Preparing the patient for laboratory tests of urine. Preparing the patient for laboratory tests. The patient must have
Any biological substrate can be a material for research: secretions of the human body, fluids obtained by puncture, puncture, diagnostic equipment, organ tissues obtained by biopsy. The ward nurse makes a selection of appointments from the medical history and writes down the necessary laboratory tests in the analysis log. After receiving the biological material, she must arrange for its timely delivery to the laboratory by issuing a referral. The direction must indicate the department, surname, name, patronymic of the patient, type and material of the study, diagnosis, date and surname of the attending physician.
The correctness of the results of a laboratory study is ensured by careful observance of the requirements for the technique of collecting biological material, which depends not only on the competent actions of the nurse, but also on her ability to establish contact with the patient, to properly instruct him about the procedure for taking the material.
To avoid the risk of infection with viral and bacterial infections transmitted through blood and other biological materials, the following precautions should be observed:
Avoid direct contact with biological material - work only with rubber gloves;
Carefully handle laboratory glassware, and in case of damage, carefully remove glass fragments;
Thoroughly disinfect containers used in the process of collecting biological material - laboratory glassware, vessels, urinals, etc.;
Before draining into the sewer, decontaminate the secretions of patients.
If the patient's biomaterial gets on the nurse's skin, immediately treat the contact areas with a 70% alcohol solution, wiping the skin with a swab soaked in it for 2 minutes; after 5 minutes, rinse the skin with running water.
Blood taken on an empty stomach, before taking medications. It is not recommended to take blood after physiotherapeutic procedures and X-ray exposure, physical and mental stress. Depending on the purpose of the study, blood sampling from a finger (capillary blood) for laboratory analysis is carried out by a laboratory assistant, and from a vein (venous blood) - by a procedural nurse. The volume of blood taken from a vein depends on the number of components to be determined - usually at the rate of 1-2 ml for each type of analysis, while the tourniquet application time should be as short as possible, since prolonged blood stasis increases the content of total protein and its fractions, calcium, potassium and other components.
When collecting sputum, several rules must be observed:
Sputum should be collected in the morning before meals;
The patient should brush his teeth and rinse his mouth with boiled water, then take a few deep breaths or wait for the urge to cough, then cough up sputum (in a volume of 3-5 ml) into a clean, dry jar given to him in advance and close it with a lid;
For bacteriological examination of sputum, a sterile container is issued, warning the patient not to touch the edges of the dishes with his hands or mouth;
For bacterioscopic examination of sputum for Mycobacterium tuberculosis, sputum is collected within 1-3 days, keeping in a cool place;
To analyze sputum for atypical (tumor) cells, it is necessary to immediately deliver the collected sputum to the laboratory, because these cells are rapidly destroyed.
Rules for taking biological samples for bacteriological research.
Any material for bacteriological studies must be collected only in sterile dishes (prepared in a bacteriological laboratory), following the rules of asepsis, and before treatment with antibacterial drugs. The collected material must be delivered to the laboratory in the maximum short time, but not later than 1-2 hours after sampling. In exceptional cases, the material may be stored at room temperature(blood for sterility) and in the refrigerator at a temperature of +4º up to 2-4 hours - the rest of the material. Transportation of samples to the laboratory should be carried out in special containers in compliance with the rules of anti-epidemic safety. The material sent for bacteriological research is accompanied by a referral, where it is necessary to indicate: medical facility, department, ward number, patient's full name, age, type of material delivered, purpose of the study, date and time of material sampling.
Pleural puncture or thoracocentesis- puncture of the chest with the introduction of a needle or trocar into the pleural cavity to extract fluid from it, followed by a physicochemical, cytological and bacteriological examination of the punctate, as well as for the introduction of drugs into the pleural cavity. Contraindications: increased bleeding, pyoderma, herpes zoster, skin lesions in the puncture area. Equipment: a sterile syringe with a capacity of 20 ml with a thin needle 5-6 cm long for anesthesia; a sterile puncture needle with a lumen of 1-1.5 mm, 12-14 cm long, connected to a rubber tube about 15 cm long; sterile tray, electric suction, 5% alcohol solution of iodine, 70% alcohol solution, sterile bandage, sterile test tubes, 0.25% novocaine solution, pillow, oilcloth, chair, mask, sterile gloves, container with disinfectant solution.
Action algorithm
1. 15-20 minutes before the puncture, as prescribed by the doctor, give the patient a subcutaneous injection of sulfocamphocaine.
2. Sit the patient, stripped to the waist, on a chair facing the back, ask him to lean on the back of the chair with one hand, and put the other (from the side of the pathological process localization) behind his head.
3. Ask the patient to slightly tilt the body in the direction opposite to the one where the doctor will perform the puncture.
4. Wash your hands with soap and running water and treat them with a disinfectant solution.
5. Put on a sterile mask, gown, gloves.
6. Treat the intended puncture site with a 5% alcohol solution of iodine, then with a 70% alcohol solution and again with iodine.
7. Apply local anesthesia with 0.25% novocaine solution in the seventh or eighth intercostal space along the scapular or posterior axillary line.
8. The doctor performs the puncture in the zone of maximum dullness of the percussion sound (usually in the seventh-eighth intercostal space; a puncture is made in the intercostal space along the upper edge of the underlying rib, since the neurovascular bundle passes along the lower edge of the rib and intercostal vessels can be damaged. If the needle enters the pleural cavity there is a feeling of "failure" in the free space.
