Collecting and testing specimens
Objectives
• Define the key terms and key abbreviations listed in this chapter.
• Explain why urine, stool, sputum, and blood specimens are collected.
• Explain the rules for collecting specimens.
• Describe the different types of urine specimens.
• Describe the equipment used for blood glucose testing.
• Identify the sites used for skin punctures.
• Explain how to promote quality of life.
Key terms
glucosuria Sugar (glucos) in the urine (uria); glycosuria
glycosuria Sugar (glycos) in the urine (uria); glucosuria
hematoma A swelling (oma) that contains blood (hemat)
hematuria Blood (hemat) in the urine (uria)
hemoptysis Bloody (hemo) sputum (ptysis means to spit)
ketone A substance that appears in urine from the rapid breakdown of fat for energy; acetone, ketone body
melena A black, tarry stool
sputum Mucus from the respiratory system that is expectorated (expelled) through the mouth
KEY ABBREVIATIONS
| BM | Bowel movement |
| ID | Identification |
| I&O | Intake and output |
| mL | Milliliter |
| oz | Ounce |
Ordered by doctors, specimens (samples) are collected and tested to prevent, detect, and treat disease. Most specimens are tested in the laboratory. All specimens sent to the laboratory require requisition slips. The slip has the person’s identifying information and the test ordered. And the specimen container is labeled according to center policy. Some tests are done at the bedside. When collecting specimens, follow the rules in Box 33-1.
See Teamwork and Time Management: Collecting and Testing Specimens.
Urine specimens
Urine specimens are collected for urine tests. Follow the rules in Box 33-1.
See Delegation Guidelines: Urine Specimens.
See Promoting Safety and Comfort: Urine Specimens.
The random urine specimen
The random urine specimen is collected for a routine urinalysis. No special measures are needed. It is collected any time during a 24-hour period. Many people can collect the specimen themselves. Weak and very ill persons need help.
COLLECTING A RANDOM URINE SPECIMEN
Quality of life
Remember to:
Pre-procedure
1 Follow Delegation Guidelines: Urine Specimens, p. 503. See Promoting Safety and Comfort: Urine Specimens, p. 503.
3 Collect the following before going to the person’s room:
• Gloves
4 Arrange collected items in the person’s bathroom.
7 Label the container in the person’s presence.
• Voiding receptacle—bedpan and cover, urinal, commode, or specimen pan (Fig. 33-1)
Procedure
12 Take the receptacle to the bathroom.
13 Pour about 120 mL (milliliters) (4 oz [ounces]) into the specimen container.
15 Measure urine if I&O are ordered. Include the amount in the specimen container.
16 Empty, clean, and disinfect equipment. Return equipment to its proper place.
17 Remove the gloves, and practice hand hygiene. Put on clean gloves.
Post-procedure
20 Provide for comfort. (See the inside of the front book cover.)
21 Place the signal light within reach.
22 Raise or lower bed rails. Follow the care plan.
24 Complete a safety check of the room. (See the inside of the front book cover.)
26 Take specimen and requisition slip to the storage area. Follow center policy. Wear gloves.
The midstream specimen
The midstream specimen is also called a clean-voided specimen or clean-catch specimen. The perineal area is cleaned before collecting the specimen. This reduces the number of microbes in the urethral area. The person starts to void into a receptacle. Then the person stops the stream of urine, and a sterile specimen container is positioned. The person voids into the container until the specimen is obtained.
COLLECTING A MIDSTREAM SPECIMEN
Quality of life
Remember to:
Pre-procedure
1 Follow Delegation Guidelines: Urine Specimens, p. 503. See Promoting Safety and Comfort: Urine Specimens, p. 503.
3 Collect the following before going to the person’s room:
• Sterile gloves (if not part of the kit)
• Voiding receptacle—bedpan and cover, urinal, commode, or specimen pan if needed
10 Provide perineal care. (Wear gloves for this step. Decontaminate your hands after removing them.)
13 Open the packet of towelettes inside the kit.
15 For a female—clean the perineal area with the towelettes.
b Clean down the urethral area from front to back. Use a clean towelette for each stroke.
c Keep the labia separated to collect the urine specimen (steps 17 through 20).
16 For a male—clean the penis with the towelettes.
c Keep holding the penis until the specimen is collected (steps 17 through 20).
