1. Chapter 44
Urinalysis

2. Blood Type Questions What is an antigen? What is an antibody?
What happens in agglutination? Why can it be deadly?
A patient with type A blood needs a blood transfusion. Identify the blood types that are compatible with hers.
TRUE OR FALSE…
______ Type O blood is considered to be a universal donor.
______ Agglutination is a form of blood clotting in the body.
______ An individual who has no antigens attached to the membrane of their RBC are referred to as blood type O.
______ A person with blood type AB is considered to be a universal donor.

3. 12/8/15
Objective: Identify the various tests used in the clinical examination of urine
Standard: Evaluate data from research articles encompassing the reliability of home testing kits (i.e., pregnancy test) and portable diagnostic equipment (i.e., glucometers).
Medical Minute: Define anuria, dysuria, polyuria, hematuria, proteinuria, nocturia – Begin reading chap 44 in PMA book
Turn in blood types homework and open book quiz to tray in the back!

4. Learning Objectives
Understand the basic structures of the urinary system
Describe the importance of urinalysis
Explain the importance of medical terms related to the urinary system
Explain the importance of the different methods of urine collection

5. Learning Objectives
Explain and educate the patient in the proper method of urine collection
Identify the various tests included in the physical and chemical examination of urine
Explain the basis for urine pregnancy testing
Recognize the basic structures or elements that may be found in normal and abnormal urine under the microscope

6. Urinary System Structures
Kidneys—filter waste from blood, regulate water, electrolyte, and acid–base content of blood, production of urine
Ureters—tubes carrying urine from kidneys to bladder

7. Urinary System Structures
Urinary bladder— collects urine and stores until released from body
Urethra—tube connecting bladder to outside of body

8. Characteristics of Urine
Urine is sterile inside of body
Urine becomes contaminated when released from the body
Urine is 95% water, 5% organic and inorganic wastes
Humans typically produce 1,000–1,500 ml urine in 24 hours

9. 12/9/15
Objective: Identify the various tests used in the clinical examination of urine
Standard: Evaluate data encompassing the reliability of home testing kits (i.e., pregnancy test) and portable diagnostic equipment (i.e., glucometers).
Medical Minute: Define turbid, specific gravity, and renal threshold
Sit in assigned seats! 

10. Urine Collection Procedure
Instruct patient
Use proper collecting containers
Label correctly
Determine if specimen is adequate amount for test
Test specimen within 30–60 minutes, refrigerate up to 8 hours
Gently mix before testing

11. Preparation for Urinalysis
Medical assistant should familiarize self with equipment:
Reagent strip—color pads dipped into urine
Analyzer—automated machine to read reagent strip
Quality control—assures accuracy of testing

12. Reagent Strip
Test strip contains individual color pads that correlate with a urine component such as glucose or blood
After dipping urine, color is compared to chart

13. Analyzer Computer printout of reagent strip
Abnormal values are flagged
Can do more urinalysis in short period of time

14. Urinalysis Three components to urinalysis: Physical—CLIA waived test
Chemical—CLIA waived test
Microscopic—CLIA non-waived test

15. Urine color changes Foods Vitamins Medications Carrots – orange
Beets – red tinged
Blackberries – red tinged
Vitamins
Vitamin C or B - bright yellow/orange
Medications
Certain antibiotics – yellowish brown

16. 12/10/15 Medical Minute Finish review questions and turn in!
What is the function of the kidneys, ureters, bladder and urethra?
How much urine does a person normally produce in one day?
Describe 3 types of urine specimens.
Identify the hormone present in urine if a female is pregnant
Describe reasons for the color of urine to be abnormal
Provide 2 examples of the physical components of urine and 2 examples of the chemical components of urine. What does it mean if they are abnormal?

17. 12/10/15
Objective: Identify the various tests used in the clinical examination of urine
Standard: Evaluate data encompassing the reliability of laboratory testing kits (i.e., pregnancy test) and portable diagnostic equipment (i.e., glucometers).

18. Chemical Components of Urine
Protein—protein may be present temporarily
If present referred to as proteinuria
Can be caused by fever, stress, or strenuous exercise
Chronic proteinuria may be due to renal failure

19. Chemical Components of Urine
Ketones—by-products of fat metabolism
should not be present in urine
If present referred to as ketonuria
Can result from starvation, high fat diet, pregnancy, or diabetes

20. 12/11/15
Medical Minute:
All of the following medical terms represent the presence of a substance in the urine EXCEPT:
A) polyuria
B) ketonuria
C) hematuria
D) glycosuria
Which of the following is the function of the ureters?
A) filters waste materials from the blood
B) discharges urine to outside the body
C) carries urine from kidneys to the bladder
D) received urine from the kidneys

21. 12/11/15
Objective:
Identify the various tests used in the clinical examination of urine.
Assess clinical symptoms related to renal dysfunction.
Standard: Evaluate data encompassing the reliability of laboratory testing kits (i.e., pregnancy test) and portable diagnostic equipment (i.e., glucometers).

22. Urine Specimens
Random urine specimen—most common type of urine specimen, used for routine screening
First-morning urine specimen—most concentrated specimen
Clean-catch midstream urine specimen (CCMS)—proper collection technique is necessary, used for urine culture

23. Urine Specimens
Catheterized urine specimen—catheter is placed into bladder to collect sterile urine – ASEPTIC technique
Suprapubic aspirate urine specimen— syringe used to directly collect urine
Sometimes used on pediatric patients
Provides sterile specimen

24. Physical Components - Color
urochrome (pigment), varies due to dilution or concentration of urine
1st urine in the morning tends to be darker
Orange/brown – liver disease (hepatitis)
Red – UTI, trauma, renal disorder
Milky – UTI
Certain foods can change the color of urine as well

25. Physical Components - Clarity
Clarity—appearance or transparency of urine
Fresh urine is usually clear or transparent
Mucus, bacteria, and cells can contribute to the cloudy appearance of urine
Terms to use: clear, cloudy, slightly cloudy, or turbid
Turbid – thick or opaque

26. Physical Components of Urine
Odor—varying odors, not generally recorded
Specific gravity— measures concentration of dissolved substances in urine, varies according to dilution or concentration of urine
Normal is
Concentrated urine has a higher specific gravity
Dehydration, heart disease, renal disease and diabetes

27. Chemical Components of Urine
pH—measures acidity or alkalinity of urine
Scale 0.0–14.0
0.0–6.0 is acidic
could indicate diabetes or starvation
8.0–14.0 is alkaline
could indicate a UTI
Normal range for urine is

28. Chemical Components of Urine
Glucose—no glucose should be present in urine
If present referred to as glycosuria
Normally the kidneys will filter and reabsorb glucose back into the bloodstream
Main cause of glucose in the urine is diabetes

29. Chemical Components of Urine
Blood—not normally found in urine
Can be found as a contaminant during menstruation
Graded as negative, trace, small, moderate, or large
If found can indicate trauma, UTI, or kidney stones

30. Chemical Components of Urine
Leukocytes—should not be present in urine
If present suggests infection (UTI)

31. Objective
Identify the various tests used in the clinical examination of urine.
Assess clinical symptoms related to renal dysfunction.

36. Group Time Find your partner, and continue reading the case studies
Come up to each station to assess your patients.
Work on Case Study 3 while others are rotating through the stations.
TURN IN CASE STUDIES AT THE END
OF CLASS!

37. Further Expansion What are the chemical components of urine?
Describe what abnormal values can indicate.

38. 12/11/15 Exit Ticket
Identify two components of urine assessed in the urinalysis.
Turn in to the blue basket!
Have a great weekend 