SPECIMEN COLLECTION

Principles of Specimen Collection 

It is imperative that specimen be collected and handles very carefully if the causative agent for infection is to be identified correctly. Specimen should be collected during the acute phase of infection and before the initiation of antibiotic therapy, if possible. Obtain an adequate amount of specimen necessary for tests. Avoid potential contamination of the specimen by using proper collection instruments and containers. Label the container properly with the name of the patient, source of specimen, date, time collected, and test to be performed. Transport the specimen to the laboratory immediately or store properly until transported.     

Types of Specimen Collection 

Urine specimen Stools specimen Sputum specimen  

in children. no conscious control and the urine is released after a small amount accumulates in the bladder. Urine collects in the bladder until pressure stimulates special sensory nerve endings in the bladder wall called stretch receptors. Normal urine is clear yellow or amber due to the presence of urochrome. between 50 to 200 ml. n babies. . This occurs when the adult bladder contains between 250 to 450 ml of urine.OVERVIEW: Micturition Voiding Urination URINE SPECIMEN All refer to the process of emptying the urinary bladder. The average amount of urine excreted per day in a healthy adult Is 1400-1500 ml/day.

Physiology of urinary elimination Stretch receptors in the bladder wall are excited Impulses are transmitted to the voiding center at the 2nd to 4th sacral vertebrae Some impulses continue up the spinal cord to the voiding control center in the cerebral cortex. . the brain sends impulses through the spinal cord to the motor neurons in the sacral area. If time is appropriate to void. causing stimulation of the parasympathetic nerves (PNS).

BUT it is still impeded by the external urethral sphincter If the time and place are appropriate for urination.The PNS innervates the detrusor muscle and the internal urethral sphincter muscle producing (a) contraction of the detrusor muscle and (b) relaxation of the internal sphincter muscle Urine can be released from the bladder. the conscious/voluntary portion of The brain relaxes the external urethral sphincter muscle Urination takes place .

Injury to any of the parts of the nervous system controlling micturition will result to intermittent INVOLUNTARY emptying of the bladder. If the time and place are inappropriate. the nerves DO NOT normally enter into micturition CONTROL. The sympathetic nervous system also innervates the bladder. Voluntary/conscious control of the micturition is possible ONLY if the nerves supplying the bladder and the urethra are all INTACT. However. causing it to relax.    . reflex subsides until the bladder becomes more filled and the reflex is stimulated again. the micturition inappropriate.

.accumulation of urine in the bladder and inability of the bladder to empty itself.    Frequency voiding at frequent intervals. Enuresis (bedwetting) occurs most often in children. more often than usual.Common Problems:  Urinary retention . Frequency usually increases with an increase in fluids. It is the opposite of retention. Urinary incontinence a temporary or permanent inability of the external sphincter muscles to control the flow of urine from the bladder.

such as 100 500 ml/day.    Polyuria or diuresis production of abnormal large amounts of urine by the kidneys. without an increased fluid intake. Anuria refers to voiding less than 100 ml/day. Dysuria either painful or difficult voiding. There may or may not be a great deal of urine in the bladder. Urgency the feeling that the person MUST void.   . Nocturia or Nycturia increased frequency at night that is NOT a result of increased fluid intake. Oliguria refers to voiding scant amounts of urine. but the person feels a need to void immediately.

 Assessment Focus: Client s ability to provide the specimen. medications/conditions that may discolor urine or affect the test results. A CLEAN-CATCH MIDSTREAM SPECIMEN IS THE BEST CLEANCLINICALLY EFFECTIVE METHOD OF SECURING A VOIDED SPECIMEN FOR URINALYSIS.Collecting a Routine Urine Specimen  Purpose: To screen the client s urine for abnormal constituents. .

urinal or commode for clients who are unable to void directly into the specimen container WideWide-mouthed container (sterile) Completed laboratory requisition Completed specimen identification label Evaluation Focus: Color. and character of urine. odor.  . Equipment: Antiseptic solution or liquid soap solution 4 x 4 inch sponges Clean gloves as needed Clean bedpan.

similar to specific gravity but more precise. specific gravity . such as appearance. pH.090 mOsm/kg-female mOsm/kg390 to 1.5 1. . Normal findings:  Appearance  Odor  Color  pH  Specific gravity  Osmolality clear faint aromatic odor clear yellow or amber 4.Urinalysis Examination of the urine for overall characteristics. osmolality. as well as microscopic evaluation for the presence of normal and abnormal cells.025 300 to 1.005 to 1.6 to 7.090 mOsm/kg-male mOsm/kg- Osmolality is the number of particles per unit volume of water.

