Respiratory Care and Specimen Collection

This is Unit Seventeen of Medical Assistant Prep. Unit Sixteen gave medications by the ordered route. This unit begins with one medication many patients rely on, oxygen, then breathing treatments and tests, and then the collection of specimens for the laboratory. Carry one idea through this lecture. The quality of a test result is mostly decided before the test begins, by coaching, labeling and clear instructions. Two constructed cases at the end show specimens collected right the first time. By the end you will be able to handle oxygen safely. To give a nebulizer treatment and coach spirometry. To collect and teach urine, stool and sputum specimens. And to collect swabs and cultures and send them to the lab.

Three entries on oxygen: why it is a medication, the nasal cannula, and fire safety.

Flow set by order.

MAS 401 Oxygen Is a Medication

Oxygen is a medication, so it requires a prescription and careful monitoring. The flow rate is set according to the order; it should not be changed without consulting the provider or the respiratory therapist. A patient who seems short of breath needs the provider, not a quick turn of the flow valve.

Two prongs.

MAS 402 The Nasal Cannula

The nasal cannula is the simplest and most common oxygen device. It is oxygen tubing ending in two short prongs that sit in the nostrils, connected to a flow meter on a tank, wall outlet or home concentrator. Before a patient leaves on portable oxygen, check that the tank has enough oxygen, is turned on, and is set at the ordered flow.

Strict rules.

MAS 403 Oxygen Feeds Fire

Oxygen supports life, and it also supports fire, so it is handled with strict safety rules. No smoking is allowed near oxygen; keep oxygen equipment at least five feet from heat sources; store cylinders upright and secured so they cannot fall. Store full tanks separately from partly used or empty ones.

Four entries on breathing: nebulizers, what spirometry measures, coaching the test, and the incentive spirometer.

Liquid into mist.

MAS 404 Nebulizers

A small hand-held nebulizer turns liquid medication into a fine mist that the patient inhales. The ordered medication goes into the nebulizer cup, and the patient breathes normally through the mouthpiece or mask while compressed air or oxygen carries the mist to the lungs. Stay with the patient, and report any worsening breathing during the treatment.

Volume and speed.

MAS 405 What Spirometry Measures

Spirometry measures how much air a person can breathe out, and how fast. The patient breathes through a mouthpiece connected to a device called a spirometer, which records the volume and speed of each breath. The result depends on the patient's effort, which is why careful coaching matters so much.

Coaching for effort.

MAS 406 Coaching a Spirometry Test

Spirometry depends on effort, so it is coached step by step as ordered. Before the visit the patient may be told to stop inhaled medicines for a period, as the provider instructs. Seat the patient and place a soft clip on the nose so all the air goes through the mouth. Have them seal their lips tightly around the mouthpiece. Ask for the deepest breath they can take, blown out as hard and fast as possible. Encourage them through the full breath out, recording as many attempts as the device and practice direct. Coach plainly, and report any problem during the test.

Not a test.

MAS 407 The Incentive Spirometer

An incentive spirometer is a different device: a breathing exerciser, not a test. It is often prescribed after surgery to help expand the lungs, reduce fluid buildup in them and help prevent pneumonia. Reinforce the use the provider has taught; do not confuse it with a diagnostic spirometry test.

Seven entries on specimens: the lab's instructions, labeling, clean-catch and twenty-four-hour urine, stool, and sputum.

Instructions first.

MAS 408 Specimens Begin With the Order and the Lab

Every specimen begins with an order and follows the testing laboratory's specific collection instructions. The lab's instructions say which container to use, how much to collect, and how to store and transport the sample. When you are unsure how to collect a specimen, ask the lab; laboratory staff are a resource.

At collection.

MAS 409 Label Every Specimen

Every specimen container is labeled with the patient's identifying information, according to the practice's policy. Label at the time of collection, then document the date and time the specimen was collected, along with anything unusual about it. An unlabeled specimen cannot be safely matched to a patient, and may have to be collected again.

Midstream.

MAS 410 The Clean-Catch Urine Specimen

A clean-catch urine specimen is collected in a way that keeps skin germs out of the sample. The patient cleans the area around the urethra with a cleansing wipe, starts urinating, and then catches the midstream portion in a sterile container. A contaminated sample can make a culture falsely positive.

Teaching the patient.

MAS 411 Teaching a Clean-Catch Collection

Patients usually collect a clean-catch specimen themselves, so clear instructions decide whether it is usable. Label the container and give the patient it with a cleansing wipe and instructions. They wash their hands, then clean the area: for a penis, the entire head; for a vagina, the inner sides of the labia, front to back. They start urinating into the toilet, then move the cup into the stream for the middle portion without touching its inside. They finish into the toilet, close the lid tightly and return it as instructed. Skipped cleaning and a touched cup spoil the sample, so explain both plainly and check understanding.

