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Urinalysis > Chapter 3 > Flashcards

Chapter 3 Flashcards

1
Q

caveman drawings & Egyptian hieroglyphics-

A

-color
-turbidity
-odor
-volume
-viscosity
-sweetness

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2
Q

5th century BC, Hippocrates wrote-

A

uroscopy books

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3
Q

developed in AD 1140-

A

color charts

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4
Q

1694, albuminuria determination by-

A

boiling

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5
Q

charlatans were also called-

A

pisse prophets

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6
Q

charlatans/pisse prophets prompted-

A

the first medical licensure laws

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7
Q

invented in 17th century-

A

microscope

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8
Q

17th century invention of the microscope led to evaluation of-

A

sediment

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9
Q

part of a routine physical in-

A

1827

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10
Q

urine contains information, which can be obtained by-

A

inexpensive lab tests to assess many metabolic functions

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11
Q

CLSI Urinalysis definition-

A

testing of urine with procedures commonly performed in an expeditious, reliable, safe, & cost effective manner

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12
Q

reasons to perform urine test- (4)

A

-aid in disease diagnosis
-screen for asymptomatic diseases
-monitor disease progress
-therapy effectiveness

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13
Q

urine formation-

A

ultra filtrate of plasma

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14
Q

kidneys convert appx. ____ of filtered plasma-

A

170,000 mL

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15
Q

average daily urine output-

A

1,200 mL

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16
Q

urine composition-

A

-95% water
-5% solutes

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17
Q

solute variations- (4)

A

-diet
-activity
-metabolism
-endocrine functions

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18
Q

major organic solute-

A

urea (protein, amino acid breakdown)

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19
Q

urea makes up appx.-

A

one half of the dissolved solids

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20
Q

inorganic- (3)

A

-chloride
-sodium
- potassium

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21
Q

____, _____, ______, & ______ are higher in urine-

A

-creatinine
-urea
-sodium
-chloride

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22
Q

urine composition may also containe- (5)

A

-cells
-crystals
-casts
-mucus
-bacteria

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23
Q

urine containing cells, casts, crystals, mucus, & bacteria increases-

A

indicative of disease

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24
Q

urine volume determined by-

A

body’s state of hydration

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25
Q

urine volume is influenced by- (4)

A

-fluid intake
-nonrenal fluid loss
-antidiuretic hormone variations (ADH)
-excretion of large amounts of dissolved solids (ex. glucose)

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26
Q

usual daily urine volume-

A

1,200 to 1,500 mL

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27
Q

normal range of urine volume-

A

600 - 2,000 mL

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28
Q

oliguria-

A

decrease in urine output

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29
Q

oliguria in infants-

A

<1 mL/kg/h

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30
Q

oliguria adults-

A

<400 mL/day

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31
Q

oliguria in children-

A

<0.5 mL/kg/h

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32
Q

nocturia-

A

-increased urine excretion at night
-normally 2 or 3 times more excretion in the day

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33
Q

polyuria in adults-

A

> 2.5 L/day

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34
Q

polyuria in children-

A

> 2.5 - 3 mL/kg/day

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35
Q

polyuria in diabetes mellitus has an increased volume caused by-

A

need to excrete the excess glucose not reabsorbed from the ultra filtrate

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36
Q

patients with polyuria in diabetes mellitus exhibit-

A

polydipsia

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37
Q

urine with diabetes mellitus appears-

A

dilute with a high specific gravity

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38
Q

polyuria in diabetes insipidus has a decreased production/function of-

A

antidiuretic hormone (ADH) causing decreased reabsorption of water from ultrafiltrate

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39
Q

polyuria in diabetes insipidus urine appears-

A

dilute with low specific gravity

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40
Q

patients with polyuria in diabetes insipidus exhibit-

A

polydipsia

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41
Q

recommended containers for urine-

A

disposable, wide-mouthed, & flat-bottom containers with screw caps

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42
Q

container capacity for specimen collection-

A

clear containers/50 mL

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43
Q

clear containers with at least 50 mL capacity facilitates-

A

automated analysis

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44
Q

minimum amount of urine for analysis-

A

12 mL

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45
Q

allows for sterile transfer of urine into tubes-

A

BD Vacutainer Urine Transfer Straw

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46
Q

info on specimen labels- (3)