17 Ask the person to void into a receptacle.
18 Pass the specimen container into the stream of urine. Keep the labia separated (see Fig. 33-2).
19 Collect about 30 to 60 mL (1 to 2 oz) of urine.
20 Remove the specimen container before the person stops voiding.
21 Release the labia or penis. Let the person finish voiding into the receptacle.
23 Provide toilet tissue after the person is done voiding.
24 Take the receptacle to the bathroom.
25 Measure urine if I&O are ordered. Include the amount in the specimen container.
26 Empty, clean, and disinfect equipment. Return equipment to its proper place.
27 Remove the gloves, and practice hand hygiene. Put on clean disposable gloves.
Post-procedure
31 Provide for comfort. (See the inside of the front book cover.)
32 Place the signal light within reach.
33 Raise or lower bed rails. Follow the care plan.
35 Complete a safety check of the room. (See the inside of the front book cover.)
37 Take the specimen and requisition slip to the storage area. Follow center policy. Wear gloves.
Stopping the stream of urine is hard for many people. You may need to position and hold the specimen container in place after the person starts to void (Fig. 33-2).
See Focus on Communication: The Midstream Specimen.
The 24-hour urine specimen
All urine voided during a 24-hour period is collected for a 24-hour urine specimen. Urine is chilled on ice or refrigerated during this time. This prevents the growth of microbes. A preservative is added to the collection container for some tests.
COLLECTING A 24-HOUR URINE SPECIMEN
Quality of life
Remember to:
Pre-procedure
1 Follow Delegation Guidelines: Urine Specimens, p. 503. See Promoting Safety and Comfort:
a Urine Specimens, p. 503
3 Collect the following before going to the person’s room:
• Urine container for a 24-hour collection
• Funnel
4 Arrange collected items in the person’s bathroom.
5 Place one 24-hour urine label in the bathroom. Place the other near the bed.
8 Label the urine container in the person’s presence. Apply the biohazard label.
• Voiding receptacle—bedpan and cover, urinal, commode, or specimen pan
• Gloves
Procedure
12 Ask the person to void. Provide a voiding receptacle.
13 Measure and discard the urine. Note the time. This starts the 24-hour collection period.
14 Mark the time on the collection container.
15 Empty, clean, and disinfect equipment. Return equipment to its proper place.
16 Remove the gloves, and practice hand hygiene. Put on clean gloves.
18 Remove the gloves. Practice hand hygiene.
19 Mark the time the test began and the time it ends on the room and bathroom labels.
a Use the voiding receptacle when voiding during the next 24 hours.
c Put toilet tissue in the toilet or wastebasket.
d Put on the signal light after voiding.
21 Return to the room when the person signals for you. Knock before entering the room.
22 Do the following after every voiding:
a Decontaminate your hands. Put on gloves.
b Measure urine if I&O are ordered.
d Empty, clean, and disinfect equipment. Return equipment to its proper place.
e Remove the gloves, and practice hand hygiene. Put on clean gloves.
g Remove the gloves. Practice hand hygiene.
h Follow “Post-Procedure” steps except for steps 28 and 33.
23 Ask the person to void at the end of the 24-hour period. Follow step 22a-g.
Post-procedure
24 Provide for comfort. (See the inside of the front book cover.)
25 Place the signal light within reach.
26 Raise or lower bed rails. Follow the care plan.
28 Remove the labels from the room and bathroom.
29 Clean and return equipment to its proper place. Discard disposable items.
30 Remove the gloves. Practice hand hygiene.
32 Complete a safety check of the room. (See the inside of the front book cover.)
33 Take the specimen and requisition slip to the storage area. Wear gloves.
The person voids to begin the test with an empty bladder. Discard this voiding. Save all voidings for the next 24 hours. The person and nursing staff must clearly understand the procedure and the test period. The test is re-started if:
See Promoting Safety and Comfort: The 24-Hour Urine Specimen.
Testing urine
The nurse may ask you to do simple urine tests. You can test for pH, glucose, and blood using reagent strips (dipsticks). The doctor orders the type and frequency of urine tests. Random urine specimens are needed.
• Testing for glucose and ketones—In diabetes, the pancreas does not secrete enough insulin (Chapter 41). The body needs insulin to use sugar for energy. If not used, sugar builds up in the blood. Some sugar appears in the urine. Glucosuria or glycosuria means sugar (glucos, glycos) in the urine (uria). The diabetic person may also have ketones (ketone bodies, acetone) in the urine. These substances appear in urine from the rapid breakdown of fat for energy. The body uses fat for energy if it cannot use sugar. Urine is also tested for ketones. These tests are usually done four times a day—30 minutes before each meal and at bedtime. The doctor uses the test to make drug and diet decisions.
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