N-Trivia

X-ray Techs Earn More Than Nurses
Throat Culture Procedure
Thoracentesis
Sputum Culture

Posted: 11 Sep 2010 10:02 PM PDT

MANILA, Philippines—Among the allied medical professions in the Philippines, their field is not as popular as nursing. But radiologic technicians like Arnold and Agnes Llegado have a secret they want to share: Compared to nursing, the rad tech's job is "less toxic"—and the pay (in some countries) is higher.

Rad techs, also called radiographers, are the guys manning the X-ray machines, CT scans, ultrasound and magnetic resonance imaging (MRI) equipment, and other new diagnostic and therapeutic medical technologies.

For a long time they were considered pretty much bottom-rung hospital employees.

At the Makati Medical Center, where Arnold and Agnes worked after getting their radiography licenses in Manila, their pay checks were only a little more than the minimum wage.

"Even when I was single, I could barely make ends meet on P10,000 (about $228) a month," said Agnes, who hails from Batangas. A condominium or a new car were things just out of her league.

The two radiographers never even imagined they could land overseas jobs. Recruiters before were always scouting for nurses and physical therapists, they recalled.

Changing demand

But times have changed with the ever increasing role of radiologic imaging in both diagnostic and therapeutic practice—now part of the fast expanding field of nuclear medicine.

In 2000, Arnold and Agnes were recruited by a hospital in Singapore.

Arnold said he almost couldn't believe it: He was to earn more than what most resident doctors earned at private hospitals in Manila.

A decade later (faster than anyone can say millennium development goal), Arnold and Agnes enjoy a lifestyle only the ultra rich and some politicians in the Philippines can afford: a decent apartment abroad, a condominium in Manila, brand new cars, yearly tours to different parts of the world, and children studying in Essex, England.

It was in Singapore where Arnold and Agnes fell in love. They returned to Manila to get married.

Six years later, Arnold's former boss at the Singapore hospital called him about a job opening in a hospital in the UK.

He was raring to go, he said, but not without Agnes. That was another good decision he made. Overseas work did not tear this family apart.

"We didn't know what awaited us. But I was confident because Agnes was with me, supporting me every step of the way. She also had to resign from her job. We started anew," Arnold told the Philippine Daily Inquirer in a video conference.

Arnold, 36, and Agnes, 31, are now blessed with two children, Aedrick and Aedrey.

Read More..

source: inquirer.net

Throat Culture Procedure

Posted: 11 Sep 2010 06:50 PM PDT

A throat culture requires swabbing the throat, streaking a culture plate, and allowing the organisms to grow for isolation and identification of pathogens. A Gram-stained smear may provide preliminary identification, which may guide clinical management and determine the need for further tests. Culture reactions must be interpreted in light of clinical status, recent antimicrobial therapy, and the amount of normal flora.

Throat flora normally include nonhemolytic and alpha hemolytic streptococci, Neisseria species, staphylococci, diptheroids, some Haemophilus species, penumococci, yeats, enteric gram-negative organisms, spirochetes, Veillonella species, and Micrococcus species.

Purpose of Throat Culture

To isolate and identify group A beta hemolytic streptococci.
To screen asymptomatic carriers of pathogens, especially Neisseria meningitides.

Throat Culture Procedure

Patient Preparation

Confirm the patient's identity using two patient identifiers according to facility policy.
Explain to the patient that the throat culture is used to identify micro-organisms that may be causing his symptoms or to screen for asymptomatic carriers.
Inform the patient that he doesn't need to restrict food and fluids for the test.
Advise the patient that a specimen will be collected from his throat. Describe the procedure, and warn him that he may gag during the swabbing.
Check the patient's history for recent antimicrobial therapy.
Determine immunization history if it's pertinent to the preliminary diagnosis.

Implementation

Ask the patient to tilt his head back and close his eyes.
With the throat well illuminated, check for inflamed areas, using a tongue blade.
Swab the tonsillar areas from side to side; include any inflamed or purulent sites. Don't touch the tongue, cheeks, or teeth with the swab.
Immediately place the swab in the culture tube. If a commercial sterile collection and transport system is used, crush the ampule and force the swab into the medium to keep it moist.
Note recent antimicrobial therapy on the laboratory request.
Label the specimen with the patient's name, physicians name, date and time of collection, and origin of the specimen. Also indicate the suspected organism, especially Corynebacterium diptheriae (requires two swabs and a special growth medium) and N. meningitides (requires enriched selective media).

