How to take sputum for general or bacteriological analysis and what do these studies show? Sputum examination: aims and methods of investigation Laboratory examination of sputum.

The mucus secreted in diseases of the respiratory organs is called. In the absence of an inflammatory process, excessive production and discharge of this secret is not observed. Normally, there is a slight production of sputum, which is usually swallowed unnoticed by a person. The main function of tracheobronchial mucus is to clear the airways of inhaled dust and other particles. Sputum consists of immunoglobulins, proteins, macrophages, glycoproteins, lymphocytes.

Sputum examination in the laboratory is carried out to clarify the diagnosis in pathologies of the respiratory organs, lungs or bronchi. Excessive secretion of mucus and the presence of impurities in it may indicate serious diseases. Sputum analysis is carried out for the following purposes:

Diagnosis of pathologies of the lungs.
Determination of the characteristics of the disease.
Evaluation of the effectiveness of the therapy.
Tracking dynamics in chronic lung pathologies.

If the patient has a prolonged cough with copious secretion, then there is a need for a clinical analysis of sputum, especially if dark spots on the chest were detected during fluoroscopy. Prior to the laboratory study of tracheobronchial mucus, diseases can be judged by its appearance, consistency, smell, and other indicators. These are the following types:

Green sputum indicates congestion, sinusitis.
The pearly white color of the mucus indicates a malignant process in the bronchi.
A large amount of blood along with sputum is an extreme degree of tuberculosis or lung cancer.
A clear liquid can be released with bronchitis.
Purulent sputum with a sharp unpleasant odor, released after severe pain in the chest, often indicates a rupture of the abscess, gangrene of the lungs, etc.
Mucus with an amber tint is released with allergies.
Blood streaks in the mucus are found when bleeding in the lungs or when.
Liquid and transparent sputum with a foamy consistency, in which purulent inclusions are present, indicates chronic bronchitis or pulmonary tuberculosis.
Mucous discharge of a rusty color can be with inflammation of the lungs.

A laboratory bacteriological examination of sputum is prescribed if severe pathologies of the lungs and bronchi are suspected, for example, tuberculosis, infectious lesions, a cancerous process, etc. In the absence of suspicious inclusions, normal color and consistency, a general sputum analysis is performed to assess the condition of the bronchi and lungs.

Main types of research:

detection of Mycobacterium tuberculosis.
Microscopic or general analysis.
Examination of the secret for atypical cells with a high probability of a malignant process in the lungs.
Bacteriological examination in infectious diseases of the lungs.

Features of the sputum collection process may be different depending on what type of study is being carried out. Most often, biomaterial sampling occurs in the morning, but if necessary, at other times of the day. Before coughing, you should thoroughly brush your teeth and rinse your mouth with an antiseptic solution, such as furatsilin or a weak solution of potassium permanganate. You need to spit out the discharge into a special sterile container.

Before collecting sputum for laboratory testing to detect lung or bronchial disease, you should properly prepare your body. Following these guidelines will make the process easier:

The day before the proposed procedure, take expectorant drugs, drink more warm water.
Carry out the procedure in the morning, because during the night the mucus accumulates in the right amount and easily leaves.
If it is not possible to cough up the mucus, then you need to inhale or take a deep breath and exhale the air several times in a row.
It is desirable to spit the material only in a special container sold in pharmacies.
During the procedure, make sure that only sputum, but not saliva, gets into the sterile container.

The very process of collecting sputum is as follows: the patient must take a deep breath and slowly exhale the air, repeat several times. Then start coughing vigorously so that a sufficient amount of mucus is released, and spit it into the container. The container must be tightly closed with a lid and placed in the refrigerator. The study of this biological material must be carried out within two hours after collection, otherwise pathogenic microorganisms may begin to multiply in it, the presence of which distorts the results of the study.

Collection of material during bronchoscopy

is a diagnostic procedure designed to examine the respiratory tract. It is carried out with abscesses in the lungs, pneumonia, tuberculosis. Bronchoscopy is also prescribed when it is impossible to obtain sputum in a natural way, and if it is necessary to study tracheobronchial mucus without impurities of saliva and nasopharyngeal contents.

