urine culture nursing interventions

CYSTITIS: Dysuria, frequency, urgency 2. Start studying CLASS 3.2: NURSING ASSESSMENTS AND INTERVENTIONS FOR URINARY ELIMINATION. It should be delivered within two hours of collection. UTI may also take on a foul-smelling odor. Sterile syringe (20 cc) and three needles (usually 20 gauge), Two blood culture bottles (one for anaerobic and one for aerobic specimens). These include vitamin C and nonsteroidal anti inflammatory medicines such as ibuprofen and aspirin. To ensure the best experience, please update your browser. Our ultimate goal is to help address the nursing shortage by inspiring aspiring nurses that a career in nursing is an excellent choice, guiding students to become RNs, and for the working nurse – helping them achieve success in their careers! There are no risks involved. If the drainage tube has a built-in sampling port, put on gloves and wipe the sampling port with alcohol. Instruct the patient to void a small amount of urine into the toilet to rinse out the urethra, void the midstream urine into the specimen cup, and the last of the stream into the toilet. Instruct the patient to urinate, flush down the urine down the toilet when he gets up in the morning. Fill out the request form completely with the following information: Family member prefix and sponsor’s social security number, Ward number if inpatient, or mobile number if outpatient, Name of the physician who ordered the culture, Aerosol of 10% sodium chloride or sterile water (optional). RESULTS: During the study period, 910 patients received empiric antibiotic therapy for UTIs but had a negative urine culture result. 2. Refrigerate the urine sample if it is not to be examined at once. A blood culture is a fairly routine test that identifies a disease-causing organism in the blood, especially in patients who have temperatures that is higher than normal, for an unknown reason. Emphasize proper hand hygiene before and after each collection. Fill out the laboratory request form completely and send the specimens to the laboratory immediately. After each bowel movement, clean the perineum and urethral meatus from front to back to reduce concentrations of pathogens at the urethral opening. Put on gloves and clean the drawing site with betadine solution or alcohol swab. Zephiran, a soap solution, or three antiseptic towelettes, Three cotton balls (to use with zephiran or soap solution). Next, the patient needs to collect a specimen from a different area of the same stool and smear a thin film of the sample onto the other slot in the test card or slide. The antibiotic discontinuation rate increased from 4% to 84%, avoiding 3429 (40%) of 8648 antibiotic days prescribed. Collect the specimen from the actual site of infection without contaminating adjacent tissues and secretions. A health care professional may culture your urine to find out what type of bacteria is causing the infection. Nurse Salary: How Much Do Registered Nurses Make? The collection should end exactly 24 hours after it began, by having the patient empty his or her bladder, or catheter bag, and adding this specimen to the collection container. This test uses guaiac as reagent to detect the presence of occult blood (blood that appears from a nonspecific source, with obscure signs and symptoms), which is not visible. Midstream “Clean-Catch” Urine Specimen, 4.3. However, never let the patient stop such medication without consulting the physician. Discuss the test and the procedure with the patient. 1. The following could affect the hospital’s reimbursement under recent healthcare reform laws and regulations: Specimen collection is also key to patient’s satisfaction and poor collection practice can lead to: Poor specimen collection may also affect nurses professionally and personally by: A throat swab culture is a laboratory diagnostic test that evaluates for the presence of a bacterial or fungal infection in the throat. See Chapter 8 for the nursing implications for antibiotic therapy. For cystitis, nitrofurantoin or trimethoprim/sulfamethoxazole (TMP/SMX) is preferred. ACTIVE LEARNING TEMPLATES CONSIDERATIONS Nursing Interventions (pre, intra, post) Preparation 1. Uncap the container but avoid touching the inside to ensure that it’s sterile. •Collecting a Sterile Urine Specimen Two methods •Insert a straight catheter into the urinary bladder and remove urine. Remove dentures, if he has them. Allow patient to wait one to two weeks after her first missed period to get the most accurate results. With regard to an infant patient, place the diaper in a leakproof bag, label it, and take the diaper and request form to the lab as soon as possible. He earned his license to practice as a registered nurse during the same year. TMP/SMX for empiric use, however, is often limited by antimicrobial resistance. These infections can include strep throat, pneumonia, tonsillitis, whooping cough, and meningitis. Place the cotton-tipped applicator into the culture tube immediately. The midstream urine is considered to be bladder and kidney washings; the portion