CHAPTER 47 Collecting, Processing, and Testing Urine Specimens © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-2 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-3 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-4 Learning Outcomes (cont.) 47.9 Describe the process of urinalysis and its purpose 47.10Identify the physical characteristics present in normal urine specimens 47.11 Identify the chemicals that may be found in urine specimens 47.12Identify the elements categorized and counted as a result of microscopic examination of urine specimens © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-9 Formation of Urine • Nephron – Functional unit of the kidney – Removes end products of metabolism – Allows for reabsorption of water and electrolytes • Processes in urine formation – Glomerular filtration – Tubular reabsorption – Tubular secretion – Maintains normal fluid balance © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-10 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-37 Chemical Testing of Urine Specimens (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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-38 Microscopic Examination of Urine Specimens • View elements only visible with microscope • Centrifuge – Obtain sediment – Spins fluid – heavier substances settle to the bottom of the tubes © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-39 Microscopic Examination of Urine Specimens (cont.) • Casts • Cells – Epithelial cells – White blood cells – Red blood cells – Cylindrical elements – Types • • • • • • Hyaline Granular RBC casts WBC casts Epithelial cell casts Waxy © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-40 Microscopic Examination of Urine Specimens (cont.) • Crystals • Yeast cells – Naturally produced solids of definite form – May be confused with RBCs – Common in urine – Associated with genitourinary tract infection, diabetes – Determine pH before testing © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-41 Microscopic Examination of Urine Specimens (cont.) • Bacteria – A few are normal – Infection if urine also has • Putrid odor • WBCs • Parasites – Infection or contamination – Trichomonas vaginalis – most common © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-42 Apply Your Knowledge What is the specific gravity shown on this refractometer screen? ANSWER: The specific gravity shown here is 1.030 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-43 Apply Your Knowledge 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-44 In Summary 47.1 Urine is formed during a filtration process that occurs in the nephron It is made up of 95% water and 5% waste products and other dissolved chemicals, including urea, uric acid, ammonia, calcium, creatinine, sodium, chloride, potassium, sulfates, phosphates, bicarbonates, hydrogen ions, urochrome, urobilinogen, a few red blood cells, and a few white blood cells © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-45 In Summary (cont.) 47.2 Instructions for obtaining specific types of specimens will vary according to the test The general instructions for urine specimen collection are: urinate into the container indicated by the laboratory; if the collection container contains liquid or powdered preservative, not pour it out; always refrigerate the labeled collection container or keep it in a cooler or pail filled with ice; be sure to keep the lid on the container © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-46 In Summary (cont.) 47.3 The general guidelines for collecting a urine specimen include: follow the procedure that is specified for the urine test that will be performed; use the type of specimen container indicated by the laboratory; properly label the specimen container; explain the procedure to the patient when assisting in the collection process; wash your hands before and after the procedure and wear gloves during the procedure; and complete all necessary paperwork © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-47 In Summary (cont.) 47.4 Several types of urine specimens are collected in the medical office Each specimen has a slightly different collection method The various specimens include random, first morning, clean-catch midstream, timed, and 24-hour 47.5 Urinary catheterization involves inserting a plastic drainage tube into the kidney, the ureter, or the bladder 47.6 When the medical assistant obtains a urine specimen from a patient or takes a history of a patient who may have a urinary problem, she or he needs to consider the patient’s sex, condition, and age © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-48 In Summary (cont.) 47.7 When collecting a chain-of-custody specimen, the following safeguards should be used: positively identify the donor; have the donor remove outer clothing and empty pockets, displaying all items; add bluing agent to the water in the toilet and turn off other water sources; remain by the door while the specimen is being obtained; measure and record the temperature of the specimen within four minutes; have the donor witness the specimen transfer; complete additional information on the form; sign the CCF; give a copy of the CCF to the donor; place the specimen in a leak-proof bag with a copy of the form; and release the specimen to the courier service © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-49 In Summary (cont.) 47.8 Proper preservation and storage of specimens are essential A specimen should not be left unpreserved for more than hour Refrigerate a specimen if it cannot be tested within an hour Bring the specimen back to room temperature before testing 47.9 Urinalysis is the evaluation of urine by various types of testing methods to obtain information about body health and disease © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-50 In Summary (cont.) 47.10 The physical characteristics of normal urine include color and turbidity, volume, odor, and specific gravity 47.11 The chemicals that may be found in urine specimens include ketones, nitrite, bilirubin, glucose, and protein 47.12 During microscopic urine examination, elements that are categorized and counted include the cells, casts, crystals, yeast, bacteria, and parasites © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47-51 End of Chapter 47 A human being: an ingenious assembly of portable plumbing ~ Christopher Morley, 1890-1957 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed [...]... Bilirubin – From the breakdown of hemoglobin – Bilirubinuria – early sign of liver disease • Urobilinogen – Elevated – increased RBC destruction – Lacking – bile duct obstruction © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 34 Chemical Testing of Urine Specimens (cont.) • Glucose – Normally in small amounts – Glycosuria – diabetes • Protein – Excess – renal disease – Proteinuria – common... performed by medical assistants – Check scope of practice – Assemble supplies – catheterization kits © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 20 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... disease • Types of testing – Physical – Chemical – Microscopic © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 27 Urinalysis (cont.)... rights reserv ed 47- 29 Physical Examination and Testing of Urine Specimens (cont.) • Visual examination – Color/turbidity – pale yellow to dark amber; clear – Volume • Normal range – 60 0–1 800 mL/24 hours • Oliguria – insufficient production of urine • Anuria – absence of urine production © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 30 Physical Examination and Testing of Urine... rights reserv ed 47- 18 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 catheter – inserted after repair of ureter © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 19 Catheterization... Catheterization – procedure by which the catheter is inserted © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 17 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 © 2011.. .47- 11 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... blood cells, sperm, and H2O2 D hydrogen ions, urochrome, and uranium ANSWER: © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 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;... © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 21 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... Specimens (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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 47- 31 Chemical Testing of Urine Specimens • Check label on specimen • Determine the status of – Carbohydrate