B.

P KOIRALA INSTITUTE OF HEALTH

SCIENCES
COLLEGE OF NURSING
DHARAN, SUNSARI.

LESSON PLAN ON
“Collection of Specimen: Urine, Stool and Sputum”

Submitted To: Submitted By:

Mrs. Sunina Adhikari Sugam Pokhrel

Senior Instructor B.Sc Nursing 4 th year

Department of Maternal Health Nursing Batch 2018

INTRODUCTION OF SESSION

Subject: Basic nursing concepts, skills and attitude

Unit 15: Assisting for Diagnostic Procedure

Topic: “Collection of specimen: urine,stool,sputum”

Venue: Classroom of B.sc Nursing 1st year

Date: 25-01-2023 Time: 11am Duration: 1 hour

Number of participants: 40 Level of participants: B.Sc. Nursing 1st year students

Language: English and Nepali

Name of Supervisor: Ms. Sunaina Adhikari, Senior Instructor

Name of Student Teacher: Sugam Pokhrel, B.Sc Nursing 4th year

GENERAL OBJECTIVES

At the end of this teaching-learning session, B.Sc nursing 1 st year students will be able to explain
about collection of specimen: urine, stool and sputum.

SPECIFIC OBJECTIVES

At the end of this teaching-learning session, B.Sc Nursing 1st year students will be able to:

 define specimen and specimen collection

 state the characteristics of normal urine
 list out the purposes of urine specimen collection
 explain the techniques of collecting urine specimen for routine examination
 describe the techniques of collecting midstream urine specimen for culture
 explain the techniques of collecting urine specimen from catheter
 explain the techniques of collecting 24 hour urine specimen
 state the characteristics of normal stool
 list out the purposes of stool specimen collection
 describe the techniques for stool specimen collection
 state the characteristics of sputum
 list out the purposes of sputum specimen collection
 describe the techniques for sputum specimen collection.
S.N. Specific Objectives Contents Time Method Media Evaluation

Self-Introduction 5 mins Brain PowerPoint What do you

Topic introduction storming presentation + understand by this
General objective Meta card picture?
Pretesting

At the end of this

teaching-learning session
the students will be able
to: Definition of specimen Interactive PowerPoint What do you
and specimen Teaching presentation understand by
1. define specimen and collection 3 mins specimen and
specimen collection specimen collection?

2. state the characteristics of Characteristics of 2 mins Interactive PowerPoint What are the
normal urine normal urine teaching presentation + characteristics of
Meta card normal urine?

3. list out the purposes of Purposes of urine 3 mins Interactive PowerPoint What are the purposes
urine specimen collection specimen collection teaching presentation of urine specimen
collection?

4. explain the techniques of Techniques of 5 mins Interactive PowerPoint How do you collect
collecting urine specimen collecting urine teaching presentation + urine specimen for
for routine examination specimen for routine Real objects routine examination?
examination

5. describe the techniques of Techniques of 6 mins Interactive PowerPoint How do you collect
collecting midstream urine collecting midstream teaching presentation + mid-stream urine
specimen for culture urine specimen for Real objects specimen for culture?
culture

6. explain the techniques of Techniques of 6 mins Interactive PowerPoint How do you collect
collecting urine specimen collecting urine teaching presentation + urine specimen from
from catheter specimen from catheter Video catheter?

7. explain the techniques of Techniques of 5 mins Interactive PowerPoint How do you collect 24
collecting 24 hour urine collecting 24 hour urine teaching presentation hr. urine specimen?
specimen specimen
DEFINITION
Specimen

Any substance which is taken from body of a person for testing in the laboratory is called
specimen. For example: Blood, Urine, Stool, Sputum, etc.

Specimen collection

It is the process of obtaining tissue or fluids for laboratory analysis. It is often a first step in
determining diagnosis and treatment.

COLLECTION OF URINE SPECIMEN

NORMAL CHARACTERISTICS OF URINE

Volume: amount varies from 1000 to 2000ml. in 24 hour.

Specific Gravity: specific gravity ranging from 1.015 to 1.025

PH: The normal PH is about 6.0, with a range of 4.6 to 8

Composition: approximately 95% water and 4% solid which consists of urea and other
inorganic substances like sodium, chloride, potassium etc.