A

-patients name
-ID number
-date
-time
-age
-location
-healthcare provider’s name

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47
Q

specimen label placement-

A

on container, NOT lid

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48
Q

requisition form (manual/computerized) must accompany-

A

specimen

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49
Q

requisition form (manual/computerized) info must match-

A

the label

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50
Q

stamped on requisition form (manual/computerized)-

A

time of receipt

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51
Q

other info available on requisition form (manual/computerized)-

A

-type of specimen
-interfering medication

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52
Q

reasons to reject specimen- (9)

A

-in unlabeled containers
-nonmatching labels & requisition forms
-contaminated with feces or toilet paper
-containers with contaminated exteriors
-insuffficient quantity
-improperly transported
-preserved incorrectly
-not collected in sterile containers
-inappropriate collection for type of test needed

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53
Q

labs must have what for rejection of specimens-

A

written policies

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54
Q

changes in urine composition take place in- (2)

A

-vivo
-vitro

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55
Q

changes in urine composition tests taken within-

A

2 hours of collection

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56
Q

proper placement if testing for changes in urine composition is delayed-

A

refrigerate or chemically preserve

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57
Q

most problems in change of urine composition are caused by-

A

bacterial growth

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58
Q

color change by modified/darkened in urine is caused by-

A

oxidation or reduction of matabolites

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59
Q

if clarity is decreased in urine it is caused by-

A

bacterial growth & precipitation of amorphous material

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60
Q

odor increase in urine is caused by-

A

bacterial multiplication causing breakdown of urea to ammonia

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61
Q

pH increase in urine is caused by-

A

breakdown of urea to ammonia by urease-producing bacteria/loss of CO2

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62
Q

glucose decrease in urine is caused by-

A

glycolysis & bacterial use

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63
Q

ketones decreased in urine is caused by-

A

violatilization & bacterial metabolism

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64
Q

bilirubin decrease in urine is caused by-

A

exposure to light/photooxidation to biliverdin

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65
Q

urobilinogen decrease in urine is caused by-

A

oxidation to urobilin

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66
Q

nitrite increase in urine is caused by-

A

multiplication of nitrate-reducing bacteria

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67
Q

RBCs, WBCs, & casts decrease in urine is caused by-

A

disintegration in dilute alkaline urine

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68
Q

bacteria increase in urine is caused by-

A

multiplication

69
Q

trichomonads decrease in urine is caused by-

A

loss of motility, death

70
Q

routine specimen preservation is refrigerated at-

A

2 - 8 degrees C

71
Q

routine specimen preservation is refrigerated at 2 - 8 degrees C because-

A

decreases bacterial growth & metabolism (must be returned to room temp. for chemical testing)

72
Q

chemical specimen preservation ideal is-

A

bactericidal: inhibits urease & preserves formed elements (should not interfere with chemical tests)

73
Q

appropriate specimen preservation must be used when-

A

transporting specimen to another lab

74
Q

refrigeration preservation advantages-

A

does not interfere with chemical tests

75
Q

boric acid preservation advantages-

A

prevents bacterial growth & metabolism

76
Q

formaline preservation advantages-

A

excellent sediment preservative

77
Q

refrigeration preservation disadvantages-

A

precipitates amorphous phosphates & urates

78
Q

boric acid preservation disadvantages-

A

interferes with drug & hormone analyses

79
Q

formalin preservation disadvantages-

A

acts as a reducing agent, interfering with chemical tests for glucose, blood, leukocyte esterase, & copper reduction

80
Q

refrigeration preservation additional info-

A

prevents bacterial growth for 24 hours

81
Q

boric acid preservation additional info-

A

-keeps pH about 6.0
-can be used for urine culture transport

82
Q

formalin preservation additional info-

A

rinse specimen container with formalin to preserve cells & casts

83
Q

sodium fluoride preservation advantages-

A

good preservative for drug analyses

84
Q

commercial preservative tablets preservation advantages-

A

-convenient when refrigeration not possible
-have controlled concentration to minimize interference

85
Q

urine collection kits (becton Dickinson, Rutherford, NJ) preservation advantages-

A

contains collection cup, transfer straw, C&S preservative tube or UA tube

86
Q

sodium fluoride preservation disadvantages-

A

inhibits reagent strip tests for glucose, blood, & leukocytes

87
Q

commercial preservation tablets preservation disadvantages-

A

check tablet composition to determine possible effects on desired tests

88
Q

Light gray & gray C&S tube preservation advantages-

A

-sample stable at room temp for 48 hours
-prevents bacterial growth & metabolism

89
Q

yellow UA Plus tube preservation advantages-

A

use on automated insturments

90
Q

light gray & gray C&S tube preservation disadvantages-

A

do not use if urine is below minimum fill line

91
Q

yellow UA plus tube preservation disadvantages-

A

must refrigerate within 2 hours

92
Q

light gray & gray C&S tube preservation additional info-

A

-preservative is boric acid, sodium borate, & sodium formate
-keeps pH at about 6.0

