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UA Exam I > Intro to Urinalysis > Flashcards

Intro to Urinalysis Flashcards

1
Q

True or False: Approximately 170,000 mL of filtered plasma forms an average daily urine volume of 1200 mL.

A

True.

1200mL = 5 cups

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2
Q

Primary components of urine consist of ________ and ______ solutes

A

organic and inorganic

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3
Q

Urine is compose of ______ % water and ____ % solutes

A

95% water
5% solutes

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4
Q

Urea is 1/2 of total ________ solids

A

dissolved

Urea = waste/break down of amino acids

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5
Q

True or False: Diet, physical activity, body metabolism, endocrine function, and sleep can affect your urine

A

True.

Examples can also include diabetes insipidus

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6
Q

What are the two major organs substances in urine? ****

A

-Creatinine
-Uric Acid

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7
Q

What is a minor organic substance in urine?

A

-Hippuric acid

(from lots of fruit and vegetables)

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8
Q

What are three inorganic substances and which have high/low concentrations in the body?

A

-Chloride
-Sodium
Potassium

There is a high concentration of salts, especially Chloride in urine. The lowest concentration of inorganic substances is Potassium.

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9
Q

True or False: other major substances that are found in urine includes hormones, vitamins, formed elements (cells, bacteria, yeast, casts, crystals), and medications

A

True

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10
Q

How can we differentiate urine from water or body fluid or synthetic?

A

We test for Urea and Creatinine.

Both Urea and Creatinine are present in higher concentrations in urine than in other body fluids.

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11
Q

What would be 4 factors that influence urine volume?

A
  1. Fluid intake: water is excreted based on the body’s state of hydration
  2. Fluid loss from non-renal sources (sweat, burns)
  3. Variations in the secretion of antidiuretic hormone ( Example of disease - Diabetes insipidus
  4. Kidney’s needs to excrete increased amounts of dissolved solids (i.e. glucose and salts)
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12
Q

What is the normal daily urine volume output?

A

1200-1500 mL

the normal range is about 600-2000 mL/dday

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13
Q

What is Oliguria?**

A

Decrease in normal daily urine volume.

This could be due to excessive water loss; vomiting, diarrhea, perspiration, severe burns.

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14
Q

What is Anuria?**

A

Cessation/stopping of urine flow.

This could be due to serious damage to kidney or a decrease in the flow of blood to kidneys

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15
Q

What is Nocturia?**

A

Increase in nocturnal excretion of urine.

This is due to kidneys typically excrete 2-3x more urine during day than night.

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16
Q

What is Polyuria?**

A

Increase in daily urine volume.

Examples include:
-Diabetes mellitus, diabetes insipidus (ADH problem)
-Diuretics, caffeine, or alcohol (these suppress secretion of ADH)

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17
Q

What is the difference of Diabetes Mellitus vs insipidus in increased urine volume?

A

Diabetes mellitus is caused by a defect in the pancreatic production of insulin or a defect in the function of insulin. The effect is an increase in the blood glucose concentration. This effect causes Polydipsia = increase in ingestion of water.

Thus urine will increase in volume and high specific gravity, due to the increase of glucose.

Diabetes insipidus is caused by a decrease in ADH production or a renal tubule dysfucnction (inability to respond), which causes Polydipsia as well.

Thus urine will increase in volume, but decrease specific gravity which will make urine diluted.

So the difference is DM- increase SG and DI is decreased SG.

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18
Q

Which of the following is False:

  • Urine specimens are collected in clean, dry, leak proof containers.
  • The lab uses screw-cap containers
  • There are special bags for pediatric specimens
    -Transfer straws/tube are not for send out specimens
A

The transfer straws/tubes are used for sendoff specimens

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19
Q

True or False: Containers should be able to collect a minimum of 50 mL for urine collection.

A

True

20
Q

True or False: Specimens are typically transported to another tube that holds 10-15mL.

Such as a centrifuge tube, glass tube or Kova tube

A

True.

Also all containers must be properly labeled.

21
Q

True or False: If only 1 label must attached to container not lid

and if multiple labels, 1 on container, 1 on lid

A

True

22
Q

Specimen collection times should be on a requisition slip (24 hour format).

When would we reject a specimen?

A
  • Two different patient labels
    -Improper transported

Other choices:
-Improper labeled, mislabeled, spelling, two different labels, wrong DOB/MRN/Time of collection
-Improper collection
-Improperly transported
- Any question of specimen integrity or identity (contamination)

23
Q

Urine specimens should be tested with _________ after collection**

A

2 hours

If more than 2 hours, urine must be: refrigerated, put on ice, or chemical preservatives.

24
Q

Why should urine be tested within _____ after collection?

A

2 hours

The number 1 reason is due to bacterial growth. Bacteria from the body’s genitalia can multiply after 2 hours. Exposure to light can affect results as well. Lastly the urine can oxidate, this reduce metabolites.

25
Q

True or False: Bacteria can increase the pH, odor levels, and nitrite in urine

AND decrease Glucose, Ketones, Bilirubin, Urobilinogen, red and white blood cells and casts

A

True

26
Q

What is the most commonly used preservation for urine?

A

Refrigeration

What are the PROS and CONS?
Pro - decrease bacterial growth

Cons - can cause precipitation of amorphous material - obscures microscopic sediment

27
Q

The ideal specimen preservative should include:

A

-Bactericidal
- inhibit urease
- preserve formed elements
-not hinder chemical tests

28
Q

What is the difference between random specimen and first morning specimen?

Specimen timing

A

Random specimen is the most common test and is useful for routine screening tests.

