chapter 19 specimen collection and diagnostic examination

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 0

CHAPTER 19Specimen Collection and Diagnostic Examination


Diagnostic ExaminationDiagnostic ExaminationPerformed by a physician at the Performed by a physician at the patientpatient’’s bedside or in a specially s bedside or in a specially equipped room equipped room The The PTPT’’ss knowledge and knowledge and organization of the diagnostic organization of the diagnostic procedure can be the keys to procedure can be the keys to success.success.


Informed Consent Informed Consent –– Informed consent:Informed consent:

The patient must fully understand what The patient must fully understand what will be done during a test, surgery, or will be done during a test, surgery, or any medical procedure and must any medical procedure and must understand the risks and implications understand the risks and implications before he or she can legally consent to before he or she can legally consent to it. it.

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Diagnostic ExaminationDiagnostic ExaminationNurseNurse’’s Responsibilitiess Responsibilities–– Reinforce physician's explanation of the Reinforce physician's explanation of the

procedure; confirm that the patient procedure; confirm that the patient comprehends it; and verify that written comprehends it; and verify that written consent is not always necessary for an consent is not always necessary for an individual test; informed verbal consent individual test; informed verbal consent may be adequate.may be adequate.

–– Anticipate the needs of the physician Anticipate the needs of the physician and have proper supplies ready.and have proper supplies ready.

–– Keep the patient adequately informed of Keep the patient adequately informed of procedural details that could cause procedural details that could cause discomfort.discomfort.


Diagnostic ExaminationDiagnostic ExaminationPreparing the Patient for Diagnostic Preparing the Patient for Diagnostic ExaminationsExaminations–– The nurse must be prepared to answer The nurse must be prepared to answer

questions for which the patient may questions for which the patient may need clarification.need clarification.

–– The patient needs to know ifThe patient needs to know ifNothing can be taken by mouth (NPO) after Nothing can be taken by mouth (NPO) after midnightmidnightBreakfast will be held until the examination Breakfast will be held until the examination is completeis completeA special room or piece of equipment is A special room or piece of equipment is required for the testrequired for the testMedication is needed before or during the Medication is needed before or during the

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Specimen CollectionSpecimen CollectionAll patients admitted to a health care All patients admitted to a health care facility have at least one laboratory facility have at least one laboratory specimen collected during specimen collected during hospitalization.hospitalization.Laboratory examination of specimens Laboratory examination of specimens of urine, stool, sputum, blood, and of urine, stool, sputum, blood, and wound drainage provides important wound drainage provides important information about body functioning information about body functioning and contributes to the assessment of and contributes to the assessment of health status.health status.Laboratory test can facilitate the Laboratory test can facilitate the


Specimen CollectionSpecimen CollectionGuidelines for Specimen CollectionGuidelines for Specimen Collection–– Consider the patientConsider the patient’’s need and ability s need and ability

to participate in specimen collection to participate in specimen collection procedures.procedures.

–– Recognize that the collection of a Recognize that the collection of a specimen may provoke anxiety, specimen may provoke anxiety, embarrassment, or discomfort.embarrassment, or discomfort.

–– Provide support for patients who are Provide support for patients who are fearful about the results of a specimen fearful about the results of a specimen examination.examination.

–– Recognize that children require clear Recognize that children require clear explanation of procedures and that they explanation of procedures and that they


Specimen CollectionSpecimen CollectionGuidelines for Specimen Collection Guidelines for Specimen Collection (continued)(continued)–– Wear gloves when collecting specimens Wear gloves when collecting specimens

of blood or other body fluids.of blood or other body fluids.–– Wash hands and other skin surfaces Wash hands and other skin surfaces

immediately and thoroughly if immediately and thoroughly if contaminated with blood or body fluids; contaminated with blood or body fluids; wash hands immediately after removing wash hands immediately after removing gloves.gloves.

–– Collect specimens in appropriate Collect specimens in appropriate containers, at the correct time, and in containers, at the correct time, and in the appropriate amount.the appropriate amount.

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Specimen CollectionSpecimen CollectionGuidelines for Specimen Collection Guidelines for Specimen Collection (continued)(continued)–– Most specimens are transported to the Most specimens are transported to the

laboratory in a separate outer plastic laboratory in a separate outer plastic bag.bag.