Color: Pale yellow/Straw colored

Odor: aromatic odor

PURPOSES OF URINE SPECIMEN COLLECTION

1) Urine RE/ME- To detect and measure the presence of abnormalities in urine such as red
blood cells, white blood cells, PH, specific gravity, epithelial cells, casts, glucose,
protein.
2) Urine Culture- To detect the micro-organisms in urine.
-To determine antibiotic sensitivity of the pathogens in the urine.
3) 24 hour Urine- To find amount of output in 24 hours

-To detect kidney, liver and cardiac condition.

-To find out the amount of different constituents the kidney excreting in a day.
TECHNIQUES OF COLLECTING URINE FOR ROUTINE
EXAMINATION
A sterile urine specimen is not required for a routine urinalysis.

Articles Required

A clean tray containing:

- Laboratory form
- Clean container with lead or cover (1)
- Bed pan or urinal (1): as required
- Disposable gloves (1pair)
- Labeling paper

Procedure

- Check physician’s order.

- Explain the procedure to the patient.
- Assemble the equipments and check the specimen form with client’s name, date and
content of urinalysis.
- Label the bottle or container with the date, client’s name, IP/ID number.
- Collect urine that the patient voids first in the morning because urine at this time is highly
concentrated.
- In case of ambulatory patients, ask patient to clean the genital areas, instruct patient to
pass the urine in a clean specimen container or bottle without spilling out.
- Care is taken to avoid contamination with feces. If woman is menstruating when a urine
sample is obtained, note this on a laboratory slip because Red blood cells may appear in
urine.
- In case of bed ridden patients, let the patient pass urine in a clean bed pan or urinals and
then to pour it in a clean specimen container or bottle without spilling them.
- Collect about 10-20ml of urine and cover it with lid.
- Wear gloves while handling urine.
- Send the specimen bottle or container to the laboratory immediately with the specimen
form. Do not leave urine standing at room temperature for a long period before sending it
to the laboratory because this may alter both appearance and chemistry of urine.
- Dispose used equipments or clean them. Remove gloves and perform hand hygiene.
- Document the procedure.
TECHNIQUES OF COLLECTING MIDSTREAM URINE SPECIMEN FOR
CULTURE
When the urine is collected for culture and sensitivity test, it should be free from contamination.
For this test usually midstream urine is taken or in some cases catheterization may be used.

Articles Required

A clean tray containing:

- Laboratory form
- Clean gloves (1 pair)
- Sterile culture bottle (wide mouthed) with level as required
- Bed pan if needed (1)

Procedure

- Check for physician’s order

- Explain the procedure to the patient.
- Assemble the equipment and check the specimen form with client’s name, date and
content.
- Label the bottle or container with the date, client’s name, IP number.
- Instruct the patient to clean the genital area with soap and water then rinse with water
alone.
- Open sterilized container and leave the cover facing inside up.
- Ask the patient to void and allow first urine to pass out because it helps to flush away any
organisms near the meatus because the findings may be inaccurate if these organisms
enter the specimen.
- Take sample of midstream urine in sterile container with wide mouth. Obtain about 30-
50ml at midstream urine.
- If the patient is bedridden, perform handwashing, put on gloves and let the patient void
first urine in bedpan and collect midstream urine into sterile container.
- Put bed pan after you collected enough sterile specimen.
- Close the container securely without touching inside of cover or cap.
- Send the specimen bottle or container to the laboratory immediately with the specimen
form.
- Dispose of used equipments or clean them.
- Remove gloves and perform hand hygiene.
- Document the procedure.
TECHNIQUES OF COLLECTING URINE SPECIMEN FROM
CATHETER
When it is necessary to collect a urine specimen from a patient with an indwelling catheter,
always obtain it from catheter itself. The specimen from drainage bag may not be fresh urine and
could result in inaccurate analysis.

Articles required

A clean tray containing:

- Clean gloves (1pair)

- A tube clamp (1)
- Kidney tray as required
- Sterile specimen collection container with lid
- Identification labels and laboratory requisition form

Procedure

- Check for physician’s order

- Explain the procedure to the patient.
- Assemble the equipment and check the specimen form with client’s name, date and
content.
- Label the bottle or container with the date, client’s name, IP/ID number.