The procedure is contraindicated after a heart attack, with pulmonary and heart failure, with exacerbation of bronchial asthma, neuropsychiatric disorders, etc. Before the diagnosis, the patient must take blood tests, make an electrocardiogram, and X-ray examination of the lungs. Description of bronchoscopy:

Local or general anesthesia is used.
A bronchoscope is inserted into the trachea and lungs through the nasal or oral cavity, and a mucus sample is taken.
After the procedure, the patient is forbidden to take blood thinners, such as aspirin.

Laboratory tests

After sputum collection and delivery to the laboratory, a comprehensive study of the biomaterial is carried out, which is necessary to clarify the diagnosis. Thus, it becomes possible to identify a variety of pathologies. The main stages of sputum examination:

Microscopic.
Bacteriological.

Clinical analysis involves the study of the color and smell of the biological fluid, its quantity, the presence or absence of impurities. In the process of performing this laboratory analysis, the features of the course of the disease in the lungs and other respiratory organs are identified. Microscopic examination is the study of a sample of tracheobronchial mucus under a microscope. Used to detect eosinophils, Kurschman coils, leukocytes, etc.

Bacterial seeding on the microflora is necessary to determine the specific causative agent of the disease. This type of study is prescribed when an increased content of leukocytes in sputum is detected. This analysis also allows you to find out to which antibacterial drug there is sensitivity in microorganisms that are the causative agents of pathology. Bacteriological examination of sputum is often performed when pulmonary tuberculosis is suspected.

Evaluation of the results of the analysis

Often the results of sputum analysis are incorrect. This is due to improper collection or storage of biological material, penetration of other substances or liquids into it, with untimely examination of mucus.

The attending doctor deciphers the results, and the treatment course is prescribed taking into account other laboratory and instrumental studies. Normally, the fluid in question has a mucous structure, transparency, it should not contain purulent inclusions, blood streaks, foreign smell, etc.

An excess of eosinophils indicates bronchial asthma or helminthiasis of the lungs.
The detection of a large number of neutrophils indicates infectious lesions of the lungs (tuberculosis, acute, etc.).
In bronchial asthma, the presence of Kurshman's spirals in the mucus is noted.
The detection of Charcot-Leiden crystals confirms the diagnosis of bronchial asthma.

With improper collection of tracheobronchial mucus during the study, an increased concentration of squamous epithelial cells (more than 25) is found. Often this is observed with a large amount of saliva in the biomaterial. And also this may be due to the decay of lung tissue with widespread tuberculosis or inflammation of the lungs with an abscess. Referral for sputum examination is issued by the following specialists:

Therapist.

Compliance with medical recommendations regarding the correct collection of biomaterial will help to obtain the most reliable research results, on the basis of which the correct treatment of the identified pathologies of the lungs and other respiratory organs is prescribed.

Pleural fluid

Transudates, as a rule, are sterile, however, they can become infected with multiple punctures.

Exudates also sometimes sterile (rheumatic pleurisy, lung cancer, lymphosarcoma). In purulent exudates, bacterioscopy of a Gram-stained smear or culture on nutrient media reveals a variety of microflora (pneumococci, streptococci, staphylococci, enterococci, Klebsiella, Escherichia coli, etc.). For targeted treatment, the sensitivity of microorganisms to antibiotics is determined. Anaerobic flora is found in putrefactive exudates. In serous, hemorrhagic exudates of tuberculous etiology, Koch's bacilli (Mycobacterium tuberculosis) can be found. To do this, the exudate is subjected to long-term centrifugation or processing by flotation.

The Rivalta test is determined by a protein substance - seromucin.

Sputum examination

Phlegm - pathological discharge of the respiratory organs: lungs, bronchi, trachea. Excreted by coughing or expectoration. As a rule, the secret of the oral cavity (saliva) and mucus from the nasopharynx are mixed with sputum. Therefore, it is very important in the study of sputum to carefully observe the rules for its collection.

For clinical laboratory research, a morning portion of sputum is taken before meals after a thorough rinsing of the mouth and throat. Sputum is collected in a clean, dry glass jar or Petri dish. Laboratory examination of sputum includes macroscopic (quantity, character, consistency and smell, presence of impurities), microscopic examination, bacteriological, as well as sputum culture on nutrient media to identify the pathogen and determine its sensitivity to antibiotics.

