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© 2009 The McGraw-Hill Companies, Inc. All rights reserved Collecting, Processing, and Testing Urine Specimens PowerPoint® presentation to accompany:

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Presentation on theme: "© 2009 The McGraw-Hill Companies, Inc. All rights reserved Collecting, Processing, and Testing Urine Specimens PowerPoint® presentation to accompany:"— Presentation transcript:

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2 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Collecting, Processing, and Testing Urine Specimens PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

3 © 2009 The McGraw-Hill Companies, Inc. All rights reserved 47-2 Learning Outcomes 47.1 Describe the characteristics of urine, including its formation, physical composition, and chemical properties Explain how to instruct patients in specimen collection Identify guidelines to follow when collecting urine specimens Describe proper procedures for collecting various urine specimens.

4 © 2009 The McGraw-Hill Companies, Inc. All rights reserved 47-3 Learning Outcomes (cont.) 47.5 Explain the process of urinary catheterization List special considerations that may require you to alter guidelines when collecting urine specimens Explain how to maintain the chain of custody when processing urine specimens Explain how to preserve and store urine specimens.

5 © 2009 The McGraw-Hill Companies, Inc. All rights reserved 47-4 Learning Outcomes (cont.) 47.9 Describe the process of urinalysis and its purpose Identify the physical characteristics present in normal urine specimens Identify the chemicals that may be found in urine specimens Identify the elements categorized and counted as a result of microscopic examination of urine specimens.

6 © 2009 The McGraw-Hill Companies, Inc. All rights reserved 47-5 Introduction Routine analysis of a urine specimen Noninvasive Used to diagnose significant conditions Medical assistant Learn about types of urine specimens Instruct or assist patient in collection of a sample Learn to process urine specimens Learn about normal / abnormal components of urine

7 © 2009 The McGraw-Hill Companies, Inc. All rights reserved 47-6 Role of the Medical Assistant Collect, process, and test urine samples Knowledge necessary Anatomy and physiology of kidneys How urine is formed Normal components of urine

8 © 2009 The McGraw-Hill Companies, Inc. All rights reserved 47-7 Role of the Medical Assistant Safety Standard Precautions PPE as needed Handle and dispose of specimens properly Dispose of used supplies and equipment properly Sanitize, disinfect, and/or sterilize reusable equipment

9 © 2009 The McGraw-Hill Companies, Inc. All rights reserved 47-8 Anatomy and Physiology of the Urinary System Organs Kidneys – remove excess water and waste products Ureters – drain urine into bladder Bladder – stores urine Urethra – drains urine to outside of the body

10 © 2009 The McGraw-Hill Companies, Inc. All rights reserved 47-9 Anatomy and Physiology of the Urinary System: Formation of Urine Nephron Functional unit of the kidney Removes end products of metabolism Allows for reabsorption of water and electrolytes Maintains normal fluid balance Processes in urine formation Glomerular filtration Tubular reabsorption Tubular secretion

11 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Physical Composition and Chemical Properties of Urine 95% water 5% waste products Other dissolved chemicals Urea Uric acid Ammonia Calcium Creatinine Sodium Chloride Potassium Sulfates Phosphates Hydrogen ions Urochrome Urobilinogen A few RBCs A few WBCs

12 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge 1.What knowledge is needed by the medical assistant related to collecting, processing, and testing urine specimens? ANSWER: The medical assistant needs to know the anatomy and physiology of the urinary system, how urine is formed, and normal components of urine. 2.Components of normal urine include A. urea, uric acid, and ammonia. B. chloride, potassium, and sugar. C. red blood cells, sperm, and H 2 O 2 D. hydrogen ions, urochrome, and uranium. ANSWER:

13 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens General collection guidelines Follow the procedure for specified test Use an appropriate specimen container Label the specimen container correctly Explain the procedure to patient Wash your hands before and after the procedure; wear gloves during the procedure Complete all necessary paperwork

14 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Types Quantitative analysis – measures amount of a specific substance in the urine Qualitative analysis – simply determines if a substance is present in the urine Types vary in the method used to collect a specimen and in the time frame in which to collect a specimen

15 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Types (cont.) Random urine specimen Most common Obtained any time during the day First morning specimen Contains greater concentration of substances Clean-catch midstream Used for culturing urine External genitalia must be cleansed Discard small amount of urine prior to collecting specimen Can also obtain by catheterization

16 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Types (cont.) Timed urine specimen Discard first specimen Collect all urine for specified time Refrigerate 24-hour specimen Collected as a timed specimen Both are used for qualitative and quantitative analysis

17 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Catheterization Urinary catheter – a plastic tube inserted to provide urinary drainage Catheterization – procedure by which the catheter is inserted

18 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Catheterization (cont.) Reasons for catheterization Relieve urinary retention Obtain a sterile urine specimen Measure the amount of residual urine Obtain a specimen if patient cannot void Instill chemotherapy Empty bladder before and during procedures

19 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Catheterization (cont.) Drainage catheters Indwelling urethral (Foley) catheter – bladder Retention catheter – renal pelvis Ureteral catheter – drainage through a wound into the bladder (cystostomy tube) Straight catheter – bladder Splinting catheters – inserted after repair of ureter

20 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Catheterization (cont.) Not a routine procedure due to risk of infection Not typically performed by medical assistants Check scope of practice Assemble supplies – catheterization kits

21 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Special Considerations Male and female patients Differences in collecting clean-catch midstream specimen Questions during history Pregnant patients Frequency Prone to urinary tract infection Urine checked for glucose and protein

22 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Special Considerations (cont.) Elderly Bladder muscles weaken Uterine supports weaken – pulls on bladder Loss of bladder control May need assistance in obtaining a specimen Repeat explanation as necessary Pediatric patients Involve child if possible Questions Diaper rash? Excessively thirsty? Difficulty urinating? Cry when urinating? How many diapers a day? Change in bladder control? Problems toilet training?