- Wash hands thoroughly, wear gloves.

- Clamp drainage tube for about 15 to 30 minutes before obtaining sample.

- Pinch the catheter with one hand and disconnect the bladder drainage tube.

- Cover the distal end of drainage tube with a sterile gauge/cap, till procedure is over.

- Release the pinch and collect urine in the sterile container from urine drainage port.
Collect 30-50ml at midstream point of voiding. Remove the gauze and discard in a
kidney basin.

- Release clamp and reconnect tubing.

- Send specimen bottle immediately to the laboratory along with the lab request form.

- Dispose used equipments or clean them.

- Remove gloves and perform hand hygiene.

- Document the procedure.

TECHNIQUES OF COLLECTING 24HOUR URINE SPECIMEN
24 hour urine specimen collection means collection of urine specimen for a period of 24 hours
without any spillage or wastage.

Articles Required

- Clean container of not less than 3 liters capacity with label, and with lid/cover
- Kidney tray or urinal to collect urine at each voiding.
- Appropriate laboratory form, dully filled.
- Disposable gloves (1pair)
- Bed pan (1) if required
- Clean measuring jar (1)

Procedure

- Check the physician’s order.

- Explain to the patient, the purpose of procedure and that all urine for the full 24 hours
must be saved.
- Assemble the equipment and check the specimen form with client’s name, date and
content.
- Label the bottle or container with the date, client’s name, IP/ID number.
- Instruct the patient to void at the time set to begin the procedure e.g. at 6 am. discard this
specimen as it was secreted during night.
- Record in nurse’s notes the time when collection begin.
- Collect the final specimen at exactly the same time the patient voided 24 hours earlier
e.g. 6 am the following day.
- Wear gloves while handling urine.
- Measure total amount of urine and record it on the specimen form and nursing record.
- Send the container with urine to laboratory when the collection is over, with requisition
forms.
- Dispose used equipment or clean them.
- Remove gloves and wash hands.
- Record in the nurse’s notes time of completing the collection and dispatching the urine to
the lab.
COLLECTION OF STOOL SPECIMEN

CHARACTERISTICS OF NORMAL STOOL

Color: light to dark brown

Odor: pungent smell

Consistency: semisolid, soft

Frequency: 1-2 times/day

Composition: water 30%, remaining part consists of undigested food, enzymes, bacteria, mucin,
salts etc.

PURPOSES OF STOOL SPECIMEN COLLECTION

- To find the cause of diarrhoea, detecting parasites and knowing the cause of symptoms
affecting the gastrointestinal tract.
- To determine presence of blood, fat, mucus, etc.
- To identify specific pathogens.

TECHNIQUES OF COLLECTING STOOL SPECIMEN

Articles required

A tray containing

- Laboratory form
- Disposable gloves (1pair)
- Kidney Tray/Plastic bag (1)
- Wooden spatula/Stick (1-2)
- Closed specimen container as ordered
- Bed pan (1) if required

Procedure

- Check the physician’s order.

- Explain procedure to the patient.
- Assemble equipment and label the container.
- Perform hand hygiene and put on gloves.
- Maintain privacy and give the bedpan when s/he has desire to defecate.
 - Allow client to pass feces into clean dry bedpan.
- Instruct patient not to contaminate stool specimen with urine, because the laboratory
study may be inaccurate if the stool contains urine.
- Remove bedpan and assist client to clean if needed.
- Collect stool specimens in a clean dry container with a clean spatula/stick for routine
stool test and with a sterile spatula into a culture container. (Usually, 1inch i.e. 2.5cm of
formed stool or 15-30mL of liquid stool is sufficient)
- Also take care not to contaminate the outside of specimen container with stool.
- Cover the container tightly.
- Wrap the spatula in wastepaper and discard appropriately.
- Send specimen to the laboratory immediately.
- Replace the equipment after cleaning, remove and discard gloves and perform hand
hygiene.
- Document the procedure.

