What is the next step performed by the nurse after a specimen has been obtained?
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Sputum specimens collected by expectoration are commonly used for cytology, culture and sensitivity, and acid-fast bacilli (AFB) testing. Cytologic examination identifies abnormal cells such as cancer. Culture and sensitivity testing identifies specific infectious microorganisms and their sensitivity to antibiotics. Optimally, sputum samples used for culture and sensitivity testing should be collected before initiating antibiotic therapy because antibiotics affect the results. AFB testing, along with culture and sensitivity testing, is used to diagnose tuberculosis (TB). When testing for TB, at least three consecutive samples are collected, with at least one being an early morning sample. Show
Prior to implementing the procedure, it is helpful to ensure the patient is well-hydrated. Hydration helps thin and loosen sputum and increases the likelihood of obtaining an adequate sample. If the patient is prescribed nebulizer treatments, it is helpful to administer this treatment prior to the procedure to help mobilize secretions. It is also important to assess if the patient is experiencing pain related to coughing. For example, pain following chest or abdominal surgery can inhibit the patient from taking deep breaths and expectorating. In this case, pain medication should be provided prior to performing the procedure. Patients can also be encouraged to support surgical wounds with a pillow while coughing to provide additional support and comfort. It is best to obtain sputum samples in the early morning because secretions accumulate overnight. The patient can rinse their mouth with water prior to the procedure, but avoid mouthwash or toothpaste because these products can affect the microorganisms in the sample. Remove dentures if they are present. Be aware that droplets and aerosols may be generated when collecting sputum specimens, so use appropriate personal protective equipment when entering the room and during the procedure based on the patient’s condition. Explain the procedure to the patient, the type of specimen required, and the difference between oral secretions and sputum. Position the patient in a seated position in a chair or at the side of the bed, or place them in high Fowler’s position. Instruct the patient to take three slow, deep breaths and then cough deeply. Repeat this process until the patient has produced sputum, with rest periods between each maneuver. When the patient has mobilized sputum, instruct them to expectorate directly into a sterile specimen container without touching the inside or rim of the container. The specimen should be at least 5 mL (one teaspoon); ask the patient to continue producing and expectorating sputum until this amount is achieved. Assess the sputum specimen to ensure it is sputum and not saliva. Sputum appears thick and opaque, whereas saliva appears thin, clear, and watery. Cap the specimen container tightly and ensure it is labeled with the patient’s name. Place the specimen in a transport bag and send it to the laboratory for analysis. Document the time and date the sputum specimen was collected and the characteristics of the sputum, including amount and color. If a patient is unable to expectorate a sputum sample, other interventions may be required to mobilize secretions. It is often helpful to collaborate with a respiratory therapist for assistance in this situation. Interventions may include nebulizers, hydration, deep-breathing exercises, chest percussion, and postural drainage. If these interventions are not successful, a sputum sample may be obtained via oropharyngeal or endotracheal suctioning; these methods are used to obtain sputum samples for patients who are intubated.[1],[2],[3] Read South Dakota Department of Health’s PDF with instructions for collecting a sputum sample: In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of diagnostic tests in order to:
Applying a Knowledge of Related Nursing Procedures and Psychomotor Skills When Caring for Clients Undergoing Diagnostic TestingDiagnostic tests can be invasive and noninvasive. Registered nurses perform some aspects of both noninvasive and invasive diagnostic tests such as an ECG and a blood sample for blood glucose testing, for example. Regardless of the nature of the diagnostic test, some of the general rule and procedures relating to all client diagnostic tests include:
Performing an Electrocardiogram (EKG/ECG)An electrocardiogram traces the electrical activity of the heart over a period to time with an electrocardiograph which is connected to the patient with the external application of electrocardiogram leads. The procedure for performing a 12 lead electrocardiogram is:
The chest or precordial leads are placed as show below: The limb leads are placed as shown below: 
Oxygen SaturationOxygen saturation reflects the amount of oxygen saturation in arterial blood. It is measured and monitored by placing a sensor on a client's finger or, when necessary, on their forehead, nose, or ear. Oxygen saturation levels are often checked with the same frequency as the patient's vital signs using a pulse oximeter and this noninvasive procedure can be done by trained and competent certified nursing assistants in the same manner that they can take and record patients' vital signs. Fecal Occult BloodFecal occult blood testing, also referred to as guaiac screening, is a screening tool for colon cancer and it is also used as part of the diagnostic tests used to determine the source of anemia that can be related to a gastrointestinal bleed. Fecal occult blood testing is done by collecting two small portions of the patient's stool and placing them on a commercially prepared slide. A drop of reagent liquid is then placed on the slide. The test is positive for occult hidden blood when the slide turns blue within 60 seconds. Blood Glucose MonitoringThe procedure for checking the client's blood glucose levels is as follows:
Routine Stool SpecimensThe procedure for collecting routine stool specimens is as follows.