9. For a test puncture, a syringe with a capacity of 10-20 ml with a thick needle is used, and to remove a large amount of liquid, a Janet syringe or an electric suction pump is used.
10. For diagnostic purposes, 50-100 ml of liquid is drawn into the syringe, the nurse pours it into pre-signed test tubes and sends it to the doctor's prescription for a physicochemical, cytological or bacteriological examination. With the accumulation of a large volume of fluid, only 800-1200 ml is removed, since the removal of a larger amount can lead to an excessively rapid displacement of the mediastinal organs to the diseased side and collapse.
11. Before disconnecting the syringe, clamp the rubber adapter. Make sure that air does not get into the pleural cavity!
12. After removing the needle, lubricate the puncture site with a 5% alcohol solution of iodine and apply a sterile bandage.
13. Place used items in a container with a disinfectant solution.
14. Deliver the patient to the ward on a stretcher.
15. Send in a sterile test tube 10-20 ml of the contents of the pleural cavity to the laboratory, attaching the direction.
16. Provide bed rest during the day, observing the general condition, bandage.
Preparation for X-ray methods of examination of the chest organs.
Before the study, the patient is freed from clothing, ointment bandages, adhesive tape stickers.
Preparing for bronchography - X-ray examination of the bronchi and trachea after pre-filling their lumen with a contrast agent.
Target: detection of tumor processes in the bronchi, expansion of the bronchi (bronchiectasis), cavities in the lung tissue (abscess, cavity).
Action algorithm
1. Conduct a test for individual tolerance of iodine-containing drugs: within 2-3 days, as directed by a doctor, the patient is offered to drink 1 tbsp. 3% solution of potassium iodide or on the eve of the study treat the skin of the inner surface of the patient's forearm with a 5% alcohol solution of iodine.
2. Clarify with the patient the presence of individual intolerance to drugs, especially anesthetics. If necessary, conduct intradermal tests with a description of the date in the medical history.
3. Monitor the patient's condition for 12 hours after the test to identify signs of hypersensitivity: lacrimation, sneezing, runny nose, skin itching, nausea, vomiting, as well as redness, soreness and swelling of the skin in the area of drug administration.
4. Clear the bronchial tree in the presence of purulent sputum using postural drainage, expectorant and bronchodilator drugs 3-4 days before bronchoscopy.
5. Explain to the patient the purpose of the upcoming study and the need for proper preparation for the study: the day before - light dinner with the exception of milk, cabbage and meat, in the morning on the day of the study, you can not take food, water, medicines and smoke, before the study - empty the bladder and intestines.
6. 30-60 minutes before the study, as prescribed by the doctor, administer to the patient medications that facilitate the introduction of a bronchoscope.
7. Monitor the patient's condition after bronchoscopy to identify possible complications associated with anesthesia, reaction to the administration of a contrast agent and retention of the latter in the lungs: the appearance or intensification of cough with sputum with a large amount of radiopaque substance (within 1-2 days) ; increase in body temperature; development of pneumonia.
8. If complications occur, inform the doctor.
Preparation for bronchoscopy- an endoscopic method for examining the trachea, bronchi of large and medium caliber using a bronchoscope inserted into the patient's airways. Objectives: diagnostic - establishing or clarifying the diagnosis of tumors of the trachea or bronchi, purulent diseases of the bronchi and lungs, pulmonary tuberculosis and other diseases of the respiratory tract; medical- in order to remove foreign bodies, bronchial secretions from the trachea and bronchi and for the local use of drugs. Equipment: sterile bronchoscope. Terms of conduct.
On the eve, it is necessary to check the presence of an ECG, a blood test for clotting time and the duration of bleeding, to find out in the patient the tolerance of drugs, especially anesthetics. Explain to the patient that dinner should be light the day before (milk, cabbage, meat are excluded), and in the morning you should not eat, drink and smoke. It is very important and responsible to monitor the patient after bronchoscopy, because. possible complications (appearance of pain, vomiting, fever, bleeding).
Action algorithm
1. Teach the patient how to prepare for the study and have a conversation about the purpose and course of the procedure.
2. As prescribed by the doctor, premedicate for several days before the procedure.
3. Ask the patient not to take food, water, medicines, do not smoke in the morning and follow the recommendations.
4. Empty the bladder and intestines in a natural way immediately before the study.
5. Carry out premedication as prescribed by the doctor 15 minutes before the procedure for free insertion of the bronchoscope.
6. Accompany the patient to the endoscopy room at the appointed time.
7. In a sitting position, perform anesthesia of the upper respiratory tract through the nose (mouth).
8. Assist the doctor during bronchoscopy.
9. Disinfect and sterilize the bronchoscope.
PREPARATION PATIENT
To LABORATORY METHODS RESEARCH
BLOOD STUDY
Blood is the universal internal environment of the body, connecting organs and systems. Pathological processes in the body entail changes in the quantitative and qualitative composition blood. Blood testing is an affordable, safe and widely used method. There are general clinical, biochemical and immunological methods of blood analysis.
General blood analysis
A general clinical blood test involves a quantitative and qualitative study of blood cells (erythrocytes, leukocytes, platelets), determination of the amount of hemoglobin, determination of hematocrit, erythrocyte sedimentation rate (ESR).
