COMPETENCY APPRAISAL - DIAGNOSTIC AND LABORATORY TESTS

Urine specimen
Specimen collection:
1. Clean catch, midstream urine specimen for routine urinalysis,
culture and sensitivity test (C & S).
The best time to collect specimen is early morning, first voided specimen.
This is concentrated form of urine and can reveal the composition of the
urine.
Provide sterile container. To ensure that the specimen is uncontaminated.
Do perineal care before collection of urine specimen to reduce
microorganisms at the external genitals.
Urine specimen
Specimen collection:
1. Clean catch, midstream urine specimen for routine urinalysis,
culture and sensitivity test (C & S).
Discard the first flow of urine to ensure that the urine specimen is
uncontaminated.
Collect the midstream urine : 30 50mls. For routine urinalysis: 5 10 mls for
urine C &S.
Discard the last flow of urine, especially among males (maybe contaminated
with semen).
Label the specimen properly.
Send the specimen immediately to the laboratory.
2. 24 hour urine specimen
Discard the first voided specimen. This was formed hours before time of
collection.
Collect all specimens thereafter, until the same time the following day. Eg.
Wednesday 10 AM ( discard the urine collected at this time) until Thursday 10
AM (collect the specimen at this time.
Soak specimen in a container with ice. To preserve the specimen.
Add preservative as ordered according to the policy of the institution.
3. Second voided specimen
This specimen is required to assess glucose levels and for the presence of
albumin in the urine.
Ask the patient to void, discard this first urine specimen. This urine may be
formed few hours ago, and may not reveal accurate levels of glucose or
presence of albumin at the time of collection.
Give the patient one glass of water to drink.

After few minutes, ask the patient to void again, and collect this urine
specimen. This urine will reveal accurate results.

Urine specimen
Specimen collection:
4. Catheterized urine specimen
Clamp the catheter for 30minutes to 1 hour. To allow urine to accumulate in
the bladder and adequate specimen can be collected.
Cleanse the drainage port of the 2- way foley catheter with alcohol swab/
cotton ball. To remove microorganisms in the area.
Use sterile needle and syringe to aspirate urine specimen from the drainage
port. This ensures sterility of the specimen.

DONTs
Collect urine specimen from the urinary drainage bag. This urine is
considered contaminated.
Detach the catheter from the connecting tube. This disturbs the closed
drainage system, and allows entry of microorganisms into the catheter.
Note: Introduce the needle diagonally to allow self sealing of the rubber
material of the catheter. This will prevent leakage of urine via the puncture
site.
Tests of glucose in the urine
Tests of glucose in the urine
1. BENEDICTS TEST
Collect urine specimen before meals.
Put 5 ml of Benedicts solution into the test tube.
Heat the Benedicts solution; there should be no color change ( If the color of
the solution is altered upon heating, it is considered contaminated).
Add 8 10 drops of urine.
Heat the Benedicts solution with the urine ( Do not boil).

Tests of glucose in the urine

1. BENEDICTS TEST
Interpretation of Results:
Blue (-) negative
Green = +
Yellow = ++

Orange = +++
Red= ++++

Tests of glucose in the urine

2. CLINITEST
Collect urine specimen before meals.
Put one clinitest tablet in a test tube.
Add 5 drops of urine.
Add 10 drops of water.
Wait for the reaction to occur.
Compare with standard color chart (results are from light green to yellow to
orange).
Test of albumin in the urine
Heat & acetic acid test
Collect urine specimen before meals.
Imaginary divide the test tube into three parts.
Put 2/3 parts of urine into the test tube.
Heat the test tube with urine; note for color change(this may be due to
amorphous urates)
Add 1/3 part of acetic acid or just a few drops, do not heat the solution. Acetic
acid tends to explode when heated.
CLOUDINESS indicates ALBUMINURIA.
Stool specimen
1. Routine fecalysis
To assess gross appearance of stool and presence of ova or parasites.
Secure sterile specimen container.
Instruct patient to defecate in a bedpan. If desired, allow the patient to void
first. Discard the urine and wash the bedpan.
Use tongue depressor to collect stool specimen.
Collect one teaspoonful or 1 inch of well formed stool.
Label the specimen immediately to the laboratory. Fresh warm specimen help
detect ova and parasites.

2. Stool culture & sensitivity test

To assess the specific etiologic agent causing gastroenteritis and bacterial
sensitivity to various antibiotic.
Use sterile test tube and sterile cotton tipped applicator.
Label the specimen properly.
Send specimen to the laboratory.
3. Guaiac stool examination (occult blood determination)
Microscopic study of stool for presence of bleeding in the gastrointestinal
tract.
Provide hemoglobin free diet for 3 days (no meat for 3 days)
Avoid red or dark colored foods (meat fibers, red or dark colored foods may
be mistaken as blood).
Temporarily discontinue iron therapy. Iron causes black or greenish
discoloration of the stool.
Positive (+) guaiac stool exam, indicates peptic ulcer disease and gastric
cancer.
SPUTUM SPECIMEN
1. Gross appearance of the sputum
Collect early morning specimen.
Use sterile container.
Rinse mouth with plain water before collection of the specimen. Do not use
astringent mouthwash because its alcohol content may destroy the
microorganisms present in the sputum.
Instruct patient to hack up sputum to ensure that it comes from the lungs
and lower airways.

