CLIENTS:
8. Retract the foreskin slightly to expose the urinary meatus if
uncircumcised.
9. Clean the urinary meatus and the distal portion of the penis using
a circular motion
10. Use each towelette only once then discard.
11. Clean several inches down to the shaft of the penis
• Clients who requires assistance, Prepare the Client and
equipment:
12. Wash the perineal area with soap and water, rinse and dry.
13. Assist the Client onto a clean commode or bedpan
14. Position the client using a bedpan or urinal
15. Open the clean catch kit, not to contaminate the container or lid
16. Puts on clean gloves
17. Clean the urinary meatus and perineal area
18. Collect the specimen from a non-ambulatory client
19. Instruct the client to start voiding
20. Place the specimen container into the stream of the urine and
collect the specimen. Taking care not to touch the container to the
perineum or pens
21. Collect 30-60ml of urine in the container
22. Cover the container tightly, touching only the outside of the
container and the cap.
23. Clean the outside of the specimen container with disinfectant
24. Label the specimen
25. Complete Laboratory requisition form with the correct
information. Then attach securely to the specimen
26. Indicate on lab slip if the client is taking any current antibiotic
therapy, or the client is menstruating
27. Bring the specimen to the laboratory immediately
Record pertinent observations of the urine, color, odor or consistency
and difficulty in voiding that the client experienced.
SPUTUM SPECIMEN COLLECTION
LEARNING OBJECTIVES:
At the end of the presentation, students will be able to:
1. Describe the specifications of suitable containers for sputum
collection.
2. Describe and demonstrate safe and correct collection of sputum.
3. Describe options for specimen collection, handling and
transport.
4. Outline requirements for a properly labelled specimen.
PURPOSE OF SPUTUM SPECIMEN COLLECTION
• Sputum sample collection involves the collection of
expectorated secretions from a patient’s lower respiratory tract
for the purpose of isolating microorganisms.
WHAT USES DOES THE TEST HAVE?
• Sputum collects in the lower parts of your lungs and bronchi,
which are the tube-like pathways that air moves through to
reach your lungs. Symptoms that may indicate the need for a
sputum culture test include:
• Cough, a fever or chills, fatigue, muscle aches, breathing
difficulties, chest pain, confusion
• The test can reveal what may be causing the cough and other
symptoms. These include:
• Bronchitis, a lung abscess, pneumonia, tuberculosis, chronic
obstructive pulmonary disease, cystic fibrosis
• Certain harmful bacteria, viruses, or fungi can cause respiratory
conditions. By determining what may be causing your
symptoms, your doctor can find the best medication to cure the
infection.
• In some instances, your doctor may order a complete blood
count to determine if white blood cells are elevated. This
increase in white blood cells can indicate an infection.
PRINCIPLES
• The goal of the specimen collector must be to maintain the
viability of the organisms with minimal contamination.
• Basic principles of specimen collection are:
 If possible, collect the specimen in the acute phase of the
infection and before antibiotics are administered.
1. Select the correct anatomic site for collection of the specimen.
2. Collect the specimen using the proper technique and supplies
with minimal contamination.
3. Collect the appropriate quantity of specimen.
4. Package the specimen in a container designed to maintain the
viability of the organisms.
5. Label the specimen accurately with the patient information.
6. Transport the specimen to the laboratory promptly.
SPECIMEN COLLECTION GUIDELINES
RESPIRATORY TRACT: Lower bronchial specimen sputum:
 Rinse mouth or gargle with water, instruct to cough deeply into
container. Or the patient should rinse the mouth with water and
expectorate with the aid of a deep cough directly into a sterile
container (expectorated sputum).
 Patients with dentures should remove the dentures first. A single
specimen should be adequate for detection of bacterial Lower
Respiratory Tract infection. If fungal or mycobacterial infections
are possible, three separate early morning specimens (collected
on successive days) are appropriate. - Specimens may be
collected through aerosol-induction in which the patient
breathes aerosolized droplets of a solution that stimulates cough
reflex (induced sputum).
GATHER EQUIPMENT:
 Sputum specimen container
 Biohazard bag for delivery of the specimen to the laboratory
 Tissue paper for the patient to clear away any secretions
 Sputum sample microbiology request form.
 Gloves and apron (if the patient is suspected of having
tuberculosis or other serious infectious diseases, you will need
to wear full personal protective equipment including a mask,
gown and goggles).
INTRODUCTION
 Wash your hands and don PPE if appropriate.
 Introduce yourself to the patient including your name and role.
 Confirm the patient’s name.
 Briefly explain what the procedure will involve using patient-
friendly language: “Today I need to collect a sputum sample to
provide more information about which bugs are causing your
current chest infection. The procedure will involve asking you to
cough up a sample of sputum into a sample pot.”
 Gain consent to proceed with the sputum sample collection.
 Ask the patient if they have any pain before continuing with the
clinical procedure.
 Position the patient sitting comfortably on a chair or bed.
SPUTUM SPECIMEN COLLECTION: ASSESSMENT SKILL
1. Explain the purpose.
 To gain cooperation from the client
 Lessen anxiety
2. Describe the procedure.
3. Allow patient drink plenty of fluids on the evening before the test.
 Drinking water will facilitate liquification and easy expulsion of
sputum when coughing.
4. Remove the dentures.
5. Ask patient to rinse his/her mouth with water to reduce specimen
contamination.
 Gargle and rinse your mouth with water just after you get up and
before you collect the specimen. (This helps to eliminate
accumulated cells arid normal bacteria that may interfere with
your test results.)
6. Obtain the sample first thing in the morning.
 Collecting your sputum in the morning makes the test more
accurate. More bacteria are present first thing in the morning.
 It’s best to collect sputum specimens first thing in the morning,
when you get up. Collect specimens only at that time unless
instructed to do otherwise by hospital personnel or your
physician.
 Collecting your sputum in the morning makes the test more
accurate. More bacteria are present first thing in the morning.
7. Instruct patient to take at least 3 deep breaths, then force out a
deep cough.
 To clear the phlegm out of the patient’s airways.
 Instruct the patient to inhale repeatedly to the full capacity of
his/her lungs and let the patient exhale the air with an explosive
cough.
8. Position patient in a chair on the side of the bed or High Fowler’s.
 Placing your patient in high fowler’s position will help mucus
drain downward out of your lungs. The unique positions
encourage different lobes, or sections, of your lung to drain out
until you can cough up or spit out the phlegm.
9. Ask patient to hold his/her breath a few seconds then cough
directly into the specimen container.
 Asking the patient to take a deep breath and hold it for three
seconds and then cough out three short breaths. Holding your
breath for three seconds helps the alveoli to re-expand.
10. Take another deep breath and cough hard until sputum comes up
to the mouth.
11. Keep him/her cough until the sputum reaches the 5 ml line (or
more) on the plastic cup.
12. Check the tip of the cap to ensure that it is secure.
13. Label the specimen with patient’s name, medical doctor’s name,
specimen type and date & time collected.
14. Send specimen with laboratory requisition immediately.
15. Follow up results/finding.