After completing the chapter, you will be able to accomplish the following:

1. Obtain a nasal swab.
2. Obtain a nasopharyngeal swab.
3. Collect a sputum specimen (expectorated) for culture.
4. Obtain a urine specimen (clean catch, midstream).
5. Obtain a urine specimen from an indwelling urinary catheter.
6. Test a stool specimen for occult blood.
7. Collect a stool specimen.
8. Obtain a capillary blood sample for glucose testing.
9. Collect a venous blood specimen by venipuncture for routine laboratory testing.
10. Obtain a venous blood specimen for culture and sensitivity.
11. Obtain an arterial blood specimen for blood gas analysis.
12. Obtain a blood specimen from a central venous access device
13. Obtain a blood specimen from an arterial catheter.

• Assessment
• Clinical Decision Making/Clinical Judgment
• Safety

• arterial blood gases (ABGs)
• expectorate
• indole
• lancet
• nares
• naris
• nasopharynx
• occult blood
• phlebotomy
• protocol
• skatole
• standard precautions
• sterile technique
• transmission-based precautions
• venipuncture

Laboratory specimens are collected to aid in the screening and diagnosing of patient health problems, in directing treatment, and in monitoring the treatment effectiveness. Blood, urine, and stool samples are commonly collected types of specimens. Follow facility protocol to collect, handle, and transport specimens. Always observe Standard Precautions (refer to Fundamentals Review 1-3 in Chapter 1) and Transmission-Based Precautions (as indicated) (refer to Fundamentals Review 1-4 in Chapter 1) and use sterile technique where appropriate. It is very important to adhere to protocols, best practice guidelines and standards, collect the appropriate amount, use appropriate containers and media, and store and transfer the specimen within specified timelines. It is also extremely important to ensure accurate labeling of any specimen collected, according to facility policy. These measures prevent invalid and inaccurate test results.

Patient teaching is an important part of specimen collection. Explain the rationale for the sample collection and the process for obtaining the specimen. Evaluate the patient's ability to follow the specific procedure for collecting the specimen.

When collecting a specimen, take care to prevent the outside of the container from becoming contaminated with any secretions or body fluids. Place all laboratory specimens in plastic bags marked “Biohazard” and seal the bags to prevent leakage during transportation.

This chapter reviews methods to obtain specimens for common laboratory and diagnostic tests. Nurses must also be knowledgeable about normal and abnormal findings associated with these laboratory tests. Fundamentals Review 18-1 and 18-2 highlight the normal findings associated with urine and stool specimens. Refer to Appendix C for identification of normal adult values for common laboratory tests.

1. Obtaining a urine specimen is a priority in Mr. Conklin's care. Results will help determine the underlying cause of their symptoms and direct treatment. As a result, you will have to take a more involved role in the collection. You will have to obtain the specimen. Continue to reinforce the need for the urine specimen. Gather the necessary supplies and place them in the patient's room or bathroom. Plan to obtain the specimen the next time Mr. Conklin has to void. Share the plan with other caregivers. When the patient communicates their need to void, put on nonsterile gloves. Assist them to the bathroom. Explain again the need and rationale for the urine specimen. Explain that you are going to clean their penis to get the specimen. Clean their penis according to the guidelines in the procedure. Ask Mr. Conklin to void into the toilet; be ready to place the specimen cup in the stream of urine to obtain a sample. Put the lid on the specimen container. After assisting the patient with the rest of their toileting needs, clean the outside of the container, if urine contacted the outside during sampling. Label the sample and transport it to the laboratory.
2. Explain the reason for the test and the procedure for stool collection. Ask about any hematuria, bleeding hemorrhoids, or recent nose or throat bleeding. These situations would require the test to be postponed. Question Ms. Yon regarding medications she use, including certain medications, such as a salicylate intake of more than 325 mg daily, steroids, iron preparations, and anticoagulants, that may lead to false-positive readings, and use of vitamin C, as this may lead to false-negative results. Ask about the use of laxatives, enemas, or suppositories for 3 days before testing. Ms. Yon should understand that they should collect the specimen the morning of her appointment and know how to handle the specimen once she has obtained it.
3. Assess Mrs. Yeletsky's knowledge regarding her understanding of what diabetes is, its effects on the body, possible complications, dietary guidelines, medications prescribed to treat their diabetes, activity level/habits, and personal hygiene, particularly foot care. You should incorporate education regarding diabetes, including simple explanations of the definition of diabetes, normal blood glucose ranges, effect of insulin and exercise, effect of food and stress, and basic treatment approaches. A referral to the diabetic clinical specialist, if available, would be appropriate, as well as a referral for outpatient follow-up. Review the patient's understanding of blood glucose monitoring and the use of the blood glucose monitor. Investigate alternative blood glucose monitors; models are available to aid people with impaired vision. Explore the support the patient has available and the possibility of a significant other assisting with their diabetes management, if appropriate.