2. SPUTUM CULTURE & SENSITIVITY TEST

To assess the specific etiologic agent causing respiratory tract infection and
bacterial sensitivity to various antibiotics.
Use sterile container.
Collect sputum specimen before the first dose of antibiotic.

3. ACID- FAST BACILLI (AFB) STAINING)

To assess presence of active pulmonary tuberculosis.
Collect sputum specimen for three consecutive mornings.

4. CYTOLOGIC / PAPANICOLAOU EXAMINATION OF SPUTUM

To assess for presence of abnormal or cancer cells.
BLOOD SPECIMEN

BLOOD SPECIMEN
The medical technologist collects the blood specimen, however the nurse
must ascertain whether the test will require fasting or not as a preparation.
No Fasting for the following tests:
CBC ( Complete Blood Count)
Hemoglobin
Hematocrit Level
Clotting Studies
Enzyme studies
Serum electrolytes

Fasting is required for the following tests:

1. Fasting Blood Sugar (FBS), BUN, Serum Creatinine
2. Serum Lipids (serum cholesterol; triglycerides
The nurse collects blood specimen for capillary blood glucose (CBG) through
finger pinprick/ needlestick before meals. Insulin injection is administered
before meals.
The normal blood glucose level is 70 - 110 mg/ dl.

BODY SECRETIONS
1. CULTURE & SENSITIVITY TEST
To assess the specific etiologic agent causing infection and bacterial
sensitivity to various antibiotics.
Use sterile test tube and sterile cotton tipped applicator.
Diagnostic tests
a. Respiratory system
Skin test: mantoux test
PPD( Purified Protein Derivative) is used.
Intradermal route of injection.
Read result within 48 72 hours after injection.
(+) Mantoux Test is induration of 10 mm or more.
For HIV positive clients, induration of 5 mm is considered positive.
(+) Mantoux Test signifies exposure to Mycobacterium tubercle.

CHEST X - RAY
Practice the client on how to hold his breath and to do deep breathing.

Instruct the client to remove metals from the chest. Metals are radiopaque.
These may be mistaken.
FLUROSCOPY
Studies the lung and the chest in motion.
BRONCHOGRAPHY
A radiopaque medium is instilled directly into the trachea and bronchi
through bronchoscope and the entire bronchial tree or selected areas may be
visualized through x- ray.
Nursing interventions before bronchogram:
Secure written consent.
Check for allergies to seafoods or iodine or anesthesia.
NPO 6 8 hours.
Pre op meds; Atropine SO4 and valium, topical anesthesia sprayed; followed
by local anesthetic injected into the larynx.
Nursing interventions after bronchogram:
Side lying position. To promote drainage from the mouth.
NPO until cough and gag reflex return. To prevent aspiration.
Cough and deep breathe client. To promote ventilation.
Low grade fever is common.
BRONCHOSCOPY
The direct inspection and observation of the larynx, trachea, and bronchi
through a flexible or rigid bronchoscope.
Diagnostic uses:
To collect secretions.
To determine location or pathologic process and collect specimen for biopsy.
Therapeutic Uses:
Remove aspirated foreign objects.
Excise lesions.
Nursing Interventions before Bronchoscopy:
Informed consent/permit needed.
Atropine SO4 and valium pre procedure, topical anesthesia sprayed followed
by local anesthesia injected into the larynx.
NPO 6 8hours. To prevent vomiting and aspiration.
Remove dentures, prostheses, contact lenses. To prevent losses of valuables.

Nursing Interventions after Bronchoscopy:

Side lying position. To promote drainage from the mouth.
Check for the return of gag reflex before giving fluid per orem.
Watch for cyanosis, hypotension, tachycardia, arrythmias, hemoptysis,
dyspnea. These signs and symptoms indicate perforation of bronchial tree.
LUNG SCAN
Following injection of a radioisotope, scans are taken with a scintillation
camera. Measures blood perfusion through the lungs. Confirms pulmonary
embolism or other blood flow abnormalities.
Remain still during the procedure. For better scan result.

SPUTUM EXAMINATION
Gross appearance. May indicate certain diseases.
Sputum C & S. to detect the actual microorganism causing infection.
AFB Staining. To assist is diagnosis of tuberculosis (TB).
Cytological examination/Papanicolau examination. To detect cancer
cells.
Early morning sputum specimen is collected. Mucous secretions accumulate
during the night. This enables the client to expectorate adequate sputum
specimen.
Rinse mouth with plain water. Do not use astringent mouthwash. Its alcohol
content can destroy the microorganisms in the specimen.
Use sterile container.
Sputum specimen for C & S is collected before the first dose of
antimicrobial. To ensure that microorganism present in the specimen can be
accurately detected.
For AFB staining, collect sputum specimen for three consecutive mornings.

Lung biopsy
To detect presence of cancer cells by obtaining some tissues from the lungs.
Transbronchoscopic biopsy done during bronchoscopy.
Percutaneous needle biopsy.
Open lung biopsy.

LYMPH NODE BIOPSY

Scalene or cervicomediastinal to assess metastasis of lung cancer.