Sputum Test for Culture & Sensitivity

Description: This test indicates the type and number of organisms in the specimen and the antibiotics to which the organisms are susceptible. Purpose: This test is intended for patients with respiratory infections. Indication: Support for diagnosing the cause of respiratory infection as indicated by the presence or absence of organisms in culture Confirmatory diagnosis of tuberculosis Monitoring for response to treatment for respiratory infections, especially tuberculosis Identification of antibiotics to which the cultured organism is sensitive

Preparation: 1. 2. 3. 4. Assist in providing extra fluids, unless contraindicated, and proper humidification. Assist with mouth care as needed. Provide sputum collection containers. If the specimen is to be obtained by tracheal suctioning, it is recommended that oxygen be administered for 20 to 30 minutes before the procedure. 5. Hyperventilation with 100% O2 should be performed before and after suctioning. Procedure: 1. 2. 3. 4. The sample is taken immediately after the patient awakens from sleep. The patient rinses his/her mouth with water. The patient coughs deeply to produce the sputum. If the patient is unable to produce the sputum, the healthcare provider may loosen sputum in the lungs by using a mist inhaler. If this does not produce the sputum, then the health care provider collects the sputum via suctioning. 5. The sample is then placed in a culture dish in an environment conducive to growing microorganisms. 6. After 3 days, tests are performed to identify the microorganism. 7. Medication is applied to a portion of the culture to determine which medication kills the microorganism. Nursing responsibilities: Before the procedure: 1. Explain to the client a. That results are most reliable if the specimen is obtained in the morning upon arising, after secretions have accumulated overnight. b. That a sample of secretions from deep in the respiratory tract, not saliva or postnasal drainage, is needed. c. The methods by which the specimen will be obtained. d. That increasing fluid intake before retiring for the night aids in liquefying secretions and may make them easier to expectorate. e. That humidifying inspired air also helps to liquefy secretions. f. That, if feasible, the client should brush the teeth or rinse the mouth before obtaining the specimen to avoid excessive contamination of the specimen with organisms normally found in the mouth. g. Proper handling of the container and specimen, if the client is to obtain the specimen independently. h. The number of samples to be obtained, because it may be necessary to analyze more than one sample for accurate diagnosis.

During the procedure: 1. The nurse should wear the following when obtaining samples: a. Gloves b. Face mask c. If possible, glasses or goggles After the procedure: 1. Provide a cool beverage to aid in relieving throat irritation caused by coughing and suctioning. 2. For specimen obtained by endotracheal tube or tracheostomy, hyperoxygenate the client after the procedure according to usual protocols. Additional suctioning may be necessary to clear secretions raised during suctioning to obtain the specimen. Findings: Clinical significance normal values/findings The client should be informed that culture results for the more common pathogenic microorganisms can be obtained in 24 to 48 hours and that sensitivity results can cause a change in antimicrobial therapy. Normal respiratory flora include: 1. Moraxella catarrhalis 2. Candida albicans 3. Diphtheroids 4. -hemolytic streptococci 5. Some staphylococci

Evaluation: 1. The characteristics (color, consistency, and volume) of the sample should be noted and documented. 2. Assess the clients color and respiratory rate, and administer supplemental oxygen as necessary. Source: Cavanaugh, B. R. (2003). Sputum Analysis. In D. Blodgett (Ed.), Nurses Manual of Laboratory and Diagnostic Tests (4th Ed.) [pp. 269-272]. Philadelphia, PA: F.A. Davis Company.

Acid-Fast Bacillus Smear and Culture

Description: This test aids in the early detection of the organism and timely initiation of antituberculosis therapy. Purpose: This test is used primarily to identify tubercle bacilli (Mycobacterium tuberculosis) Indication: Suspected pulmonary tuberculosis Monitoring for response to treatment for pulmonary tuberculosis

Preparation: The preparation for obtaining the specimen are the same as those described in Sputum Test for Culture & Sensitivity. Procedure: The procedure for obtaining the specimen are the same as those described in Sputum Test for Culture & Sensitivity. Nursing responsibilities: Before the procedure: The nursing responsibilities before the procedure are the same as those described in Sputum Test for Culture and Sensitivity. During the procedure: The nursing responsibilities during the procedure are the same as those described in Sputum Test for Culture and Sensitivity.

After the procedure: If tuberculosis is suspected, the client may be placed on AFB or respiratory isolation, pending AFB smear results.

Findings: Clinical significance normal values/findings The client should be informed that it may be several weeks before culture results are available. Negative for AFB

Evaluation: The evaluation after obtaining the specimen are the same as those described in Sputum Test for Culture & Sensitivity. Source: Cavanaugh, B. R. (2003). Sputum Analysis. In D. Blodgett (Ed.), Nurses Manual of Laboratory and Diagnostic Tests (4th Ed.) [pp. 269-272]. Philadelphia, PA: F.A. Davis Company.

