Stool, Gastric, Sputum and Throat CulturesPN 103

Stool cultures What are the reasons to obtain a stool

culture? How is a culture obtained? What does the nurse do with the culture once it is obtained? What is the pathophysiology of

constipation and diarrhea?

Stool cultures Stool cultures are obtained after an

MD/NP order is given secondary to signs and symptoms of an abnormal gastrointestinal process

Detects the presence of bacteria, parasites and/or bleeding

-observed for stool amount, color, consistency and presence of fats

Stool cultures See FON, pps.499-500 -Inform the patient that a stools specimen is needed -Carry out the collection in a manner that will not cause stress or make the patient feel hurried or embarrassed -When the specimen is obtained, correctly label the container for the proper test -if a stool specimen is for ova and parasites (o & p),obtain an appropriate container with a special solution

Stool cultures http://

www.youtube.com/watch?v=oFQo0E3N1F8

Hemoccult stool Blood in urine or feces is abnormal Bright red blood in the stool -blood is fresh and is from the lower GI system, rectum or anus Black, tarry and malodorous stool -old, blood and is from the esophagus or upper GI system

Hemoccult stool Occult blood -blood that is not visible and can only be detected microscopically

Hemoccult stool Testing is usually done on the nursing

unit and results are called into the HCP http://www.youtube.com/watch?v=IGPVlo2bNmQ

Hemoccult stool Black Melena, Blood in stool (usually from upper GI tract)

Esophageal Variances, Mallory-Weiss tear, Bleeding stomach or duodenal ulcer, Gastritis, Trauma, Bowel ischemia, Vascular malformation

Black licorice, iron, lead, bismuth medicines (Pepto-Bismol), blueberries • Cleanse your liver & colon • Reduce aspirin/Ibuprofen • Reduce alcohol use

Tarry Blood in stool which has been exposed to digestion Esophageal Variances, Mallory-Weiss tear, Bleeding stomach or duodenal ulcer, Gastritis, Trauma, Bowel

ischemia, Vascular malformation Black licorice, iron, lead, bismuth medicines (Pepto-Bismol), blueberries, exposed to digestive juices •

Cleanse your liver & colon • Reduce aspirin/Ibuprofen • Reduce alcohol use

Hemoccult stool Maroon Hematochezi, Blood in stool (usually from lower GI tract)

Diverticulitis, Vascular malformation, Intestinal Infection (including parasites), Irritable Bowel Syndrome (IBS), Tumors, Polyps, Colon Cancer, Ulcers, Gastritis, Esophageal Variances

Red colored gelatin, popsicles, Kool-Aid, tomato juice, soup, beets. • Cleanse your liver & colon

• Reduce aspirin/Ibuprofen • Reduce alcohol use

Red Blood in stool from very late in GI tract

Hemorrhoids, Anal fissures, Ulcers, Polyps, Red colored gelatin, popsicles, Kool-Aid, tomato juice, soup, beets. • Cleanse your liver & colon

• Reduce aspirin/Ibuprofen • Reduce alcohol use

Hemoccult stool Orange

Transit time of stool is too fast, not sufficiently exposed to bile during digestion.

Low bile salt production, Consumption of medications containing beta-carotene or aluminum hydroxide, obstructed or diseased liver

Carrots, Sweet potatoes, kale, spinach, turnip greens, winter squash, collard greens, cilantro, thyme, artificial orange food coloring • Cleanse your liver & colon

• Reduce aspirin/Ibuprofen • Reduce alcohol use

Yellow

Possible malfunction of digestive system

Gilbert's Syndrome, malabsorption, parasite infection, pancreatic cancer Carrots, Sweet potatoes, artificial yellow food coloring • Digestive Enzymes • Cleanse your liver & colon

• Reduce aspirin/Ibuprofen • Reduce alcohol use

Hemoccult stool Green

Transit time of stool is too fast, not sufficiently exposed to bile during digestion

Low bile salt production, Obstructed or diseased liver Green leafy vegetables, dark purple/green food coloring, foods containing chlorophyll • Digestive Enzymes • Cleanse your liver & colon

• Reduce aspirin/Ibuprofen • Reduce alcohol use

Clay

Stool is not being properly exposed to bile during digestion.

Malabsorption, Hepatitis, Gallbladder disorders High amounts of fatty foods • Digestive Enzymes • Cleanse your liver & colon • Reduce aspirin/Ibuprofen • Reduce alcohol use

Stool collection for ova and parasites (O & P) Microscopic examination for parasites -If specimen is not refrigerated, it must be tested in the laboratory 3 hours after the specimen was obtained -If the specimen is able to be refrigerated or has a preservative in the collection bottle, it can be tested 2-3 days after it is collected

Constipation/Diarrhea Constipation and diarrhea are usually

the main signs of a GI disturbance -usually when a stool sample is orderedWhat is constipation?http://www.youtube.com/watch?v=BmVTO99QXFcWhat causes constipation?http://www.youtube.com/watch?v=nBGqh0Qv3_c

Constipation/Diarrhea What is diarrhea? http://

www.youtube.com/watch?v=nFLYlWL-aAE

What causes diarrhea? http://

www.youtube.com/watch?v=3AFDrfG0B9s

Gastroccult testing Gastric secretion testing for blood -esophagus, stomach, small or large intestine -can either be emesis or obtained via nasal-gastric (N/G) suctioningSee FON pps. 501-502, Skill 19-8

Throat culture Obtained if a patient has

signs/symptoms of an upper respiratory or sinus infection

Always obtain cultures before an antibiotic is started

-If the patient is already on antibiotics before the culture is taken, document this on the lab requisition slip

Throat culture The patient may experience discomfort

while having the culture obtained secondary toe the heightened sensitivity of the mucosal membranes

- may cause gagging -collect a throat culture at least 1 hour after eating to reduce the risk of vomiting

Throat culture Assess the condition of the of the oral

cavity/posterior pharynx Assess for complaints of a sore throat Assess for systemic indications of

infection, including fever, chills and malaise

Throat culture See FON, pg. 506 http://

www.youtube.com/watch?v=0pzI0ZgcC3M

Rapid strep test http://

www.youtube.com/watch?v=Hl6vItGt4qQ

Sputum culture Purpose is to obtain sputum from the lung -sputum contains mucous, cellular debris, microorganisms and occasionally blood or pus Must be obtained from deep in the bronchial tree -not oral mucous/saliva -possible contamination of food

Sputum culture Early morning is the best time for collection

secondary to the patient’s respiratory passages have not cleared.

Tests include: -culture and sensitivity (C & S) -culture bacteria -cytology -abnormal cell structure/pathology -acid fast bacilli (AFB) -tuberculosis

Sputum culture Patient may require to be suctioned if

unable to expectorate Suctioning can sometimes provoke

coughing which has the potential to induce vomiting and constriction of the pharyngeal, laryngeal or bronchial muscles

-may also stimulate the vagal nerve fibers which can result in cardiac dysrhythmias and increased intracranial pressure

Sputum culture Explain the procedure to the patient Instruct the patient on drinking extra

fluids the night before the test to help loosen up secretions and make it easier for the patient to expectorate for the specimen

See FON pg. 503 http://

www.youtube.com/watch?v=Nyqr7_JmBok