FUNDAMENTALS OF NURSING (DAY 1)
Lecturer: Prof. Melody Bautista
LABORATORY AND DIAGNOSTIC EXAMINATION
Urine Specimen
Clean-catch midstream
- Urinate, stop, urinate, collect urine
- Urine specimen for routine urinalysis culture and
sensitivity test
1) Best time to collect is in the morning first voided
urine (concentrated urine)
2) Provide sterile container for immediate analysis
(pero kapag hindi, ex: 24 hrs or 3 days collection,
ung clean container lng ang gagamitin)
3) Do perineal care before collection of urine (tubig
lang)
4) Discard the first flow of urine
5) Label the specimen properly
6) Send the specimen immediately to the
laboratory (after 30 mins)
7) Document the time of specimen collection and
transport to the laboratory.
8) Document the appearance, odor, and usual
characteristics of the specimen.
• Normal color = amber, light yellow
• Normal odor = aromatic
• Abnormal odor = fishy (+ infection)
• pH = 5.5 - 6.5 slightly acidic
• Normal = urinate every 3-4 hours
Culture and sensitivity test
- To identify the etiologic agent
- Principles:
1) Sterile technique (gloves, specimen bottle,
syringe, needles, swab)
2) Collect before the first dose of antibiotic
therapy.
3) Small amount is needed for the analysis
• Routine analysis = 15-30 ml
• Urine culture and sensitivity = 5ml only
4) Send the specimen immediately without delay.
Para hindi magkaroon ng multiplication of
bacteria.
• Collect sample after cleaning the wound.
1 of 6
COMPETENCY APPRAISAL 2
January 07, 2023 (1:00-7:00 PM)
24-hour urine specimen
1) Discard the first voided urine.
2) Collect all specimen thereafter, until the
following day
3) Soak the specimen in a container with ice
preservative.
4) Add preservative as ordered according to
hospital policy.
- Principle: Start and end on an empty bladder.
• Discard the first voided = not included in the
collection because that is concentrated urine
• Last urine for collection = included in the
collection
• Missed urine = discontinue the urine collection,
notify MD, repeat the collection per doctor’s
order or per protocol
• Ex:
o Creatinine clearance (qualitative) – to
check the glomerular filtration rate (GFR).
Avoid high protein food intake before the
test. Avoid strenuous exercise (Physical
exercise may lead to an acute rise in
creatinine serum concentrations (SCr)
due to increased creatinine release from
muscle cells)
o Schilling’s test – confirmatory test of
pernicious anemia, vit b12 deficiency, and
Intrinsic factor deficiency anemia.
o Vanillylmandelic acid (VMA) – epinephrine
metabolites, pheochromocytoma –
adenoma in adrenal medulla. BP 260/180
o 18hr ACTH / 17-ketosteroid test – adrenal
cortex function. Dx: Cushing and
Addison’s
o Uric acid – low purine diet
Second voided urine
- Glucosuria – DM, TPN, Cushing’s syndrome
- Required to assess glucose level and for the
presence of albumin in the urine. (albuminia – PIH,
nephrotic syndrome)
- Discard the first urine
- Give the patient a glass of water to drink
- After few minutes, ask the patient to void. (ang
kailangan freshly formed urine)
Catheterized urine specimen
- Sterile technique to prevent UTI (nosocomial
infection = hospital acquired = negligence)
- Clamp the catheter for 30 min to 1hr to allow urine
to accumulate in the bladder and adequate
specimen can be collected.
FUNDAMENTALS OF NURSING (DAY 1)
Lecturer: Prof. Melody Bautista
- Clamping the drainage tube and emptying the urine
into a container are contraindicated after
genitourinary surgery.
- Aspiration – bevel up 45 degrees
- Sterile urine specimen can be obtained from
closed drainage system.
- Do not disconnect, do not drain
- 3ml of urine is needed for urine culture and 30 ml
for routine urinalysis. 15-30ml
Stool specimen
Fecalysis
- To assess gross appearance of stool and presence
of ova or parasite
- Secure a sterile specimen container
- Ask the patient to defecate into a clean, dry bed
pan or a portable commode.
• Melena = UGI bleeding
• Hematochezia = LGI bleeding
- No water, no urine, no soap, no toilet paper
- 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 results.)
