1. Processing and Testing Urine and Stool Samples47
Processing and Testing Urine and Stool Samples

2. Learning Outcomes
47.1 Discuss the role of the medical assistant in collecting, processing, and testing urine and stool samples.
47.2 Carry out procedures for following guidelines when collecting urine specimens.

3. Learning Outcomes
47.3 Describe the process of urinalysis and its purpose.
47.4 Carry out the proper procedure for collecting and processing a stool sample for fecal occult blood testing.

4. Introduction
Proper collection of urine and stool specimens key to diagnosing
Medical assistant
Learn about urine and fecal specimens
Instruct or assist patient in collection of a specimen
Constituents of urine samples
Chain of custody for drug screening
Learning Outcomes: Discuss the role of the medical assistant in collecting, processing, and testing urine and stool samples.
The routine analysis of a urine specimen is a simple, noninvasive diagnostic test.
Many significant conditions may be noted with the assessment of the physical, chemical, and microscopic examinations of a patient’s specimen.
Medical Assistant will learn
How to correctly process a specimen, including a random specimen and a chain of custody drug screen.
Learn to identify normal and abnormal constituents of urine samples and what may cause these abnormal elements to be present in a specimen.
Reasons for collecting fecal samples.

5. The 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
Learning Outcomes: Discuss the role of the medical assistant in collecting, processing, and testing urine and stool samples.
You may also have to deal with a variety of patient groups who require special care, including elderly patients and pediatric patients.

6. Role of the Medical Assistant
Potentially hazardous waste
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
Learning Outcomes: Discuss the role of the medical assistant in collecting, processing, and testing urine and stool samples.
Urine and fecal specimens are potentially infectious body waste.
Take precautions to protect yourself, the patient, and others in the environment from transmitting disease-causing microorganisms.

7. Apply Your Knowledge Very Good!
What does the medical assistant need to know 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.
Learning Outcomes: Discuss the role of the medical assistant in collecting, processing, and testing urine and stool samples.
Very Good!

8. Obtaining Urine Specimens
General guidelines
Follow procedure for specified test
Use appropriate specimen container
Label specimen container correctly
Explain the procedure to patient
Wash your hands before and after; wear gloves
Complete paperwork
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
It is essential to collect, store, and preserve urine specimens in ways that do not alter their physical, chemical, or microscopic properties.

9. Obtaining Urine Specimens (cont.)
Instruct patients
Test-specific
General
Use correct container
Do not discard preservative
Refrigerate the collection container
Keep lid on the container
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
If patients will need to collect a urine specimen at home, it is your responsibility to provide instructions for obtaining the specimen.
Test-specific
General instructions.
Urinate into the container required by the laboratory.
If any of the preservative spills on you, wash the area immediately. Follow office procedures for accidental exposure.
Always refrigerate the labeled collection container or keep it in a cooler or pail filled with ice.

10. Specimen Types Quantitative analysis Qualitative analysis Vary in
The method used to collect a specimen
The time frame in which to collect a specimen
Follow procedure exactly
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
A quantitative analysis is a test that measures the amount of a specific substance in the urine
A qualitative analysis simply measures the presence of a substance in urine.
You must follow the steps in the procedure exactly, or instruct the patient to follow them exactly.

11. Specimen Types (cont.) Random urine specimen First morning specimen
Most common
Obtained any time during the day
First morning specimen
Collected after a night’s sleep
Contains greater concentration of substances
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
Random Urine Specimen
Single urine specimen taken at any time of the day and collected in a clean, dry container.
Urine specimens should be processed within 1 hour of collection or refrigerated.
Before processing refrigerated specimens, allow them to come to room temperature.