Nursing Interventions

Send the specimen to the laboratory immediately. Unless a commercial sterile collection and transport system is used, keep the container upright during transport.

Interpretation

Normal Results

Non-hemolytic and alpha-hemolytic
Neisseria species
Staphyloccoci
Diphtheroids
Some hemophilus species
Pneumococci
Yeats
Enteric gram-negative rods
Spirochetes
Veillonella species
Micrococcus species

Abnormal Results

Group A beta-hemolytic streptococci (Streptococcus pyogenes) (scarlt fever and pharyngitis).
Candida albicans (thrush)
Corynebacterium diphtheriae (diphtheria)
Bordetella pertusis (whooping cough)
N. gonorrhoeae
Neisseria meningitides
Mycoplasma and Chlamydia

Interfering Factors

Failure to report recent or current antimicrobial therapy on the laboratory request (possible false negative).
More than a 15 minute delay in sending the specimen to the laboratory.

Precautions

Obtain the throat specimen before beginning antimicrobial therapy.
Wear gloves when performing the procedure and handling of specimens.

Thoracentesis

Posted: 11 Sep 2010 06:41 PM PDT

Also known as pleural fluid aspiration, the thoracic wall is punctured to obtain a specimen of pleural fluid for analysis or to relieve pulmonary compression and resultant respiratory distress. Locating the fluid before thoracentesis reduces the risk of puncturing the lung, liver, or spleen.

The pleural cavity should contain less than 20 ml of serous fluid. Pleural effusion results from the abnormal formation or reabsorption of pleural fluid. Certain characteristics classify pleural fluid as either a transudate or exudates.

Pupose

To provide pleural fluid specimens to determine the cause and nature of pleural effusion.
To provide symptomatic relief with large pleural effusion.

Procedure

Preparation

Check the patient's history for bleeding disorders or anticoagulant therapy.
Explain that a chest X-ray or ultrasound study may precede the test.
Explain the procedure to the patient.
Instruct the patient no to cough, breathe deeply, or move during the test to minimize the risk of lung injury.
Record the patient's baseline vital signs.
Shave the area around the needle insertion site, if necessary, and position the patient properly.

Implementation

Position the patient to widen the intercostals spaces and allow easier access to the pleural cavity.
If the patient can't sit up, position him on his unaffected side with the arm on the affected side elevated.
After the patient is in proper position, prepare and drape the site.
Inject a local anesthetic into the subcutaneous tissue; the thoracenthesis needle is then inserted.
When the needle reaches the pocket of fluid, it's attached to a 50-ml syringe or a vacuum bottle and the fluid is removed.
During aspiration, the patient is monitors for signs of respiratory distress and hypotension.
Pleural fluid characteristics and total volume are noted.
After the needle is withdrawn, apply pressure until hemostasis is obtained and a small dressing is applied.
Place specimens in proper containers, labeled appropriately, and send to the laboratory immediately.
Pleural fluid for pH determination must be collected anaerobically, heparinized, kept on ice, and analyzed promptly.

Nursing Interventions

Elevate the head of the bed to facilitate breathing.
Obtain a chest X-ray.
Tell the patient to immediately report difficulty of breathing.
Immediately report signs and symptoms of pneumothorax, tension pneumothorax, and pleural fluid reaccumulation.
Monitor the patient for reexpansion pulmonary edema (RPE), a rare but serious complication of thoracentesis. Thoracentesis hould be halted If the patient has sudden chest tightness or coughing.
Monitor vital signs, pulse oximetry, and breathe sounds.
Observe the puncture site and dressings.
Watch for subcutaneous emphysema.
Monitor pleural pressure.

Interpretation

Normal Results

Negative pressure in the pleural cavity with less than 50 ml serous fluid.

