Chapter 18: Laboratory Specimen Collection

resistant

A nasal swab can be part of screening process to detect potential infection with drug _______________ microorganisms?

- there is abnormal bleeding in lower digestive tract

A postive iFOBT means what?

- expectoration into a sterile container -endotracheal suctioning (ususally during bronchoscopy) -transtracheal aspiration

A sputum sample can be collected in what three ways?

the lungs (not just saliva)

A sputum sample should be from where?

viral, bacterial or fungal infections

A sputum specimen is ordered if what kinds of infections?

-C-diff -parasites -electrolytes -fat -leukocytes

A stool sample may be ordered to screen and culture for what kinds of things?

-unclamp the tubing

After collecting urinary catheter urine sample, what do you absolutely need to make sure you do?

-a collection container

After collecting urine from urinary catheter into syringe you need to transfer it to what?

15-30 seconds

After inserting nasopharynx swab, you should leave it in the nasopharynx for about _________ to __________ seconds ?

5 minutes

After obtaining a blood sample at radial artery for AGB's, you should hold a gauze on site, after removing needle, for how long?

ventilation; carbon dioxide

Analysis of ABG evaluates _______________by measuring blood pH and partial pressures of arterial paO2, and partial pressure of arterial _____________ ______________ paCO2?

IV; stroke

Avoid getting a blood draw sample from same side as an _______ or that has been effected by a ________.

-medications that they take (some may effect results of test) -assess for signs and symptoms of urinary tract infection (burning, pain, frequency) - assess patients ability to cooperate with collection process (determine need for assistance)

Before collecting a midstream urine sample, what should you assess?

-assess the patient's lung sounds -O2 stats -assess patients level of pain (may need to administer med before getting sample) - assess characteristics of sputum (color, quantity, presence of blood and viscosity)

Before collecting a sputum sample you should assess what?

-clear nose and throat -rinse mouth out with water

Before collecting sputum specimen you should have patient do what?

-bend it on itself or clamp it

Before collecting urine specimen from urinary cath port, you need to do what with tubing below port?

-clean the port with alcohol or disinfectant wipe

Before connecting syringe on port to get sample you need to make sure to do what?

-might cause some discomfort, but shouldn't be painful -might cause gagging

Before doing a nasopharyngeal collection, you should warn the patient of what?

-assess the patient's understanding of the collection procedure, reason for testing and ability to cooperate -inspect the patient's nares and for presence of nasal symptoms (discharge, erythema, congestion) -assess for conditions that would contraindicate obtaining a nasal swab, such as injury to the nares or nose and surgery of nose

Before getting a nasal swab you should assess what?

-review their medical record -assess patients cardiac status (HR, BP, heart sound) -assess respiratory status (RR, lung sounds, use of O2, O2 stat) -determine adequacy of peripheral blood flow to extremity to be used by performing allen test -assess patient's radial pulse -assess patients understanding about the need for specimen collection -ask patient if they feel faint, sweaty, or nauseated

Before obtaining a blood specimen to assess a patient's arterial blood gas analysis?

-cough into a tissue -blow nose into tissue -tilt head back

Before obtaining a nasopharyngeal specimen, you should have a patient do what?

-patients medical record for blood specimen -assess labs -assess patient for allergies -assess for any medications or conditions that may effect patients bleeding time -assess patient's anxiety -assess patency of veins in both upper limbs -avoid veins that are tender, sclerosed, thrombosed, fibrosed, or hard

Before obtaining a venous blood specimen, you should assess what?

-bacteria; fungi; septicema

Blood cultures are performed to detect ______________ invasion or ___________ and ths systemic spread of such an infection (________________) through bloodstream?

inaccurate

Blood sugar changes in fingertips very quickly, thus this can cause an ___________________ reading?

Yes, as long as it is not contaminated with urine

Can stool be collected from a brief?

Only if you place new bag on and collect it immediately as patient passes stool into appliance

Can you obtain a stool sample from an ostomy bag?

urinalysis and culture

Collecting a urine specimen for ___________ and _____________ is an assessment to measure to determine the characterstics of patients urine?

