BF Exam 2 Chapter 6 Flashcards
1
Q
What are reagent strips for dipstick made of?
A
Chemical-Impregnated absorbent pads on plastic strip.
2
Q
What kind of result does the reagent dipstick show?
A
Color
3
Q
How are the urine dipstick colors interpreted?
A
By looking at the color produced and comparing it to the manufactures chart.
4
Q
What kind of results are reported from dipstick?
A
Semi-quantitative readings of neg, trace, 1+, 2+, 3+ and 4+.
5
Q
6 improper techniques of reagent dipstick?
A
Testing cold samples.
Unmixed urine (cells sink to bottom of tube)
Overdipped strip
Improper timing
Lighting
Misreading color chart
6
Q
How should reagent strips be stored?
A
In sealed container .
7
Q
When should you not use reagent strips?
A
When exposed to moisture, heat, volatile chemicals, past expiration date and light.
8
Q
How do you perform a urine dipstick?
A
- Take your reagent from sealed container.
- Dip reagent in tube with 10-12 ml of urine, quickly.
- Blot side of reagent on napkin.
- Set timer
- Read results
9
Q
When do you do QC on reagent strips?
A
Every 24 hours
New bottle of strips are opened
When results are questionable
Concerns of strip integrity
10
Q
What are the 10 tests on reagent strip?
A
Leukocyte (esterase)
Nitrite
Protein
Glucose
Urobilinogen
Specific gravity
Blood
pH
Ketone
Bilirubin
11
Q
What is used as a confirmatory test?
A
Tablets and liquid chemical
12
Q
What is urine pH?
A
-log of H+ concentration
13
Q
More H+ in urine?
A
Acidic
14
Q
Less H+ in urine?
A
Alkaline
15
Q
What 2 organs are major regulators of acid-base content?
A
Lungs and Kidney
16
Q
Normal range for pH?
A
4.5 to 8.0
17
Q
Urine pH result increments?
A
0.5
18
Q
Clinical significance of increased pH?
A
Following meals (foods absorb acids in stomach)
Diet heavy in vegetables
19
Q
Clinical significance of decreased pH?
A
Respiration decreases during sleep
Foods that produce acid
Metabolic disorders
20
Q
What range does the reagent have?
A
5.0 to 9.0
21
Q
pH range for methyl red?
A
4.0 to 6.0
22
Q
pH range for bromothymol blue?
A
6.0 to 9.0
23
Q
What is protein in urine called?
A
Proteinuria
24
Q
Normal protein range?
A
<10 mg/dL
25
Primary protein of concern?
Albumin
26
Normal protein found and where does it originate from?
Tamm-Horfsfall (uromodulin) from RTE cells.
27
Value for clinical proteinuria?
>30 mg/dL
28
What causes proteinuria?
Glomerular nephritis
Pyelonephritis
Malignant hypertension
Reabsorption and filtration of protein
29
Protein-reagent strip principle?
Protein error of indicators
30
Color progression of protein on reagent?
Yellow to blue
31
Resulting of protein on reagent?
Neg, trace (<30 mg/dL), 1+, 2+, 3+, 4+
32
False positive protein?
Alkaline urine
Reagent in urine too long removes buffer
Pigmented urine (medications)
High SG
33
False negative protein?
Urine too diluted
Vaginal discharge
Heavy mucous
Semen
34
Should protein be positive if RBCs are seen under microscope?
Yes
35
Confirmatory test for protein?
Sulfosalicyclic Acid (SSA) precipitation
36
When would glucose be present in urine?
When threshold levels exceed
37
Where is glucose normally contained and reabsorbed?
In the glomerular ultrafiltrate and in the proximal tube
38
Glucose renal treshold?
160 to 180 mg/dL
39
What is glucose in urine called?
Glycosuria
40
Diabetes mellitus vs Diabetes insipidis
Mellitus cause by insulin / Insipidis caused by ADH
41
Diabetes mellitus urine volume?
Increased
42
Diabetes mellitus SG?