Every sample.

MAS 412 The Twenty-Four-Hour Urine Collection

A twenty-four-hour urine collection gathers all urine over a full day, because some substances vary through the day. The patient receives a special container and the lab's instructions for how to collect and store the samples. Go over the lab's start, stop and storage instructions with the patient, because a missed sample spoils the whole collection.

Two parts, each square.

MAS 413 Stool Specimens and Hidden Blood

Stool specimens are collected to test for cancer, parasites or hidden blood, following the lab's specific instructions. For a fecal occult blood test, often done at home, a thin smear goes on each square of a test card, taken from two different parts of the stool. Label the card before the patient takes it home, and review the instructions with them.

From deep in the lungs.

MAS 414 Sputum Specimens

Sputum comes from deep in the lungs, not saliva, and early morning is the best time to collect it. The patient rinses with water, not mouthwash, takes three slow deep breaths, coughs deeply, and spits directly into a sterile container without touching the inside or rim. Coughing produces droplets, so wear the protective equipment the situation calls for.

Eight entries on swabs and cultures: throat and nasal swabs, protection, wound cultures, timing, transport, and two constructed cases.

Tonsils and back of throat.

MAS 415 The Throat Swab

A throat swab collects a sample from the tonsils and the back of the throat, as the test ordered requires. It is commonly used to test for strep throat, and the swab must avoid touching the tongue and teeth on the way in and out. Keep the swab's soft tip from touching anything but the target area.

Front or deep.

MAS 416 Nasal Swabs

Nasal swabs are collected from either the front of the nose or deep in the nasal passage, as the test requires. An anterior nasal swab goes no more than half an inch in and stays ten to fifteen seconds; a nasopharyngeal swab goes in until resistance, about the nostril-to-ear distance. Hold children still, with help from a parent, to prevent injury.

Droplets during collection.

MAS 417 Protection During Respiratory Swabs

Collecting respiratory swabs can expose staff to infectious droplets. When the practice's policy calls for it, wear a gown, a respirator or face mask, gloves and eye protection while collecting, and within about six feet of the patient. Follow the policy for each specimen type; it may change with circulating illnesses.

Cleanest tissue.

MAS 418 Wound Cultures

A wound culture identifies the bacteria in a wound and which antibiotics can treat them. Irrigate the wound first, then swab the cleanest tissue, not pus or dead tissue, rotating the swab over about a one-centimeter area. A swab taken from pus or debris misleads the result.

Timing matters.

MAS 419 Cultures Come Before Antibiotics

Specimens for culture and sensitivity testing are ideally collected before antibiotics are started. Antibiotics already in the patient's system can affect the culture's results. If a patient has already started antibiotics, tell the provider and note it with the specimen, because the lab needs to know.

Capped, labeled, bagged.

MAS 420 Sending Specimens to the Lab

After collection, a specimen is capped, labeled, bagged and sent to the laboratory. Close the container tightly, clean the outside if the procedure calls for it, place it in a transport bag, and document the collection. Follow the lab's storage instructions, such as refrigeration, until the specimen leaves.

A urine sample and a home test card.

MAS 421 Teaching Two Home Collections

A constructed case pays off the opening idea. The provider orders a clean-catch urine today and a home occult blood test. The assistant labels the cup and explains the steps in order. Asked to repeat them, the patient mixes up cleaning and starting, so she goes over them until he has it right, and his sample comes back properly collected. She labels the test card before handing it over, shows him how to take samples from two parts of the stool, one thin smear per square, and reviews the lab's storage and return instructions. She documents both, and that instructions were given. Labeling first and a repeat-back prevented a contaminated sample and an unlabeled card. Neither failure would have been his fault, and either would have meant collecting again.

A swab from a six-year-old.

MAS 422 A Child's Throat Swab

A second constructed case collects a throat swab from a six-year-old for an ordered rapid strep test. In plain words, the assistant tells him that a soft swab will tickle the back of his throat for a second. She asks his mother to hold him on her lap, one arm around his body and a hand steadying his forehead. She labels the container first and opens the swab without touching its tip. She guides it past tongue and teeth, rubs the back of the throat and the tonsils, and withdraws it the same careful way. She praises how still he stayed, runs or sends the test by procedure, and documents it. A swab touching tongue or teeth collects the wrong material, and a sudden move can hurt him, so the hold comes first.

Look at what you can now do. You can treat oxygen as a medication, check a portable tank before a patient leaves, and keep oxygen away from fire. You can give a nebulizer treatment and coach a spirometry test for full effort, and you know an incentive spirometer is an exerciser. You can follow the lab's instructions, label at collection, and teach urine, stool and sputum collections. And you can collect swabs and cultures safely and send them to the lab correctly. Unit Eighteen turns to point-of-care testing and patient education.