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Laboratory Examination

I. URINE SPECIMEN

1. Clean-Catch mid-stream urine specimen for routine urinalysis, culture and sensitivity test
  • Best time to collect in the morning, first voided urine
  • Provide sterile container
  • Do perineal care before collection of the urine
  • Discard the first flow of urine
  • Label the specimen properly
  • Send the specimen immediately to the laboratory
  • Document the time of specimen collection and transport to the lab
  • Document the appearance, odor, and usual characteristics of the specimen
2. 24-hour urine specimen (ex. creatinine clearance, Schilling test)
  • Discard the first voided urine
  • Collect all specimen thereafter until the following day
  • Soak the specimen in a container with ice
  • Add preservative as ordered according to hospital policy
3. Second-voided urine - required to assess glucose level and for the presence of albumin in the urine.
  • Discard the first urine
  • Give the patient a glass of water to drink
  • After few minutes, ask the patient to void
4. Catheterized Urine specimen
  • Clamp the catheter for 30 min to 1 hr to allow urine to accumulate in the bladder and adequate specimen can be collected
  • Clamping the drainage tube and emptying the urine into a container are containdicated after a genito-urinary surgery

II. STOOL SPECIMEN

1. Fecalysis - to assess gross appearance of stool and presence of ova or parasite
  • Secure a sterile specimen container
  • Ask the patient to defecate into a clean, dry bed pan or a portable commode
  • Instruct client not to contaminate the specimen with urine or toilet paper (urine inhibits bacterial growth and paper towel contain bismuth which interfere with the test result
2. Stool Culture and sensitivity test - to assess specific etiologic agent causing gastroenteritis and bacterial sensitivity to various antibiotics

3. Fecal occult blood test - valuable test for detecting occult blood (hidden) which may be present in colo-rectal cancer, detecting melena stool
  • Advise client to avoid ingestion of red meat for 3 days
  • Patient is advise on high residue diet
  • Avoid dark food and bismuth compound
  • If client is in iron therapy, inform physician
  • Make the stool is not contaminated with urine, soap solution or toilet paper
  • Test sample from several portion of the stool

III. BLOOD SPECIMEN

a. No fasting test - CBC, Hgb, Hct, clotting studies, enzyme studies, serum electrolytes, glycosylated Hgb
b. Fasting test - FBS, BUN, Creatinine, serum lipid (cholesterol, triglyceride)

Venipuncture pointers
  • Never collect a venous sample from the arm or a leg that is already being use for I.V. therapy or blood administration because it may affect the result
  • Never collect venous sample from an infectious site because it may introduce pathogens into the vascular system
  • Never collect blood from an edematous area,AV shunt, site of previous hematoma, or vascular injury
  • Don't wipe off the povidine-iodine with alcohol because it cancels the effect of povidine-iodine
  • If a patient has a clotting disorder or is receiving anticoagulant therapy, maintain pressure on the site for at least 5 min after withdrawing the needle
Arterial puncture for ABG test
  • Before arterial puncture, perform Allen's test first
  • If the patient is receiving O2, make sure that the patent's therapy has been underway for at least 15 min before collecting arterial sample
  • be sure to indicate on the laboratory request slip the amount and type of O2 therapy the patient is having
  • If the patient has just received a nebulizer treatment, wait about 20 min before collecting the sample
IV. SPUTUM SPECIMEN

1. Gross appearance of the sputum
  • Collect early in the morning
  • Use sterile container
  • Rinse the mouth with plain water before collecting the specimen
  • Instruct the patient to hack-up the sputum
2. Sputum culture and sensitivity test
  • Use sterile container
  • Collect Specimen before the first dose of antibiotic
3. Acid-fast Bacilli
4. Cytologic sputum exam - to assess for presence of abnormal or cancer cells


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