93
Q

yellow UA plus tube preservation additional info-

A

-round or cortical bottom, no preservative
-preservative is sodium

94
Q

cherry red/yellow preservative plus tube preservation advantages-

A

-specimen stable for 72 hrs at RT
-instrument compatible

95
Q

cherry red/yellow preservative plus tube disadvantages-

A

-must be filled to minimum fill line
-bilirubin & urobilinogen may be decreased if specimen is exposed to light & left at RT

96
Q

Cherry red/yellow preservative plus tube preservation additional info-

A

-preservative is sodium propionate ethyl paraben & chlorhexidine
-round or conical bottoms

97
Q

composition of urine depends on-

A

patient’s metabolic state

98
Q

specimen conditions may include-

A

time, length, & method of collection & patient’s dietary intake & medicine intake

99
Q

patients must be instructed when special techniques are-

100
Q

most common type of specimen received-

A

random specimen

101
Q

when is a random specimen collected-

A

at any time

102
Q

random specimen has routine screenings for-

A

obvious abnormalities

103
Q

random specimen collection times must be-

104
Q

dietary intake & physical activity for a random specimen may-

A

alter results

105
Q

for a random specimen, patients may have to collect an additional specimen under-

A

controlled conditions

106
Q

for ideal screening first morning specimens, the patient is-

A

in a basal state

107
Q

first morning specimens are used for-

A

orthostatic protein confirmation & urine pregnancy tests

108
Q

first morning specimens are more concentrated than-

A

a random specimen

109
Q

patients collect first morning specimens-

A

immediately among arising & delivers to the lab within 2 hours

110
Q

alternative placement to first morning specimens-

A

refrigeration

111
Q

glucose tolerance specimens are collected at the same time as-

A

blood samples

112
Q

glucose tolerance testing include fasting periods-

A

1 hour, 2 hour, 3 hour, & sometimes 4 hour, 5 hour, & 6 hour specimens

113
Q

glucose tolerance specimen results are correlated with-

A

renal threshold for glucose

114
Q

carefully timed 24-hour specimens will produce-

A

accurate quantitative results

115
Q

24 hour timed specimens are good for-

A

diurnal variation solutes

116
Q

diurnal variation solutes include- (3)

A

-catecholamines
-17 hydroxysteroids
-electrolytes

117
Q

for 24 hour timed specimens, the patient must remain-

A

adequately hydrated during short collection periods

118
Q

for 24 hour timed specimens, the patient must be instructed-

A

on the procedure for collecting a timed specimen

119
Q

during a 24 hour timed specimen, concentration of a substance in a particular period must be-

A

calculated from the urine volume produced during that time

120
Q

24 hour specimens must be-

A

thoroughly mixed & the volume accurately measured & recorded

121
Q

in 24 hour specimens, multiple containers of the same collection must be-

A

combined & mixed thoroughly

122
Q

24 hour timed specimens should be kept-

A

refrigerated or kept on ice during the collection period

123
Q

24 hour timed specimen additives should not-

A

interfere with the tests to be performed

124
Q

common errors associated with timed urine collections- (5)

A

-loss of urine specimen
-inclusion of two first morning specimens
-inaccurate measurement of total urine volume
-inadequate urine preservation
-transcription error

125
Q

sterile catheterized specimens are collected from the bladder with-

A

a hollow tube (catheter)

126
Q

most common tests for catheterized specimens-

A

bacterial culture

127
Q

opposed to catheterized specimens, midstream clean-catch specimens are-

A

safer & less traumatic

127
Q

midstream clean-catch specimens are an alternative to-

A

catheterized specimens

128
Q

midstream clean-catch specimens are less contaminated than-

A

routine collection

129
Q

during midstream clean-catch tests, provide patients with-

A

-mild antiseptic towelettes
-sterile container
-instructions

130
Q

during midstream clean-catch tests ______ shouldn’t be used-

A

strong bacterial cleansing agents

131
Q

patient instructions for midstream clean-catch tests- (8)