> Blood sampling is carried out on an empty stomach, in the morning. In case of urgent need, blood sampling can be carried out at any time of the day, however, it is desirable that at least 2 hours have passed since the last meal.
> It is not recommended to take blood after exercise, after the use of drugs, especially when they are administered intramuscularly or intravenously, after exposure to X-rays and physiotherapy procedures.
> Repeated studies must be carried out at the same hours, since the morphological composition of the blood is subject to fluctuations throughout the day.
> Fence on general analysis blood can be drawn from both a vein and a finger. If it is necessary to simultaneously study the clotting time and the duration of bleeding, the sampling is performed only from a finger.
If the above rules are not followed, the research results will be incomparable and may lead to erroneous interpretation.
However, changes in urine can also appear with various diseases of the internal organs. Pathological metabolic products enter the bloodstream, and then, filtered by the kidneys, are found in the urine.
A laboratory study of urine is carried out regardless of the nature of the disease. In most cases, urine for research is taken in the morning, immediately after sleep. Before collecting urine for analysis, the patient must carefully toilet the external genitalia. When urinating, the first portion of urine is not used. Starting from the middle of urination, urine is collected in a container designed for collection. Urine collected in a clean and dry container (on which a sticker is made in advance with the patient's surname and initials, the nature of the study), no later than 1 hour should be delivered to the laboratory.
Laboratory methods for examining urine include:
General clinical analysis of urine
Urinalysis according to Nechiporenko
Urinalysis according to Zimnitsky
Examination of daily urine for sugar, etc.
Indications for the study - the appointment of a doctor.
Contraindications - no.
Preparing the patient for the study:
> In a confidential setting, provide the patient (or members of his family) in an accessible form with basic information about the nature of the upcoming study.
> Obtain patient consent for the study.
> If the patient is menstruating, advise her to cover the vagina with a tampon.
> Teach the patient how to properly toilet the vulva (washing) the morning before the exam.
> If the patient is on bed rest, a washing procedure is performed.
On the eve of urine collection (at least a day before) you should:
> observe a moderate water and food regimen,
> exclude excessive fluid intake, or eat foods that cause an increased need for water (pickles, sweets),
> avoid foods that stain urine (beets, carrots), medicines (aspirin, iron supplements),
> do not abuse products containing a large number of organic acids (tomatoes, sorrel, apples),
> if possible, do not take drugs: diuretics, strong oxidizing agents (vitamin C).
Eliminate heavy physical activity (hard work, sports competitions, long transitions, flights, etc.)
General clinical analysis of urine
Defines her physiochemical properties: color, smell, relative density, content of erythrocytes, leukocytes, protein, etc.
For a general clinical analysis, the patient should collect 100-200 ml of freshly passed morning urine (medium stream) in a clean, dry glass dish.
Nechiporenko test
Urinalysis according to the Nechiporenko method is used for the quantitative determination of formed elements (erythrocytes, leukocytes) in order to diagnose inflammatory diseases of the kidneys.
For this study, at any time of the day (preferably in the morning), you need to take an average portion of urine. 2-3 ml is enough for analysis, but the patient should know that the Nechiporenko test cannot be carried out with a general urine test.
Znmnitsky test
Urinalysis according to the Zimnitsky method is used to determine the concentration and excretory ability of the kidneys under the conditions of the patient's usual regimen. Daily urine is examined, collected according to a certain scheme in 8 cans. Day, night, daily diuresis is determined, as well as in each portion of the collected urine - the amount and relative density.
Urine collection technique:
> On the eve of the patient to warn about the need to comply with the usual drinking regimen
> At 6 o'clock in the morning, the subject empties the bladder.
> Every 3 hours, 8 servings are collected - each in a separate dish: from 6-9 hours; from 9-12 o'clock; from 12-15 hours; from 15-18 hours; from 18-21 hours; from 21-24 hours; from 24-3 hours; from 3-6 o'clock.
8. Examination of daily urine for sugar
The reasons for the appearance of sugar in the urine are varied and characteristic of diseases that require mandatory medical intervention (diabetes mellitus, chronic nephritis, thyrotoxicosis, etc.).
Urine collection technique:
> Urine is collected during the day.
> At 8 o'clock the patient empties the bladder.
> All urine excreted during the day is collected in one vessel, which is stored in a cool place.
If it is necessary to determine the amount of sugar in separate portions, urine is collected in 3 different containers (from 6 to 14 hours, from 14 to 22 hours, from 22 to 6 hours). The direction indicates "urine for sugar."
RESEARCH FEATURES
The study of feces is a laboratory method that can be of tangible benefit in making a diagnosis. The reliability of the results depends on the correct preparation of the patient, proper collection, storage, delivery of biological material to the laboratory for research.
It is necessary to examine the feces no later than 8-12 hours after receiving the material, store it at a temperature of 3-5 ° C until the study.
Stool is collected in a clean, dry glass jar free from soap and disinfectants.
There are the following types of examination of feces:
General analysis of feces (coprogram)
Feces on helminth eggs
Feces for occult blood (Gregersen's reaction).
Preparing the patient for the study:
> Before the examination, the patient is canceled medications (laxatives, bismuth and iron preparations, etc.) that interfere with the correct diagnosis. During an appropriate period, various physiotherapeutic procedures in the abdomen should be avoided.