12. Specimen Types (cont.) Clean-catch midstream Used for culturing urine
External genitalia must be cleansed
A small amount of urine is discarded prior to collecting specimen
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
Clean-Catch Midstream Urine Specimen
Sometimes referred to as mid-void.
Collected and submitted for culturing to identify the number and the types of pathogens present.
Method requires special cleansing of the external genitalia to avoid contamination by organisms residing near the urethral meatus.
Have the patient void a small amount of urine into the toilet prior to collecting the midstream specimen to flush the normal flora out of the distal urethra to prevent possible contamination of the specimen.
Refer to Procedure 47-1 Collecting a Clean-Catch Midstream Urine Specimen
Refer to CONNECT to see a video about Collecting a Clean-Catch Midstream Urine Specimen.

13. Specimen Types (cont.) Timed urine specimen 24-hour specimen
Procedure 47-2 Collecting a 24-Hour Urine Specimen
Specimen Types (cont.)
Timed urine specimen
Discard first specimen
Collect all urine for specified time
Refrigerate
24-hour specimen
Timed collection
Instruct as for a timed specimen
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
Timed Urine Specimen
A timed urine specimen to measure a patient’s urinary output or to analyze substances.
Instruct the patient to:
Discard the first specimen.
Then collect all urine for the specified time.
Be sure the urine does not mix with stool or toilet paper.
Keep the sample refrigerated until returning it to the physician’s office or laboratory.
24-Hour Urine Specimen
Collected over a 24-hour period
Used to complete a quantitative and qualitative analysis of one or more substances,
To instruct the patient in the proper collection process.
Procedure 47-2 Collecting a 24-Hour Urine Specimen

14. Catheterization
Procedure by which the catheter is inserted into the bladder
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
A urinary catheter is a sterile plastic tube inserted into the kidney, ureter, or bladder to provide urinary drainage.

15. Catheterization (cont.)
Reasons
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
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.

16. Catheterization (cont.)
Drainage catheters
Indwelling urethral catheter
Retention catheter
Ureteral catheter
Cystostomy tube
Straight catheter
Splinting catheter – inserted after repair of ureter
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
The two primary types of urinary catheters are:
Drainage catheters – used to withdraw fluids and include:
An indwelling urethral (foley) catheter placed in the bladder.
A retention catheter in the renal pelvis.
A ureteral catheter
A catheter for drainage through a wound that leads to the bladder.
A straight catheter to collect specimens or instill medications.
Splinting catheters – inserted after surgical repair of the ureter. It must remain in place for at least a week after surgery.

17. Catheterization (cont.)
Not a routine procedure due to risk of infection
Not typically performed by medical assistants
Check scope of practice
Assemble supplies
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
You may be required to assemble the necessary supplies and to assist the physician during it.
Catheterization performed in a physician’s office is usually done for diagnostic purposes using a specially prepared catheterization kit.

18. 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
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
Special Considerations in Male and Female Patients
Guidelines may differ for collecting urine specimens from a male or female patient.
In addition, when you take a medical history on a male or female patient, you will need to ask particular questions as part of your assessment.
Special Considerations in Pregnant Patients
Ask about any pain during urination or in the kidney area.
Ask about urine leakage and whether she has previously been pregnant.
Ask if any previous babies were delivered by forceps, which can injure urinary and genital structures.

19. Establishing Chain of Custody
Do not alter the procedure
Explain procedure
Consent form gives permission to
Collect the specimen
Prepare it for transport to laboratory
Release the results to agency requesting test
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
Chain of custody may be needed for
Drug analysis
Alcohol analysis
Refer to Procedure 47-3 Establishing Chain of Custody for a Urine Specimen
Since supplying a specimen for drug or alcohol testing could be self-incriminating, it is important to thoroughly explain the procedure to donors and have them sign a consent form.
Encourage patient to list on the consent form all substances consumed in the last 30 days, and how much.
The chain of custody form verifies that the patient whose name is on the CCF and consent forms is the same person who provided the sealed specimen sent to the laboratory.

