Stool, Gastric, Sputum and Throat Cultures

1. Stool, Gastric, Sputum and Throat Cultures PN 103

2. 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?

3. 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

4. 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

5. Stool cultures • http://www.youtube.com/watch?v=oFQo0E3N1F8

6. 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

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

8. Hemoccult stool • Testing is usually done on the nursing unit and results are called into the HCP http://www.youtube.com/watch?v=IGPVlo2bNmQ

9. 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

11. 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

12. 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

13. 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

14. 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

16. Constipation/Diarrhea • Constipation and diarrhea are usually the main signs of a GI disturbance -usually when a stool sample is ordered What is constipation? http://www.youtube.com/watch?v=BmVTO99QXFc What causes constipation? http://www.youtube.com/watch?v=nBGqh0Qv3_c

17. Constipation/Diarrhea • What is diarrhea? • http://www.youtube.com/watch?v=nFLYlWL-aAE • What causes diarrhea? • http://www.youtube.com/watch?v=3AFDrfG0B9s

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

19. 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

20. 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

21. 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

22. Throat culture • See FON, pg. 506 • http://www.youtube.com/watch?v=0pzI0ZgcC3M • Rapid strep test • http://www.youtube.com/watch?v=Hl6vItGt4qQ

23. 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

24. 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

25. 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

26. 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