Definition
Collecting stool specimen is a vital diagnostic procedure used to detect gastrointestinal infections, bleeding, parasites, malabsorption, or inflammatory conditions.
It involves collection of a small quantity of stool sample in a container or with the help of a fecal swab, laboratory for an overall analysis as directed by the physician, e.g., routine, culture or microbiological examination.
Types of Fecal Examination
| Method of fecal analysis | Aspects assessed | Tool used |
| Physical | Color, volume, consistency, odor, appearance, texture. | Inspection and comparison, e.g., using Bristol stool chart. |
| Chemical | pH, occult blood, fat, carbohydrate, reaction, etc. | Guaiac test, immunological test, flushable reagent pads, etc. |
| Microscopic | Food remnants, pus, red blood cells, microbes, etc. | Slides. |
| Culture | Disease causing or pathogenic microbes, such as shigella species, salmonella species, etc. | Microscopic view and interpretation of slides with stool specimen collected with the help of rectal swab. |
Purpose
- To test the stool for normalcy and presence of abnormalities.
- To culture the organisms that are not part of the normal bowel flora, e.g., Salmonella, Shigella, rotavirus, etc.
- To identify warning signs of gastrointestinal disorders, e.g., colorectal cancer, GI bleeding, inflammation or infection.
Articles
- A clean specimen container with spatula for putting the specimen into the container.
- Fecal swab for taking culture specimen.
- Dry bedpan (for helpless patients). Additional bedpan for rinsing and cleaning.
- Holder or plastic bag to collect stool (for ambulatory patients).
- Laboratory requisition form.
- Clean gloves.
- Wastepaper (for wrapping used spatula).
- A pitcher of water (for helpless patient).
- Tissues/towel.
Procedure
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedure Check the physician’s order and nursing care plan. | Obtain specific instruction and information. |
| 2. | ldentify the patient. | Helps to perform the right procedure for the right patient. |
| 3. | Explain to patient the procedure and make sure the patient understands what is expected of him/her as per the specific fecal test ordered. | Aids in proper collection of specimens. |
| 4. | Give the labeled container and spatula to the patient with instructions. i. To defecate into clean dry bedpan. ii. Not to contaminate the specimen with urine. | |
| 5. | During procedure Don gloves. | |
| 6. | For helpless patient: assist patient onto the clean bedpan. | |
| 7. | Leave him with instructions. | |
| 8. | When done, remove and keep aside the bedpan after placing the second one for cleansing. | |
| 9. | Collect about 2 cm of formed stool or 20-30 mL of liquid diarrheal stool in case of routine examination;1 cm of formed stool or 10-15 mL of liquid diarrheal stool in case of culture sample. | Stool cultures require only a small sample which is taken using a fecal swab. |
| 10. | Once the specimen is collected send it to the laboratory with the appropriate requisition forms. | |
| 11. | After procedure Wash and replace the reusable articles | |
| 12. | Dispose of the used spatula wrapped in wastepaper. | Prevents contamination. |
| 13. | Wash and dry hands. | Prevents cross-contamination. |
| 14. | Record the information in the patient’s chart. |
Special Considerations
- Send specimen to be examined for parasites immediately, so that parasites can be observed under microscope while viable, fresh and warm.
- In case of specimen for ova and parasites examination, the stool collected in clean container should be transported immediately so that the test can be performed, and the stool is in the vial within 2 hours of collections. Using the spork, built in the vial small sample of the collected stool is put in, till the fluid in the vial reaches till the marking on the vial. The content is then mixed with the Spork, capped tightly and inverted several times to mix the content thoroughly.
- In case of fecal occult blood test (FBOT) the stool sample should be taken stepwise, correctly scratched with the sampling probe, to ensure the amount of stool specimen is transmitted into the FOBT probe.
- Inform if bleeding hemorrhoids or hematuria is present.
- Postpone the test if woman is menstrual, until three days after it has ceased.
- Consider that intake of folic acid, anticoagulant, barium, bismuth, mineral oil, vitamin C, and antibiotics may alter the results.
- Use two bedpans for helpless patients – one for collecting specimen and another for cleaning.
- Stool specimen for culture can be obtained directly from the rectum using a sterile swab.
- If a patient passes blood and mucus, include this information in specimen label.
- Provide assistance to helpless patients to sit on the pan, clean him/her after defecation, and collect the specimen.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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