- Usually about 2.5 cm (1inch) of formed stool or 15
to 30ml of liquid stool is adequate.
- 15-30ml: Routine urinalysis, Liquid stool, Sputum
gross appearance
- Random specimen collection maybe delegated.
(UAP/ NA, family member, client himself)
Stool culture and sensitivity test
- Assess specific etiologic agent causing
gastroenteritis and bacterial sensitivity to various
antibiotics.
- The nurse dips a sterile swab into the specimen,
preferably where purulent fecal matter is present,
and using sterile technique, places the swab in a
sterile test tube.
Fecal occult blood test (Guaiac Stool Exam)
- Are valuable test for detecting occult blood
(hidden) which may be present in colorectal cancer,
detecting melena stool
- Advise client to avoid ingestion of red meat for 3
days. (beef, goat, lamb)
- Patient is advise on a high residue diet
- Avoid dark food and bismuth compound
- Iron, NSAID, steroids, ASA, anticoagulants,
thrombolytic should be avoided
- Avoid vit C from all food sources
- Make sure the stool. In note contaminated with
urine, soap solution or toilet paper
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COMPETENCY APPRAISAL 2
January 07, 2023 (1:00-7:00 PM)
- Test sample from several portion of the stool
- Collect for 3 consecutive days to prevent false
result
- Positive color of EZ detect colon disease test = blue
Blood specimen
Venipuncture (venous blood)
- Involves piercing a vein with a needle and collecting
a blood sample in a syringe or evacuating tube
- Typically using the antecubital fossa
- A phlebotomist from the laboratory usually perform
the procedure
- Strict asepsis to prevent infection
- If client has clotting disorder or under
anticoagulant therapy, apply pressure on the site
for 5 mins to prevent hematoma formation
- Hemophilia, Von will brands, dengue, ITP, cancer,
heparin, warfarin, ASA, Plavix
- Never collect blood sample from:
• Arm used for IV therapy
• Blood administration
• Infection site because this may introduce
pathogens into the vascular system
• Edematous arm
• Arteriovenous shunt – hemodialysis
• Previous hematoma or vascular injury
Arterial puncture for ABG analysis
- Allens test = to check for collateral circulation
- Before arterial puncture, perform Allen’s test first.
(press the radial and ulnar artery and release one at
a time to check for the return of color)
- If the patient is receiving oxygen, make sure that the
patient therapy has been underway for at least 15
min before collecting arterial sample. To prevent
false result
- Be sure to indicate on the laboratory request slip
the amount and type of oxygen therapy the patient
is having.
FUNDAMENTALS OF NURSING (DAY 1) COMPETENCY APPRAISAL 2
Lecturer: Prof. Melody Bautista January 07, 2023 (1:00-7:00 PM)

- If the patient has just received a nebulizer 2) Collect specimen before the first dose of antibiotic
treatment, wait about 20 mins before collecting the 3) Send the specimen immediately before any
sample. contaminating organisms can grow, multiply, and
- Priority = to prevent bleeding (hematoma produce false results.
formation) 4) 5 ml of sputum is needed
- Press the puncture site with sterile gauze pad for at Acid fast bacilli
least 5min if with bleeding disorder. - Confirmatory test for PTB
- Put the labeled sample in the ice filed plastic bag - to assess presence of active pulmonary
ad send the specimen immediately to the tuberculosis
laboratory. To prevent blood hemolysis - Collect sputum in three consecutive morning to
- Monitor bleeding at the puncture site. prevent false result
- No fasting for the following tests: - Sputum smear:
• CBC • gm (+) = blue, purple
• Hgb • gm (-) = pink, red
• Hct - Same procedure (sputum collection is before
• Clotting studies (PT,PTT, INR, bleeding) breakfast)
• Enzyme studies (amylase, lipase, trypsin Cytologic sputum exam
• Serum electrolytes (k, Na, Mg, Ph, Ci, Ca - to assess for presence of abnormal or cancer cells.