Increased due to glucose presence
43
Diabetes insipidis urine volume?
Greatly increased
44
Diabetes insipidis SG?
Decreased
45
What causes nondiabetic glycosuria?
Renal tubules ability to reabsorb
Pancreatic disease
Endocrine disorders
Infection
46
Glucose reagent strip reaction
Glucose + O2 > gluconic acid + H2O2
H2O2 +chromogen > oxidized colored
chromogen + H2O
47
Resulting report for glucose?
Neg, trace, mg/dL
48
Color of glucose on reagent?
Green being negative to brown being highest concentration of glucose
49
Glucose false positives?
Cleaning agents (bleach, peroxidase)
50
Glucose false negatives?
Cold specimens
Increased SG
Increased ketones
Alkaline pH
51
Copper reduction test
Looks for other reducing substances like galactose
52
Glucose dipstick pos, clinitek neg
Glucose present in small amounts
53
Glucose dipstick neg, clinitek pos
Non-glucose reducing substance
54
Glucose dipstick pos, clintek pos
Glucose present
55
Glucose dipstick neg, clintek neg
No glucose
56
What is ketonuria?
Ketones present in urine.
57
Ketosis?
Disease state where patient has increased amounts of ketones.
58
Acidosis?
State when blood pH is decreased, can cause ketosis.
59
Ketoacidosis?
Blood acidosis as a result of increased ketones.
60
What type of ketone is found in urine?
Mostly acetoacetic acid and acetone
61
What type of ketone is not commonly found in urine ketones?
Beta-hydroxybutyrate
62
Why does ketones appear in the urine?
Body will break down stored fats for energy instead of glucose producing ketones (acid by-product).
63
Relationship between insulin and ketones?
When insulin is difficient, body will use body fat forming ketones.
64
Color of ketones on reagent?
Pale/orange to purple
65
Resulting of ketones?
Neg, trace, small, mod, large
66
Typical urine in a diabetic patient?
Low pH (too much keto acids)
High SG (because of glucose)
Increased glucose
Increase ketone
67
Ketone reaction on reagent?
Acetoacetate (in urine) + sodium nitropursside + glycine > purple color
68
Interferences of ketone reaction?
Medication (levodopa)
Breakdown of acetoacetic acid by
bacteria
69
Ketones confirmatory test?
Acetest
70
How do you perform an acetest?
1. Place tablet on paper towel
2. Add one drop of urine onto tablet
3. Wait 30 seconds
4. Compare color on tablet with chart
71
What is blood in urine called?
Hematuria
72
What color is urine for hematuria?
Cloudy red
73
What is destructed RBCs in blood called?
Hemoglobinria
74
What color is hemoglobinuria?
Clear red
75
How big does the RBC have to be considered clinically significanty?
Greater than >5 cell/uL
76
How do you differentiate between hemoglobinuria and hematuria?
Microscopic analysis
77
What area of the organ can hematuria come from?
Upper and lower urinary tracts
Glomerulus
Renal tubules
Ureters
Bladder
78
What can cause hemoglobinuria?
Burns
Crash injuries
Toxins
Incompatible blood transfusions
79
What is hemosiderin?
Yellow/brown granules in sediment containing iron from lysed RBCs.
80
Result of intact RBCs on reagent pad?
Neg, trace (with specks), mod (with specks)
81
Result of hemoglobin on reagent pad?
Trace, small, mod, large
82
False positive blood in urine?
Menstrual contamination
83
False negative blood in urine?
Ascorbic acid
High SG (crenated cells)
High concentrations of nitrite
84
What can bilirubin in the urine indicate?
Liver disease
85
Where does bilirubin come from?
From degradation of hemoglobin
86
What bilirubin is water insoluble?
Unconjugated bilirubin/indirect
87
What bilirubin is water soluble?
Conjugated bilirubin/direct
88
What bilirubin goes to the liver?
Unconjugated bilirubin
89
What does unconjugated bilirubin turn into once in the liver?