20. Preservation and Storage
Changes can 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
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens.
Changes that can affect the physical, chemical, and microscopic properties of urine, and invalidate certain test results, occur in urine kept at room temperature for more than 1 hour.
Refrigeration is the most common method for storing and preserving urine.
Refrigeration can cause other changes in the urine that may affect the physical characteristics of sediment and specific gravity.
Bring the specimen back to room temperature before testing to correct these problems.
Chemical preservatives can be used preserve specimens, especially 24-hour specimens or those that must be sent a long distance to a laboratory.

21. Correct! Apply Your Knowledge T F T T F True or False:
A random urine specimen can be collected any time.
A clean-catch midstream urine specimen should be collected the first thing in the morning.
Instruct the patient to discard the first specimen when collecting a timed or 24-hour specimen.
A chain of custody form gives you permission to release the results to the agency requesting the test.
Urine specimens should be refrigerated if they will not be tested within four hours.
ANSWER: T F
first morning T
Learning Outcome: Carry out procedures for following guidelines when collecting urine specimens. T F
Correct!
one

22. Urinalysis
Evaluation of urine to obtain information about body health and disease
Types of testing
Physical
Chemical
Microscopic
Learning Outcome: Describe the process of urinalysis and its purpose.

23. Urinalysis (cont.) Values Screening – must have follow-up testing
Negative or none, normal, or a range of concentration
Within normal limits indicate health and normality
Screening – must have follow-up testing
Learning Outcome: Describe the process of urinalysis and its purpose.
Refer to Table 47-2 Standard Urine Values and Table 47-3 Common Urine Tests According to Clinical Condition.
Because a urine test is a screening test, all abnormal values must be followed up with a confirmatory test.

24. 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
Learning Outcome: Describe the process of urinalysis and its purpose.
With adequate fluid intake, the average adult daily urine output is 1250 milliliters or approximately 5 cups per 24 hours.
If total intake and output measurements are not approximately equal, urinary tract dysfunction may be the cause.
Urinary system works with other body systems
Disorders in other systems can affect urinary system.
Disorders in urinary system can affect other body systems.

25. Physical Examination and Testing of Urine Specimens
Check label
Check for visible contamination
Check time since collection
Visual examination
Color and turbidity
Volume
Odor
Specific gravity
Learning Outcome: Describe the process of urinalysis and its purpose.

26. Physical Examination and Testing of Urine Specimens (cont.)
Color
Pale yellow to dark amber
Concentration
Turbidity – clear or cloudy
Learning Outcome: Describe the process of urinalysis and its purpose.
Color
The color comes from a yellow pigment called uro-chrome
Depends on food or fluid intake, medications, and waste products in the urine.
A pale color indicates dilute urine, and a dark color indicates concentrated urine.
Turbidity – note whether the urine is clear, slightly cloudy, cloudy, or very cloudy
Refer to Table 47-4 Urine Color and Turbidity: Possible Causes.

27. Physical Examination and Testing of Urine Specimens (cont.)
Volume
600 to 1800 mL/24 hours
Oliguria
Anuria
Odor
Not typically recorded
Distinct, aromatic
Learning Outcome: Describe the process of urinalysis and its purpose.
Volume
Varies according to the patient’s age; adult urine volume is 600 to 1800 mL / 24 hr.
Urine volume is typically measured on a timed specimen
Oliguria – insufficient production of urine; dehydration, decreased fluid intake, shock, and renal disease.
Anuria – absence of urine production; renal or urethral obstruction and renal failure
Odor
Normal, freshly voided urine is distinct and sometimes characterized as aromatic.
After urine has been standing for a while – odor similar to ammonia.
Diseases, bacteria, and particular foods can cause changes in urine odor
Odor variations:
Foul-smelling – presence of infection
Fruity – uncontrolled diabetes
Musty – phenylketonuria (infants)