that the physician wants tested. Avoid mixing urine or regular toilet paper into the sample. Urinalysisis an extremely valuable tool for diagnosis and screening. Drink liberal amounts of fluids daily to flush out bacteria. Ten to 15 ml of sputum is typically needed for laboratory analysis. The clean-catch urine method is used to prevent germs from the penis or vagina from getting into a urine sample. Urine HCG tests are a common method of determining if a woman is pregnant. Wear gloves when handling any bodily discharge. Refrigerate the specimen and keep it cool until you can get it to your health care provider. Identifies causuative organisms in suspected infections of the kidney, ureter, bladder, and urethra This method allows a specimen, which is not contaminated from external sources to be obtained without catheterization. Use appropriate transport media such as anaerobic transport vials, culturette for bacterial culture, and the like. A delay in examining the specimen may cause a false result when bacterial determinations are to be made. Collect the specimen and unclamp the tubing. INTERVENTION  Assess for changes in usual voiding pattern. HEALTHLAB. Urinary Retention Care Plan Nursing interventions and rationales. Gently mix the blood with the solution in both bottles. •Obtain a specimen from the port of an indwelling catheter using sterile technique. Supplies and equipment required to collect a sputum specimen are: To prepare your patient, have him drink enough fluids on the night before the test, provided that he’s not on a fluid restriction. Doing so could kill bacteria in the sputum, rendering it useless. The supplies and equipment required to obtain a sample for throat culture are: 10. Midstream “clean-catch” urine collection is the most common method of obtaining urine specimens from adults, particularly men. The combination of grossly elevated urine glucose and ketones is also considered significant. A 24-hour urine collection is noninvasive (the skin is not pierced). Remove the syringe and needle while applying pressure to the venipuncture site with the cotton ball or gauze pad. Instruct the patient to void directly into a clean, dry container. This hormone can be detected in small amounts in both the urine and the blood of a pregnant woman as early as 10 days after conception. It is one way of knowing about the patient’s health status by identifying pathogens and analyzing urine, blood, sputum, and feces. Among patients with discontinued antibiotics, none was diagnosed with a UTI within 14 days of the initial urgent care encounter. Don gloves and goggles. Avoid bath tubs. Label the specimen container with patient identifying information, and send to the lab immediately. During the intervention, significant reductions in the urine culture and positive culture rates were observed (P = .014). Duplicated specimen collections and re-testing, Decreased ability to provide up-to-date, proper patient care, Unnecessary repeated specimen collection and patient dissatisfaction, Sterile cotton-tipped applicator specimen collection tip (culturette). A urine culture C& Sis ordered. At 7:00 am the next morning, void and add the urine to the collection container. Inject 5 cc of blood into the anaerobic bottle, not allowing air to enter the bottle. Replace the needle on the syringe with another sterile needle. Luckily. 25 N Winfield Road Winfield IL 60190 Phone: 630 933-2633 Fax: 630 933-5292. He wants to guide the next generation of nurses to achieve their goals and empower the nursing profession. Consumption of certain foods, such as beets or asparagus can impart a characteristic odor to urine. It is not necessary to keep the specimen sterile because the gastrointestinal tract is not sterile. 4. [ 1, 2] However, nurses' knowledge of … urine (except in neutropenic patients) + Positive urine culture (bacterial growth in urine culture) 1. Urine testing or urinalysis is a valuable tool to screen an patient and diagnose their health status. Discuss that this is done to detect the presence or absence of infecting organisms and, therefore, must be free from contaminating matter that may be present on the external genital areas. Instruct the patient to continue to keep the collection container refrigerated until transfer to laboratory. Frail, elderly nursing home residents are often unable to provide midstream voided urine specimens for diagnostic testing. It is done to isolate and identify any pathogens, which may be medium. Media:- nutritive agar plate Method:-Place a […] What are the recommended nursing interventions when phlebitis is noted? 