PNC 1 SKILLS - Collecting a Wound Culture

The nurse is collecting a wound culture from a client's puncture wound. What is the nurse's first step in the procedure?

Clean the wound. Rationale: To obtain a wound culture, the nurse would first clean the wound, then obtain the wound culture, redress the wound, and document the procedure when complete. Cleaning the wound removes previous drainage and wound debris, which could introduce extraneous organisms into the collected specimen, resulting in inaccurate results

The nurse is obtaining a wound culture and has removed the old dressing and discarded it, performed hand hygiene and applied fresh gloves. What should the nurse do next?

Cleanse the wound with a nonantimicrobial cleanser. Rationale: After removing the old dressing, discarding it, performing hand hygiene and applying fresh gloves, the nurse should cleanse the wound with a nonantimicrobial cleanser to prevent the culture from being contaminated by extraneous wound debris. The assessment of drainage for amount, type, color, and odor should have happened when the nurse removed the old dressing, because the old dressing is part of that information. The wound bed should be dried after the wound is cleaned, not before, and the nurse should not open the culture tube until the wound is cleansed and patted dry.

The nurse is caring for a client with an abdominal wound and prescriptions from the health care provider. Which prescription will the nurse initiate first?

Obtain a sterile wound culture Rationale: The nurse should first obtain the sterile wound culture. The culture should be obtained as soon as possible, because it takes time for the results to return and must be done before the nurse can start the ciprofloxacin. Antibiotics interfere with microorganism growth and the primary reason for obtaining a culture is to identify the cause of the infection. Identifying the invading microorganisms helps to determine treatment options and select the most appropriate treatment. The culture should be obtained while the client is in bed; therefore, it should be done before assisting the client up to a chair. Consulting the dietician to assist the client with meal choices should wait until the culture is obtained and the antibiotic is started, because it is of less importance to the well-being and safety of the client.

A nurse is collecting a wound culture from a client from two different sites. Which actions should the nurse take while performing this procedure? Select all that apply.

Press and rotate the swab several times over the wound surfaces. , Insert a swab into the wound. , Place the swab in the culture tube when done. Rationale: The nurse should carefully insert the swab into the wound and then press and rotate the swab several times over the wound surfaces. After collecting the specimen, the nurse should place the swab back in the culture tube. The nurse should be careful to keep the swab and the inside of the culture tube sterile at all times. This means that the nurse should avoid touching the swab to intact skin at the wound edges or to the outside of the tube, as this would contaminate both the swab with organisms not in the wound and the areas that the swab touches with organisms found in the wound. A different swab, not the same, should be used for each wound site to prevent cross-contamination.

The nurse is collecting a wound culture and has removed the current dressing and discarded it. What should the nurse do next?

Remove gloves and perform hand hygiene. Rationale: After removing the current dressing and discarding it, the nurse should remove the gloves and perform hand hygiene. Then the nurse should apply fresh gloves; sterile gloves may be indicated if the wound edges must be separated to insert the culture swab. After hand hygiene and applying fresh gloves, the nurse would assess and clean the wound using a non-antimicrobial cleanser such as sterile saline, open the culture tube, obtain the culture and complete the procedure. Identifying the client using two client identifiers should happen before the procedure is begun along with explaining the procedure to the client.

When collecting a culture from a client's wound, according to evidence-based practice, which type of motion will the nurse use when applying the swab to the wound tissue to obtain the most accurate results?

Rolling motion Rationale: The nurse would insert the swab into the wound and gently roll it over the wound surfaces to obtain a sample of the pathogens causing the infection. Using a pushing motion, up-and-down motion, or back-and-forth motion will not provide the most accurate results according to evidence-based practice and may actually cause injury to the wound tissues.