> If the purpose of research is to detect hidden bleeding, then in the 3 days preceding the analysis, foods such as meat, fish, all types of green vegetables should be excluded from the diet.
> The material for the study, collected in a clean and dry dish, on which a sticker is made in advance with the name and initials of the patient and the nature of the study, must be delivered to the laboratory no later than 2 hours later.
X-ray methods of research
- Stomach and duodenum
- Large intestine (irrigoscopy)
Insurance policy, passport.
Direction.
Outpatient card.
Sheet.
X-ray examination of the stomach and duodenum
X-ray research method that allows you to determine the shape, size, and mobility of the stomach.
Indications for research:
Peptic ulcer of the stomach and duodenum.
tumor processes.
Stomach bleeding.
Preparing the patient for the study:
For two days of the study, exclude black bread, milk, vegetables from the diet (to exclude flatulence).
On the evening before the study, a cleansing enema is done 12 hours before the examination.
The study is carried out strictly on an empty stomach, even smoking is prohibited.
Research technique:
The doctor offers the patient to take a few sips of barium suspension and takes a series of pictures to study the relief of the mucous membrane,
The patient then drinks the rest of the barium and takes a series of standing and lying down polyprojections to examine the size, shape, contours, and function of the organs.
Sequence of direction for research:
The examination is carried out after
Conducting fibrogastroscopy.
To conduct the study, the patient must have:
Insurance policy, passport.
Referral from a gastroenterologist.
The result of the study of fibrogastroscopy.
Outpatient card.
X-RAY EXAMINATION OF THE COLON (IRRIGOSCOPY)
Irrigoscopy is X-ray method bowel examinations using medical barium sulfate.
Indications for research:
Chronic colitis.
Developmental defects.
Tumors.
Contraindications to the study:
Any gestational age.
Severe condition of the patient.
Preparing the patient for the study:
To conduct this study, it is necessary to thoroughly clean the intestines.
> For two days of the study, exclude black bread, milk, vegetables from the diet (to exclude flatulence);
> On this day, it is allowed to have breakfast, lunch and in the evening - a light dinner.
biochemical blood test(bilirubin, urea, uric acid, creatinine, total protein, albumin, haptoglobin, cholesterol, ASaT, ALAT, serum glucose, alkaline phosphatase, blood and urine α-amylase, potassium, sodium, calcium, chlorine, magnesium, phosphorus, iron, CC, LDL (LDL), NDL (HDL) GGTP, transferrin, ferritin, glycosylated hemoglobin, triglycerides, urine protein, thymol test, capillary glucose, microalbumin).
blood hormonal levels(prolactin, thyroid-stimulating hormone, FSH, cortisol, progesterone, free T-4, testosterone, estradiol, luteinized hormone, free T-3, alpha-phenoprotein (AFP), beta-hCG, free estriol), hematological tests (determination of leukocytes, hemoglobin, erythrocytes, hematocrit, MCHC, MCCH, RDW, MCV, leukocyte formula, platelet reticulocytes, ESR, erythrocytes with basophilic granularity, malaria).
immunological, enzyme immunoassays(microreaction for syphilis, rheumatic factor, CRP, blood group, Rh factor, anti-erythrocyte antibodies, TTEEL, determination of anti-O-streptolysin, A / T for chlamydia, A / T for CMV, A / T for HSV, A / T for toxoplasma, A / T to the rubella pathogen, Ig “E”, Hepatitis B, Hepatitis C, AT to HBS Ag, A / T to HbcorA / T to Hbe Ag) the results of which depend on the physiological state of the person.
If possible, it is recommended to donate blood in the morning, from 8 to 11 am, on an empty stomach (at least 8 hours and not more than 14 hours of hunger, drink water, as usual), avoid food overload the day before. If you are taking any medications, you should consult with your doctor about the advisability of conducting a study while taking medications or the possibility of stopping the drug before the study, the duration of the withdrawal is determined by the period of removal of the drug from the blood. Alcohol - avoid drinking alcohol on the eve of the study. Smoking - do not smoke for at least 1 hour before the study. Eliminate physical and emotional stress on the eve of the study. It is undesirable to donate blood for laboratory testing shortly after physical therapy procedures, instrumental examinations and other medical procedures. After some medical procedures (for example, a prostate biopsy before a PSA test), laboratory testing should be postponed for a few days. When monitoring laboratory parameters in dynamics, it is recommended to conduct repeated studies under the same conditions: in the same laboratory, donate blood at the same time of day, etc.
Preparing for a blood test.
Preparation for the study: the morning hours are most suitable for blood tests. For most studies, blood is taken strictly on an empty stomach. Coffee, tea and juice are also food. You can drink water. The following intervals after the last meal are recommended:
- for a general blood test at least 3 hours;
- for a biochemical blood test, it is advisable not to eat for 12-14 hours (but not less than 8 hours). 2 days before the examination, it is necessary to refuse fatty and fried foods. Before a blood test, physical activity should be minimized as much as possible. Avoid running, climbing stairs. Avoid emotional arousal. For 10-15 minutes you need to rest, relax and calm down in order to avoid the unmotivated release of hormones into the blood and an increase in their rate. You can not donate blood immediately after physiotherapy, ultrasound and x-ray examination, massage and reflexology. Before donating blood, you need to calm down in order to avoid an unmotivated release of hormones into the blood and an increase in their rate. To donate blood for viral hepatitis it is advisable to exclude citrus fruits, orange fruits and vegetables from the diet 2 days before the study. To correctly evaluate and compare the results of your laboratory tests, it is recommended that they be carried out in the same laboratory, since different laboratories may use different methods of analysis and measurement units.