The urethral orifice is colonized by bacteria.Technique for Obtaining Clean-Catch Midstream CleanVoided Specimen: Nursing action MALE PATIENT Instruct the patient to expose glans and cleanse area around meatus. Wash area with mild antiseptic solution or liquid soap. Rinse antiseptic solution or soap solution thoroughly because these agents can inhibit bacterial growth in a urine culture. Rinse thoroughly. Rationale . Urine readily becomes contaminated during voiding.

The first portion of urine washes out the urethra and contains debris. . Collect the midstream urine specimen in a sterile container.Allow the initial urinary flow to escape. The midstream sample reflects the status of the bladder. Avoid collecting the last few drops of urine. Prostatic secretions may be introduced into urine at the end of the urinary stream.

Keeping the labia separated prevents labial or vaginal contamination of the urine specimen.FEMALE PATIENT Ask the patient to separate her labia to expose the urethral orifice. Rinse thoroughly and wipe the perineum from the front to back. . Cleanse the area around the urinary meatus with sponges soaked with antiseptic/ soap solution. Urine readily becomes contaminated during voiding. but do not use sponges more than once. The urethral meatus is colonized by bacteria.

While the patient keeps the labia separated. making sure that the container does not come in contact with the genitalia. FOLLOW-UP PHASE: Send specimen to laboratory immediately to avoid multiplication of urinary bacteria and lysis of cells. The first portion of the urine washes out the urethra. Have the patient remove the container from the stream while she is still voiding. This helps wash away urethral contaminants. . instruct her to void forcibly. Allow initial urinary flow to drain into bedpan (toilet) and then catch the midstream specimen in a sterile container.

chiefly due to the presence of urobilin.STOOL SPECIMEN OVERVIEW: Defecation The expulsion of feces from the rectum and anus. An adult usually forms 7 to 10 liters of flatus (air or gas) in the large intestine every 24 hours. feces that contain less water may be hard and difficult to expel. They are soft but formed. Normal feces require normal fluid intake. varying from several times per day to two or three times per week. The frequency of defecation is highly individual. . The amount of feces also varies from person to person Normal feces are made of about 75% water and 25% solid materials. Feces are normally brown.

spicy foods. Barium swallow Anesthesia and Surgery Pathologic conditions (spinal cord and head injuries) Irritants (bacterial toxins.Factors That Affect Defecation             Age and development Diet (sufficient bulk. poison) Pain (hemorrhoid) . Dicyclomine HCl-Bentyl) HClDiagnostic Procedures (cleansing enema. roughage) Fluid (adequate fluid intake) Activity (peristalsis) Psychologic Factors LifeLife-style Medications (laxatives.

Physiology of Defecation Peristaltic waves move the feces into the sigmoid colon and the rectum Sensory nerves in the rectum are stimulated Individual becomes aware of the need to defecate Internal anal sphincter relaxes and feces move into the anal canal. External anal canal relaxes when the individual sits on a toilet or bedpan Expulsion of feces through the anus .

and (b) a sitting position. Normal defecation is facilitated by (a) thigh flexion. the urge to defecate normally disappears for a few hours before occurring again. leading to constipation. and by contraction of the levator ani muscles of the pelvic floor. which increases the pressure within the abdomen. If the defecation reflex is ignored.Expulsion of feces is assisted by contraction of the Abdominal muscles and the diaphragm. which increases abdominal pressure. which moves the feces though the anal canal. which increases the downward pressure of the rectum. . Repeated inhibition of the urge to defecate can result in expansion of the rectum to accommodate accumulated feces and eventual loss of sensitivity to the need to defecate.