Abnormal Results

Bloody fluid suggests possible hemothorax, malignancy, and traumatic tap.
Milky fluid suggests chylothorax.
Fluid with pus suggests empyema.
Transudative effusion suggests heart failure, hepatic cirrhosis, or renal disease.
Exudative effusion, suggests lymphatic drainage abstraction, infections, pulmonary infarctions, and neoplasma.
Positive cultures suggest infection.
Predominating lymphocytes suggest tuberculosis or fungal or viral effusions.
Pleural fluid glucose levels that are 30 to 40 mg/dl lower than blood glucose levels may indicate cancer, bacterial infection, or metastasis.
Increased amylase suggests pleural effusions associated with pancreatitis.

Interfering Factors

Failure to use sterile technique.
Antimicrobial therapy before fluid aspiration for culture (possible decrease in numbers of bacteria, making it difficult to isolate the infecting organism).

Precautions

Thoracentesis is contraindicated in the patient who has a history of bleeding disorders or anticoagulant therapy.
The strict sterile technique.

Complications

Laceration of intercostals vessels
Pneumothorax
Mediastinal shift
Reexpansion pulmonary edema (RPE)
Bleeding and infection

Sputum Culture

Posted: 11 Sep 2010 06:36 PM PDT

Bacteriologic examination of sputum – material raised from the lungs and bronchi during deep coughing – is an important aid in managing lung disease. The usual method of specimen collection is expectoration. Other methods include tracheal suctioning and bronchoscopy. A gram stain of expectorated sputum must be examined to ensure that it's representative of secretions from the lower respiratory tract rather than contaminated by oral flora. Careful examination of an acid-fast sputum smear may provide presumptive evidence of a mycobacterial infection, such as tuberculosis.

Sputum may be cultured to identify respiratory pathogens. Expectoration, the usual sputum collection method, may require ultrasonic nebulization, hydration, or chest percussion and postural drainage. Less common method include tracheal suctioning where in it provides a more reliable diagnostic specimen but generally isn't used, unless expectoration fails to provide sample.

Purpose

To isolate and identify causes of pulmonary infections.
To aid diagnosis of respiratory diseases, such as bronchitis, tuberculosis, lung abscess, and pneumonia.

Procedure

Preparation

Inform the patient that his test requires a sputum specimen.
Explain that the specimens may be collected on at least three consecutive mornings if the suspected organism is Myobacterium Tuberculosis.
Inform the patient that result for TB cultures take up to 2 months.

Implementation

Expectoration

Put on gloves and a mask.
Instruct the patient to cough deeply and expectorate into the container.
If the cough in nonproductive, use chest physiotherapy or nebulization to induce sputum, as ordered.
Using aseptic technique, close the container securely and place it in a leak proof bag before sending it to the laboratory.

Tracheal Suctioning

Give oxygen to the patient before and after the procedure as necessary.
Attach the sputum trap to suction catheter.
Lubricate the catheter with normal saline solution and pass the catheter through the nostril without suction.
Advance the catheter into the trachea; apply suction while withdrawing the catheter, not during catheter insertion.
Suction only for 5 to 10 seconds at a time.
Stop suction and remove the catheter.
Discard the catheter in the proper receptacle.
Detach the in-line sputum trap from the suction apparatus and cap the opening.
During the passage through the throat and oropharynx, sputum specimens are commonly contaminated with indigenous bacterial flora.
Label the container with the patient's name, the nature and origin of the specimen, the date and time of collection, the initial diagnosis, and any current antimicrobial therapy.
Send the specimen to the laboratory immediately after collection.

Nursing Interventions

Provide mouth care to the patient.
Monitor his vital signs and respiratory status.
Monitor oxygen saturation with a pulse oximeter.
If the patient becomes hypoxic or cyanotic during suctioning, remove the catheter immediately and give oxygen while suctioning pulse oximetry.

Interpretation

Normal Results

Common flora includes alpha-hemolytic streptococci. Neisseria, and diptheroid.
Presence of common flora doesn't rule out infection.

Abnormal Results

Because sputum is invariably contaminated with normal oropharyngeal flora, a culture isolate must be interpreted in light of the patient's overall clinical condition.
Isolation of Myobacterium Tuberculosis suggests tuberculosis.
Isolation of pathogenic organisms most often includes Streptococcus pneumonia, Myobacterium Tuberculosis, Klebsiella pneumoniae (and other Enterobacteriaceae), Haemophilus influenzae, Staphyloccocus aureus, and Pseudomonas aeruginosa.

Complications