CHAPTER 2 - Urine Specimen Types, Collection, and Preservation Flashcards
1
Q
purposes of performing a routine urinalysis
A
(1) to aid in
the diagnosis of disease;
(2) to screen for asymptomatic, congenital, or hereditary disease;
(3) to monitor disease progression;
and
(4) to monitor therapy effectiveness or complication
2
Q
urine is “?” of the kidneys and can provide a fountain of information about the health of an individual
A
fluid biopsy
3
Q
only organs that can have their functional status evaluated by nonivasive means
A
kidneys
4
Q
urine is ? = used to evaluate and monitor body homeostasis and
many metabolic disease processes
A
ultrafiltrate of the plasma
5
Q
3 basic types of urine collection
A
first morning
random
timed collection
6
Q
ideal urine specimen must be
A
adequately concentrated
7
Q
detection of chemical components and formed elements fo intrest depend on ? and ?
A
- patient’s state of hydration
- the length
of time the urine is held in the bladder
8
Q
first morning specimen: urine has been retained in the bladder for approx ? hours
A
8 hours
9
Q
specimen is ideal to test for substances that require CONCENTRATION or INCUBATION for detection (nitrates, proteins)
A
First morning specimen
10
Q
first morning specimen is used to confirm ? and ?
A
postural and orthostatic proteinuria
11
Q
morphology of cellular components and casts is enhanced by the ? of FMS
A
high osmolality
12
Q
formed elements that more stable in these conc. acidic urine spx
A
WBC, RBC, casts
13
Q
ex. of spx that can crystallize on cooling to room temp
A
amorphous urates
14
Q
spx must be preserved if it is not going to be analyzed within 2 hours of collection.
A
frst morning spx
15
Q
type of spx: routine screening is most often
performed
A
random urine spx
16
Q
random urine spx: ? and ? can directly affect urine composition
A
excessive fluid intake
strenuous exercise
17
Q
w prior hydration - ? is ideal for cytology studies
A
random “clean catch” urine spx
18
Q
prior hydration for random urine spx: drink ? to ? oz of water each hour for - hours before urine collection
A
24-32 oz; 2 hours
19
Q
Most cytology
protocols require collection of these specimens (random urine spx) daily for ? to
? consecutive days
A
3-5
20
Q
One method that can be used to increase the cellularity of a
urine specimen (random urine)
A
patient exercises for 5 min
21
Q
spx for quantitiave urine assays
A
timed collection
22
Q
two types of timed urine spx
A
(1) urine colletected for a predetermined length of time
(2) collected during a specific time of day
23
Q
4-hour or 12-hour for determination of ?,?, ?
A
urine
albumin, creatinine, and the albumin-to-creatinine ratio
24
Q
timed collection (4/12-hour) is ideal spx to screen for ?
A
microalbuminaria
25
2-hour collection for determination of - is s preferably collected
from 2 PM to 4 PM
urinary urobilinogen
26
time when maximal excretion of urobilinogen is known to occur
2-4pm
27
most common errors encountered in quantitative urine tests are related
directly to - or -
specimen collection or to handling problems
28
errors related to specimen collection or to handling problems
LIIIT
- loss of spx
- inclusion of first two morning spx
- innacurate total volume measurement
- inadequate preservation
- transcription error
29
uses of random spx
- Routine screening
- Cytology studies (with
prior hydration)
- Fluid deprivation tests
30
uses for first morning spx
- Routine
screening; good
recovery of cells
and casts
- To confirm
postural or
orthostatic
proteinuria
* Cytology
studies
31
uses of timed collection
QCCE
- quantitative chemical analysis
- chemical tests
- cytology studies
- evaluation of fistula
32
sufficient volume for timed urine collection protocol ?
50 ml
33
50 ml is removed from timed urin collection for ? and ?
routine testing
repeat or addtl testing
34
types of collection technique
- routine void
- catheterized, urethral
- catheterized, ureteral
- suprapubic aspirate
- pediatric collection bag
35
collection technique that requires no patient prep, no assistance other than clear instructions
routine void
36
spx collection technique done if there is possibility of contamination or bacterial culture is desired
midtsream clean catch spx
37
- of male and - of female is throoughly cleansed and rinsed before collection of a midtsream clean catch xpc
glans penis
urethral meatus
38
midstream technique allows collection of spx that represents elements and analytes from the -, -, and -
bladder
ureter
kidneys
39
this technique eliminates sources of contamination and provides excellent spx for routine urinalysis and urine culture
midstream "clean catch"
40
urine spx can be collected at any time from this reservoir
catheterized spx
41
type of infx common in catheterized patients
Urinary tract infextions
42
collection technique involves collecting uine directly from the bladder by puncturing the abdominal wall and the distended bladder using a needle and syringe.
