ADVERTISEMENTS:
The following points highlight the responsibilities of professional nurses in the transmissible diseases. The responsibilities are:- 1. Assisting the Physician in the Diagnosis of the Disease 2. Assisting the Physician in the Treatment and 3. Assisting the Physician in the Prevention of Transmissible Diseases.
1. In the Diagnosis of the Disease a Nurse can Assist the Physician for:
(i) The Collection of Specimen:
If she has an excellent understanding of the procedure, she can collect herself the specimen for the diagnostic purpose, otherwise she may make preparation for the collection. Poorly and carelessly taken specimen is of no use for correct diagnosis of the disease.
(ii) Labelling:
The nurse should be responsible to label the specimen containers the following information:
ADVERTISEMENTS:
(a) The patients name;
(b) Case Registration number;
(c) Date;
(d) Physician’s name;
ADVERTISEMENTS:
(e) Ward number;
(f) The site of collection of specimen (e.g., throat, cervix, abscess etc.). Adhesive tape is always preferable to the paper label, pasted with gum, which may fall off if it is not properly secured by rubber band.
As soon as the specimen is collected, it should be labelled immediately and kept aside; then the nurse should proceed with the next specimen, otherwise she is liable to mix the specimens and she may be confused during the peak hour of work in the ward. If there is a slightest suspicion, the samples should be discarded and, again, the new samples should be collected.
Petri plate containing solid culture medium should be labelled on its bottom because its lid may be transposed. Specimen should be transmitted immediately to the laboratory, if there is delay, the specimen will dry and the microorganisms will perish, thereby there is possibility of wrong report.
The microbiological diagnostic report is the deciding factor for the life of the patient, so, the life and death of a patient depend upon the laboratory report. Hence, the specimen collection, immediate transfer to the laboratory and quick processing in the laboratory are very important considerations for the correct diagnosis of the disease and for the life of the patient,
(iii) Swabs:
The nurse should have the sound knowledge to collect the material for the bacteriological examination with the help of sterile swabs. Test tubes containing swabs are readily available in the bacteriological laboratory. It should be always borne in mind that while taking a swab for culture it is necessary to touch the lesion or spot from which the specimen is required with the help of sterile swab. The swab containing the specimen should be inserted quickly into the sterile test tube and sent immediately to the laboratory and used for the inoculation of the media in the microbiological laboratory.
(iv) Throat Culture:
During the collection of the specimens with the help of throat swab from the tonsils or from the pseudo-membranes of the faucial region of the throat, it is necessary to have clear vision of the throat with good light by using tongue depressor or tea-spoon. The same procedure is applicable to septic sore throat and other throat infections.
Specimens for meningococci (causative organism of meningitis) should be collected from the nasopharynx with the help of the post-nasal swab by passing it back gently through the nostril. The specimen should be cultured and incubated immediately, because meningococci are very fragile and die rapidly.
In whooping cough, the specimen can be collected by exposing, in front of the mouth of the patient, petri plates containing media suitable for the growth of desired bacteria when the patient coughs. The spray of the sputum produced by cough inoculates the medium. The plate should be covered immediately with the lid and placed in the incubator in an inverted position.
(v) Sputum:
ADVERTISEMENTS:
The nurse should guide the patient to collect very carefully the sputum in the sterile wide mouthed cup of 2 oz. capacity. The specimen must not consist of material from the mouth and throat (i.e., mucus, saliva, food particles). The sputum should be certainly collected direct after expectoration or after cough that brings secretions up from the lungs (not from the throat) and sent immediately to the microbiological laboratory. In case of infants, the sputum should be obtained by throat swab, since they swallow the sputum.
(vi) Urine:
The nurse should invariably instruct the female patients to collect with extreme care the midstream urine (MSU) into a sterile test tube after separating the vulva so to avoid the contamination of urine by bacteria present on the skin and mucus membrane of the genitalia and the test tube should be closed quickly with sterile cotton plug and sent immediately to the laboratory. The first stream of urine should be allowed to run off to wash out any bacteria present in the urethra. The collection of urine by catheterisation can be done only by the physician with the assistance of the nurse.