If necessary, sputum is stored in a cool place, preferably in the refrigerator.

Sputum delivered to the laboratory is first examined macroscopically (i.e., physical properties are determined).

Quantity sputum (per day) depends on the nature of the pathological process. Bronchitis, bronchial asthma, lobar pneumonia are usually accompanied by scanty (2-5 ml) sputum - single spitting. When opening a lung abscess, gangrene is characterized by sputum production in large quantities, which can sometimes reach up to 1-2 liters per day.

Character: sputum is not uniform. It consists of mucus, pus, blood, serous fluid, fibrin. The content of these substrates in sputum determines its character.

The nature of sputum can be: mucous, mucopurulent, mucopurulent-bloody, serous, serous-purulent, bloody-mucous.

When describing sputum, it is customary to put the predominant substrate in second place.

Colour depends on:

The nature of sputum (the predominance of one of the substrates gives it the appropriate shade);

Inhaled particles that stain sputum. Grayish, yellowish, greenish color of sputum depends on the content and amount of pus.

Rusty, red, brownish, yellow color - from the admixture of blood and its decay products. Gray and black colors give sputum coal and dust, white - flour dust.

Inhaled dust containing dyes can turn sputum blue and other colors.

Consistency depends on the composition of the sputum. A viscous consistency is observed in the presence of mucus, sticky - with a large amount of fibrin, semi-liquid - from the presence of serous fluid in the mucopurulent sputum, liquid - from the presence of serous fluid.

Smell the unpleasant smell of freshly isolated sputum is determined with a lung abscess, and putrefactive - with gangrene, the decay of a malignant tumor. In other cases, freshly isolated sputum has no odor.

Division into layers observed in cases of sputum during emptying of large cavities in the lung (lung abscess, bronchiectasis). The lower, dense layer consists of pus, detritus, the upper layer is liquid. On its surface sometimes there is a third - foamy layer.

Microscopic examination of sputum consists of the study of native and stained preparations. In the native preparation, epithelial cells, leukocytes, single erythrocytes, drusen of actinomycosis, echinococcus elements, crystals of fatty acids and hematoidin, mucus strands can be found.

You can consider elements of bronchial asthma in it: eosinophils in large numbers, Charcot-Leiden crystals and Kurshman spirals.

Eosinophils are rounded formations of dark gray color.

Charcot Leiden Crystals- shiny, transparent, often in the form of octahedrons and rhombuses. It is believed that they are of a protein nature, formed during the destruction of eosinophils.

Kurshman spirals- casts of transparent mucus from spastically contracted bronchi.

Elastic fibers can also be seen in the native preparation. They are formed as a result of the breakdown of lung tissue. Elastic fibers are found in tuberculosis and lung abscess. They are two-circuit shiny formations.

Leukocytes are always found in sputum in greater or lesser quantities, depending on its nature. The more pus in the sputum, the more white blood cells.

red blood cells They look like discs of yellowish color. Single erythrocytes can be found in any sputum. They are found in large numbers in blood-stained sputum (pulmonary hemorrhage, pulmonary infarction, congestion in the pulmonary circulation, neoplasm of the lung)

squamous epithelial cells get into the sputum from the oral cavity, nasopharynx.

atypical cells in malignant neoplasms.

Alveolar macrophages belong to the cells of the histiocytic system. In preparations, they are located in the form of large accumulations, more often in mucous sputum with a small amount of pus. They are found in various pathological processes (pneumonia, bronchitis, occupational diseases).

Bacteriological examination of sputum consists in sowing sputum on special media and is used if bacterioscopic examination does not detect the alleged pathogen. Bacteriological research allows to identify the type of microbes, to determine their virulence. In clinical practice, sputum can be a material for determining the sensitivity of microbes to antibiotics.