Gram-Staining
Description: This staining technique involves smearing a small amount of sputum on a slide and then exposing it to gentian or crystal violet, iodine, alcohol, and safranine, a red dye. Purpose: This technique allows for morphological examination of the cells contained in the specimen and differentiates any bacteria present into either gram-positive organisms, which retain the iodine stain, or gram-negative organisms, which do not retain the iodine stain but can be counterstained with safranine. Indication: Determination of types of leukocytes present in sputum (e.g., neutrophils indicating infection and eosinophils seen in asthma) Differentiation of gram-positive from gram-negative bacteria in respiratory infections

Preparation: The preparation for obtaining the specimen are the same as those described in Sputum Test for Culture & Sensitivity. Procedure: The procedure for obtaining the specimen are the same as those described in Sputum Test for Culture & Sensitivity. Nursing responsibilities: Before the procedure: The nursing responsibilities before the procedure are the same as those described in Sputum Test for Culture and Sensitivity. During the procedure: The nursing responsibilities during the procedure are the same as those described in Sputum Test for Culture and Sensitivity. After the procedure: The nursing responsibilities after the procedure are the same as those described in Sputum Test for Culture and Sensitivity. Findings: Clinical significance normal values/findings Normal sputum contains leukocytes, alveolar macrophages, and a few squamous epithelial cells

Evaluation: The evaluation after obtaining the specimen are the same as those described in Sputum Test for Culture & Sensitivity. Source: Cavanaugh, B. R. (2003). Sputum Analysis. In D. Blodgett (Ed.), Nurses Manual of Laboratory and Diagnostic Tests (4th Ed.) [pp. 269-272]. Philadelphia, PA: F.A. Davis Company.

Nose/Throat Test for Culture & Sensitivity

Description: A tissue sample of the infected area is taken and places in an environment conducive to the growth of microorganisms for 3 days. The tissue sample is then examined to identify the presence and the type of microorganism. Once the microorganism is identified, a sensitivity test is usually performed to determine the medication that kills the microorganism. Purpose: This test is ordered when the patient has throat infection and to identify suspected infections or carrier states caused by: S. aureus Group A streptococci N. gonorrheae C. diphtheria B. pertussis C. albicans H. influenzae

Indication: Diagnose upper respiratory viral infections causing bronchitis, pharyngitis, croup, and influenza. Diagnose bacterial infections such as tonsillitis, diphtheria, thrush, gonorrhea, pertussis, or streptococcal throat infection. Determine effective antimicrobial therapy specific to identified microorganism and sensitivity.

Preparation: Informing the client or caregiver, or both of the reason for the procedure and the method of obtaining the specimen.

Procedure: 1. The client is placed in a sitting position. 2. The healthcare provider swabs the throat with a sterile swab to collect a tissue sample. More than one sample might be taken. Nasal culture: a. Gently raise the tip of the nose b. Insert a flexible swab into the nares and rotate it in place against the sides c. Then remove the swab and place it in the appropriate medium to be transported to the laboratory for immediate examination. Throat culture: a. Tilt the head slightly backward b. Depress the tongue with a tongue blade c. Insert the swab through the mouth to the pharyngeal and tonsillar area without touching any part of the oral cavity. d. Rub the areas, including any lesions, inflammations, or exudate, with the swab. e. Remove the swab and introduce into the medium. f. Transport the specimen to the laboratory for immediate testing. 3. The sterile swab is place in a culture tube and sent to the laboratory. 4. The sample is then placed in a culture dish in an environment conducive to growing microorganism. 5. After 3 days, tests are performed to identify the microorganism. 6. Medication is applied to a portion of the culture to determine which medication kills the microorganism.

Nursing responsibilities: Before the procedure: 1. A history should include information regarding the presenting signs and symptoms, past immunizations, and antimicrobial therapy administered before the test. During the procedure: 1. The nurse should wear the following when obtaining samples: a. Gloves b. Face mask c. If possible, glasses or goggles After the procedure: 1. Resumption of the treatment regimen for signs and symptoms of upper respiratory infection. 2. Provide comfort measures such as antiseptic gargles; warm most applications; and inhalants. Findings: Clinical significance normal values/findings Negative, no growth of pathogens

Evaluation: 1. Assess the clients reaction to the procedure. Source: Cavanaugh, B. R. (2003). Culture and Sensitivity Tests. In D. Blodgett (Ed.), Nurses Manual of Laboratory and Diagnostic Tests (4th Ed.) [pp. 355-356]. Philadelphia, PA: F.A. Davis Company.

Fagerstrm Test for Nicotine Dependence

Description: This is a method for determining the physical nicotine addiction by smokers. Purpose: This test can read out the chances for successful smoking cessation. Indication: Early morning smokers >10 cigarettes consumed daily Multiple, unsuccessful attempts for abstinence in the past

Procedure: The test consists of six questions, the answers leave a categorization of nicotine dependence. Accordingly, the following dependency levels are distinguished: low dependence (0 to 2 points) average response (3-5 points) strong dependence (6-7 points) very strong dependence (8-10 points)

1) How soon after you wake up do you smoke your first cigarette? after 60 minutes (0 points) 31-60 minutes (1 point) 6-30 minutes (2 points) within 5 minutes (3 points)

2) Do you find it difficult to refrain from smoking in places where it is forbidden? No (0 points) Yes (1 point)

3) Which cigarette would you hate most to give up? The first in the morning (1 point) Any other (0 points)

4) How many cigarettes per day do you smoke? 10 or less (0 points) 11-20 (1 point) 21-30 (2 point) 31 or more (3 point)

5) Do you smoke more frequently during the first hours after awakening than during the rest of the day? No (0 points) Yes (1 point)

6) Do you smoke even if you are so ill that you are in bed most of the day? No (0 points) Yes (1 point)

Source: Fagerstrm Test (http://www.stop-simply.de/raucherberatung/fagerstroem-test.html). Accessed on June 16, 2013, from Stop-Simply.de.