(vii) Faeces:
The nurse should collect fresh stool in a sterile container and send it to the laboratory for the isolation of dysentery, typhoid, paratyphoid bacilli and for the demonstration of eggs or cysts of the parasites (hookworm, tapeworms, protozoa). Mucus should be preferred particularly for the culture of dysentery bacilli and be sent to the laboratory by Stuart’s transport medium or glycerol saline, as these bacilli are delicate.
The collection of “rice water stool” in case of cholera should be carried out on a clean paper or leaf, but never from a bedpan, because the left-over disinfectant in the bedpan may destroy Vibrio cholerae. This method of collection of stool in sterile container should be strictly followed by the nurse to obtain the correct laboratory diagnosis.
(viii) Blood for Culture:
ADVERTISEMENTS:
Blood should be collected in a sterile container for blood culture to diagnose septicemia or bacteriemia. In the early stage of bacteriemia (first week) in typhoid, Salmonella typhi (typhoid bacilli) can be isolated. The nurse should collect aseptically about ten ml of blood with a sterile syringe with extreme care and full responsibility.
Before puncturing the skin over the vein, she should sterilize the skin with alcoholic solution of iodine (1 per cent) and remove the excess of iodine within 1 -2 minutes with a sterile gauze soaked in 70 per cent ethyl alcohol. This is a valuable procedure to avoid the contamination of blood with staphylococci or other organisms from the skin.
The nurse should know very well that Trypticase soy broth can support early and rapid growth of all organisms responsible for blood infections and it can be used at bedside for the quick inoculation before the blood is clotted.
In case the blood is to be sent to the laboratory, it should be mixed with an anticoagulant (sterile solution of sodium citrate), particularly for microbiological investigations, but, for chemical examination, sodium oxalate is mostly used to prevent clotting.
(ix) Blood for Serological Tests:
ADVERTISEMENTS:
The blood can be drawn at one puncture for culture, serology and microscopic examination. The blood for serology should be put into a clean, dry test tube without anticoagulant and this test tube should be kept in a slanting position on the working table till the blood is clotted.
For blood grouping, it is convenient to have only a few drops of blood by puncturing the finger or ear lobe with the help of the sterile needle after sterilising the site with ethyl alcohol. A thin uniform blood film can be also prepared from a drop of blood on a clean slide.
(x) Peritoneal and Pleural Fluids:
These specimens can be collected very carefully only by the physician, but the nurse should prepare the sterile needles, test tubes and other accessories and she is responsible for proper labelling and dispatching the specimen promptly to the laboratory.
(xi) Cerebrospinal Fluid (CSF):
The site for lumbar puncture should be disinfected with extreme care beforehand and covered with sterile gauze after the needle is withdrawn. This is the responsibility of the nurse. The lumbar puncture is always made by the physician. The nurse should know that CSF is used for the diagnosis of meningitis (caused by meningococci, pneumococci, streptococci or other organisms) and it is turbid.
ADVERTISEMENTS:
White blood cells or leucocytes can be counted if the fluid is clear or cloudy and the differential counts of cells is also possible from the smear of the sediment. Albumin or globulin content can also be determined chemically. Both number of cells and the protein content may be much increased although the fluid remains clear. This can differentiate paresis from other form of neurosyphilis. In suspected cases of syphilis, CSF can be used for serological tests.
Reporting of the Results of Laboratory Tests:
The nurse should read at first the results of the laboratory report, if the patient is in hospital and there is any abnormality in the report it should be brought at once to the notice of the physician, because he visits once or twice a day and he depends on the information provided by the nurse during his absence.
Abnormal findings in the laboratory report may provide some indications for better diagnosis and treatment of the patient. If this information is delayed, the physician may delay necessary treatment required for the speedy recovery of the patient. Therefore, the nursing student should acquire a sound knowledge during her training period to read the laboratory report, since she will become a fully responsible professional nurse in the hospital.