A

-wash hands
-remove lid from sterile container without touching the insides
-females will separate the skin folds apart & begin to void into the toilet
-males will cleanse the tip of the penis with antiseptic towelette & let dry. retract the foreskin if uncircumcised
-males will void into the toilet & hold back the foreskin if necessary
-bring the urine container into the middle stream of urine & collect an adequate amount of urine, do not touch the inside of the container or allow the container to touch the genital area
-finish voiding into the toilet
-cover the specimen with the lid, touch only the outside of the lid & container

132
Q

for midstream clean-catch tests, confirm the container is-

A

labeled correctly with the patient’s first & last name, time of collection, & place it in the specified area or follow facility policy

133
Q

suprapubic aspiration is completely free of-

A

extraneous contamination for culture & cytology

134
Q

suprapubic aspiration has external introduction of needle for-

A

aspiration from the bladder

135
Q

prostatitis collection is similar to-

A

midstream clean-catch

136
Q

prostatitis 3 glass collection container 1-

A

first urine passed in sterile container

137
Q

prostatitis 3 glass collection container 2-

A

-midstream urine in sterile container
-massage prostate to obtain prostatic fluid

138
Q

prostatitis 3 glass collection container 3-

A

remaining urine & fluid in sterile container

139
Q

prostatitis 3 glass collection quantitative cultures on all 3 specimens-

A

examine 1 & 3 microscopically

140
Q

prostatic infection-

A

-higher WBC/hps count in specimen 1
-bacterial count in specimen 3 is 10 times higher than specimen 1

141
Q

prostatitis specimen 2 is a control for-

A

bladder or kidney infection

142
Q

positive culture in prostatitis specimen 2 invades-

A

positive culture in specimen 3 (cannot differentiate urinary tract infection from prostate infection)

143
Q

pre- & post- massage prostatitis specimen 1 test-

A

midstream clean catch specimen

144
Q

pre- & post- massage prostatitis specimen 2-

A

post- massage specimen

145
Q

positive result is significant in the prostatitis post massage specimen of-

A

> 10 times the pre massage count

146
Q

Stanmey-Mears tests include exams of-

A

4 urine specimens

147
Q

first urine prostatitis specimen is-

A

voided bladder (VB1) & represents the urethral specimen

148
Q

second urine prostatitis specimen is-

A

voided bladder 2 (VB2) & represents the bladder specimen

149
Q

third urine prostatitis specimen is-

A

expressed prostatic specimen (EPS)

150
Q

fourth urine prostatitis specimen is-

A

voided bladder (BV3) collected after EPS

151
Q

10 mL of urine for a prostatitis specimen is used for-

A

both the first & second specimens

152
Q

all 4 prostatitis specimens are sent for-

153
Q

after centrifugation for prostatitis specimens, the sediment is examined for- (4)

A

-WBC/aggregates & macrophages
-oval fat bodies
-bacteria
-fungal hypha

154
Q

urethral infection or inflammation is tested for by-

155
Q

urinary bladder infection is tested for by-

156
Q

prostatic secretions are-

A

cultured & examined for WBC

157
Q

___-____ WBC is considered abnormal-

158
Q

pediatric specimen collection process- (5)

A

-soft, clear, plastic bags with hypoallergenic tape applied to the genital area
-diaper is placed over the collection bag
-check the bag every 15 minutes
-remove bag after specimen has been collected
-label the bag or collection container

159
Q

during drug specimen collection, what needs to be documented?

A

proper collection, labeling, & handling

160
Q

chain of custody-

A

documentation from the time of specimen collection until the time of receipt of lab results

161
Q

drug specimen standardized form always-

A

accompanies specimen

162
Q

drug specimens must withstand-

A

legal scrutiny

163
Q

drug specimen collection points to consider- (2)

A

-photo ID of urine donor or ID by employer
-no unauthorized access to specimen

164
Q

witnessed versus unwitnessed drug specimen collection- (2)

A

-determined by test orderer
-both specimens must be handed immediately to collector

165
Q

adulteration tests temp taken-

A

-within 4 minutes
-32.5 - 37.7 degrees C

166
Q

drug specimen adulteration tests report temperatures-

A

outside of range immediately & collect another specimen ASAP

167
Q

drug specimen adulteration tests inspect urine color for-

A

anything unusual

168
Q

drug specimen collection follow lab instructions for-

A

labeling, packaging, & transport

Urinalysis (7 decks)

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