It is the opposite of constipation and results from rapid movement of fecal contents through the large intestine. Fecal impaction a mass or collection of hardened. Results from prolonged retention and accumulation of fecal material. Diarrhea the passage of liquid feces and an increased frequency of defecation. Fecal incontinence refers to the loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter.     . hard stool or the passage of no stool for a period of time. Flatulence The presence of excessive flatus and leads to stretching and inflation of the intestines. dry.refers to the passage of small.Common Problems  Constipation . puttylike feces in the folds of the rectum.

dried constituents of digestive juices. semisolid. It is performed to check for the presence of any reducing substances such as white blood cells. Normal Findings:      Color Consistency Shape Amount Odor own Constituents inorganic adult: brown. moist cylindrical (contour of rectum) varies with diet (100-400 g/day) (100aromatic: affected by ingested food and person s bacterial flora small amounts of undigested roughage. or bile and signs of poor absorption as well as screen for colon cancer. soft. sloughed dead bacteria and epithelial cells. fat. matter  . sugars. infant: yellow formed. protein.Stool Examination (Fecalysis) Refers to a series of laboratory tests done on fecal samples to analyze the condition of a person's digestive tract in general.

Collecting a Routine Stool Specimen  Purpose: To determine the presence of occult blood. viruses.  Equipment: Clean or sterile bedpan or bedside commode Disposable gloves Plastic specimen container with a lid Tongue blades (two) Paper towel Completed laboratory requisition Completed identification label . bacteria. or other abnormal constituents in the stool. parasites.

explain that a stool specimen is needed.Technique for Obtaining Stool Specimen Nursing action Gather the equipment needed. check his identification. Approach the patient. It is necessary to inform and get the cooperation of the patient. and enlist his cooperation. . Rationale Supplies will be convenient for use in collecting the specimen.

.Tell the patient how to assist in the collection of the specimen. and. Putting the lid immediately on the specimen container prevents the spread of microorganisms . Make sure not to contaminate the outside of the container. Use the tongue blade to transfer adequate amount of stool to the container and put the lid. b) save the stool. The patient should be asked to: a) use the bedpan or bedside commode . c) notify the nurse that he has the stool for the specimen. Collect a specimen of the stool after the patient has defecated.

Wrap the used tongue blade in a paper towel before disposing them in a waste container. Label and send the specimen to the laboratory. . Ensure client comfort. Wrapping the used tongue blade prevents the spread of microorganisms by contact with other articles.

Clients need to cough to bring sputum up from the lungs. the clear liquid secreted by the salivary glands in the mouth. Sputum specimen are often collected in the morning. and trachea into the mouth and expectorate it into a collecting container.SPUTUM SPECIMEN OVERVIEW  Sputum is the mucous secretion from the lungs. Healthy individuals DO NOT produce sputum.     . It is important to differentiate it from saliva. bronchi. bronchi. and trachea.

This often determines the number of specimens to obtain and the time of day to obtain them.  Assessment Focus: Client s ability to cough and expectorate secretions. and. Purpose: To identify specific microorganism and its drug sensitivities or the presence of cancerous cells. identify the purpose for which it is to be obtained.  . type of assistance required to produce the specimen. to assess the effectiveness of therapy.Collecting a Sputum Specimen Before collecting a sputum specimen.

Equipment: Container with a cover Disposable gloves (if assisting the client) Disinfectant and swabs. or liquid soap and water Paper towels Completed label Completed laboratory requisition Mouthwash .

don gloves and hold the cup. or for client who is unable. So that the client can expectorate into it. These positions allow maximum lung ventilation and expansion.Technique for Obtaining Sputum Specimen Nursing action Give the client information and instructions on the procedure to be done. Assist the client to a standing or a sitting position Ask the client to hold the sputum cup on the outside. . making sure that the sputum does not come in contact with the outside of the container. Rationale To enlist patient cooperation.

Cover the container with the lid immediately after the sputum is in the container.Ask the patient to breathe deeply and then cough up secretions A deep inhalation provides sufficient air to force secretions out of the airways and into the pharynx. Covering the container prevents the inadvertent spread of microorganisms to others. . Assist the client to repeat coughing until a sufficient amount of sputum has been collected.

Label properly and transport the specimen to the laboratory. Assist the client to rinse the mouth with a mouthwash as needed. Ensure client comfort. Assist the client to a position of comfort that allows maximum lung expansion as required.Remove gloves. Inaccurate identification and/or information on the specimen container can lead to errors of diagnosis or therapy .

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