28. Physical Examination and Testing of Urine Specimens (cont.)
Urine Specific gravity
1.002 to 1.028
Fluctuates in response to fluid intake
Methods
Refractometer
Reagent strips
Learning Outcome: Describe the process of urinalysis and its purpose.
Urine specific gravity – a measure of the concentration or amount of substances dissolved in urine. It is an indicator of kidney function.
Specific gravity – weight of sample divided by weight of distilled water
Increase – indicates that the kidneys are not properly diluting urine.
Decrease – indicate that the kidneys are not properly concentrating urine.
Refractometer
Optical instrument that measures the bending of light as it passes through a liquid.
Must be calibrated every day
Advantages – the process takes little time and requires little urine.
Refer to Procedure 47-4 Measuring Specific Gravity with a Refractometer
Reagent Strip Measurement.
Test pads contain chemicals that react with substances in the urine and change color in precise ways.
The reagent strip container includes a color chart for interpreting color changes on the test pads.
Refer to procedure 47-5 performing a reagent strip test

29. Chemical Testing of Urine Specimens
Check label
Reagent strip testing
Color change
Follow instructions carefully
Learning Outcome: Describe the process of urinalysis and its purpose.
Prior to performing chemical tests, always check for proper identification on the urine specimen to be tested.
Reagent strips or certain automated machines that use photometry are used to determine
Carbohydrate metabolism, liver or kidney function, or acid-base balance
The presence of drugs, toxic environmental substances, or infections.
Testing with Reagent Strips
Color changes indicate the presence of that substance and its concentration in the urine specimen.
Used to test urine for a number of substances including ketones, nitrite, pH, blood, bilirubin, glucose, specific gravity, protein, and leukocytes.
Choose the appropriate strip according to the chemical test requested
Refer to Procedure 47-5 Performing a Reagent Strip Test
Refer to CONNECT to see a video about Performing a Reagent Strip Test .

30. Chemical Testing of Urine Specimens
Quality assurance
Keep bottle tightly closed
Remove strip just prior to use
Do not touch pads
Check for discoloration and expiration date
Date new bottles and discard after 6 months
Learning Outcome: Describe the process of urinalysis and its purpose.

31. Chemical Testing of Urine Specimens (cont.)
Ketone bodies
Products of fat and protein metabolism
Normally none in urine
Urinary pH
Measure of acidity or alkalinity
Normal 5.0 to 8.0
Learning Outcome: Describe the process of urinalysis and its purpose.
Ketone bodies
Intermediary products of fat and protein metabolism in the body.
Include acetone, acetoacetic acid, and beta-hydroxybutyric acid.
Normally, there are no ketones in urine.
Ketones in the urine may indicate that a patient is following a low-carbohydrate diet, or it may indicate that the patient has a condition such as starvation, excessive vomiting, or diabetes mellitus.
Test urine immediately or cover the specimen tightly and refrigerate
Urinary pH
pH can provide information about a patient’s metabolic status, diet, medications being taken, and several conditions.
The average urine pH is 6.0, which is slightly acidic and can range from 5.0 to 8.0.
Alkaline urine – possible urinary tract infection or metabolic or respiratory alkalosis.
Acidic urine – possible phenylketonuria or acidosis.

32. Chemical Testing of Urine Specimens (cont.)
Blood
Use a strip that reacts with hemoglobin
Hematuria
Hemoglobinuria
Myoglobinuria
Learning Outcome: Describe the process of urinalysis and its purpose.
Blood
Blood in the urine may due to menstruation, urinary tract infection, or trauma or bleeding in the kidneys.
Use a reagent strip that reacts with hemoglobin.
Strip will have two indicators – one for nonhemolyzed blood, the other for hemolyzed blood.
Hematuria – presence of blood in the urine; caused by cystitis; kidney stones; Menstruation; or ureteral, bladder, or urethral irritation.
Hemoglobinuria – presence of free hemoglobin in the urine; a rare condition caused by transfusion reactions, malaria, drug reactions, snakebites, or severe burns.
Myoglobinuria – injured or damaged muscle tissue.
Reagent strip testing does not distinguish between the latter two conditions.