–– Deliver specimens to the laboratory Deliver specimens to the laboratory within the recommended time or ensure within the recommended time or ensure that they are stored properly for later that they are stored properly for later transport.transport.

–– Use aseptic technique in all collections Use aseptic technique in all collections to prevent contamination, which can to prevent contamination, which can cause inaccurate test results.cause inaccurate test results.


Figure 19Figure 19--11

Enclose specimen in a plastic bag.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)


Specimen CollectionSpecimen CollectionCollecting a Midstream Urine Collecting a Midstream Urine SpecimenSpecimen–– Midstream urine specimenMidstream urine specimen

Urine is collected after voiding is initiated Urine is collected after voiding is initiated (midstream) and before voiding is (midstream) and before voiding is completed.completed.This is the cleanest part of the voided This is the cleanest part of the voided specimen.specimen.

–– Several tests can be ordered on one Several tests can be ordered on one sample of urine: pH, protein, glucose, sample of urine: pH, protein, glucose, ketonesketones, blood, and specific gravity., blood, and specific gravity.

–– NurseNurse’’s responsibilitiess responsibilities

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Skill 19Skill 19--2: Step 22: Step 2

Collecting a midstream urine specimen.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.). St. Louis: Mosby.)


Skill 19Skill 19--3: Step 7a3: Step 7a

Collecting a midstream urine specimen.



Specimen CollectionSpecimen CollectionCollecting a Sterile Urine SpecimenCollecting a Sterile Urine Specimen–– Two methodsTwo methods

Insert a straight catheter into the urinary Insert a straight catheter into the urinary bladder and remove urine.bladder and remove urine.Obtain a specimen from the port of an Obtain a specimen from the port of an indwelling catheter using sterile technique.indwelling catheter using sterile technique.

–– Residual urineResidual urineThis is urine left in the bladder after voiding.This is urine left in the bladder after voiding.The patient voids, and catheterization is The patient voids, and catheterization is performed within 10 minutes.performed within 10 minutes.Residual urine is more than 50 ml of urine Residual urine is more than 50 ml of urine remaining in the bladder.remaining in the bladder.

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Specimen CollectionSpecimen CollectionCollecting a 24Collecting a 24--Hour Urine SpecimenHour Urine Specimen–– This is required for test of renal function This is required for test of renal function

and urine composition.and urine composition.–– The entire volume of urine from a 24The entire volume of urine from a 24--

hour period is collected.hour period is collected.–– If urine is accidentally discarded or If urine is accidentally discarded or

contaminated or patient is incontinent, contaminated or patient is incontinent, restart time period.restart time period.


Specimen CollectionSpecimen CollectionMeasuring Blood Glucose LevelsMeasuring Blood Glucose Levels–– The use of a meter to measure blood The use of a meter to measure blood

glucose is a more meaningful test for glucose is a more meaningful test for use by persons with diabetes than use by persons with diabetes than testing urine for the presence of testing urine for the presence of glucose.glucose.

–– A skin puncture can be easily performed A skin puncture can be easily performed by the patient at home and provides by the patient at home and provides more accurate information than does more accurate information than does the urine glucose/acetone determination the urine glucose/acetone determination test.test.



Measuring blood glucose levels.


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Skill 19Skill 19--5: Step 17b5: Step 17b




Specimen CollectionSpecimen CollectionCollecting a Stool SpecimenCollecting a Stool Specimen–– Stool specimens are collected and Stool specimens are collected and

examined for a variety of reasons.examined for a variety of reasons.Determine the presence of infection, Determine the presence of infection, bleeding, or hemorrhagebleeding, or hemorrhageObserve the amount, color, consistency, and Observe the amount, color, consistency, and presence of fatspresence of fatsIdentify parasites, ova, and bacteriaIdentify parasites, ova, and bacteria


Specimen CollectionSpecimen CollectionCollecting a Stool Specimen Collecting a Stool Specimen

The PT collects the feces, labels the The PT collects the feces, labels the specimen, sends the specimen and specimen, sends the specimen and laboratory request to the laboratory.laboratory request to the laboratory.–– Stool to be examined for parasites must Stool to be examined for parasites must

be taken to the laboratory immediately be taken to the laboratory immediately –– Stool specimen for ova and parasite Stool specimen for ova and parasite

(O&P) examination must be collected in (O&P) examination must be collected in an appropriate container with a special an appropriate container with a special solution.solution.