test questions

1. Name the method for obtaining pleural fluid.

2. What is a transudate and what causes it?

3. What is exudate and what causes it?

4. The difference between transudate and exudate.

5. Diagnostic value of microscopic examination of the pleural fluid.

6. List the types of exudates.

7. Name the causes of hemorrhagic exudate. List its features.

8. What is chylous exudate? When is it observed?

9. What is chylous exudate? List its differences from chylous exudate.

10. Name the distinguishing features of serous and purulent exudates.

11. What is sputum? How is sputum collected for laboratory and microbiological testing?

12. Significance of macroscopic examination of sputum.

13. Diagnostic value of the amount of sputum.

14. What color of sputum can be observed?

15. What causes the appearance of "rusty" sputum? When is it observed?

16. Diagnostic value of the nature of sputum.

17. Significance of microscopic examination of sputum.

18. What are Kurshman spirals? When do they appear?

19. Diagnostic value of elastic fibers in sputum.

20. What does the appearance of Charcot-Leiden crystals indicate?

21. What are Dietrich plugs? When do they appear in sputum?

22. What is the difference between Dietrich's plugs and "rice bodies"?

23. The value of bacteriological examination of sputum.

Control tasks

1. A patient with fluid in the pleural cavity on the right up to the II rib was admitted to the emergency department of the hospital, where it was proposed to urgently remove the fluid. What is the name of the procedure for removing fluid from the pleural cavity? On what topographic lines is it carried out?

2. A patient with circulatory failure revealed the presence of fluid in the pleural cavity. What type of fluid has accumulated in the pleural cavity?

3. Fluid was found in the pleural cavity in a patient with a long rheumatic history. What is the origin of the fluid in the pleural cavity?

4. During pleural puncture, the patient received hemorrhagic exudate. What process can be suspected in this case?

5. During the pleural puncture, a liquid with a relative density of 1.010 was obtained, the protein content was 15 g/l, the Rivalta test was negative. Assess the nature of the liquid.

6. For diagnostic purposes, the patient underwent a pleural puncture, during which a yellow-green liquid was obtained. The protein content is 52 g/l, Rivalta's test is positive. Assess the nature of the liquid.

7. Before collecting the morning portion of sputum, the patient forgot to brush his teeth and make a toilet of the oral cavity. Is the result of laboratory sputum examination reliable in this case?

8. Macroscopic examination of sputum is transparent, vitreous, microscopic examination revealed a large number of eosinophils, Kurshman's spirals, Charcot-Leiden crystals. What disease is this sputum analysis typical for?

9. Examination of sputum revealed large amounts of elastic fibers and cholesterol crystals. What process is this sputum analysis typical for?

10. Sputum staining according to Ziel-Nilson revealed a large number of microorganisms. What microorganism is this stain used to identify?

11. Against the background of severe suffocation, a patient has an abundant amount of liquid, opalescent foamy sputum. What condition is this macroscopic examination of sputum typical for?

12. A patient has a cough with the release of a moderate amount of mucopurulent-bloody sputum containing dense whitish lumps of "rice bodies". What pathology can be thought of in this case?

Similar information.

Sputum examination involves the determination of the physical properties of sputum, its microscopic examination in a native smear and bacteriological examination in stained preparations.

Collection of material

Sputum obtained by coughing in the morning before meals is collected in a clean, dry bottle. Before the examination, the patient should brush their teeth and rinse their mouth thoroughly with water.

Physical properties

Sputum is placed in a Petri dish, examined against a light and dark background, and its properties are described. The amount of sputum per day for various pathological processes can be different: for example, with bronchitis - scant (5-10 ml), with a lung abscess, bronchiectasis - a large amount (up to 200--300 ml).

The division into layers is observed in cases of emptying of large cavities in the lung, for example, lung abscess. In this case, sputum forms 3 layers: the lower layer consists of detritus, pus, the upper layer is liquid, sometimes there is a third layer on its surface - a foamy layer. Such sputum is called three-layer.

Character: the nature of sputum determines the content of mucus, pus, blood, serous fluid, fibrin. Its character can be mucous, mucous-hyoid, mucous-purulent-bloody, etc.

Color: depends on the nature of the sputum, on exhaled particles that can color the sputum. For example, a yellowish, greenish color depends on the presence of pus, "rusty" sputum - from the breakdown of red blood cells, occurs with croupous pneumonia. Blood streaks in sputum or red sputum may be mixed with blood (tuberculosis, bronchiectasis). Gray and black color gives sputum coal.

