CHAPTER I

INTRODUCTION
A. Background
In determining the diagnosis of a disease, several laboratory
tests are needed, namely examination of specimens taken from patients.
Laboratory examination is a special examination procedure and procedure
by taking materials or samples from sufferers. Samples taken can be in the
form of blood, urine, feces, sputum, vaginal secretions, etc. to determine
the diagnosis accompanied by other tests as a support. A series of
laboratory examinations are carried out with specific objectives for
example to detect diseases, determine risks, monitor disease progress,
monitor treatment progress, and others. Knowing whether there are
abnormalities or diseases that are commonly encountered and potentially
dangerous.
Tests or examinations can be clinical chemistry, hematology,
immunology, serology, clinical microbiology, and clinical parasitology.
Examination examination methods continue to evolve from qualitative,
semi-quantitative, and are carried out manually, semiotomatic, automatic,
to robotics. This means that the equipment develops from simple to
sophisticated and expensive so that test costs can increase.
There are several respiratory tract diseases that start attacking
many Indonesian people. Such as pulmonary tuberculosis, bacterial
pneumonia, chronic bronchitis, and so on. For this reason, it is necessary
to test specimens to determine these diseases using sputum or sputum.
B. Problem Formulation
a. What is the Definition of Sputum?
b.How the Sputum Formation Process?
c. What is the Sputum Classification?
d.What about sputum examination?
e. How is Sputum Collection?
f. What are the criteria for good sputum conditions?

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C. Aim
a. To Know the Definition of Sputum
b.To find out the process of opening Sputum
c. To Know Sputum Classification
d.To Know Sputum Examination
e. To Know Sputum Collection
f. To find out the criteria for good Sputum conditions

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 CHAPTER II
DISCUSSION

A. Definition of Sputum
Sputum (phlegm) is material that is removed from the lungs
and trachea through the mouth. Usually also called ecpectoratorian
(Dorland, 1992). Sumpum, sputum, or ripples are coughed secretions and
originate from the throat, nose or mouth. This difference should be
explained to the patient whose sputum will be examined.
Sputum released by a patient should be evaluated on its source,
color, volume, and consistency because the condition of sputum usually
shows specifically the pathological event process in the formation of
sputum itself.
Sputum examination is needed if lung disease is suspected.
Respiratory mucous membranes respond to inflammation by increasing
secretion output which often contains disease-causing microorganisms.
Sputum is different from sputum which is mixed with saliva.
Sputum is thicker and has no foam bubbles on it. Sputum is taken from the
lower respiratory tract while sputum mixed with saliva is taken from the
throat.
B. Sputum formation process
A normal adult can produce 100 ml of mucus in the airway
every day. This mucus is herded into the pharynx by a mechanism of
cleaning the cilia from the epithelium lining the respiratory tract.
Abnormal circumstances of excessive mucus production (due to physical,
chemical, or infection that occurs in the mucous membrane), causing the
cleaning process does not run normally, so that the mucus is buried. When
this happens, the mucous membrane will be stimulated, and the mucus will
be removed with high intrathoracal and intraabdominal pressure.

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 Conveyed, the air came out with rapid acceleration and carried a mucus
secretion buried earlier. The mucus will come out as sputum.
Sputum released by a patient should be evaluated on the
source, color, volume, and consistency, because the condition of sputum
usually shows specifically the pathological events in the formation of
sputum itself. (Price Wilson)
C. Sputum Classification
Sputum released by a patient should be evaluated on the
source, color, volume, and consistency, because the condition of sputum
usually shows specifically the pathological events in the formation of
sputum itself.
       classification of sputum formation and possible causes:
1. Sputum that is produced when cleaning the throat, possibly from the
sinuses, or nasal passages, not from the lower airway.
2. Abundant & purulent sputum → suppurative processes (eg lung
abscess)
3. Sputum which is formed slowly & continues to increase → taanda
bronchitis / bronchhiectasis.
4. Yellowish sputum → infection process.
5. Green sputum → pus accumulation process. This green color is due
to the presence of verdoperoksidase produced by PMN in the
sputum. Green sputum is often found in people with bronchhiectasis
due to accumulation of sputum in the dilated and infected bronchus.
6. pink & foamy sputum → signs of acute pulmonary edema.
7. Slimy, sticky, gray / white sputum → sign of chronic bronchitis.
8. Sputum is foul smelling → signs of lung abscess / bronchhiectasis.
D. Sputum examination
Sputum examination is usually necessary if lung disease is
suspected. Respiratory mucous membranes respond to inflammation by
increasing secretion output which often contains the causative organism.
Pay attention and note the volume, consistency, color and smell of
sputum. Sputum examination includes examining:

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 1. Gram staining, this examination usually provides enough
information about the organism that is sufficient to establish a
presumptive diagnosis.
2. Sputum culture identifies specific organisms to make definitive
diagnoses. For the purposes of this examination, sputum must be
collected before antibiotic therapy and afterwards to determine
the efficacy of therapy.
3. Acid-Resistant Basil (BTA) determines the presence of
mycobacterium tuberculosis, which after staining the bacteria
does not experience discoloration by acidic alcohol.
E. Sputum Collection
The client should be informed about this examination so that
sputum can be collected which is really appropriate for this
examination. Instruct the patient to collect only sputum from the lungs.
(Because often if the client is not explained so, the client will collect
saliva and not sputum). Usually it takes about 4 ml of sputum for a
laboratory examination. Nursing implications for sputum collection
include:
1. Clients who have difficulty in forming sputum or those who form a
lot of sputum can become dehydrated, multiply the client's fluid
intake.
2. Collect sputum before eating and avoid the possibility of vomiting
due to coughing.
3. Instruct clients to rinse with water before collecting specimens to
reduce sputum contamination.
4. Instruct the client to alert the doctor as soon as the specimen is
collected so that the specimen can be sent to the laboratory as soon
as possible.

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F. Criteria for Good Sputum Conditions
To obtain good sputum conditions Laboratory personnel must
provide an explanation of the importance of sputum examination both the
first examination and re-sputum examination. Give an explanation of the
correct cough to get sputum coughed from the inside of the lungs after
several deep breaths and not only saliva from the mouth. Also examine the
volume of sputum which is 3-5 ml, the condition of the sputum for
laboratory examination is important, a good sputum contains several
particles or a little thick and slimy sometimes even festering and yellowish
green (Bastian et al, 2008). 13 Good sputum conditions There are 5 criteria
obtained when receiving a sputum specimen, namely:
a. Purulent is the condition of sputum in a thick and sticky state.
b. Mukopurulen is the condition of sputum in a thick, greenish-yellow
color.
c. Mucoid is a condition of sputum in a state of slimy and thick.
d. Hemoptysis is a condition of sputum mixed with blood.
e. Saliva is saliva.

CHAPTER III
CLOSING

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A. Conclusion
Sputum (phlegm) is material that is removed from the lungs
and trachea through the mouth. Usually also called ecpectoratorian.
Sputum examination is needed if lung disease is suspected. Respiratory
mucous membranes respond to inflammation by increasing secretion
output which often contains disease-causing microorganisms.
       Intake of sputum should be done in the morning, where the
possibility of getting inner sputum is greater. Sputum released by a patient
should be evaluated on its source, color, volume, and consistency because
the condition of sputum usually shows specifically the pathological events
in the formation of sputum itself.

B. Suggestion
The taking of specimens in the form of sputum is useful in
determining diagnoses and in knowing respiratory diseases such as
pulmonary tuberculosis, bacterial pneumonia.

REFERENCES

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Gandasoebrata, R. 1984. Clinical Laboratory Staff. Ed. 5th Jakarta: Dian Rakyat

Publisher.

Jawetz, Melnick, Adelberg. 1996. Medical Microbiology edition 20. Jakarta:

Penbiter of the EGC Medical Book.

Zulkifli Amin, Asril Bahar, 2006. Lung Tuberculosis, Internal Medicine Teaching

Book, Jakarta: UI