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Collecting a stool specimen.

(From Sorrentino, S.A. [2004]. Mosby’s textbook for nursing assistants. [6th ed.]. St. Louis: Mosby.)



Collecting a stool specimen.

(From Sorrentino, S.A. [2004]. Mosby’s textbook for nursing assistants. [6th ed.]. St. Louis: Mosby.)


Specimen CollectionSpecimen CollectionDetermining the Presence of Occult Determining the Presence of Occult Blood in Stool (Blood in Stool (GuaiacGuaiac))–– Bright red bloodBright red blood indicates the blood is indicates the blood is

fresh and that the site of bleeding is in fresh and that the site of bleeding is in the lower gastrointestinal tract.the lower gastrointestinal tract.

–– Black, tarry fecesBlack, tarry feces indicates the indicates the presence of old blood and that the site presence of old blood and that the site of bleeding is higher in the GI tract.of bleeding is higher in the GI tract.

–– OccultOccult indicates blood is present in the indicates blood is present in the stool but cannot be seen without a stool but cannot be seen without a microscope.microscope.

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Determining the presence of occult blood in stool.



Specimen CollectionSpecimen CollectionCollecting a Sputum SpecimenCollecting a Sputum Specimen

–– It must come from deep in the bronchial It must come from deep in the bronchial tree.tree.

–– Early morning is the best time to collect Early morning is the best time to collect a specimen, because the patient has not a specimen, because the patient has not yet cleared the respiratory passages.yet cleared the respiratory passages.



Collecting a sputum specimen by suction.


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Collecting a sputum specimen by suction.




Collecting a sputum specimen by expectoration.

(Grimes, D. [1991]. Infectious diseases, Mosby’s clinical nursing series. St. Louis: Mosby.)


Specimen CollectionSpecimen CollectionMany tests can be performed on Many tests can be performed on sputum.sputum.–– CultureCulture

Cultivation of microorganisms or cellsCultivation of microorganisms or cells

–– SensitivitySensitivityDetermining the effectiveness of antibioticsDetermining the effectiveness of antibiotics

–– CytologyCytologyStudy of cellsStudy of cells

–– AcidAcid--fast bacillusfast bacillusOrganism responsible for tuberculosisOrganism responsible for tuberculosis

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Specimen CollectionSpecimen CollectionObtaining a Wound CultureObtaining a Wound Culture–– Aerobic organismsAerobic organisms

Grow in superficial wounds exposed to the Grow in superficial wounds exposed to the airairSpecimen collected by inserting a sterile Specimen collected by inserting a sterile swab (picture next slide swab (picture next slide



Wound culture tube.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)



Aerobic culture tube.


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Specimen CollectionSpecimen CollectionObtaining a Wound Culture Obtaining a Wound Culture

Anaerobic organismsAnaerobic organismsGrow within body cavitiesGrow within body cavitiesSpecimen collected by using a sterile Specimen collected by using a sterile syringe tip to aspirate visible drainage from syringe tip to aspirate visible drainage from the inner would, expelling any air from the the inner would, expelling any air from the syringe, and injecting the syringe contents syringe, and injecting the syringe contents into a special vacuum container with culture into a special vacuum container with culture mediummedium


Specimen CollectionSpecimen CollectionObtaining a Throat CultureObtaining a Throat Culture–– Ask patient to open mouth and say Ask patient to open mouth and say

““ah.ah.””–– If pharynx is not visualized, depress If pharynx is not visualized, depress

tongue with tongue blade and note tongue with tongue blade and note inflamed area of pharynx and tonsils.inflamed area of pharynx and tonsils.

–– Insert swab without touching lips, teeth, Insert swab without touching lips, teeth, tongue, or cheeks.tongue, or cheeks.

–– Gently but quickly swab Gently but quickly swab tonsillartonsillar area area side to side, making contact with side to side, making contact with inflamed or purulent sites.inflamed or purulent sites.