1. It has been a useful tool of diagnosis since the earliest days of medicine. Record the amount, consistency, and color of the sputum collected, as well as the time and date in the nursing notes. Label the specimen properly and fill out  test request form completely. Throat swab culture is done to detect the presence of organisms in the throat that could cause infection. The additional intake will further increase sputum production overnight and assure that you’ll get a good sample. Wanting to reach a bigger audience in teaching, he is now a writer and contributor for Nurseslabs since 2012 while working part-time as a nurse instructor. A sputum specimen is a sample of material expelled from the respiratory passages taken for laboratory analysis to determine the presence of pathogens. With the use of a tongue blade, transfer a portion of the feces to the specimen container. Urine is formed in the kidneys and, through glomerular filtration, tubular reabsorption and tubular secretion, is how the body gets rid of its natural waste products (Marieb and Hoehn, 2010). The outcome of treatment for UTI is determined by follow-up urinalysis and culture. Lessen transport time and maintain an appropriate environment between collection of specimens and delivery to the laboratory. A sample of urine collected at any time of the day. It looks like your browser needs an update. However, it can be difficult to keep urine away from the stool sample. •The patient voids, and catheterization is performed A "clean-catch" urine sample is necessary to assure accurate results. This type of sample may be used to detect the presence of various substances in the urine at one particular point in the day. Urine cultures should be reserved for patients likely to have complicated UTIs, patients failing initial anti‐microbial therapy, patients with atypical symptoms, and patients with upper UTIs, including acute pyelonephritis. It provides valuable information about hydration, renal and urinary tracts, liver disease, diabetes mellitus and urinary-tract infections. Have the patient sit comfortably either on bed or chair while explaining the procedure. Patient Instructions for the Collection of Urine for Urinalysis and/or Culture and susceptibility studies. Not Treating Asymptomatic Bacteriuria It can confirm the presence of harmful bacteria.  Instruct patient regarding reason for symptoms. The midstream urine is considered to be bladder and kidney washings; the portion that the physician wants tested. Label the culture tube with the patient’s name, SSN, and ward number if applicable. During an invasive collection, technique urine is contaminated with a normal flora of urethra for this urine culture the quantitative estimation of colony count is utilized to deal with the infection. On day 2, urinate into the container when you get up in the morning. Gil Wayne graduated in 2008 with a bachelor of science in nursing. Urine culture. Once you’ve collected the specimen, securely cap the container. You have entered an incorrect email address! Pigments and other compounds in certain foods and medications may change the color of urine. PYELONEPHRITIS: Fever and flank pain 3. Note that the specimen was collected. A bacterial count of 100,000 or greater per mL of urine, What are some examples of infections from bacteria found in a positive urine culture, Verify orders, identify patient, explain procedure and purpose to the patient, and collect specimen, Label the specimen container, place in a biohazard bag, collect requisition, and transport to the lab. Allow the patient to tilt his head back and ask him to say “Ahhh.”. Use the same cleaning methods and the plastic bags for collecting the urine. Assist the patient to comfortable position. Ask him to tell you when he feels the urge to have a bowel movement. Swab the tonsillar areas from side to side and make sure to include any inflamed or purulent sites. Draw at least 10 cc of blood from the patient (5 cc is needed for each bottle). For the clean-catch urine culture, obtain povidone-iodine wipes and a sterile specimen container. Ask for someone within the team to assist if the patient is uncooperative. Example: Begin collecting the 24-hour urine specimen by voiding at 7:00 am and discarding the urine. This type of specimen is most convenient to obtain. The test is relatively simple for the patient and involves a simple blood draw. And prepare himself when he feels the urge to have a bowel movement. Fill out the laboratory request form completely, label the specimen container with patient identifying information, and send to the lab immediately. or sepsis associated with UTI. Refrain from touching the tongue, cheeks, or teeth with the applicator, due to possible contamination with oral bacteria. The patient may be asked to stop taking certain medications that may alter the blood culture results. 