suprapubic aspiration
43
suprapubic aspiration is used principally for -
bacterial cultures
44
suprapubic aspiration is used principally for bacterial cultires, esp for - and in -
anaerobic microbes and in infants
45
patients that are unable to urinate voluntarily
newborns
infants
pediatric patients
46
area that is cleansed and dried before spx bag is placed onto the skin of the pediatric patient
perineal area
47
pediatric patient is checked every - min to see if adeq spx has veen collected
15 min
48
urine for bacterial culture is obtained by - or -
catheterization
suprpubic aspiration
49
uses for routine void
routine screening
50
uses for midstream clean catch
- Bacterial and
fungal cultures
(sterile container required)
- Routine screening
- Cytology
51
A catheter is
inserted into the
bladder via the
urethra
* Urine flows
directly from
bladder through
catheter into
plastic bag
catheterized, urethral
52
collection technique done To determine
and differentiate
kidney infections
catheterized, ureteral
53
* A catheter is
inserted through
the urethra and
bladder and into the
left and right ureter;
urine is collected
from each ureter
before it reaches
the bladder
Catheterized,
ureteral
54
use of suprapubic aspiration
bacterial and fungal cultures
55
collection technique Used with patients
unable to urinate
voluntarily
pediatric collection bag
56
use for pediatric collection bag
- routine screening
- quantitiave assays
57
most common reasons for spx rejection
unlabeled and improperly labeled urine spx
58
reasons for urine spx rejection (6)
UMISIV
- unlabeled
- mislabaled
- inappropriate urine collection technique or spx type for test
- specimen not properly preserved; inappropriate preservative used
- insufficient volume of urine for test req
- visibly contaminated urine
59
routine urinalysis require ? vol of urine when urinalysis is performed manually
10-15 ml of urine
60
? vol hinder performance of the microscopic examination when the urinalysis is performed manually and can limit the chemical tests performed
<12 ml
61
fully automated urinalysis system such as the iQ200 system, complete urinalysis can be perfromed w -ml of urine
4 ml
62
urine vol needed for 24-hour urine collection (quantitative urine tests)
1 ml
63
- to - ml is usually retained to ensure sufficient specimen in case repeat or additional testing is required later
20-50 ml
64
container have an opening of - to - cm and have a capacity of - to - ml
opening: 4-5 cm
capacity: 50-100 ml
65
type of container used if urine spx is stored for a longer han 2 hrs before testing
sterile container
66
urine container capacity for the collection of 12-hour and 24-hour urine specimens for quantitative analyses
3000 ml
67
12-hour and 24-hour urine specimens is usually made of -, that protect spx from - and -
brown opaque plastic; ultraviolet and white light
68
preseravtices added to large containers for the collection of 12/24 hr urine spx
acid preservatices
69
collection bag used for collection spx from pediatric patient
clear, plaible, polyethylene urine collection bag
70
- enables transfer of the urine that has accumulated to another collection container, thereby eliminating the need for multiple collection bags.