Consistency: depends on the composition of sputum, liquid - mainly on the presence of serous fluid, sticky - in the presence of mucus, viscous - fibrin.

Odor: Fresh sputum is usually odorless. The unpleasant smell of freshly excreted sputum usually appears with a lung abscess, with lung gangrene - putrefactive.

microscopic examination

Native preparations are prepared by selecting material from different places of sputum, and all particles that stand out in color, shape, and density are also taken for research.

The selection of the material is carried out with metal sticks, placed on a glass slide and covered with a coverslip. The material must not extend beyond the coverslip.

Leukocytes: always found in sputum, their number depends on the nature of the sputum.

Eosinophils: are recognized in the native preparation by a darker color and the presence of a clear, uniform, light-refracting granularity in the cytoplasm. Often located in large clusters. Eosinophils are found in bronchial asthma, other allergic conditions, helminthiasis, lung echinococcus, neoplasms, eosinophilic infiltrate.

Erythrocytes: have the appearance of yellow discs. Single erythrocytes can be found in any sputum, in large numbers - in sputum containing an admixture of blood: neoplasms of the lung, tuberculosis, pulmonary infarction.

Squamous epithelial cells: get into the sputum from the oral cavity, nasopharynx, do not smolder of great diagnostic value.

Cylindrical ciliated epithelium: lines the mucous membrane of the larynx, trachea, bronchi. It is found in large quantities in acute catarrhs of the upper respiratory tract, bronchitis, bronchial asthma, lung neoplasms, pneumosclerosis, etc.

Alveolar macrophages: large cells of various sizes, often round, with black-brown inclusions in the cytoplasm. They are more common in mucous sputum with a small amount of pus. They are found in various pathological processes: pneumonia, bronchitis, occupational lung diseases, etc. Alveolar macrophages containing hemosiderin, the old name is "heart disease cells", have golden yellow inclusions in the cytoplasm. To identify them, a reaction to Prussian blue is used. Reaction course: a piece of sputum is placed on a glass slide, 2 drops are added 5% hydrochloric KIOLOTE solution and 1-2 drops 5% yellow blood salt solution. Stir with a glass rod and cover with a coverslip. Hemosiderin lying intracellularly stains blue or blue. These cells are found in sputum during congestion in the lungs, lung infarcts.

Fatty degeneration of cells (lipophages, fat balls): more often rounded, their cytoplasm is filled with fat. When Sudan III is added to the preparation, the drops turn orange. Groups of such cells are found in neoplasms of the lung, actinomycosis, tuberculosis, etc.

Elastic fibers: in sputum they look like crumpled shiny fibers. As a rule, they are located against the background of leukocytes and detritus. Their presence indicates the decay of lung tissue. They are found in abscess, tuberculosis, neoplasms of the lung.

Coral fibres: Rough branching formations with tuberous thickenings due to the deposition of fatty acids and soaps on the fibres. They are found in sputum with cavernous tuberculosis.

Calcified elastic fibers are coarse rod-shaped formations impregnated with lime salts. They are found during the collapse of a petrified focus, lung abscess, neoplasms, the element of decay of a petrified focus is called Ehrlich's tetrad: I) calcified elastic fibers; 2) amorphous lime salts; 3) cholesterol crystals; 4) Mycobacterium tuberculosis.

Spirals Kurshma on_- mucus formations are compacted, twisted into a spiral. The central part sharply refracts light and looks like a spiral, along the periphery, free-lying mucus forms a mantle. Curshman spirals are formed with bronchial ace tme.

Crystal formations: Charcot-Leiden crystals, elongated shiny diamonds, can be found in yellowish sputum pieces containing a large number of eosinophils. Their formation is associated with the breakdown of eosinophils,

Hematoidin crystals: have the shape of rhombuses and golden needles. They are formed during the breakdown of hemoglobin during hemorrhages, the decay of neoplasms. In the preparation of sputum are usually visible against the background of detirit, elastic fibers.

Cholesterol crystals: colorless quadrilaterals with a broken off step-like angle, are found during the decay of fatty degenerate cells, in cavities. Meet with tuberculosis, lung abscess, neoplasms.