Determination of the blood group.
Preparation for analysis is not required.
Preparing for the delivery ofgeneral clinical analysis of urine- only morning urine is collected, taken in the middle of urination. Morning urine:
- collection is made immediately after getting out of bed, before taking morning coffee or tea;
- previous urination was no later than 2 am;
- before collecting a urine test, a thorough toilet of the external genitalia is performed.
- 10 ml of urine is collected in a special container or tube with a lid, labeled with the necessary data and direction.
The collected urine is immediately sent to the laboratory.
Daily urine collection- the patient collects urine for 24 hours with a normal drinking regimen (about 1.5 liters per day).
- in the morning at 6-8 o'clock he empties the bladder and pours out this portion, then during the day he collects all the urine in a clean, wide-mouthed vessel made of dark glass with a lid with a capacity of at least 2 liters;
- the last portion is taken at the same time when the collection was started the day before, the time of the beginning and end of the collection is noted;
- at the end of the collection of urine, its volume is measured, the urine is thoroughly shaken and poured 50-100 ml into a special container in which it will be delivered to the laboratory;
- be sure to indicate the volume of daily urine.
Urine collection for research according to Nechiporenko- revealing the latent inflammatory process.
- in the morning on an empty stomach collect 10 ml of morning urine taken in the middle of urination in a special laboratory container.
Collection of urine for research according to Zimnitsky - the patient takes into account the amount of fluid drunk per day.
- after emptying the bladder at 6 o'clock in the morning, every 3 hours during the day, urine is collected in separate containers, which indicate the time of collection or the number of servings, a total of 8 servings. 1 serving - from 6-00 to 9-00, 2 servings - from 9-00 to 12-00, 3 servings - from 12-00 to 15-00, 4 servings from 15-00 to 18-00, 5 servings - from 18-00 to 21-00, 6 portion - from 21-00 to 24-00, 7 portion - from 24-00 to 3-00, 8 portion - from 3-00 to 6-00 hours;
- all the collected amount of urine in 8 special containers is delivered to the laboratory;
- be sure to indicate the volume of daily urine.
Urine collection for microbiological examination (urine culture)- morning urine is collected in a sterile laboratory container with a lid;
- the first 15 ml of urine are not used for analysis, the next 5-10 ml are taken;
- collected urine is delivered to the laboratory within 1.5 - 2 hours after collection;
- storage of urine in the refrigerator is allowed, but not more than 3-4 hours;
- urine collection is carried out before the start of drug treatment;
- if you need to evaluate the effect of the therapy, then urine culture is performed at the end of the course of treatment.
Preparing for a stool test.
3-4 days before the study of stool analyzes, stop taking laxatives, castor and vaseline oils, activated charcoal (sorbents) and stop the administration of rectal suppositories. Feces obtained after an enema, as well as after taking barium (during an X-ray examination) are unsuitable for research. Before collecting feces, first urinate into the toilet and flush it. Next, by natural defecation into the toilet or bedpan, collect the stool. Then the average portion of feces is taken with a spoon into a clean, disposable container with a screw cap in an amount not exceeding 1/3 of the volume of the container. If the feces are collected in the evening, storage in the refrigerator at T = 2-8 ° C during the night is allowed. In the morning, the feces must be delivered to the laboratory.
Preparation for testingfeces for carbohydrates.
Fecal masses are necessarily collected with a liquid part. Avoid the use of diapers and other absorbent materials. Freshly collected feces are delivered to the laboratory as soon as possible, or frozen and delivered to the laboratory in this form.
Preparation for deliverystool for occult blood.
Special preparation is required in order to exclude a false positive reaction: three days before this test, meat, liver, black pudding and all foods containing iron (apples, bell pepper, spinach, white beans, etc.). The stool must be obtained without the use of enemas and laxatives. The collection of feces is carried out in a special container that can be bought at pharmacies or obtained from us, the volume is about 1 teaspoon. The material is delivered to the laboratory within 5 hours.
Preparation for the delivery of feces to identify helminthic invasions.
Within two days, the patient should not eat hard, poorly digestible food ("food garbage"): seeds, nuts, raw vegetables and fruits with skins, as well as sorbents: Activated carbon and more, as well as mushrooms!
Preparing for a sputum test.
Preparation for the study: after a thorough toilet of the oral cavity (brushing teeth and rinsing with boiled water), a morning portion of sputum is collected in a sterile dish. Of diagnostic value is sputum of a mucous or mucopurulent nature, as well as sputum containing dense whitish inclusions, and sputum colored yellowish, gray or brown. The volume of sputum sufficient for the study is 3-5 ml. To increase the information content, it is possible to repeat (up to 3 times) sputum examination, which allows increasing the number of positive findings. If sputum is produced irregularly or in scanty quantities, expectorants or irritant inhalations should be used the night before and early in the morning on the day of sputum collection. The preparation of smears from the material obtained in this way should be made on the day of its collection. In the absence of sputum, the impossibility of aerosol inhalation or its failure to study for mycobacteria, it is necessary to examine the washings of the bronchi or stomach
Recommendations for women to prepare for a PCR smear test(chlamydia, ureaplasma, mycoplasma, gardnerella, gonococcus, trichomonas, cytomegalovirus, herpes, candida, HPV).
