Presentation on theme: "Collecting, Processing, and Testing Urine Specimens"— Presentation transcript:
1 Collecting, Processing, and Testing Urine Specimens Chapter 47Collecting, Processing, and Testing Urine SpecimensPowerPoint® presentation to accompany:Medical AssistingThird EditionBooth, Whicker, Wyman, Pugh, Thompson
2 Learning Outcomes47.1 Describe the characteristics of urine, including its formation, physical composition, and chemical properties.47.2 Explain how to instruct patients in specimen collection.47.3 Identify guidelines to follow when collecting urine specimens.47.4 Describe proper procedures for collecting various urine specimens.
3 Learning Outcomes (cont.) 47.5 Explain the process of urinary catheterization.47.6 List special considerations that may require you to alter guidelines when collecting urine specimens.47.7 Explain how to maintain the chain of custody when processing urine specimens.47.8 Explain how to preserve and store urine specimens.
4 Learning Outcomes (cont.) 47.9 Describe the process of urinalysis and its purpose.47.10 Identify the physical characteristics present in normal urine specimens.47.11 Identify the chemicals that may be found in urine specimens.47.12 Identify the elements categorized and counted as a result of microscopic examination of urine specimens.
5 Introduction Routine analysis of a urine specimen Medical assistant NoninvasiveUsed to diagnose significant conditionsMedical assistantLearn about types of urine specimensInstruct or assist patient in collection of a sampleLearn to process urine specimensLearn about normal / abnormal components of urine
6 Role of the Medical Assistant Collect, process, and test urine samplesKnowledge necessaryAnatomy and physiology of kidneysHow urine is formedNormal components of urine
7 Role of the Medical Assistant SafetyStandard PrecautionsPPE as neededHandle and dispose of specimens properlyDispose of used supplies and equipment properlySanitize, disinfect, and/or sterilize reusable equipment
8 Anatomy and Physiology of the Urinary System OrgansKidneys – remove excess water and waste productsUreters – drain urine into bladderBladder – stores urineUrethra – drains urine to outside of the body
9 Anatomy and Physiology of the Urinary System: Formation of Urine NephronFunctional unit of the kidneyRemoves end products of metabolismAllows for reabsorption of water and electrolytesMaintains normal fluid balanceProcesses in urine formationGlomerular filtrationTubular reabsorptionTubular secretion
10 Physical Composition and Chemical Properties of Urine 95% water5% waste productsOther dissolved chemicalsUreaUric acidAmmoniaCalciumCreatinineSodiumChloridePotassiumSulfatesPhosphatesHydrogen ionsUrochromeUrobilinogenA few RBCsA few WBCs
11 Apply Your Knowledge Very Good! 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.Components of normal urine includeA. urea, uric acid, and ammonia.B. chloride, potassium, and sugar.C. red blood cells, sperm, and H2O2D. hydrogen ions, urochrome, and uranium.ANSWER:Very Good!
12 Obtaining Specimens General collection guidelines Follow the procedure for specified testUse an appropriate specimen containerLabel the specimen container correctlyExplain the procedure to patientWash your hands before and after the procedure; wear gloves during the procedureComplete all necessary paperwork
13 Obtaining Specimens: Types Quantitative analysis – measures amount of a specific substance in the urineQualitative analysis – simply determines if a substance is present in the urineTypes vary in the method used to collect a specimen and in the time frame in which to collect a specimen
14 Obtaining Specimens: Types (cont.) Random urine specimenMost commonObtained any time during the dayFirst morning specimenContains greater concentration of substancesClean-catch midstreamUsed for culturing urineExternal genitalia must be cleansedDiscard small amount of urine prior to collecting specimenCan also obtain by catheterization
15 Obtaining Specimens: Types (cont.) Timed urine specimenDiscard first specimenCollect all urine for specified timeRefrigerate24-hour specimenCollected as a timed specimenBoth are used for qualitative and quantitative analysis
16 Obtaining Specimens: Catheterization Urinary catheter – a plastic tube inserted to provide urinary drainageCatheterization – procedure by which the catheter is inserted
17 Obtaining Specimens: Catheterization (cont.) Reasons for catheterizationRelieve urinary retentionObtain a sterile urine specimenMeasure the amount of residual urineObtain a specimen if patient cannot voidInstill chemotherapyEmpty bladder before and during procedures
18 Obtaining Specimens: Catheterization (cont.) Drainage cathetersIndwelling urethral (Foley) catheter – bladderRetention catheter – renal pelvisUreteral catheter – drainage through a wound into the bladder (cystostomy tube)Straight catheter – bladderSplinting catheters – inserted after repair of ureter
19 Obtaining Specimens: Catheterization (cont.) Not a routine procedure due to risk of infectionNot typically performed by medical assistantsCheck scope of practiceAssemble supplies – catheterization kits
20 Obtaining Specimens: Special Considerations Male and female patientsDifferences in collecting clean-catch midstream specimenQuestions during historyPregnant patientsFrequencyProne to urinary tract infectionUrine checked for glucose and protein
21 Obtaining Specimens: Special Considerations (cont.) ElderlyBladder muscles weakenUterine supports weaken – pulls on bladderLoss of bladder controlMay need assistance in obtaining a specimenRepeat explanation as necessaryPediatric patientsInvolve child if possibleQuestionsDiaper rash?Excessively thirsty?Difficulty urinating?Cry when urinating?How many diapers a day?Change in bladder control?Problems toilet training?