Dietrich's plugs: small yellowish-gray grains with an unpleasant odor, found in purulent sputum. Microscopically they are detritus, bacteria, crystals of fatty acids in the form of needles and droplets of fat. Formed during stagnation of sputum in the cavities with lung abscess, bronchiectasis.

Bacteriological research

Test for tuberculosis mycobacteria: The drug is prepared from purulent sputum particles, dried

in air and fixed over the flame of the burner. Dyed by

Tsil-Nilson.

Staining method: Reagents:

I) carbolic fuchsin,

2) 2% alcoholic solution of hydrochloric acid,

3) an aqueous solution of 0.5% methylene blue.

Coloring progress:

1. A piece of filter paper is placed on the preparation and a solution of carbolic fuchsin is poured.

2. The drug is heated over the flame of the burner until vapors appear, cooled and heated again (so 3 times).

3. Remove the filter paper from the cooled glass. Discolor the smear in hydrochloric alcohol until the paint is completely gone.

4. Washed with water.

5. Finish the preparation with methylene blue for 20-30 seconds.

6. Rinse with water and air dry. Microscopically with an immersion system. Mycobacterium tuberculosis stains red

all other elements of sputum and bacteria - in blue. Tuberculous mycobacteria have the appearance of thin, slightly curved rods with thickenings at the ends or in the middle.

Acid-resistant saprophytes are also stained red when stained according to Ziehl-Nielson. Differential diagnosis of tuberculous microbacteria and acid-resistant saprophytes is carried out by methods of sowing and infection of animals.

Sputum examination can also be carried out by the flotation method. Potenger method: research progress:

1. Freshly isolated sputum (no more than 10-15 ml) is placed in a narrow-necked bottle, a double amount of caustic alkali is added, the mixture is vigorously shaken (10-15 minutes).

2. Pour in 1 ml of xylene (you can use gasoline, toluene) and about 100 ml of distilled water to thin the sputum. Shake again for 10-15 minutes.

3. Add distilled water to the neck of the bottle and leave to stand for 10-50 minutes.

4. The resulting upper layer (whitish) is removed drop by drop with a pipette and applied to glass slides preheated to 60°. Each subsequent drop is applied to the dried previous one.

5. The preparation is fixed and stained according to Ziehl-Nilson.

Test for other bacteria:

Other bacteria found in sputum, such as streptococci, staphylococci, diplobacilli, etc., can only be recognized by culture. Bacteriological examination of the preparation in these cases is only of approximate value. Preparations are stained with methylene blue, fuchsin or g frame. Gram stain: Reagents: I) carbolic solution of gentian violet,

2) Lugol's solution,

3) 96° alcohol,

4) 40% solution of carbolic fuchsin.

Research progress:

1. A strip of filter paper is placed on the fixed preparation, a solution of gentian violet is poured, stained for 1-2 minutes.

2. The paper is removed and the drug is poured with Lugol's solution for 2 minutes.

3. Lugol's solution is drained and the drug is rinsed in alcohol until gray.

4. Washed with water and stained for 10-15 seconds with a solution of magenta.

Equipment.

FULL NAME. patient,

address or medical record number,

date of referral for research.

2. Sterile, wide-mouth jar with a kraft paper lid, taken in

bacteriological laboratory.

Sputum collection technique.

Collect sputum in the morning before meals.
In the evening and 1.5 - 2 hours before the examination, brush your teeth.
Immediately before the examination, rinse your mouth and throat with boiled water.
Explain to the patient that during the collection of sputum, he should not touch the edges of sterile dishes with his hands or mouth. Do not touch the inside of the cover. And after coughing, immediately close the jar with a lid.
Cough up and collect mucus. Not less than 5 ml.
Deliver to the laboratory no later than 1 - 1.5 hours after collection.

diagnostic value.

The causative agent of the pathological process is identified (inoculation is done on nutrient media), and it is also possible to select an antibiotic effective for this pathogen (that is, to determine the sensitivity of the pathogen to a particular antibiotic).

Collection of sputum for Mycobacterium tuberculosis by flotation.

Equipment.

FULL NAME. patient,

address or medical record number,

date of referral for research

2. Clear dark glass wide mouth jar with screw cap

(since mycobacterium tuberculosis perishes in the light)

Sputum collection technique.