Specimen CollectionSpecimen CollectionObtaining a Throat Culture Obtaining a Throat Culture Immediately place swab in culture Immediately place swab in culture tube and crush tube and crush ampuleampule at bottom of at bottom of tube. tube. –– Securely attach properly completed Securely attach properly completed

label and requisition slip to side of label and requisition slip to side of specimen container.specimen container.

–– Enclose in a plastic bag.Enclose in a plastic bag.–– Send specimen immediately to Send specimen immediately to

laboratory or refrigerate.laboratory or refrigerate.–– patient teachingpatient teaching

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Documentation Documentation

–– Complete procedure by documenting Complete procedure by documenting the following:the following:

TimeTimeType of specimenType of specimenSent to laboratory with requisition slipSent to laboratory with requisition slipPatient responsePatient response


Specimen CollectionSpecimen CollectionCollecting a Blood Specimen Collecting a Blood Specimen ((VenipunctureVenipuncture))–– Veins are a major source of blood for Veins are a major source of blood for

this type of testing.this type of testing.–– Blood tests can yield valuable Blood tests can yield valuable

information about nutritional, information about nutritional, hematological, metabolic, immune, and hematological, metabolic, immune, and biochemical status.biochemical status.


Specimen CollectionSpecimen CollectionPossible risks of Possible risks of venipuncturevenipuncture

Anticoagulant therapyAnticoagulant therapyLow platelet countLow platelet countBleeding disordersBleeding disordersPresence of Presence of arteriovenousarteriovenous shunt or fistulashunt or fistulaAfter breast or After breast or axillaryaxillary surgery performed surgery performed on that sideon that side

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A, Parts of the Vacutainer. B, Blood collects in a Vacutainer tube.

(A, from Zakus, S.M. [1995]. Clinical procedures for medical assistants. [3rd ed.]. St. Louis: Mosby. B, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.

Louis: Mosby.)



Vacutainer tube guide.

(From Zakus, S.M. [1995]. Clinical procedures for medical assistants. [3rd ed.]. St. Louis: Mosby.)

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Skill 19Skill 19--13: Step 17b(6)13: Step 17b(6)

Performing the venipuncture.



Specimen CollectionSpecimen CollectionCollecting a Blood Specimen Collecting a Blood Specimen Collection tubesCollection tubes

Tubes come in different sizes.Tubes come in different sizes.Blood test ordered determines the amount Blood test ordered determines the amount of blood needed.of blood needed.Some tests require additivesSome tests require additives——chemicals chemicals that preserve blood until testing.that preserve blood until testing.Rubber stoppers are color coded. The color Rubber stoppers are color coded. The color coding signals the type of additive, the coding signals the type of additive, the amount of blood to collect, and the amount of blood to collect, and the recommended tests.recommended tests.The collection tube must be labeled with the The collection tube must be labeled with the patientpatient’’s identifying information.s identifying information.



Labeling the blood tube.


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Collection Sites Collection Sites

Selecting a venipuncture site. A, Inner arm. B, Dorsal surface of hand.



Performing the venipuncture.



ElectrocardiogramElectrocardiogram(ECG or EKG) is a graphic (ECG or EKG) is a graphic representation of electrical impulses representation of electrical impulses generated by the heart during a generated by the heart during a cardiac cycle.cardiac cycle.It identifies abnormalities that It identifies abnormalities that interfere with electrical conduction interfere with electrical conduction through cardiac tissue.through cardiac tissue.This procedure is usually done at the This procedure is usually done at the patientpatient’’s bedside.s bedside.

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Skill 19Skill 19--14: Step 10b14: Step 10b

Performing an electrocardiogram (ECG).

(From Sorrentino, S.A. [2004]. Assisting with patient care. [2nd ed.]. St. Louis: Mosby.)


Performing an electrocardiogram (ECG).

(From Phipps, W.J., Monahan, F.D., Sands, J.K., Marek, J.F., Neighbors, M. [2003]. Medical-surgical nursing: health and illness perspectives. [7th ed.]. St. Louis: Mosby.)


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chapter 19 specimen collection and diagnostic examination

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