22 Obtaining Specimens: Chain of Custody Do not alter established procedurePositively identify patientExplain procedure and have patient sign a consent formExamine specimen and check temperatureComplete documentation
23 Obtaining Specimens: Preservation and Storage Chemical, physical, and microscopic changes occur if urine is left at room temperature for more than 1 hourPreservationRefrigerationPrevents growth for 24 hoursReturn to room temperature before testingChemical preservativesSpecimens only
24 Correct! 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!
25 UrinalysisEvaluation of urine to obtain information about body health and diseaseTypes of testingPhysicalChemicalMicroscopic
26 Urinalysis (cont.) Values Negative or none, normal, or a range of concentrationWithin normal limits indicate health and normalityScreening test – must have follow-up testing
27 Urinalysis (cont.)Average adult daily urine output is 1250 mL/24 hoursIntake and output should be approximately the sameDysfunctions of other body systems can affect urinary function
28 Urinalysis: Physical Examination and Testing Check labelCheck for visible contaminationCheck time since collectionVisual examinationColorVolumeNormalOliguriaOdorSpecific gravity
29 Urinalysis: Physical Examination and Testing (cont.) Visual examinationColor / turbidity – pale yellow to dark amber; clearVolumeNormal range – 600–1800 mL/24 hoursOliguria – insufficient production of urineAnuria – absence of urine production
30 Urinalysis: Physical Examination and Testing (cont.) OdorDistinct, aromaticStanding at room temperature – ammoniaAffected by disease and foodsSpecific gravity1.002 to 1.028Fluctuates in response to fluid intakeMethodsRefractometerReagent strips
31 Urinalysis: Chemical Testing Check label on specimenDetermine the status ofCarbohydrate metabolismLiver or kidney functionAcid-base balancePresence of drugs, toxins, or infectionsReagent strip testingChanges indicate presence of concentration of a substanceFollow instructions carefully
32 Urinalysis: Chemical Testing (cont.) pHNormal 5.0 to 8.0AlkalineUTIMetabolic / respiratory alkalosisAcidicPhenylketonuriaAcidosisKetone bodiesNormally none in urinePresencePatient on a low-carbohydrate dietStarvationExcessive vomitingDiabetes mellitus
33 Urinalysis: Chemical Testing (cont.) GlucoseNormally in small amountsGlycosuria – diabetesProteinExcess – renal diseaseProteinuria – common in pregnancy and after heavy exerciseBlood – normally noneBilirubin – early sign of liver diseaseUrobilinogenElevated – increased RBC destructionLacking – bile duct obstruction
34 Urinalysis: Chemical Testing (cont.) PhenylketonesPresence indicates PKU – genetic disorderBlood testing is more routine for newbornsNitrite – suggests bacterial infectionLeukocytes – urinary tract or renal infection
35 Urinalysis: Chemical Testing (cont.) Pregnancy testDetect human chorionic gonadotropin (HCG)Peak at 8 weeksQuick, easy to perform and interpretEnzyme immunoassay (EIA)Newer technologyAntigen / antibody reaction
36 Urinalysis: Chemical Testing (cont.) Presence of STDsScreening for chlamydia – 15- to 25-year-old sexually active femalesNucleic acid amplification tests (NAATs)Detect nucleic acid in urineChlamydia and gonorrheaAdvantage – highly specific, non-invasiveDisadvantage – expensive, no organism remains for culture
37 Urinalysis: Microscopic Examination View elements only visible with microscopeCentrifugeObtain sedimentSpins fluid – heavier substances settle to the bottom of the tubes
39 Urinalysis: Microscopic Examination (cont.) CrystalsNaturally produced solids of definite formCommon in urineDetermine pH before testingYeast cellsMay be confused with RBCsAssociated with genitourinary tract infection, diabetes
40 Urinalysis: Microscopic Examination (cont.) BacteriaA few are normalInfection if urine also hasPutrid odorWBCsParasitesInfection or contaminationTrichomonas vaginalis – most common
41 Apply Your Knowledge Super! What is the specific gravity shown on this refractometer screen?ANSWER: The specific gravity shown here isSuper!
42 Apply Your Knowledge Super! 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.Super!
43 In SummaryCharacteristics of urine provide information about a patient’s healthMedical assistantCollects, processes, and tests urine specimensMust understand the urinary system and characteristics of urineAssists and instructs patients in specimen collection
44 End of ChapterEnd of Chapter 47A human being: an ingenious assembly of portable plumbing.~ Christopher Morley,