Sputum is collected during the day.
If the sputum leaves in a small amount, then the collection takes place within 3 days. The spittoon in this case is stored in a cool, dark, dry place.
For a reliable analysis, 15-20 ml of sputum is needed.
Warn that sputum is collected only when coughing, and not when expectorating.
It is necessary to observe the rules of personal hygiene before and after sputum collection.

diagnostic value.

Detection in the sputum of the causative agent of tuberculosis - Mycobacterium tuberculosis.

Collection of sputum for atypical cells.

The patient preparation and collection rules are the same as for the general clinical analysis.

BUT! Freshly isolated sputum is examined, as atypical cells are rapidly destroyed.

Sometimes preliminary inhalations are used with the proteolytic enzyme trypsin, which promotes the release of sputum from the deepest parts of the bronchial tree.

Bronchoscopy.

Bronchoscopy - a method of examining the bronchi using a special bronchofibroscope device.

Purpose of the procedure:

Diagnostics.

Visually examining the bronchial mucosa of large and medium caliber, you can detect erosion, ulcers, inflammatory changes, neoplasms.

Using special tweezers, you can take a piece of tissue from a suspicious place

for cytological and histological examination

Therapeutic.

You can remove a foreign body, remove polyps. You can extract purulent, viscous sputum, as well as introduce antibiotics and other medicinal substances into the bronchus cavity.

Training objectives:

Inform the patient about the upcoming procedure and obtain his consent.
Prepare the necessary equipment to ensure a clear execution of the study.

Equipment:

Bronchoscope
Rubber gloves
Syringes 10 and 20 ml
Anesthetic solution (novocaine 1%, trimecaine 5%, lidocaine 2%)
Atropine solution 0.1%
Diphenhydramine solution 1%
Direction for research
Anaphylactic Shock Kit

Information for the patient on preparation for the study.

In an accessible form, provide the patient or his relatives with information about the essence and goals of the upcoming study. Get consent.
Warn the patient that on the day of the study you can not eat, drink, smoke.
The night before, as prescribed by the doctor, premedicate with tranquilizers.
Immediately before the study, ask the patient to empty the bladder.
Come to the endoscopy room with a towel and a referral at the appointed time.

Research methodology:

Immediately before the study, 15 minutes before the doctor's prescription, inject the patient subcutaneously with 0.1% 1 ml of atropine, 1% 1 ml of diphenhydramine.
Put on sterile gloves.
Ask the patient to sit on a chair with their head tilted back slightly.
Administer upper respiratory tract anesthesia.
Assist physician during bronchoscopy.
After the end of the procedure, discard gloves and used tools in a disinfectant solution.
Conduct the patient to the ward, warn about the need not to eat or smoke for 2 hours after the examination.

postural drainage.

This is the use of a certain body position - special "drainage" postures and exercises with forced elongated exhalation to improve sputum discharge.

Contraindications:

Hemoptysis.
Occurrence during the procedure of significant shortness of breath or an attack of suffocation.
Increase in blood pressure.
Dizziness.
Arrhythmias.

Action algorithm:

Explain to the patient the meaning and purpose of the procedure.
Get his consent.
Prepare the spittoon.
Give one of the drainage positions.
Monitor the patient's condition and the correctness of the procedure.
Repeat the procedure 3-5 times with breaks of 10-15 minutes.
Place the patient in a normal position in bed.
Disinfect sputum and spittoon.
Recording of the procedure performed in the nursing card.

The procedure for performing the procedure:

Exercises are performed 2 times a day - in the morning and in the evening.
Expectorants are preliminarily taken - an infusion of thermopsis, rosemary, coltsfoot.
After 20 to 30 minutes after this, the patient alternately takes the drainage positions (see below).
In each position, the patient first performs 4 - 5 deep slow respiratory movements, inhaling air through the nose, and exhaling through pursed lips. Then, after a slow deep breath, a forced exhalation is made with persistent coughing 3-5 times.

A good result is achieved by combining drainage positions with various methods of chest vibration.

A. Lying in bed, the patient turns around the longitudinal axis of his body and in intermediate positions (45˚) makes forced exhalations. It is necessary to complete a full 360˚ rotation.