33. Chemical Testing of Urine Specimens (cont.)
Bilirubin
Breakdown of hemoglobin
Bilirubinuria ~ early sign of liver disease
Urobilinogen
Elevated – increased RBC destruction
Lacking – bile duct obstruction
Learning Outcome: Describe the process of urinalysis and its purpose.
Bilirubin and Urobilinogen
Hemoglobin breaks down, it converts into conjugated bilirubin in the liver and then to urobilinogen in the intestines.
Bilirubinia – bilirubin in the urine is one of the first signs of liver disease.
Urine turns yellow-brown to greenish orange.
Urobilinogen is present in the urine in small amounts.
Must be performed on a fresh urine specimen.

34. Chemical Testing of Urine Specimens (cont.)
Glucose
Normally in small amounts
Glycosuria – diabetes
Protein
Normally excreted in small amounts
Proteinuria – excess protein in the urine
Learning Outcome: Describe the process of urinalysis and its purpose.
Glucose
Present in normal urine, but only in small quantities not detectable by the reagent strip test for glucose.
Glycosuria – the presence of significant glucose in the urine.
Blood is more commonly tested for glucose than urine is because reagent strip tests may show false-negative results.

35. Chemical Testing of Urine Specimens (cont.)
must test the urine immediately or refrigerate the
Chemical Testing of Urine Specimens (cont.)
Phenylketones
Phenylketonuria (PKU)
Blood testing is more routine for newborns
Nitrite – suggests bacterial infection
Leukocytes – urinary tract or renal infection
Learning Outcome: Describe the process of urinalysis and its purpose.
Nitrite
The test is not definitive.
Use the first morning specimen.
Test the urine immediately or refrigerate.
Leukocytes – use strip tests for leukocyte esterase.
Phenylketones
Phenylketonuria (PKU) – a genetically inherited disorder in which the body cannot properly metabolize the nutrient phenylalanine.
Phenylketones accumulate in the bloodstream, resulting in mental retardation.
Although urine can be tested for the presence of phenylketones, blood testing is routine for newborns before discharge, at least 24 hours after birth.

36. Chemical Testing of Urine Specimens (cont.)
Pregnancy tests
Detect human chorionic gonadotropin (HCG)
Quick, easy to perform and interpret
Enzyme immunoassay (EIA) test
Learning Outcome: Describe the process of urinalysis and its purpose.
Pregnancy Tests
Based on detecting human chorionic gonadotropin, or HCG, secreted by the placenta.
Levels usually peak at about 8 weeks.
Commercial pregnancy tests are manufactured for use in the clinical setting and at home.
Newer technologies have been developed called membrane EIAs; in these tests, most of the reagents are incorporated into an absorbent membrane in a plastic case.
Refer to Procedure 47-6 Pregnancy Testing Using the EIA Method
CONNECT to see a video about Pregnancy Testing Using the EIA Method.

37. Chemical Testing of Urine Specimens (cont.)
Presence of STDs
Screening for chlamydia
Nucleic acid amplification tests (NAATs)
Detect nucleic acid in urine
Chlamydia and gonorrhea
Advantages vs. disadvantages
Learning Outcome: Describe the process of urinalysis and its purpose.
The CDC recommends that all sexually active females between the ages of 15 and 25 be screened annually for chlamydia
Nucleic acid amplification tests (NAATs) have recently been developed that utilize urine samples to detect the presence of nucleic acid.
By amplifying nucleic acids specific to chlamydia and gonorrhea, the test can detect the presence of very small numbers of bacteria.
Advantages of NAATs
Sample collection is easy.
Tests are highly specific and sensitive.
Organisms do not have to be living to be detected.
Good screening tools for asymptomatic patients.
Disadvantages
The tests are expensive.
No living organisms remain for use in a follow-up culture.

