TB Nurse Case
Management
Antonio,
San Antonio Texas
March 2-4, 2011
Collecting a Quality Sputum
Alisha Blair, LVN
March 2, 2011
Alisha Blair, LVN has the following
disclosures to make:
• No conflict of interests
• No relevant financial relationships with
any commercial companies pertaining
to this educational activity
1
Collecting a
Quality Sputum
Alisha Blair, LVN
Heartland National TB Center
March 2nd, 2011
Objectives
• Identify Challenges in Collecting a Quality Sputum
• Discuss the Physiology of Sputum Production and
Clearance
• Discuss the Physiology of Cough
• Brief Demonstration of Cough Methods/Technique
2
Sputum Sample Issues
• Saliva
Specimen A
–S i Saliva
Appears as S li
• Contaminated Specimen
– Blood, food, mouth wash, other oral organisms
• Insufficient Quantity
g g p y,
– Patient resists the urge to cough deeply, vomits while
coughing, Not enough specimen lab rejection
Respiratory Tract Overview
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Respiratory Overview
• Cilia-Tiny hair like particles that trap large pieces
of Debris and sweep them out of the airways
• Goblet Cells- Mucus producing cells in the
surface epithelium
Healthy individual d 10-100ml f
• A H lth i di id l may produce 10 100 l of
mucus per day
Movement of Mucus
• Cilia in the nose moves collected mucus there towards
the throat where it is most times swallowed and digested
in the stomach
• Cilia in the deep respiratory passages sweeps mucus
towards the pharynx to be swallowed
• When there is an excess of mucus production cough
receptors are stimulated which causes air and mucus to
be forcibly expelled from the trachea
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Cough Reflex
• Cough is usually stimulated in response to irritation to the
respiratory system
• Irritation of the respiratory passages may result from
contact with a foreign body, mechanical obstruction of the
airway, or excessive buildup of fluid that obstructs portion
of the airway
Sputum Collection
• Overnight, mucus pools in the lung
S O GS U U g e the
• FIRST MORNING SPUTUM will give you t e
best specimen
– Before brushing teeth (but rinse mouth with water)
– Steam from hot shower will assist with loosening
mucus in respiratory passages
• Adequate hydration necessary to produce fluid
mucus
5
Limit Contamination and Rejection
• Instruct Patient to rinse mouth with
water before giving sample
• No food or drink before sample is
given
• Instruct patient on cough
technique as to limit throat irritation
and possible contamination of
sample with blood
• Transport specimens immediately
or refrigerate
Needed Supplies
• Sterile Leak Proof Specimen Container
• Clean Disposable Gloves
• Tissue
• Emesis Basin or Trash Container
• Identification Labels
• Laboratory Requisition
• Bio Hazard Bag
• Hypertonic Saline Solution
– Induced Specimens
• Nebulizer
– Disposable Mouth Piece and Tubing
• PPE
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How to Coach A Cough
1 Mississippi, 2 Mississippi
Coaching A Cough
1. Forceful Cough
1. Take Deep breath, filling the lungs as completely as possible
2.
2 Contract the upper abdominal muscles
3. Expel all of the air using one forceful cough
4. Repeat the process one or two times until mucus is loosened
2. Huffing
1. Take Deep breath, filling the lungs as completely as possible
2. Blow the air out in forceful bursts through an open mouth while
Huff ,
saying “ Huh or Huff”, as if you are blowing steam into the
mirror.
3. Repeat as many times as needed to clear the loosened mucus
from the airway
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Cough Techniques Contd.
3. Controlled Coughing Technique
1. Sit on a chair or on the edge of a bed with both feet on the
floor. L
fl li htl forward. R l
Lean slightly f d Relax
2. Fold arms across abdomen and breathe in slowly through your
nose
3. To exhale: lean forward, pressing arms against your abdomen.
Cough 2-3 times through a slightly open mouth. Cough should
be short and sharp.
4. Breathe in again by “sniffing” slowly and gently through your
noise. This gentle breath helps prevent mucus from moving
back down your airways
5. Rest
6. Perform again if needed
Special Thanks
Lorna Will Wisconsin
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References
• Richardson, Marion. “The Physiology of Mucus and
System
Sputum Production in the Respiratory System”
Physiology of Sputum Production Vol.99, Issue 23.
(2003) pp. 63.
http://www.health.state.mn.us/divs/idepc/diseases/tb/fact
sheets/sputum.html#2
sheets/sputum html#2
Questions
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