2. Assisting the Physician in the Treatment:
The nurse is fully responsible to carry out very carefully the orders given by the physician regarding the treatments and medicines. Particularly, while administrating the antibiotics or chemotherapeutic agents, she should observe very strictly the time interval indicated by the physician.
If she does not stick to the time interval, there is possibility of low concentration of antibiotics or chemotherapeutic agents in the blood which may result, ultimately, in the development of drug resistant microorganisms. Multiple drug resistant strains of Staph, aureus are very common in the hospital, because of the insufficient use of the antibiotics in the infection.
ADVERTISEMENTS:
In addition to the duties carrying out the orders of the physician, nursing care of the patient (e.g., bath, care of the skin and general cleanliness) should be taken by the nurse, which is one of the most important supportive treatments for the speedy recovery. Hygienic measures can prevent fecal contamination of food which may enter the mouth; thus, the transmissible intestinal infection can be ultimately prevented. The nurse should report immediately to the physician the untoward symptoms noticed during the treatment.
3. Assisting in the Prevention of Transmissible Diseases:
(a) Inhibition, destruction and removal of microorganisms; and
(b) Assisting in the immunization programme in the community are two most important nursing responsibilities to prevent the transmissible diseases, knowledge gained during the nursing training will aid these nursing responsibilities. For example, the knowledge of the transmissibility of the infection will help to protect the population from the known cases of the infectious diseases. The nurse administrates the antigens (vaccines) and antibodies during the outbreak of the infectious diseases in the community.
Besides, she educates the community in clear explicit language about the danger of the spread of the infections amongst the population, their prevention and other hygienic measures to combat the transmissible diseases in the community population, e.g., destruction of the microorganisms excreted through body fluids and discharges.
The carriers of the disease can be detected and treated by assisting the physician. In case of the outbreak of intestinal infections like cholera, the feces should be disinfected or destroyed or disposed-off away from the human dwelling. The vectors (flies) should also be destroyed by the use of insecticides. Thus, it can be concluded that the nursing responsibilities in transmissible diseases are the application of the nursing microbiology knowledge.
Collection of Specimens and Diagnosis of Disease:
Diagnosis is the determination of the exact nature of the disease. The laboratory contributes to this diagnosis by finding and identifying the specific pathogens. The laboratory diagnosis is reached by three general methods — microscopic examination of material, cultivation of material, and serological tests.
ADVERTISEMENTS:
All laboratory diagnosis depends upon the specimens collected and care and intelligence used in collecting them. Since the nurse is responsible for collecting many of the specimens and for sending them to the laboratory, she should learn how and why this is an important factor in diagnosis.
The purpose of this exercise is to acquaint the student with the collection of specimens and to set the stage for the rest of the work in the microbiology laboratory.
There are a few general rules that can be followed for all specimens; however, each hospital and laboratory will have its own rules and regulations.
The following are general rules:
1. Secure an uncontaminated specimen.
2. Label it fully and accurately.
3. Handle it with care to avoid infection.
4. See that the specimens reaches the laboratory promptly.
The types of specimens collected for laboratory diagnosis are:
ADVERTISEMENTS:
(1) Pus,
(2) Sputum,
(3) Feces,
(4) Urine,
(5) Spinal fluid,
(6) Peritoneal and pleural fluids,
(7) Blood,
(8) Cultures from nose, throat, etc.
Materials Needed:
1. Sterile applicator or swab in test tube
2. Tongue depressors
3. Blood agar plates
4. Laboratory sheets used to record finding in the microbiology laboratory.
Procedure or Instructions:
1. The students should work in pairs. The bottom of a blood agar plate should be divided into 2 parts. Each student will take a throat culture of the other and streak a half of the plate for each student. The throat culture is done as follows: hold the tongue with the tongue depressor with a sterile applicator touch the back of the throat, being careful not to touch the teeth or tongue. Labelled, incubated and examined after 24 hours or next day.
2. The laboratory record sheets should be filled up.
3. Serology tests from the laboratory should be understood as to how these blood tests are done for diagnosis.