38. Microscopic Examination of Urine Specimens
View elements only visible with microscope
Centrifuge
Spins urine ~ heavier substances settle to the bottom of the tubes
Sediment examined
Learning Outcome: Describe the process of urinalysis and its purpose.
A microscopic examination of urine sediment may be performed to view elements only visible with a microscope.
Elements are categorized and counted.
Refer to Procedure 47-7 Processing a Urine Specimen for Microscopic Examination of Sediment

39. Microscopic Examination of Urine Specimens (cont.)
Cells
Epithelial cells
Renal
Transitional
Squamous
White blood cells
Red blood cells
Learning Outcome: Describe the process of urinalysis and its purpose.
Epithelial Cells
Renal epithelial cells – several may indicate tubular damage in the kidneys.
Transitional epithelial cells – a few appear normally in urine, but several may indicate tubular damage.
Squamous epithelial cells – occur in sheets or clumps
White Blood Cells – found in large numbers if inflammation is present or if the specimen was contaminated during collection.
Red Blood Cells
Enter the urinary tract during inflammation or injury.
Numerous RBCs may indicate urinary infection, obstruction, inflammation, trauma, or tumor.

40. Microscopic Examination of Urine Specimens (cont.)
Casts
Cylindrical elements
Protein
Classification
Hyaline
Granular
RBC casts
WBC casts
Epithelial cell casts
Waxy
Learning Outcome: Describe the process of urinalysis and its purpose.
Casts
Form when protein from the breakdown of cells accumulates and precipitates in kidney tubules and is washed into urine.
Cylinder-shaped elements with flat or rounded ends; assume the size and shape of the tubules.
Indicate renal pathologic conditions or can be caused by strenuous exercise.
Classified according to their appearance and composition
Hyaline casts – form because of diminished urine flow through individual nephrons; kidney disease or strenuous exercise
Granular casts – kidney disease or strenuous exercise.
Red blood cell casts – hyaline casts with embedded red cells; always indicate an abnormality
White blood cell casts – hyaline casts with leukocytes; may indicate pyelonephritis.
Epithelial cell casts – contain embedded renal tubular epithelial cells indicate excessive kidney damage.
Waxy casts – rare, yellow, glassy, brittle, smooth, and homogeneous structures with cracks or fissures and squared or broken ends. These casts occur with severe renal disease.

41. Microscopic Examination of Urine Specimens (cont.)
Crystals
Naturally produced solids of definite form
Common in urine
Determine pH before identifying
Learning Outcome: Describe the process of urinalysis and its purpose.
Crystals are naturally produced solids of definite form.
They are commonly seen in urine specimens, especially those permitted to cool.
They usually do not indicate a significant disorder, except when found in large numbers in patients with kidney stones and in a few pathologic conditions.
Different substances tend to crystallize in acidic and alkaline urine.
Determine the pH of a patient’s urine before you try to identify any present crystals.

42. Microscopic Examination of Urine Specimens (cont.)
Yeast cells
May be confused with RBCs
Associated with genitourinary tract infection, diabetes
Bacteria
A few are normal
Infection if odor and WBCs are present
Parasites – may indicate infection
Learning Outcome: Describe the process of urinalysis and its purpose.
Yeast Cells
Usually oval and may show budding, may be confused with RBCs.
Also associated with external genitalia contamination, vaginitis, urethritis, and prostatitis.
Also commonly seen in the urine of patients with diabetes.
Bacteria – suspect a urinary tract infection if the urine has bacteria, a putrid odor, and numerous white blood cells.
Refer to Educating the Patient: Preventing Urinary Tract Infections.
Parasites
May signal genitourinary tract infection or external genitalia contamination.
The most common urinary parasite, trichomonas vaginalis is typically found in vaginal disorders but also may appear in males.

43. Apply Your Knowledge
What is the specific gravity shown on this refractometer screen?
ANSWER: The specific gravity shown here is
Learning Outcome: Describe the process of urinalysis and its purpose.