23 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Chain of Custody Do not alter established procedure Positively identify patient Explain procedure and have patient sign a consent form Examine specimen and check temperature Complete documentation

24 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Specimens: Preservation and Storage Chemical, physical, and microscopic changes occur if urine is left at room temperature for more than 1 hour Preservation Refrigeration Prevents growth for 24 hours Return to room temperature before testing Chemical preservatives Specimens only

25 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge A patient has returned to the office and is complaining of not being able to empty her bladder fully after her hysterectomy. The physician has asked you measure the patient’s residual urine. How do you do this and why? ANSWER: A residual urine is done to measure the amount of urine in the bladder after voiding. You will ask the patient to empty her bladder and then perform a straight catheterization to measure any urine remaining in her bladder. Correct!

26 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis Evaluation of urine to obtain information about body health and disease Types of testing Physical Chemical Microscopic

27 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis (cont.) Values Negative or none, normal, or a range of concentration Within normal limits indicate health and normality Screening test – must have follow-up testing

28 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis (cont.) Average adult daily urine output is 1250 mL/24 hours Intake and output should be approximately the same Dysfunctions of other body systems can affect urinary function

29 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Physical Examination and Testing Check label Check for visible contamination Check time since collection Visual examination Color Volume Normal Oliguria Odor Specific gravity

30 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Physical Examination and Testing (cont.) Visual examination Color / turbidity – pale yellow to dark amber; clear Volume Normal range – 600–1800 mL/24 hours Oliguria – insufficient production of urine Anuria – absence of urine production

31 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Physical Examination and Testing (cont.) Odor Distinct, aromatic Standing at room temperature – ammonia Affected by disease and foods Specific gravity to Fluctuates in response to fluid intake Methods Refractometer Reagent strips

32 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Chemical Testing Check label on specimen Determine the status of Carbohydrate metabolism Liver or kidney function Acid-base balance Presence of drugs, toxins, or infections Reagent strip testing Changes indicate presence of concentration of a substance Follow instructions carefully

33 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Chemical Testing (cont.) Ketone bodies Normally none in urine Presence Patient on a low- carbohydrate diet Starvation Excessive vomiting Diabetes mellitus pH Normal 5.0 to 8.0 Alkaline UTI Metabolic / respiratory alkalosis Acidic Phenylketonuria Acidosis

34 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Chemical Testing (cont.) Blood – normally none Bilirubin – early sign of liver disease Urobilinogen Elevated – increased RBC destruction Lacking – bile duct obstruction Glucose Normally in small amounts Glycosuria – diabetes Protein Excess – renal disease Proteinuria – common in pregnancy and after heavy exercise

35 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Chemical Testing (cont.) Nitrite – suggests bacterial infection Leukocytes – urinary tract or renal infection Phenylketones Presence indicates PKU – genetic disorder Blood testing is more routine for newborns

36 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Chemical Testing (cont.) Pregnancy test Detect human chorionic gonadotropin (HCG) Peak at 8 weeks Quick, easy to perform and interpret Enzyme immunoassay (EIA) Newer technology Antigen / antibody reaction

37 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Chemical Testing (cont.) Presence of STDs Screening for chlamydia – 15- to 25-year-old sexually active females Nucleic acid amplification tests (NAATs) Detect nucleic acid in urine Chlamydia and gonorrhea Advantage – highly specific, non-invasive Disadvantage – expensive, no organism remains for culture

38 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Microscopic Examination View elements only visible with microscope Centrifuge Obtain sediment Spins fluid – heavier substances settle to the bottom of the tubes

39 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Urinalysis: Microscopic Examination (cont.) Cells Epithelial cells White blood cells Red blood cells Casts Cylindrical elements Types Hyaline Granular RBC casts WBC casts Epithelial cell casts Waxy

40 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Crystals Naturally produced solids of definite form Common in urine Determine pH before testing Yeast cells May be confused with RBCs Associated with genitourinary tract infection, diabetes Urinalysis: Microscopic Examination (cont.)

41 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Bacteria A few are normal Infection if urine also has Putrid odor WBCs Parasites Infection or contamination Trichomonas vaginalis – most common Urinalysis: Microscopic Examination (cont.)

42 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge 1. What is the specific gravity shown on this refractometer screen? ANSWER: The specific gravity shown here is

43 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge 2. A urinalysis has detected that a patient has protein in his urine. Why is this important? ANSWER: Protein in the urine usually indicates renal disease.

44 © 2009 The McGraw-Hill Companies, Inc. All rights reserved In Summary Characteristics of urine provide information about a patient’s health Medical assistant Collects, processes, and tests urine specimens Must understand the urinary system and characteristics of urine Assists and instructs patients in specimen collection

45 © 2009 The McGraw-Hill Companies, Inc. All rights reserved End of Chapter A human being: an ingenious assembly of portable plumbing. ~ Christopher Morley,


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