-diabetes - seziures -enteral, and parenteral feeding -liver disease - pancreatitis - head injury, stroke - alcohol and drug intoxication - sepsis

Controlling a patient's blood glucose levels is an important part of care for patients with many conditions, including what?

no, use same swab for each nare

Do you use two different swabs, one for each nare when getting nasal swab specimen?

-nitrates -white blood cells

During urinalysis if urine contains what two things, a culture of a urine specimen may be ordered?

-initial screening for disorders like cancer -gastrointestinal bleeding -ulcer disease -inflammatory bowel disorders -intestinal polyps

Fecal occult blood testing, tests for blood in stool and is used for what kind of screenings?

blue

For a gFOBT, any of what color on sample after developer drops, is a sign for positive sample of blood in stool?

-cirucular motion

For a urine midstream collection, you or the male patient should clean the penis starting at the tip of penis and use what motion to work down the penis to clean it?

1. anaerobic medium 2. areobic medium

For a venous blood specimen blood is collected into to bottles one containing what and the other containing what/

sterile

For most tests like urinalysis, drug testing, diabetes testing, the specimen doesnt need to be what?

22-26 mEq/L

HCO3 normal range?

three

How many stool samples should be collected consecutively to test for colon cancer?

1 inch of formed stool or 15-30 mL of liquid stool

How much of a stool is usually needed for a good specimen to culture?

about 10-20 mL

How much urine should you on average collect into collection container?

immediately

How quickly should you get sputum specimen to the lab?

3-5 minutes

If you are testing card for occult blood for gFOBT yourself, you should wait how long before testing it?

3; 5 minutes

If you are testing iFOBT, you need to put how many drops on sample, and wait how long before reading?

over entire window

If you are testing iFOBT, you need to spread sample where?

-clamp tubing below access port for up to 30 minutes

If you need to collect a urine sample from urinary catheter, but there is no urine or insufficient amount in the catheter tubing, what should you do?

Both, some are needless and others require a need or blunt cannula

Indwelling catheter drainage tubes have a special sampling ports, are they needless systems or do they require needles?

-touching edge or inside of container

Instruct patient to expectorate sputum into container, without doing what?

-infections (like flu and other respiratory infections) -carrier state for certain organisms

Nasal swabs are usually taken in aim to diagnose what?

staphylococcus aureus

Nasal swabs are usually used to detect presence of organisms like what?

> 80-100 mm Hg

PaO2 normal range?

oxygen saturation > 95%

SaO2 normal range?

No, may be contaminated

Should you use first drop you get when getting sample for blood glucose?

antibodies

The immunochemical fecal occult blood test (iFOBT or FIT) uses _____________ directed against human hemoglobin to detect blood in the stool.

3 times

To verify validity of test, you should repeat an fecal occult test how many times with different samples of stool?

-fluid

Unless contraindicated, you should encourage patient to consume extra what at night to liquify secretions and make it easier to cough up in the morning?

1.015 to 1.025

Urine should have what specific gravity?

sweet

Urine that has high glucose content has what smell?

30 mL

Usually for a good sample of blood, you should obtain about how many mL of blood from two different sites?

in the morning

Usually secretions accumulate during the night, thus it is desirable to collect sputum sample when?

mask, googles, clean gloves

What PPE is needed for getting a nasal swab?

45-65 degrees

What angle should you hold needle for obtaining a blood sample for AGB's at radial artery?

viral infections

What are nasopharyngeal swabs primarily used to detect?

Arterial blood gases (ABG's)

What are obtained to determine the adequacy of oxygenation and ventilation to assess acid-base status, and to monitor the effectiveness of treatment?

-diagnose disease, test for drug sensitivity, guide patient treatment and assess for hypersenstivity states

What are reasons that sputum is analyasized?

-Bordetella pertussis - Corynebacterium diphtheriae -Neisseria meningitis -methicillin-resistant Staphylococcus aureus - Haemophilus influenza - viruses causing rhinitis

What are some common viruses or viral infections that a nasopharyngeal swab can be used to detect?