• Glycosylated hbg (hba1c) - Serial collection or 3 consecutive mornings
- Fasting is required: - Collect 5ml of sputum
• FBS Fasting plasma glucose test - Biopsy:
• BUN • Cytologic - ng. 25,26,27,28
• Creatinine • Histologic - 14,16,18
• Serum lipid\cholesterol, triglyceride
• BUA DIAGNOSTIC TEST AND PROCEDURES
10 hrs - book PPD test (Purified Protein Derivative Test)
Clinical - 8 hours - + exposure TB
NPO post midnight - Read result 48-72 hours after injection
- For HIV positive clients, induration of 5mm is
Sputum specimen considered positive
- Normal: clean, opaque, white - For non-HIV induration of more than 10 mm is
- Abnormal: considered positive
- Volar surface - non hairy, free from skin problem
• yellow = acute bronchitis
PPD test Interpretation: from WHO
• Yellow green = PTB
• 5mm (+) = immunocompromised client (HIV/ AIDS,
• Rusty = pneumonia
Cancer, autoimmune/ SLE, Cushing diseases,
• Bloody = PTB, lung cancer
steroid therapy, post splenectomy)
Gross appearance of the sputum
• 10 mm (+) = high risk client (front liner, medical
1) collect early in the morning
staff)
2) Use sterile technique.
• More than 10 mm (+) = non high risk (15 mm)
3) Rinse the mouth with plain water before collection
of the specimen (contraindicated mouth wash) • Outright (+) PPD (hindi mo na kailangan imeasure
4) Instruct the patient to hack up sputum ung mm, pag nakita ng doctor positive agad)
(expecturate) a) inflamed
5) 15-30 ml of sputum is needed b) Infected
6) Offer mouthwash after the collection to remove any c) Necrotic
unpleasant taste. d) Blistered
7) Send the specimen immediately or refrigerated.
With MDs ordder ID = 10-15 degrees bevel up
Sputum culture and sensitivity test - needle gauge - 25, 26, 27, 28
1) use sterile container to prevent contamination - Needle length - 3/8, 5/8
- (+) wheal with 3-5 secs (correct technique)
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FUNDAMENTALS OF NURSING (DAY 1)
Lecturer: Prof. Melody Bautista
- (-) wheal > 5 secs ( wrong technique) Repeat testing
at the opposite forearm
- Slow diffusion
Intradermal (10-15 degrees)
- clean the volar surface of the upper forearm with
alcohol and allow it to dry
- Contraindication:
• current reaction to smallpox vaccine
• A rash
• A skin disorder
• Active TB
Bronchography/ gram
- a radiopaque medium is instilled directly into the
trachea and bronchi through bronchoscope and
the entire bronchial tree or selected areas may be
visualized through X-ray
1) Secure consent
2) Check for allergies to seafood or iodine or
anesthesia.
3) NPO 6-8 hours before the test
4) NPO until gag reflex return to prevent aspiration.
Iodine-based contrast agent
- allergic/ anaphylactic reaction
- Normal reaction = warm sensation, salty taste,
metallic taste, flushing
- Abnormal = allergic reaction - urticaria/ pruritis/
itchiness, periorbital edema, swollen lips, hives, s/s
respiratory distress (namamaga ang airway), DOB,
SOB, wheezing (bronchospasm), high RR
(tachypnea), use of accessory muscle for breathing,
subcostal retractions, expiratory grunting, nasal
flaring,
- “Do you have allergies to seafood shellfish?”
- Emergency medication at bedside:
1) Epinephrine (vasoconstriction) - relaxes the
bronchial muscles (bronchodilation), side
effects: high HR BP, palpitation.
2) Diphenhydramine (Benadryl) antihistamine,
side effects: drowsiness
3) Steroid (Solu-contef) - anti-inflammatory
action
- All client undergoing upper endoscopy Dx Test
- Preop meds:
1) Lidocaine spray - anesthesia to remove the gag
reflex (open epiglottis) - aspiration. Delay
swallowing the spray in 1min.
4 of 6
COMPETENCY APPRAISAL 2
January 07, 2023 (1:00-7:00 PM)
2) Diazepam (valium) - anti anxiety, take VS before
drug administration. Antidote: flumazenil
(ROMAZICON)
3) Atropine sulfate (anticholinergic drug) - to
decrease oral, respiratory, gastric secretion.