4. With this, nurses should be knowledgeable enough about the hospital’s policy and procedures for specimen collection. Assess the client’s previous elimination pattern and note for presence of frequency, urgency, burning sensation, size and force of urinary stream. How would the nurse obtain a urine C& S from an indweling urinary catheter catheter? One of the many responsibilities assigned to us, as nurses, is to collect and label specimen for analysis and to ensure their delivery to the lab. Urine cultures reveal bacteria Indwelling catheters – assess and clean around meatus and monitor output closely – CAUTI (Catheter-Associated UTI – sentinel event) Learn vocabulary, terms, and more with flashcards, games, and other study tools. Instruct the patient to void a small amount of urine into the toilet to rinse out the urethra, void the midstream urine into the specimen cup, and the last of the stream into the toilet. By following the directions listed Nurseslabs – NCLEX Practice Questions, Nursing Study Guides, and Care Plans, Nurses’ Guide to Specimen Collection, Preparation, and Handling Procedures, 3.1. Always observe proper hand hygiene prior to the test. Obtain povidone-iodine solution, sterile towels, and an appropriate sterile tray (paracentesis, thoracentesis, arthrocentesis, bone marrow aspiration). Shower rather than bathe in a tub because bacteria in the bath water may enter the urethra. A specimen will be rejected by the laboratory if it contains excessive numbers of epithelial cells from the mouth or throat or if it fails to show adequate numbers of neutrophils on gram staining.  Tell patient to observe urine … Tell the patient that he needs to collect a sample from his bowel by placing a sheet of plastic wrap or paper loosely across the toilet bowl to catch the stool or he can use a dry container to collect the stool. To whom can the nurse delegate the task of taking the urine sample to the labatory? Record any difficulties the patient had or if the urine had an abnormal appearance. In The Most Common Inpatient Problems in Internal Medicine, 2007. Explain to the patient that this kind of urine collection involves first voiding approximately one half of the urine into the toilet, urinal, or bedpan, then collecting a portion of midstream urine in a sterile container, and allowing the rest to be pass into the toilet. Observe proper hand hygiene and gather equipment. Stools specimen are often tested for blood. Urine Culture. If you can’t obtain the sample before the patient has breakfast, though, wait at least an hour after he’s eaten before trying. Nurseslabs.com is an education and nursing lifestyle website geared towards helping student nurses and registered nurses with knowledge for the progression and empowerment of their nursing careers. For instance, the presence of group A streptococcus bacteria in your throat is a key sign that you may have strep throat. Expanded cost-per-Medicare beneficiary due to repeated specimen collections and unnecessary treatment. Poor specimen quality can affect key quality reporting requirements and metrics, Decreases patient satisfaction from improper collection technique. Bedpan should be provided when the patient is ready. Collect ample amount of sample by using appropriate collection devices such as sterile, leak-proof specimen containers. A pregnancy test measures a hormone in the body called human chorionic gonadotropin (HCG), a hormone produced during pregnancy. It is cheap and simple to perform and can indicate a variety of disorders and diseases (Wells, 1997). The sample is then taken to the laboratory for culture. If no dangerous bacteria are present in the stool culture but symptoms still exist, other explanations like irritable bowel syndrome, a parasitic infection, or other diagnosis can be explored. 6. And knowing the proper way of gathering specimen is necessary for self-protection and to prevent the spread of disease. His goal is to expand his horizon in nursing-related topics. 24-hour urine sample is needed. The patient may need to stop taking medicines that can interfere with the test. This will complete the specimen collection. Residual urine •This is urine left in the bladder after voiding. A 24-hour urine collection is performed by collecting a person’s urine in a special container over a 24-hour period. Generally, the patient will be given one or more containers to collect and store urine over a 24-hour time period. Inform the patient to not mix the sample with urine. 3. Cranberry juice or vitamin C tablets may be given to increase urine acidity.  Instruct patient about good perineal care and cleansing after each bowel movement. If the patient has trouble bringing up secretions, however, have him breathe into the nebulizer and try again. Label the bottle with patient identifying information, the date, and time the collection begins and ends. Milk products and citrus fruits, which make urine more alkaline, may be limited. At a 90-degree angle, insert a needle with a large syringe, depending on how much urine is required for the specific test. The amount and kinds of waste in the urine make it lighter or darker. There is no discomfort when the test is done since it only involves normal bowel function. Close the slots and put the name of the patient and the date on the test kit. CATHETER-ASSOCIATED UTI: Fever and suprapubic tenderness Urinary Tract Infections Proud to be a NURSE ANTIBIOTIC STEWARD 2 It is important to follow the “clean-catch” protocol in order to have accurate results from an uncontaminated sample. ¥ All care sites within our hospital system implemented the Afterward, tell the patient to collect the rest of his urine in the special bottle for the next 24 hours, storing it in a cool environment.