-Assess patients understanding of collection procedure, reason, ability to cooperate -assess patient's nares and for presence of nasal symptoms -Inspect patient's nasopharynx -assess for conditions that would contraindicate a nasopharyngeal swab, (injury of nares or nose, sugery of nose or throat)

What are things that need to be assessed before obtaining a nasopharyngeal swab?

-do not open drainage system to get sample (exposes specimen for contaimination and can contaiminate tubing that could cause bladder infection) -do not take urine sample from catheter drainage bag because urine is not fresh and bacteria may be present

What are two things you should not do to collect urine sample from urinary cath tubing?

-tuna -salmon -oranges -tomatoes -broccli -cauliflower -apples -mushrooms -banans -red meat

What certain foods can create a false positive for guaiac fecal occult blood test?

-plastic collection receptacle in the toilet

What do you collect stool sample in?

-unless patient able to tell you how long it has been you should discard it

What do you do when collecting sputum sample, and the patient produces sputum and didnt tell you and so you don't know how long specimen has been sitting at bedside, what should you do?

chronic bronchitis

What does a gradual increase of sputum over time, suggest?

lung tumor, TB

What does a pink-tinged, mucoid (mucous) sputum sample suggest?

-there is a active bleed somewhere in the digestive tract

What does a positive gFOBT (guaiac fecal occult blood test) mean?

pulmonary edema

What does a profuse, frothy, pink sputum sample suggest?

TB, pneumonia

What does a rust colored sputum sample suggest?

bacterial infection

What does a thick and yellow or green sputum (purulent) sputum suggest?

cold, viral infections, bronchitis

What does a thin, white, or clear, mucoid (mucous) sputum suggest?

lung abscess, bronchiectasis, anaerobic infection

What does foul-smelling sputum and bad breath (haloitosis) suggest?

Venipuncture

What involves piercing a vein with a needle to obtain a venous blood sample, which is collected in a syringe or tube?

guaiac fecal occult blood test (gFOBT)

What is a chemical test that detects the enzyme peroxidase in hemoglobin molecules when blood is present in the stool sample?

arterial blood gass (AGB's)

What is a laboratory test that evaluates the adequacy of oxygenation, ventilation and acid-base status?

cloudy

What is abnormal turbidity of urine?

occult blood

What is blood in stool?

occult blood

What is blood that is hidden in the stool specimen or cannot be seen on gross examination?

expectorate

What is expeled from the mouth, spit?

-pale yellow, straw colored

What is normal color for urine?

aromatic, develops an ammonia odor

What is normal odor of urine?

6.0 ph (4.8 to 8.0)

What is normal pH of urine?

clear, or translucent

What is normal turbidity of urine?

-radial artery

What is the most common site to obtain a sample for ABG's?

sputum

What is the result of the reaction of the lungs to any constant recurring irritant; comes from deep within bronchi, not from postnasal region?

midstream catch

What kind of urine specimen most closely reflects the characteristics of the urine being produced by the body?

-patients medical record for blood specimen -assess labs -assess patient for allergies -assess for any medications or conditions that may effect patients bleeding time -assess patient's anxiety -assess patency of veins in both upper limbs -avoid veins that are tender, sclerosed, thrombosed, fibrosed, or hard

What should you asses before getting a venipuncture blood sample?

-assess patient's understanding of collection procedure and ability to cooperate -assess the patient for history of GI bleeding -review medications - assess patient for any blood in perineal area, including hemorrhoids, menstruation, UTI, vaginal or rectal tears

What should you assess before doing any kind of fecal occult blood test?

-assess patients understanding of the need for test and the requirements of the test -assess the patient's understanding of collection procedure and ability to cooperate -ask them when last BM was

What should you assess before getting a stool specimen for culturing?

-review their medications (some may affect results of tests) -assess characterisitics of urine drainage from catheter -inspect catheter tubing to identify type of port

What should you assess before getting a urinary catheter urine sample?

