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Collecting, Processing, and Testing Urine Specimens

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Presentation on theme: "Collecting, Processing, and Testing Urine Specimens"— Presentation transcript:

1 Collecting, Processing, and Testing Urine Specimens
Chapter 47 Collecting, Processing, and Testing Urine Specimens PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

2 Learning Outcomes 47.1 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
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

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

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

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

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

10 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

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 include A. urea, uric acid, and ammonia. B. chloride, potassium, and sugar. C. red blood cells, sperm, and H2O2 D. hydrogen ions, urochrome, and uranium. ANSWER: Very Good!

12 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

13 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

14 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

15 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

16 Obtaining Specimens: Catheterization
Urinary catheter – a plastic tube inserted to provide urinary drainage Catheterization – procedure by which the catheter is inserted

17 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

18 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

19 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

20 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

21 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?

22 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

23 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

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 Urinalysis Evaluation of urine to obtain information about body health and disease Types of testing Physical Chemical Microscopic

26 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

27 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

28 Urinalysis: Physical Examination and Testing
Check label Check for visible contamination Check time since collection Visual examination Color Volume Normal Oliguria Odor Specific gravity

29 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

30 Urinalysis: Physical Examination and Testing (cont.)
Odor Distinct, aromatic Standing at room temperature – ammonia Affected by disease and foods Specific gravity 1.002 to 1.028 Fluctuates in response to fluid intake Methods Refractometer Reagent strips

31 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

32 Urinalysis: Chemical Testing (cont.)
pH Normal 5.0 to 8.0 Alkaline UTI Metabolic / respiratory alkalosis Acidic Phenylketonuria Acidosis Ketone bodies Normally none in urine Presence Patient on a low-carbohydrate diet Starvation Excessive vomiting Diabetes mellitus

33 Urinalysis: Chemical Testing (cont.)
Glucose Normally in small amounts Glycosuria – diabetes Protein Excess – renal disease Proteinuria – common in pregnancy and after heavy exercise Blood – normally none Bilirubin – early sign of liver disease Urobilinogen Elevated – increased RBC destruction Lacking – bile duct obstruction

34 Urinalysis: Chemical Testing (cont.)
Phenylketones Presence indicates PKU – genetic disorder Blood testing is more routine for newborns Nitrite – suggests bacterial infection Leukocytes – urinary tract or renal infection

35 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

36 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

37 Urinalysis: Microscopic Examination
View elements only visible with microscope Centrifuge Obtain sediment Spins fluid – heavier substances settle to the bottom of the tubes

38 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

39 Urinalysis: Microscopic Examination (cont.)
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

40 Urinalysis: Microscopic Examination (cont.)
Bacteria A few are normal Infection if urine also has Putrid odor WBCs Parasites Infection or contamination Trichomonas vaginalis – most common

41 Apply Your Knowledge Super!
What is the specific gravity shown on this refractometer screen? ANSWER: The specific gravity shown here is Super!

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 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

44 End of Chapter End of Chapter 47 A human being: an ingenious assembly of portable plumbing. ~ Christopher Morley,

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