Preparation for the study:
- you can not urinate 3 hours before taking the material, if the analysis is taken from the urethra
- it is impossible to conduct such studies during the reception period antibacterial drugs.
- these studies are not given during the period of menstruation and within 1-2 days after its completion.
- 2-3 days before the visit to the laboratory, you should stop using any vaginal tablets, balls, suppositories - both therapeutic and contraceptive (Pharmatex, Pantex-Oval, Klion D, Polygynax and others).
- the night before and in the morning on the day of taking a smear, you should not wash the toilet of the external and internal genital organs (douche);
- IMPORTANT! Do not take smears for PCR after colposcopic samples;
- refrain from sexual intercourse 1-2 days before the smear.
Preparation for the delivery of a smear for cytology(preventive, diagnostic, puncture cytology of the breast, karyopyknotic index, sputum for atypical cells).
To obtain adequate examination results, gynecologists recommend refraining from sexual intercourse 1-2 days before taking a smear. Also, try not to douche, use tampons, or inject any medications (vaginal tablets, suppositories) into your vagina at least 2 days before visiting your gynecologist.
Laboratory research methods serve milestone examination of the patient. The data obtained help to assess the patient's condition, make a diagnosis, monitor the patient's condition in the dynamics and course of the disease, and control the treatment.
Mandatory - prescribed to patients in accordance with the standards of care (for example, general blood and urine tests).
Additional - appoint strictly according to indications depending on the specific case (for example, the study of gastric juice to study the secretory function of the stomach).
Planned - is prescribed a certain number of days after the previous study in order to monitor the patient in dynamics and control the treatment.
Urgent s- they are prescribed in an urgent (urgent) situation, when further treatment tactics may depend on the results of the study.
Material for laboratory research:
Secretions of the human body - sputum, urine, feces, saliva, sweat, discharge from the genitals.
Fluids obtained by puncture or pumping - blood, exudates and transudates, cerebrospinal fluid.
Fluids obtained with the help of instrumental diagnostic equipment, contents of the stomach and duodenum, bile, bronchial contents.
Organ tissues (liver, kidney, spleen, bone marrow) obtained by biopsy (lifetime taking of a small amount of tissue for microscopic examination for diagnostic purposes); contents of cysts, tumors, glands.
Rules for the collection of biological material
Blood test
When examining blood, it must be remembered that all vital processes are subject to significant variations under the influence of external factors, such as changing the time of day and year, food intake, and changes in solar activity.
The biochemical composition of biological fluids is subject to individual fluctuations in different people, reflecting the influence of gender, age, diet, lifestyle.
The morphological composition of blood fluctuates throughout the day. Therefore, it is advisable to carry out blood sampling at the same time of day.
Avoid fatty foods in the evening, a in the morning on an empty stomach, before taking medications, donate blood .
Depending on the purpose of the study, blood sampling for laboratory analysis is carried out from a finger
(capillary blood) and from a vein
(deoxygenated blood):
A laboratory assistant takes blood from a finger.
This analysis is necessary for: quantitative and qualitative study of blood cells (erythrocytes, leukocytes, platelets), determining the amount of hemoglobin in the blood and the erythrocyte sedimentation rate (ESR). Such an analysis is called general blood test.
In some cases, blood is taken from a finger to determine the content in the blood glucose, blood clotting and bleeding time.
Blood from a vein is taken by a procedural nurse through a puncture in most cases of the cubital vein.
This analysis is necessary for the quantitative study biochemical parameters blood (liver tests, rheumatological tests, glucose, fibrinogen, urea, creatinine, etc.), detection of infectious agents (blood sampling for blood culture and determination of sensitivity to antibiotics), antibodies to HIV, etc. The volume of blood taken from a vein depends on the amount determined components - usually at the rate of 1-2 ml for each type of study.
Biochemical, immunological, hematological studies
Blood is taken on an empty stomach. 12 hours before the study, you must refrain from eating, drinking alcohol and smoking, taking medications is negotiated with your doctor.Limit physical and emotional activity for 20-30 minutes.
It is not recommended to take blood for research immediately after physiotherapeutic procedures, X-ray examination, after taking alcohol, drugs (with the exception of a special examination for the presence of these components in the blood).
It is very important that you follow these recommendations exactly as only in this case will reliable results of blood tests be obtained.
Urinalysis
Urinalysis is of great diagnostic value not only in diseases of the kidneys and urinary tract but also in diseases of other organs and systems.
Methods for examining urine :
1. General urine analysis:
Determine the color, transparency, smell, reaction, relative density;
Microscopic examination of the sediment is carried out, the components of which are formed elements (erythrocytes, leukocytes, epithelial cells, cylinders, as well as crystals and amorphous masses of salts);
carry out chemical analysis for the detection of protein, glucose, ketone bodies, bilirubin and urobilin bodies, minerals;
2. Nechiporenko test:
The number of formed elements in 1 ml of urine is counted;
3.Zimnitsky's test(to assess the concentration and excretory functions of the kidneys):
Carry out a comparison of the relative density of urine in portions collected at different periods of one day (starting from 6 am every 3 hours in separate jars), and analyze the ratio of daytime and nighttime diuresis;
4.Bacteriological examination of urine:
Carried out with infectious diseases of the kidneys and urinary tract;
5. Determination of a number of parameters in urine collected per day: daily diuresis, protein content, glucose, etc.
PREPARATION FOR RESEARCH
In the morning it is necessary to wash the external genitalia and perineum warm water with soap in a certain sequence (pubic area, external genitalia, perineum, area anus) and wipe dry the skin in the same order. After hygiene procedure the patient must release the initial portion of urine into the toilet, and then collect 150-200 ml of urine in a jar (the so-called middle portion of the urine stream). The most informative is the analysis of urine collected in the morning after sleep, since the first morning portion of urine is usually the most concentrated.