Allen's test

What test should you perform before obtaining a sample for AGB's from radial artery?

nasopharyngeal swab

What uses a flexible wire that collects a specimen from the posterior nasopharynx?

the first void, in the morning

What voiding of the day contains the highest number of bacteria and should be collected when possible?

-offer patient fluids to drink (not too much though, cause could dilute urine) -may need to return later in day to supply sample

When collecting a midstream urine sample, and the patient cannot provide a sufficent urine sample, what should you do?

-dont use as urine sample for culture (heavily contaimnated) -attempt to collect urine in next void

When collecting a midstream urine sample, and the patient missed voiding into specimen container but did void into collection receptacle in toilet, what do you do?

-depress tongue with depressor by pushing down halfway back on tongue -press slightly off center to avoid eliciting the gag reflex

When collecting a nasopharyngeal specimen, the patient gags as soon as the tongue depressor is placed in mouth, what should you do?

-call laboratory, they may still accept specimen based on what they need

When collecting a stool specimen for culture, the patient is menstruating or has discarded toilet paper into commode with stool, what should you do?

-call laboratory, they may still accept specimen

When collecting a stool specimen for culture, the specimen gets left on counter for awhile, what should you do?

-instruct patient that the specimen needs to come from lungs -review procedure of collection with them -discard the contaminated container -place new container at bedside

When collecting sputum sample, patient spits into container without specimen from lungs, what should you do?

-every 15 minutes

When getting a bag urine sample from infant, you should check the bag how often?

-assess the patient's history for indications necessitating the monitoring of blood glucose levels -assess signs and symptoms of hypoglycemia and hyperglycemia -assess patients knowledge about monitioring blood glucose -inspect area of skin to be used (avoid bruised or open areas in skin)

When getting a blood sample for blood glucose testing you should assess for what?

perpendicular

When getting a blood sample for blood glucose testing, you should hold lancet ___________________ to skin and pierce skin with lancet?

-only volume needed for accurate testing

When getting a blood sample, how much blood should you collect?

-edematous -paralyzed -burned -scarred -tattooed -same side of mastectomy -arteriovenous shunt or graft

When getting a venipuncture, you should avoid what kinds of areas?

upward

When inserting nasopharynx swab, you should make sure to NOT insert swab ________, and dont force it?

tongue depressor

When inspecting patients throat and beginning to insert nasopharyngeal swab, you should use what to move toungue down?

-recap container (protects from exposure to humidity)

When removing a blood glucose strip from container, what do you want to make sure you do immediately after getting strip?

-could be sign of belled from a source other than GI tract

When testing for gFOBT, and you get one window testing positive and the other window testing negative, what does this mean?

2

When testing for occult blood for gFOBT , you place ________ drops of developer over each window and wait the time stated on instructions?

-urinate a small amount into toilet -then stop -then urinate in collection container

When trying to catch a midstream sample of urine, you should have the patient do what first?

-apply pressure until you are sure bleeding has stopped (about 5 minutes), -notify primary care provider

When trying to obtain a venipuncture blood sample, a hematoma develops at the site, what should you do?

-have patient make a fist -try tapping on skin over vein lightly several times -if unsuccesful remove tourniquet and try lowering patients arm to allow blood to pool in veins -try applying warm compress on patients arm for 10 minutes

When trying to obtain a venipuncture blood sample, after applying the tourniquet, you have trouble finding a distended vein, what should you do?

-stop the venipuncture -if patient in bed lie them flat and elevate feet -if patient in chair, have them put their head between their knees -encourage patient to take slow deep breaths -call for assistance -get vital signs

When trying to obtain a venipuncture blood sample, and patient reports feeling light-headed and says she /he is going to faint, what should you do?

-elevate the area and apply a pressure dressing -if bleeding continous past 10 minutes notify primary care provider

When trying to obtain a venipuncture blood sample, oozing or bleeding continoues from the puncture site for more than a few minutes, what should you do?

-maintain a firm pressure on puncture site for at least 5 minutes after withdrawing needle

When trying to obtain a venipuncture blood sample, patient has a clotting disorder or is receiving anticoagulant therapy, what should you do?