Bacteriological examination of sputum makes it possible to detect pathogens of various diseases. The presence of tuberculosis mycobacteria in the sputum is important for the diagnosis. Sputum for tank - research for sowing is collected in a sterile dish (wide-mouthed). The dishes are issued by the tank - laboratory.

ATTENTION!!!

If there is not enough sputum, it can be collected up to 3 days, keeping it in a cool place.

Sputum on the tank - sowing in tuberculosis patients for the reliability of the result is collected within 3 days, in different sterile containers (3 jars).

If it is necessary to prescribe antibiotics, sputum is examined for sensitivity to them. To do this, the patient in the morning, after rinsing his mouth, coughs and spits sputum several times (2-3 times) into a sterile Petri dish, which is immediately sent to the laboratory.

ATTENTION!!!

Give clear instructions to the patient about the use of sterile utensils to collect sputum for analysis:

a) do not touch the edges of the dishes with your hands

b) do not touch the edges with your mouth

c) after expectoration of sputum, immediately close the container with a lid.

THEN item 7

To the tank - laboratory

Sputum for microflora and

sensitivity to

antibiotics (a/b)

Sidorov S.S. 70 years old

3/IV–00 signed m/s

Sputum analysis for bacteriological examination.

Target: to ensure high-quality preparation for the study and timely receipt of the result.

Training: informing and educating the patient.

Equipment: sterile jar (spittoon), direction.

Execution sequence:

Explain to the patient (family member) the meaning and necessity of the upcoming study and obtain his consent to the study.

A) in stationary conditions:

briefing and provision of laboratory glassware to be carried out the night before;

B) in outpatient and inpatient settings explain to the patient the features of preparation:

brush your teeth thoroughly the night before;

in the morning after sleep, rinse your mouth thoroughly with boiled water

Instruct the patient on how to handle sterile laboratory glassware and how to collect sputum:

Cough, open the lid of the jar (spittoon) and spit out sputum without touching the edges of the jar;

Close the lid immediately.

Ask the patient to repeat all the information, ask questions about the technique of preparation and collection of sputum.

Indicate the consequences of violating the nurse's recommendations.

A) on an outpatient basis:

Give a direction for the study by filling it out in the form;

Explain to the patient where and at what time he (the family) should bring the bank and referral.

B) in a hospital setting:

Indicate the place and time where to bring the jar (spittoon);

Deliver the collected material to the bacteriological laboratory no later than 1.5 - 2.0 hours after the collection of the material.

Storage of material even in cold conditions is unacceptable!

Taking feces for analysis.

A great help in recognizing a number of diseases, including gastrointestinal ones, is the study of feces. Determination of the basic properties of feces by examination makes it possible to draw a number of diagnostic conclusions and is available to the sister.

The daily amount of feces in a healthy person depends on the quality and quantity of food, and on average is 100 - 120 g. If absorption is impaired and the rate of movement through the intestines is increased (enteritis), the amount of feces can reach 2500 g, with constipation, feces are very small.

Fine- bowel movements are performed once a day, usually at the same time.

ATTENTION!!!

For research, it is better to take feces after an independent act of defecation in the form in which it is excreted.

bacteriologically

macroscopically

Kal explore microscopically

chemically

Macroscopically determined:

A) color, density (consistency)

B) shape, smell, impurities

Colour–fine

with mixed food - yellowish-brown, brown;

with meat - dark brown;

with milk - yellow or light yellow;

the newborn is greenish-yellow.

REMEMBER!!! The color of feces can change:

Fruits, berries (blueberries, currants, cherries, poppies, etc.) - in a dark color.

Vegetables (beets, carrots, etc.) - in a dark color.

Medicinal substances (salts of bismuth, iron, iodine) - in black.

The presence of blood gives the feces a black color.

Consistency(density) feces are soft.

In various pathological conditions, feces can be:

mushy

moderately dense

semi-liquid
Putty (clay), often gray in color and depends on a significant admixture of undigested fat.

The shape of the feces- Normally cylindrical or sausage-shaped.

With spasms of the intestines, feces can be ribbon-like or in the form of dense balls (sheep feces).

Smell of feces depends on the composition of the food and the intensity of the processes of fermentation and decay. Meat food gives a pungent odor. Dairy - sour.