Routine Urine SpecimensThe procedure for collecting a routine urine specimen is to:
Obtaining a Clean Catch or Midstream Urine SpecimenCollecting a clean catch or midstream urine specimen varies among the genders. Males should cleanse the penis from the urinary meatus to the peripheral area using a circular pattern and using only one disposable antiseptic wipe for each swipe. Females should use one antiseptic wipe for each swipe from the front to the back and from the inner labia to the outer labia. Then,
Obtaining a Timed Urine Specimen Such as a 24 Hour UrineTimed urine specimens are collected during a specified period of time, as indicated in the doctor's order. For example, urine is collected for a full day when a twenty 24 hour urine specimen is ordered. Nurses will then collect all urine passed during this period of time or they will ask the patient to collect all voided urine so that the nurse can place it into the correct urine collection container. When the duration of collection has been reached, all the collected urine is then labeled and delivered to the diagnostic laboratory for testing. Obtaining a Sputum SpecimenSputum specimens are collected by providing the patient with a specimen collection container and asking the client to deep breath, cough and expel sputum into the container. They should also be instructed to not allow saliva into the container. Once the specimen is collected, it is then labeled and delivered to the diagnostic laboratory for testing. Collecting a Throat Culture
Nurses educate clients about the purposes, required preparation, procedures, results and the implications of abnormal and normal diagnostic tests including the results of all laboratory tests and testing. Performing Fetal Heart MonitoringFetal heart monitoring was fully discussed previously under "Checking and Monitoring the Fetal Heart during Routine Prenatal Exams and During Labor". Monitoring the Results of Maternal and Fetal Diagnostic TestsThe results of maternal and fetal diagnostic tests such as a non-stress test, amniocentesis and ultrasound was fully discussed previously under "Providing Prenatal Care and Education". Monitoring the Results of Diagnostic Testing and Intervening as NeededThroughout the course of care, nurses monitor the results of diagnostic tests and modify the plan of care, as indicated. They also notify the physician when laboratory results are outside of normal limits and/or a significant change for the client. RELATED CONTENT:
SEE – Reduction of Risk Potential Practice Test Questions
Alene Burke, RN, MSN Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members. Latest posts by Alene Burke, RN, MSN (see all) What is the next step to be performed by the staff nurse after a specimen has been collected?Exactly 24-hours after beginning the collection, ask the patient to void. This will complete the specimen collection. Instruct the patient to continue to keep the collection container refrigerated until transfer to laboratory. Send the bottle and laboratory request form to the lab.
What interventions should the nurse follow when collecting the urine specimen?More help for you. Collect supplies.. Introduce yourself, check patient's identification band or tag.. Wash hands, put on gloves.. Explain procedure to patient. ... . Wipe genitals with a towelette or clean with a washcloth.. Allow urine for flow for two seconds, then place sterile container to collect sample.. What is the procedure for collecting specimens?There are four steps involved in obtaining a good quality specimen for testing: (1) preparation of the patient, (2) collection of the specimen, (3) processing the specimen, and (4) storing and/or transporting the specimen.
When a urine specimen is needed How should the nurse instruct 1 point the staff to collect it?When a urine specimen is needed, how should the nurse instruct the staff to collect it? Place a collection hat to the front of the toilet., Use a bedside commode., Place a collection hat to the back of the toilet., Use a bedpan or fracture pan.
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