-perform veinpuncture without tourniquet to minmize risk of hematoma

When trying to obtain a venipuncture blood sample, yo notice patient has large, distended highly visible veins, what should you do?

concentrated; diluted

When urine is darker? lighter?

insertion site

When using a butterfly needle for a venous blood specimen for culture and sensitivity testing, you should not touch what?

center, another

When you have a sample of stool for all kinds of stool samples, you need to get a testing card, and take a wooden applicator and with one end of applicator gather a sample of stool from ____________ of stool and place it in one of the testing windows, then use other end of applicator to get another sample of stool from ______________ area of stool and place on other window on testing card.

-superficial veins in arm in antecubital fossa (basilic, median cubital, and cephalic veins)

Which type of veins are most commonly used for venipunctures?

-perineal skin or hair

While collecting urine specimen midstream the collection container cannot touch what?

6 inches

While observing nasopharynx, you should gently insert the swab straight back into the nostril, aiming posteriorly along the floor of the nasal cavity; insert about _________ inches?

-if in critical condition, may be arterial blood -but you most likely obtained a sample from venous site by accident (if patient awake, normal O2)

While trying to get an arterial blood specimen for blood gas analysis, after inserting the needle you note that the syringe is fillig slugglishy with dark red/purple blood, what should you do?

-typically occurs as result of arterial spasm -replace needle with smaller one and try to puncture again

While trying to get an arterial blood specimen for blood gas analysis, blood will not flow into syringe, what should you do?

-obtain a small arm board -place roll of gauze undrneath patients arm -tape fingers to forearm to the arm board

While trying to get an arterial blood specimen for blood gas analysis, patient cannot keep wrist extended or lying flat, what should you do?

-expect to hold pressure on site for at least 10 minutes

While trying to get an arterial blood specimen for blood gas analysis, patient is on an anticoagluant therapy, what should you do?

-if site not actively bleeding, consider placing a small presssure bandage on instertion site -contionouly check site for bleeding and assess the extremity to ensure blood flow is adequate

While trying to get an arterial blood specimen for blood gas analysis, puncture site continoues to ooze, what should you do?

- try other extremity, - if other extremiity has a positive result use this extremity -if both extremities are negative, notify primary care provider

While trying to get an arterial blood specimen for blood gas analysis, the allen's test is negative, what should you do?

-stop -don not make more than two attempts from same site

While trying to get an arterial blood specimen for blood gas analysis, you cannot obtain a specimen from the site after two attempts, what should you do?

-notfiy priamry care provider (aterial thrombosis may have occured)

While trying to get an arterial blood specimen for blood gas analysis,blood was drawn without incident but now 2 hours later, patient complains of tingling in fingers and hand is cool and pale, what should you do?

-using too much force may cause needle to touch bone, causing patient pain

While you are attempting to puncture radial artery for blood gas anaylsis specimen collection, the patient complains of severe pain, what should you do?

inner wrist

You should absoutely not get a venipuncture sample where due to high risk for damage to underlying structures?

2 to 3

You should do no more than _____ to ______ sets of blood samples in a 24 hr period?

-inhale deeply 2-3 times -cough with exhalation

You should instruct patient to do what to make sure you get an accurate sputum specimen and not just saliva?

-spread labia, and keep them spread while a towellete or washcloth is used to clean side of urinary meatus and then center of meatus (front to back) -also keep them spread during cleaning and collection

You should or instruct patient to do what, while trying to perform parieneal care for female patient before midstream urine collection?

-patient had food that can cause false positive within three days of test -woman is menstruating - patient is bleeding from hematuria or hemmorihds - patient has had recent nose or throat bleed

You should postpone guaiac fecal occult blood test when?

giving antibotics

You should try to make sure urine specimen is obtained before giving what medication?

7.35-7.45

pH normal range?

35-45 mm Hg

paCO2 normal range?

-edges of fingers (most common) -palm of hand -forearm -upper arm -calf -anterior thigh

what are all the different locations on the body that you can obtain a blood sample for blood sugar testing from?

Indole

what is produced by decomposition of tryptophan in the intestine; contributes to the peculiar odor of feces?