UNIT FOUR
578
Clinical Skills and Care
Skill 28.2 Obtaining a Throat Culture Specimen
Assessment Step 1. Verify the health-care provider’s order for throat culture. Planning Step 1. Gather needed equipment and supplies: throat culture swab, tongue blade, clean gloves, and examination light if needed. Implementation Steps 1. Follow the Initial Implementation Steps located on the inside front cover. 2. Assist the patient to an upright position in the bed or chair to allow better visualization of the throat. If the room is dark, use an examination light to make it easier to visualize the throat. 3. Ask the patient to open their mouth widely and say “Ah” to allow access to the back of the throat. Place the tongue blade on the tongue to hold it down during the procedure. Tell the patient to breathe through the mouth. This helps prevent gagging. 4. Remove the swab from the tube without touching any part of the swab itself. Hold onto the cap into which the swab handle is inserted. Touching any part of the swab, even while wear- ing clean gloves, can contaminate the specimen. 5. Insert the swab into the patient’s mouth without touching the teeth, cheeks, lips, or gums, which would cause contamina- tion of the specimen. 6. Using one side of the swab, slide it against the back of the throat and tonsils to the right of the uvula. Target reddened areas or patches of white or yellow exudate to ensure that pathogens are obtained.
7. Using the other side of the swab, slide it against the back of the throat and tonsils to the left of the uvula, targeting the same type of areas. This allows collection of specimens from different areas of the throat to more easily identify pathogens. 8. Carefully replace the swab into the sterile tube. Contamina- tion of the swab or tube can lead to misdiagnosis and inap- propriate treatment for the patient. 9. Crush the capsule in the end of the tube to provide a moist environment for the pathogens until the culture is done. 10. Label the tube according to facility policy. 11. Follow the Ending Implementation Steps located on the inside back cover. Evaluation Steps 1. Ensure that an adequate specimen has been taken so that the culture will grow any pathogens present in the patient’s throat. 2. Evaluate the patient’s tolerance of the procedure. Did it cause gagging or throat discomfort? 3. Ensure that the throat culture tube is placed in the appropri- ate biohazard specimen bag with the requisition and taken to the laboratory.
Sample Documentation
10/10/28 1330 Throat culture obtained per order and delivered to the laboratory. Pharynx red with yellowish-white patches noted on tonsils bilaterally. Culture taken from these areas. C/o sore throat before and after procedure. ____________________ _____________________________________________________ Nurse’s signature and credentials
Skill 28.3 Assisting With Incentive Spirometry
Assessment Steps 1. Verify the health-care provider’s order for incentive spirome- try. Note: Some hospitals do not require a health-care pro- vider’s order for this because it is considered a nursing or respiratory therapy order. Always follow your facility’s policy. 2. Determine the patient’s pain level, availability, and willingness to perform the procedure. It may be necessary to medicate the patient for pain before beginning the procedure. Planning Steps 1. Obtain an incentive spirometer. 2. Plan for appropriate time for incentive spirometry; avoid mealtimes.
Implementation Steps 1. Follow the Initial Implementation Steps located on the inside front cover. 2. Assist the patient to an upright position in the bed or chair to enlarge the rib cage and allow for maximum lung expansion. 3. Splint abdominal or chest incisions with a pillow to prevent pain during deep inhalation and exhalation. 4. Place the mouthpiece of the incentive spirometer between the patient’s lips to prevent air from escaping around it during inhalation.
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