Side effects: tachycardia, palpitation, increase
BP
- AV block - bradycardia = Isoproterenol, dopamine,
epinephrine, atropine sulfate
- Priority care post upper endoscopy (to prevent
aspiration)
1) Maintain in NPO until gag reflex return. (Tap the
posterior part of the tongue)
2) Check the gag reflex before giving anything per
orem.
3) Position: Lateral, COMA (head is on the side and
slightly down), sims
4) Suction PRN
5) Remove any food, fluids at the bedside table.
Bronchoscopy
- direct visualization of the larynx, trachea and
bronchi through a flexible fiver-optic bronchoscope
- Pre-procedure nursing care:
1) Informed consent (invasive)
2) NPO 6-12 hrs. prior to test
3) Coagulation studies (PT-Normal 10-13 serum
4) IV sedatives to relax the client
5) Lidocaine spray to suppress the gag reflex
6) Resuscitation equipment available
- Indication:
1) To remove foreign object
2) For bronchial washing
- Post procedure nursing care:
1) VS normal RR 12-20
2) Fowlers
• low 15-25 degrees - 1 pillow
• Semi 30-40 degrees - 2 pillows
• Fowlers 45-55 degrees - 3 pillows
• High 60-90 degrees - 4 pillows
3) Check gag reflex
4) NPO until gag reflex return
5) Monitor for bloody sputum
6) Monitor respiration
7) Monitor or complications
8) Notify the MD if complications occur
Air - pneumothorax - 2nd 3rd ribs
Fluid - pleural effusions - 8th 9th ribs
Blood - hemothorax - 8th 9th ribs
Pus - empyema -8th 9th ribs
FUNDAMENTALS OF NURSING (DAY 1)
Lecturer: Prof. Melody Bautista
Thoracentesis (pleural tap)
- Aspiration of fluid or air in the pleural space
1) Secure consent, take VS
2) Position upright leaning on overed table
3) Avoid cough during insertion
4) Advise client to remain still during the insertion
of the needle to prevent trauma
5) Apply pressure dressing as the needle are being
withdrawn to prevent bleeding
6) Turn to unaffected side after the procedure to
prevent leakage of fluid in the thoracic cavity.
Affected side (splinting) to prevent bleeding
7) Check for expectoration of blood (hemoptysis)
this indicate trauma and should be reported to
MD immediately.
Lung biopsy
- Painless
- Pre-procedure nursing care:
1) Secure consent - invasive
2) Check coagulation 10-13 secs
3) Have vit K at bedside - coagulant
4) Maintain sterile technique
5) Local anesthetic required
6) Pressure during insertion and aspiration
7) Administer analgesics and sedatives as
prescribes
- Position: unaffected side, to expose the affected
side
- Post procedure: affected side (splinting)
- Check for bleeding
1) check the dressing
2) Check for ecchymosis
3) VS - concealed bleeding, decrease BP LOC,
increase HR RR
- Post procedure nursing care:
• pressure dressing to prevent bleeding (priority)
5 of 6
COMPETENCY APPRAISAL 2
January 07, 2023 (1:00-7:00 PM)
• Monitor for bleeding
• Monitor for respiratory distress
• Monitor for complications
• Prepare for CXR (pneumothorax, bleeding)
Pulse oximetry (SpO2)
- Normal value 95-100%
- Procedure:
1) A sensor is placed, finger, toe, nose, earlobe or
forehead
2) Dont select an extremity with an impediment to
blood flow
3) Lower than 91% - immediate treatment
4) Lower than 85% - hypo-oxygenation
5) Lower than 70% - life threatening situation
- Volatile to light
• cover with linen
• Contraindicate reading
• Uncooperative
• Hindi pwede sa nag chichills, tremors, serizure
Holter monitor
- it is continuous ECG monitoring, over 24 hours
period
- The portable monitoring is called telemetry unit,
dynamic monitoring, or ambulatory ECG
- Avoid magnets, metal detectors, high voltage,
areas, and electric blankets.
- Stress the importance of logging his usual activities,
emotional upset, fatigue, chest pain, an ingestion
of medication
- Indication: chest pain, dysrhythmia rhythm
Diagnostic test with chest electrodes
1) Remove any metal objets from the body (jewelries,
keys, coins, belt)
2) Check the chest area for any irritation or injury
3) If the chest is hairy, trim, clip, shave
4) Remain still during the test
Echocardiogram
- a noninvasive ultrasound test that is used to
examine the size, shape, and moilitu of the cardiac
structure.