exit port or tubing
71
info provided on all lables
patients fill name
unique identification number
room number
date and time of collection
preservative used
72
change due to Oxidation or reduction of solute
color = darkens
73
physical change due to Crystal precipitation; bacterial proliferation
decreased clarity
74
ammoniacal odor is due to -
bacterial conversion of urea to ammonia + bacterial proliferation
75
chemical changes due ro removal of chemical entity by various mechanisms may lead o - results
false-negative
76
- and - increase in unpreserved
urine as bacteria proliferate, converting nitrate to nitrite and
metabolizing urea to ammonia
urine nitrite
pH
77
microscopic change is due to
disintegration of formed elements (hypotonic and alkaline urine or from unchecked bacterial growth)
78
chemical change mechanism: Consumed by cells and/or bacteria
decreased glucose
79
chemical change mechanism: Volatilization and bacterial conversion
decreased ketones
80
chemical change mechanism: Photo-oxidation to biliverdin by light exposure
decreased bilirubin
81
chemical change mechanism: oxidation to urobilin
decreased urobilinogen
82
chemical change mechanism: Bacterial conversion of dietary nitrates
increased nitrite
83
chemical mechanism: bacterial conversion of urea to ammonia; loss of CO2
increased pH
84
microscopic changes in unpreserved urine
decreased: blood cells and casts, trichomonads
increased: bacteria
85
microscopic changes: disintegration, especially in dilute and alkaline urine
decreased blood cells and casts
86
decreased trichomonads in unpreserved urine is due to
loss of characteristic MOTILITY AND DEATH
87
type of preservative used depends on
- type of collection
- tests to be performed
- time delay before testing
88
easiest and most common form of preservation,
refrigeration at 4°C to 6 °C
89
- prevents bacterial proliferation, and the specimen remains suitable for culture for up to 24 hours
refrigeration
90
urine preservative that is not recommended for routine urinalysis spx
refrigeration
91
induce precipitation of amorphous urate and phosphate crystals that can interfere substantially with the microscopic examination
refrigeration
92
routine urinalysis spx that must be transported long distances
commercial transport tubes w a preservative
93
Acceptable for routine urinalysis;
preserves chemical and formed
elements in urine at room temperature
commerical transport tubes
94
* pH and SG may be altered;
varies with tube used
* Can interfere with chemistry
tests
commercial transport tube
95
Preserves sediment elements (e.g.,
casts, cells)
* Inhibits bacterial and yeast growth
thymol
96
* Interferes with protein
precipitation tests
* In high concentration, can
precipitate crystals
thymol
97
Excellent cellular preservative; False-negative reagent strip
tests for blood and
urobilinogen
formalin
98
Unacceptable for urinalysis
testing
* Potential chemical hazard
acids (HCl,
glacial acetic
acid)
99
For quantitative analysis of
urine solutes, such as
steroids, hormones, etc
acids
100
For quantitative analysis of
porphyrins, porphobilinogen,
sodium carbonate
101
* Unacceptable for urinalysis
testing; Stabilizes porphyrins, porphobilinogen,
sodium carbonate
102
Stabilizes calcium, phosphorus,
steroids, hormones
Acids (HCl,
glacial acetic
acid)
103
Excellent cellular preservative
* Commercially available and inexpensive; Potential chemical hazard
saccomanno's fixative
104
preservatives and additives of BD VACUTAINER; Plus Plastic
Conical UA Preservative Tube
chlorhexidine
ethyl paraben
sodium propionate
105
D VACUTAINER; Plus Plastic Conical UA Preservative Tube: tube draw and stabilizes urine for up to
8ml; 72 hrs
106
InTac UA System, Therapak Corporation: tube draw and stabilizes urine for up to
5-8ml; 96 hrs
107
preservatives and additives of InTac UA System, Therapak
Corporation
Dowicil 200
Mannitol
Polyethylene glycol
108
BD VACUTAINER; C & S
Preservative Tube: tube draw and stabilizes urine for up tp
4 ml draw; 48 hrs
109
D VACUTAINER; C & S
Preservative Tube additives and preservatives
boric acid
d-sorbitol
sodium formate
sodium acetate
110
Commercial Urine Transport Tubes With Preservative
Urinalysis
* Urine culture
and sensitivity
* Can be used for
urinalysis
* Bacteriostatic
BD vacutainer C and S preservative Tube
111
BD vacutainer C and S preservative Tube adjusts ph and SG to
Ph: 6-7
SG increase: 0.006-0.007
112
collection preservative needed for a particular analyte can differ among laboratories. these variations stem from:
1. diff test methods
2. how often the test is performed
3. time delay and transportation conditions
113
helpful in identifying urine spx to which addtl liquid has been added
ph
specific gravity
temperature
114
urime pH in fresh urine spx
4-8 pH
115
urine pH in fresh urine spx specific gravity
1.002 to 1.035
116
normal temo of urine spx
32.5 and 37.5
117
when - is performed, , concern may be raised regarding whether the fluid collected is
amniotic fluid or urine aspirated from the bladder.
amniocentesis
118
single most useful substance that identifies a fluid as urine
high creatine conc (50 times higher that of plasma)
119
conc of ??? are higher in urine than in any other body fluid
sodium
urea
chloride
120
? and ? is not present in urine from healthy individuals
protein and glucose
121
body fluids that contain glucose and high protein
amniotic fluid
plasma exudates