First morning specimen is BEST for routine screening tests, for it is more concentrated.

It is most mostly used for pregnancy (HGC hormone)

and orthostatic (postural) porteinuria - protein in the urine.
-Normal at night, increased during day.
-Urine voided prior to recumbent position, then after ~8 hours urine is taken upon waking up.

29
Q

what is fasting specimen (second morning)?

A

urine specimen collected after a period of time after fasting (generally not ingesting foods or fluids for 10-12 hours.

It is the 2nd voided specimen

For Glucose monitoring

Examples: 2 hour post prandial specimens, Glucose tolerance specimens, 24 hour timed specimens

30
Q

What is the Specimen timing/collection process for 2 hour post prandial specimens?

A
  1. Pt completely voids urine and discards sample
    2.Pt eats a meal (typical meal or special drink with known glucose concentration like Glucola)
  2. 2 hours post meal- specimen is collected and tested for glucose
  3. Monitor insulin therapy in patients with diabetes mellitus
31
Q

True or False: Glucose tolerance specimens have urine samples collected along with blood samples

A

True.

Urine samples tested for glucose. Useful to determine the patient’s ability to metabolized a measured amount of ingested glucose. The urine results are correlated with the blood glucose levels (associated with renal threshold for glucose.)

Perform a glucose tolerance test (GTT)
- Fast for 8-12 hours, draw blood and urine
-Eat/drink, draw blood and urine 2 hours post meal

32
Q

What is the normal, prediabetes, and diabetes ranges for fasting PLASMA Glucose Test ?**

A

Normal: less than 110 mg/dl
Pre-diabetes: 110-125 mg/dl
diabetes: greater than 126

33
Q

What is the normal, pre diabetes, and diabetes ranges for ORAL Glucose Tolerance Test?

A

Normal: less than 140 mg/dl
Pre-diabetes: 140-199 mg/dl
Diabetes: greater than 200 mg/dl

34
Q

True or False: for 24 hour (timed) specimen, IF the concentration of a substance varies during daily activities, a 24 hour specimen is collected.

Ex: creatinine

A

True.

***Patient empties bladder and discards urine (flush) timing starts after patient discards urine.

Patient over next 24 hours urinated into 1 collection container. Container usually contains a preservative or is placed in a refrigerator.

35
Q

The following is an example of what test?

  1. At 8:00 AM patient empties bladder and discards the urine.
  2. Patient collects all urine for the next 24 Horus and places it into the collection container.
  3. At 8:00 AM the following day, the patient voids and adds this urine to the container.
  4. Specimen is delivered to the laboratory and analyzed.
A

24 hour specimen.

This is an example of a timed specimen scheduled for 24 hour collection starting at 8:00 AM.

36
Q

True or False: Urine can be collected by

-Catheterized specimen
-Midstream clean catch specimen
-Suprapubic specimen
-Pediatric specimen
-Prostatitis specimen

A

True

37
Q

How is specimen collected via Catheterized Specimen?

A

Specimen is collected from a tube (catheter) that is placed through the urethra into the bladder = sterile conditions.

Specimens may be collected separately from each kidney by passing a catheter through the ureter of each kidney

It is used fro bacterial culture. If used for routine analysis, bacterial culture must be done first.

38
Q

How is specimen collected via midstream clean-catch specimen?

A
  1. Prior to urinating, wipe genital area with cleansing pad.
  2. Urinate a small amount into the toilet bowl, and then stop the flow of urine.
  3. Then collect a sample of urine into the clean or sterile cup, until it is half full.
  4. Finish urinating into the toilet bowl.

Less traumatic. More representative of urine in the bladder - less contamination from cells and bacteria than routine voided specimen.

39
Q

How is specimen collected via Suprapubic Aspiration?

A

Urine is collected by introduction of a needed through the abdomen into the bladder.

Useful for bacterial culture that is completely free of extraneous contamination. Useful for cytology.

40
Q

How is specimen collected via Pediatric Specimen?

A

A soft, clear plastic bag is attached to the genital area of the patient.

The bag has an adhesive on its edges. The urine collects in a sterile bag. Useful for collecting urine from infants.

41
Q

How is specimen collected via Prostatitis Specimen?

A

3 step collection:
-Collect beginning of urination
-Collect mid-stream clean catch
-Prostate is massaged, collect final cotton (end stream) Prostatic fluid will pass into remaining urine

Analysis:
-Quantitative cultures on all 3 collections
-1st and 3rd examined microscopically
-If prostatic infection, 3rd specimen has WBC and Bacteria 3X that of 1st specimen (Second specimen

42
Q

What is the process of Prostatitis Specimen? (short version )

A

look at image

43
Q

True or False: There are specific collection procedures and documentation during a drug specimen collection.

A

True.

COC documentation accompanies samples at every step.

44
Q

What is Chain of Custody (COC)?**

A

procedure is the process that provides the documentation of proper sample identification from the time of collection to the final reporting of test results.

Procedure is necessary to legally prove that no tampering of the specimen occurred.

Sometimes the collection of specimen must be witnessed.

45
Q

True or False: During a drug specimen collection, urine temperature is taken within 4 mins of collection time.

A

True.

32.5-37.5 C

Some urine collection cups have hormonal indicators to differentiate male from female.

46
Q

Real life event:
-A specimen comes in for a routine urinalysis with culture.
-Problem: Specimen is not in “normal” sterile UA cup, it is in one of these… (cup with drug test on lid)
-What do you do?

A

Reject and ask for a recollection.

UA Exam I (2 decks)

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