- Client should remain still, in supine position slightly
turned to the left side, with HOB elevated 15-20
degrees (low fowlers)
- The conductive gel is applied to the to the left of the
sternum, third or fourth intercostal space
- The test takes about 30-45 mins
- TEE - transesophageal echocardiagram
FUNDAMENTALS OF NURSING (DAY 1)
Lecturer: Prof. Melody Bautista
- invasive kaya dapat ay informed consent
- Preop meds - lidocaine, atrophine sulfate
- Indication: morbid obesity >300 lbs. massive chest
trauma
Electrocardiography
- graphic recording of the electrical activity of the
heart
- Check the chest for any injury or skin irritation
- If the area is excessively hairy, clip it
- Remove clients jewelry, coins, belt or any metal
- Tell client to remain still during the procedure
Cardiac catheterization
- femoral angiogram coronary angiogram
- Indication to assess the location and extent
damage of the coronary vessel.
1) Secure consent
2) Invasive procedure
3) Assess allergy to iodine.
4) VS for baseline information
5) Have client voided before the procedure.
6) Monitor PT, PTT
• PT = 10-13 secs
• PTT = 20-36 secs
7) ECG prior to test
8) NPO for 4-6 hours before the test
9) Shave the groin or brachial area
• First line defense against infection = intact skin and
mucus membrane
• Second line = Good immune response
• Third line = immunization/ vaccination
• to visualize the left side of the heart - use femoral
artery or brachial artery
• to visualize the right side of the heart – use
antecubital vein, femoral vein, or subclavian vein.
After the procedure:
• apply pressure dressing over the puncture site
• Bed rest to prevent bleeding on the site
• Do not flex extremity
• Elevate the affected extremities on extended
position to promote blood supply back to the heart
and prevent thrombophlebitis.
• Monitor VS especially peripheral pulses
• Monitor extremity for color, temp, tingling to assess
for impaired circulation
6 of 6
COMPETENCY APPRAISAL 2
January 07, 2023 (1:00-7:00 PM)
Neurovascular status assessment
- “arterial perfusion”
- cast, traction, angiogram, retsraint
1. Skin color - abnormal = pale/ pallor
2. Skin temperature = cool to touch
3. Sensation - abnormal = tingling, numbness,
pricking (paresthesia)
4. Capillary refill - Normal < 3 secs - press the
nail bed
5. Distal pulse/ peripheral pulse
• 0 = absent pulse (abnormal)
• +1 = weak/ thready (abnormal)
• +2 = normal
• +3 = full/ increased (hypervolemia, CHF)
• +4 = bounding (hypervolemia, CHF)
Hi Graduating SNs! Start na ang 4th yr 2nd sem natin at
ang last semester natin this nursing college life huhu
So naisipan ko lang mag transcribe uli ng mga
discussion, lalo na sa CA. Apaka busy din kase natin
nun 1st sem, lalo na may mga seminar chuchu na yan
kaya d ko na naasikaso un mga reviewers non, napa
wapakels nlng ako ee hahaha pero ito, kompleto un
natype kong ppt ni mam melody today pero hindi
masyado kompleto un mga nasulat ni mam sa ppt nya
at un mga snabi nya lng. On the spot ko lang natype to.
Hindi naman tulad nun 1st and 2nd yr natin, kompleto
video lecs non kaya nababalikan at kompleto natatype
sa reviewers. Kayaaaa kung may mali akong natype
dyan or kulang, icorrect/ inote nyo nlng.
Just don’t expect na mag tatranscribe ako lagi sa CA
review, laptop ko gamit ko, eh buset ambilis malowbat,
d naman ako makacharge kasi nakaupo ako sa gitna
HAHAHA pero hanap nlng ako paraan. Need ko rin
talaga mag ganto kasi ambagal ko magsulat at madali
ako sumuko sa sulat ee. Mas hilig ko magtype hehe
Ayon lng skl, napahaba ang message ko HAHA
Good luck to our last semester!
RN 2024 CUTIE <3
Aki