COLLECTION OF SPUTUM SPECIMEN

CHARACTERISTICS OF SPUTUM
Sputum is a mixture of saliva and mucus coughed up from the respiratory tract, typically as a
result of infection or other disease. Sputum is formed when there are disorders of lungs,bronchi
and trachea.

Color: Normally it is colorless

Odor: Odorless

PURPOSES OF SPUTUM SPECIMEN COLLECTION

- To diagnose respiratory infections
- To assess the efficacy of treatment to disease such as Tuberculosis

TECHNIQUES OF COLLECTING SPUTUM SPECIMEN

Articles Required

A tray containing

- Laboratory form
- Disposable gloves (1pair)
 - Sterile covered sputum container
- Sputum mug or cup (1)
- Kidney tray (1)
- Tissue paper as required

Procedure

- Check the physician’s order.

- Assemble equipment and label the container.
- Perform hand hygiene and put on gloves.

- It is best to obtain sputum samples in the early morning because secretions accumulate
overnight. The patient can rinse their mouth with water prior to the procedure but avoid
mouthwash or toothpaste because these products can affect the microorganisms in the
sample.
- Be aware that droplets and aerosols may be generated when collecting sputum specimens,
so use appropriate personal protective equipment when entering the room and during the
procedure based on the patient’s condition. Explain the procedure to the patient, the type
of specimen required, and the difference between oral secretions and sputum. Position the
patient in a seated position in a chair or at the side of the bed or place them in high
Fowler’s position.
- Instruct the patient to take three slow, deep breaths and then cough deeply. Repeat this
process until the patient has produced sputum, with rest periods between each maneuver.
- When the patient has mobilized sputum, instruct them to expectorate directly into a sterile
specimen container without touching the inside or rim of the container. The specimen
should be at least 10 mL; ask the patient to continue producing and expectorating sputum
until this amount is achieved.
- Assess the sputum specimen to ensure it is sputum and not saliva. Sputum appears thick
and opaque, whereas saliva appears thin, clear, and watery.
- Instruct client to wipe around mouth and discard it properly.
- Cap the specimen container tightly and ensure it is labeled well and send it to the
laboratory for analysis.
- Replace articles, remove gloves, and wash hands.
- Document the time and date the sputum specimen was collected and the characteristics of
the sputum, including amount and color.

REFERENCES
GN Mandal, Durga Subedi. A Textbook of Fundamental of Nursing;2015. 2nd edition.
Kathmandu; Dillibazar.Makalu Publication.P.165-170
Pathak S, Devkota R. A Textbook of Fundamentals of Nursing.1 st revised edition (2019).
Bhotahity; Kathmandu.Vidyarthi Pustak Bhandar.P.156-163

Patrica A. Potter, Anne Griffin Perry, Fundamental of Nursing;2001. 5 th edition.Harcourt Private

Limited.P.1494-1562

Carol R.Taylor, Carol Lillis. Fundamental of Nursing;2009. 6th edition. Wolters Kluwer Pvt.Ltd.

BPKIHS Procedure Manual

POST TEST

MCQs (5*1=5)

1. Normal color of urine is

a. Pink
b. Pale yellow
c. Deep yellow
d. Brown

2. Before obtaining urine sample from foley’s catheter, the tube should be clamped
for about
a. 5-10 min
b. 50-60 min
c. 15-30 min
d. 3-5 min

3. First step a nurse should do before collecting any specimen

a. Explain procedure to the patient
b. Fill the investigation form
c. Check the physician’s order
d. Take patient’s consent

4. The best time for collection of sputum specimen is

a. Early morning
b. After breakfast
c. At evening
d. At bedtime
5. The proper way to obtain sputum culture is to
a. have the patient spit in a paper towel.

b. have the patient cough up the sputum and then swish around in mouth for
a while and then spit it out.
c. have the patient immediately spit the coughed-up sputum into a sterile
specimen cup.
d. have the patient fill their mouth with saliva and spit it into a cup.
Answer Key:

1) b
2) c
3) c
4) a
5) c

ASSIGNMENTS

SAQ (2+5=7)

a) Define specimen and specimen collection. Describe the procedure of collecting

mid-stream urine specimen. (2+5)