Conjugated bilirubin
90
Where does conjugated bilirubin go to?
Bile duct then intestines.
91
What happens to bilirubin if theres a bile duct obstruction?
Goes back into circulation and is excreted in urine.
91
Conjugated bilirubin appears in urine when...?
Bile duct obstruction
Liver disease or damage
91
What does conjugated bilirubin reduce to?
Urobilinogen
stercobilinogen
Urobilin
92
Resulting of bilirubin?
Neg, small, mod, large
93
False positives of bilirubin?
Urine pigments
Pyridium (UTI drug)
NSAID
*need to do confirmation testing*
94
False negative bilirubin?
Old specimens (bili oxidizes to
biliverdin, which is not recognized
on reagent pad)
Nitrite (combines with reaction and
blocks bilirubin from reacting)
95
How do you perform an ictotest?
1. Place drop of urine on mat
2.Place tablet on mat with uriine
3. Wait for result
96
Bilirubin confirmation test?
Ictotest
97
Result of pos bilirubin from ictotest?
Blue to purple color
98
Where does urobilinogen come from?
From the feces; reabsorbed back into the blood stream
99
Clinical significance of urobilinogen in urine?
Liver disorders
Hepatitis
Cirrhosis
Hemolytic disorders
100
Bilirubin and urobilinogen relationship in hemolytic disorders
Neg bilirubin, pos urobilinogen
101
Is there urobilinogen in urine if there's a bile obstruction?
No
102
Does reagent strip have a negative reading? If no, why?
No because <1mg/dL is excreted through urine
103
What is the reagent reaction called for urobilinogen?
Erlich's reagent
104
Urobilinogen resulting
Normal 0.2, 1.0 (yellow/light peach
color)
Abnormal 2, 4, 8 (red)
Measured in mg/dL
105
False positives of urobilinogen?
Sulfonamides
106
False negatives of urobilinogen?
Broad spectrum antibiotics
Urine nitrites
Oxidation of urobilinogen to
urobilin
Biliary obstruction
107
Where does nitrites come from?
Certain sp. of bacteria that converts nitrates to nitrites.
108
Clinical significance of nitries?
UTI
109
What is reaction called for nitrites?
Greiss reaction
110
Greiss reaction (nitrites)?
Aromatic amine reacts with nitrite to form diazonium salt. Salt reacts with sulfanilic acid + acetic acid to form a pink color.
111
Resulting of nitrite?
Neg or Pos
112
False negative nitrites?
Nonreductase-containing bacteria
Not enough time between bacteria
and nitrates
Bacteria converting nitrite to
nitrogen
High SG
High urobilinogen
Lack of nitrates in urine
113
What should you do if nitrite negative but still suspect UTI?
Perform urine culture
114
What test detects for the presence of leukocytes in urine?
Leukocyte esterase
115
Clinical significance of LE?
Bacteria and nonbacterial UTIs
Inflammation of the urinary tract
Test in conjunction to pos nitrites
116
LE reaction?
LE reacts with indoxylcarbonic acid esterase to produce indoxyl which then reacts with diazonium salt to create a purple color.
117
LE resulting
Neg (yellow), trace, small, mod, large (purple)
118
False positive LE
Strong oxidizing agents
119
False negative LE
High conc of protein and glucose
Crenation from high SG
Inaccurate timing (2 mins)
120
Does a high concentrated urine indicate low or high SG?
High
121
What indicator measures pH change?
Bromothymol blue
122
What color is alkaline in SG?
Blue
123
What color is acidic in SG?
Red
124
What should you do the SG result if pH if 6.5 or higher?
Add 0.005 to your reading
125
What is microalbuminuria?
Diabetic nephropathy with type 1 and 2 diabetes mellitus.
126
What is the purpose of a creatInine reagent strip?
To correlate creatinine with albumin results to determine albumin:creatinine ratio
127
Normal A:C ratio (ACR)?
<30 mg/g
128
Result range in patients with CKD over >3 months?
30-300 mg/g