Containers with a lid for collecting urine should be prepared in advance: washed with a detergent solution or soap, rinsed at least 3 times to remove detergent residue and dried thoroughly. Urine collected for research should be delivered to the laboratory no later than 1 hour after collection. Storage of urine before analysis is allowed only in the refrigerator for a maximum of 1.5 hours.
Peculiarities of urine collection various methods research:
General urine analysis: after the hygiene procedure, an average portion of urine (150-200 ml) is collected in a clean container.
Test according to Nechiporenko: after the hygiene procedure, an average portion of urine (40 ml) is collected in a clean container.
Zimnitsky's test: the patient should urinate into the toilet at 6 o'clock in the morning, then sequentially collect urine in numbered containers, changing them every 3 hours. If there is no urine for 3 hours, the container remains empty. All eight containers must be labeled with the portion number and time of urine collection:
- № 1, 6.00-9.00;
- № 2, 9.00-12.00;
- № 3, 12.00-15.00;
- № 4, 15.00-18.00;
- № 5, 18.00-21.00;
- № 6, 21.00-24.00;
- № 7, 24.00-3.00;
- № 8, 3.00-6.00.
Bacteriological examination of urine: after the hygiene procedure, collect 10-15 ml of urine from the middle portion into a sterile tube and immediately close it with a stopper.
Daily urine collection: the patient should urinate into the toilet at 8 a.m., then collect urine in a graduated container or a three-liter jar during the day until 8 a.m. the next day inclusive. If you plan to analyze daily urine for glucose, protein, etc., after collecting urine, you need to measure the total amount of urine and point it in the direction, then thoroughly stir all the urine with a wooden stick and pour 100-150 ml of urine into a vial for the laboratory.
Sputum examination
Sputum is a pathological secret released from the respiratory tract when coughing.
The main methods of sputum examination:
1. General sputum analysis:
Determine the amount, color, smell, consistency, nature of sputum;
A microscopic examination of sputum is carried out in order to detect accumulations of cellular elements, Charcot-Leiden crystals, elastic fibers, Kurshman spirals, elements of neoplasms (atypical cells), etc.;
A chemical analysis is carried out to determine the protein and its amount, the determination of bilirubin.
2. Bacteriological examination of sputum:
Detection of microflora in sputum and determination of its sensitivity to antibiotics;
Sputum analysis for the presence of Mycobacterium tuberculosis.
PREPARATION FOR RESEARCH
To collect sputum, the patient should brush his teeth at 8 o'clock in the morning on an empty stomach and rinse his mouth thoroughly with boiled water. Then you need to take a few deep breaths or wait for the urge to cough, then cough up sputum (in a volume of 3-5 ml) into a clean, dry graduated jar prepared in advance and close it with a lid. To collect sputum for the purpose of bacteriological examination, a sterile container is issued; in this case, the patient must be warned not to touch the edges of the dishes with his hands or mouth. When collecting sputum for atypical cells, it is necessary to immediately deliver the material to the laboratory, since tumor cells are quickly destroyed.
Examination of feces
Examination of feces is important component examination of patients, especially with diseases of the gastrointestinal tract.
The main methods for examining feces:
1. Scatological study(gr. kopros- feces) - study the digestive capacity of various parts of the digestive tract:
Determine the color, density (consistency), shape, reaction (pH), the presence of visible impurities (residues food products, pus, blood, mucus, calculi, helminths);
A microscopic examination of feces is carried out, which allows to identify the remains of protein (muscle and connective fibers), carbohydrate (vegetable fiber and starch) and fatty (neutral fat, fatty acids, soaps) food, cellular elements (leukocytes, erythrocytes, macrophages, intestinal epithelium, malignant cells). tumors), crystalline formations (triple phosphates, calcium oxalates, cholesterol crystals, Charcot-Leiden, hematoidin), mucus;
A chemical analysis is carried out to determine blood pigments, stercobilin, ammonia and amino acids, soluble mucus.
2.Fecal occult blood test- reactions Gregersen, Weber.
3.Analysis of feces for the presence of protozoa and helminth eggs.
4.Bacteriological research to identify the pathogen infectious disease intestines.
Patient preparation for the delivery of feces consists of the following steps:
Withdrawal of medications: 2-3 days before the study, the patient should stop medicines, the impurities of which can affect appearance feces, interfere with microscopic examination and increase intestinal motility (bismuth, iron, barium sulfate, pilocarpine, ephedrine, activated charcoal, laxatives, drugs administered in rectal suppositories prepared on a fatty basis, oil enemas).
Correction of the diet: during a coprological study, the patient is prescribed a trial diet containing an accurately dosed set of products 5 days before stool delivery.