44. Apply Your Knowledge C F I B H G D A E ANSWER: Matching:
pale yellow to dark amber
cloudiness
absence of urine
measure of concentration of urine
acidity or alkalinity of urine
genetically inherited disorder
may indicate tubular damage
cylinder-shaped sediment of proteins
naturally produced solids in cool urine
Casts
Specific gravity
Normal color
Renal epithelial cells
Crystals
Turbidity
PKU pH
Anuria C F
Super! I B H
Learning Outcome: Describe the process of urinalysis and its purpose. G D A E

45. Collecting and Processing Stool Specimens
Screening for colorectal cancer
Fecal occult blood test
Tests for hidden blood
Foods and medication may cause false-positives
Patient instruction important
Learning Outcome: Carry out the proper procedure for collecting and processing a stool sample for fecal occult blood testing.
The collection technique varies with the suspected condition or microorganism.
Screening for Colorectal Cancer
The fecal occult blood test (FOBT) is a test for occult blood in the stool.
May indicate colorectal cancer, hemorrhoids, and gastric ulcers.
Some food, such as broccoli and beets, and drugs, like aspirin and ibuprofen, may cause a false-positive test.
A positive test warrants further investigation for the cause of the bleeding.
Refer to Educating the Patient: Collecting a Stool Sample and Procedure Fecal Occult Blood Testing Using the Guaiac Testing Method

46. Collecting and Processing Stool Specimens (cont.)
Suspected Bacterial Infection
Shigella or Salmonella
Loose, bloody or mucus-tinged stools
Culture media
Promote growth of intestinal pathogen
Suppress growth of other microorganisms
Learning Outcome: Carry out the proper procedure for collecting and processing a stool sample for fecal occult blood testing.

47. Collecting and Processing Stool Specimens (cont.)
Suspected Protozoal or Parasitic Infection
O & P specimen
Three separate sets of fresh and preserved specimens
Special kits available
Learning Outcome: Carry out the proper procedure for collecting and processing a stool sample for fecal occult blood testing.
O&P specimen, short for an ova and parasites specimen.
Specimen is examined for the presence of protozoans or parasites and their eggs
Obtain both a fresh and a preserved stool specimen.
A fresh specimen is examined both macroscopically and microscopically for the presence of microorganisms.
A preserved specimen is needed because certain forms of these organisms are destroyed within a short time after leaving the body and may not be detected in the fresh specimen.
Special stool collection kits are available. They contain a specimen container for a fresh sample along with vials of two types of preservatives.
Collect a series of at least three stool specimens for examination.
Three specimens are required because different diagnostic forms of the microorganism may be present in the stool at different times, and some could be missed with only one sample.

48. Very Good! Apply Your Knowledge
Besides how to collect the stool sample for FOBT testing, what else do you need to tell the patient?
ANSWER: The patient need to know to follow all pretest dietary and medication instructions.
Learning Outcome: Carry out the proper procedure for collecting and processing a stool sample for fecal occult blood testing.
Refer to CONNECT to see activities about Ordering a Test, Recording Test Results, and Processing Test Results.
Very Good!

49. In Summary
47.1 Your role as a medical assistant includes collecting, processing, and testing urine samples, and processing and testing stool samples.
You will also be responsible for teaching patients proper collection methods for urine and stool samples.

50. In Summary (cont.)
47.2 The general guidelines for collecting a urine specimen include:
following the procedure specified for the urine test that will be performed;
using the type of specimen container indicated by the laboratory;
properly labeling the specimen container;
explaining the procedure to the patient when assisting in the collection process;
washing your hands before and after the procedure and wearing gloves during the procedure; and
complete all necessary paperwork.

51. In Summary (cont.)
47.3 Urinalysis is the evaluation of urine by various types of testing methods to obtain information about body health and disease.

52. In Summary (cont.)
47.4 The general guidelines for collecting a stool specimen include:
instructing the patient about the need to follow all collection procedures including when to collect, how to collect, and how to return the specimen to the office;
following the testing procedure for fecal occult blood testing, using Standard Precautions when performing the test; and
documenting the test and results in the patient’s chart.

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