The Schmidt diet (2250 kcal) and/or the Pevsner diet (3250 kcal) are usually used. The Schmidt diet is sparing, it includes oatmeal, lean meat, mashed potatoes, egg, wheat bread and drinks (milk, tea, cocoa). Pevzner's diet is designed according to the principle of maximum for healthy person food load, it includes fried meat, buckwheat and rice porridge, fried potatoes, salads, sauerkraut, butter, rye and wheat bread, fresh fruits, compote. With the help of these diets it is easier to determine the degree of assimilation of food (degree of indigestion).
When analyzing feces for occult blood, a patient is prescribed a milk-vegetable diet 3 days before stool delivery and excludes iron-containing foods (meat, liver, fish, eggs, tomatoes, green vegetables, buckwheat porridge), as they can act as catalysts in the reactions used to detect blood.
PREPARATION FOR RESEARCH
Collection of feces carried out in clean, dry plastic or glass containers with hermetically sealed lids. It is unacceptable to deliver feces for research in match or cardboard boxes.
Rules for collecting feces
Feces should not contain foreign impurities (urine, discharge of the genitourinary organs). Do not collect feces after enemas. If it is necessary to know the exact number of bowel movements, then the empty container is weighed before collection and after collection of the material.
The patient is advised to urinate into the toilet, then by natural defecation, feces are collected in a bedpan or pot (make sure that urine does not get into). For the study, 10-15 g of feces is enough. Feces taken from different places, in an amount of 1 g, is collected in a clean, dry container.
Feces should be delivered to the laboratory within 8 hours after collection (in a hospital - within 1 hour). Examine the feces no later than 8-12 hours after its isolation, and before that it is stored at a temperature of 3 to 5 °C. The most accurate idea of the functional state of the digestive tract is given by a three-fold study of feces.
Target: diagnostic.
Indications:
1. As directed by a doctor.
2. Organ diseases
urinary system.
Contraindications: no.
Prepare:
1. Container (dry, clean) with a lid - 200.0 ml (for collecting urine for general analysis).
2. A container washed with soda - 200.0 ml (for collecting urine according to Nechiporenko).
3. Sterile container with a lid - 200.0 ml (to collect urine for bacteriological examination).
4. Boiled water.
6. Hygienic sterile wipes, cotton balls.
7. Container with disinfectant solution.
8. Gloves.
10. Forceps (clamp)
Patient preparation:
IN OUTPATIENT CONDITIONS
1. Explain the purpose of the study, obtain consent to the procedure.
2. Teach the patient the technique of the hygiene procedure (washing) and explain the need for it on the eve of urine collection in the evening and in the morning, before urine collection.
3. Teach the patient how to properly prepare a container for collecting urine.
4. Teach the patient the technique of collecting urine (collecting an average portion of urine).
5. Ask the patient to repeat all the information received from the nurse.
Execution technique
(performed by the patient):
1. Wash the genitals and perineum with warm boiled water and soap in a certain sequence (training conducted by a nurse). Dry in the same sequence with sanitary napkins.
2. Collect urine:
Discard the first stream of urine at the expense of "1.2" into the toilet;
Delay urination and substitute a container for collecting urine under the urethra;
Continue urination (it is possible at the expense of "1,2,3,4,5") into a container and collect 150-200 ml of urine (average portion of urine);
Delay urination, set aside the container with the collected urine;
Complete urination into the toilet;
Close the jar with a lid.
3. Attach the direction to the container, send to the laboratory.
Patient preparation:
IN HOSPITAL CONDITIONS
1. Establish a relationship of trust, explain the course of the procedure, obtain consent to the procedure.
2. Inform the patient about the hygiene procedure (washing) on the eve of the study in the evening and immediately before urine collection in the morning.
3. Teach the patient the technique of collecting urine (collecting the middle portion).
Execution technique
(performed by a nurse):
1. Carry out hygienic treatment of hands, put on gloves.
2. Wash the patient with boiled water using napkins or cotton balls on a forceps (clamp) in the sequence: pubic area and inner thighs, external genitalia and perineum, anus area in the direction from the urethra. Carry out drying with napkins in the same sequence.
3. Collect an average portion of urine - 150.0-200.0 ml in a dry, clean container.
Aftercare:
1. Remove gloves, disinfect them. Perform hand hygiene.
2. Issue a referral to the laboratory. Attach the referral to the container with urine, send it to the clinical laboratory.
Possible complications:
Notes:
1. The collected urine is delivered to the laboratory within 1 hour.
2. During the patient's menstruation, the vaginal area is plugged with a sterile swab.
3.When general clinical urine examination assesses: the physical properties of urine, the chemical composition of urine and the microscopic sediment of urine.
4. Collection of urine for research according to Nechiporenko carried out according to the method of collecting urine for a general analysis. Features of urine collection according to Nechiporenko: the volume of collected urine must be at least 10 ml, urine collection is carried out in a dish treated with soda. Urine collection according to Nechiporenko is carried out to determine the number of formed elements in the urine (leukocytes and erythrocytes).
5. Collection of urine for bacteriological research is carried out according to the method of collecting urine for a general analysis. Collection Features urine for bacteriological analysis: collection of an average portion of urine is carried out in a sterile container, urine collection is carried out before the start of antibiotic therapy. When collecting urine for bacteriological examination, the type of pathogen that caused the infection of the urinary system is determined and an effective antibiotic is selected.