Non-Blood Specimens Flashcards by Do Re Mi

liquid or semi-liquid substances provided by the body
found within various organs and body spaces

Non-blood specimen

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4 roles of the phlebotomist in collection in non-blood samples

specimen collection
gives instruction
labeling or transporting the specimen to the laboratory
processing

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Aside from blood, what are 3 samples collected by the phlebotomist/med tech?

oropharyngeal swab
nasopharyngeal swab
breath sample

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What are the 3 basic information that must be seen in a label?

name
date of collection
time of collection

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where is the label pasted?

container (body)

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where should we not paste the label?

On the lid of the container

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most frequently analyzed non-blood body fluid

urine

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spx that is readily available, easy to collect, and inexpensive to test

urine

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Urine analysis can aid in 4 things

monitoring wellness
diagnosis and treatment of UTI
detection and monitoring the progress of treatment in metabolic disease
determining effectiveness or complications of therapy

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Urine is examined preferably in ____, but can go up to ______ at maximum

1 hour
2 hours

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What to do if you cannot process a urine sample immediately?

refrigerate

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What does refrigerating a sample do?

Slows metabolic process/deterioration

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Accuracy in urine results depends on 4 things, which are?

collection method
container used
specimen transportation and handling
timeliness of testing

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What is the most commonly requested urine test?

routine urinalysis

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Test that:
* screens for urinary and systemic disorders
* part of a physical examination

routine urinalysis

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3 analysis conducted in routine urinalysis

physical
chemical
microscopic

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6 characteristics analyzed in physical analysis/macroscopic observation in routine urinalysis

color
clarity
specific gravity
odor
volume
osmolality

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What does specific gravity and osmolality indicate?

urine concentration

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Type of urine analysis that:
* uses plastic reagent strip (dipstick)
* special timing
* tests for bacteria, bilirubin, blood glucose, ketones, leukocytes, nitrite, protein, and urobilinogen
* measure pH and specific gravity

Chemical analysis

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How are the results in chemical analysis in routine urinalysis reported as?

negative, trace, 1+, 2+, 3+, 4+

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Type of analysis done in routine urinalysis that:
* tests for cells, crystals, and microorganisms
* urine is centrifuged
* supernatant is discarded
* a drop of sediment is placed on a glass slide, covered with a coverslip
* examined under the microscope

microscopic analysis

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WBCs in urine means what?

Pyuria

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RBCs in urine mean what

Hematuria

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WBC and bacteria in urine mean what?

There is UTI

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4 characteristics of urine collection container

* clear, dry * chemically clean * with tight-fitting lids * sterile (for culture & sensitivity)

Urine must be transported to the laboratory promptly, but if maintained in _______ & _______, it can be stable for up to 2 hours

* room temperature * protected from light

test done to: * confirm UTI * measure urine on a special nutrient medium

urine culture and sensitivity

How long is urine incubated in a urine culture and sensitivity test?

18 to 24 hours

Urine is incubated for 18 to 24 hrs in a urine culture and sensitivity test. At what temperature is it incubated?

35 - 37 degrees Celsius

Test done in urine to check for bacterial growth

urine culture and sensitivity

What is the bacterial count in urine culture and sensitivity that is significant

bacterial count > 100,000 cfu/ml

If a microorganism is identified in urine, a _________ test is performed to determine which antibiotics will be effective against the microorganism

Sensitivity or antibiotic susceptibility test

Test done in urine to detect cancer, cytomegalovirus, and other viral and inflammatory diseases of the urinary tract

urine cytology studies

In urine cytology studies, smear containing cells from the urinary tract is tested. What stain is used to the smear?

Papanicolaou (PAP) stain

Identify which urine test: * checks for the presence of abnormal cells under a microscope * examined as soon after collection as possible

urine cytology test

What method of urine collection is done for urine cytology studies sample?

fresh clean-catch specimen

How is the urine specimen in urine cytology studies preserved?

An equal volume of 50% alcohol is used

Urine test done to: * detect illegal use of recreational drugs, anabolic steroids to enhance performance, unwarranted prescription drugs * monitor therapeutic drug use * confirm a diagnosis of drug overdose

Urine Drug Screening

What sample is used in urine drug screening

random sample

What forms are used in urine drug screening

custody and control forms

# In urine sample collection for drug testing: Samples are ensured to be not _____________ (3)

* adulterated * substituted * diluted

# In urine sample collection for drug testing: The urine collection area has a ____ urinal, and a ____ that is separate from the toilet area

* waterless * sink

Urine test that tests for creatinine or specific gravity to known if the specimen is too dilute

Urine drug testing

Glucose in urine indicates what (2)

* diabetes mellitus * renal disease

ketones in urine indicates what

diabetes ketoacidosis

Ketones are created when the body breaks down fat for energy because of two things, which are?

* diet is deficient in carbohydrates, or when the * body does not metabolize glucose properly

In urine glucose and ketone testing, what do you do?

compare color changes in the test strip to a color chart

In urine pregnancy testing, what hormone is detected?

human chorionic gonadotropin (HCG)

What hormone is: * produced by cells within the developing placenta, hence indicating pregnancy * present in serum and urine within 8 to 10 days after conception

human chorionic gonadotropin

What urine specimen is preferred for urine pregnancy testing?

first morning specimen

How many days after conception is HCG detected in serum and urine?

8 to 10 days

Does HCG in urine always indicate pregnancy?

No, it also appears in the urine of patients with certain types of cancer

Why is first morning specimen preferred for urine pregnancy testing?

Because first morning urine specimen is the most concentrated

# Type of urine specimen Collected at any time

random urine specimen

# Type of urine specimen * first voided specimen/overnight specimen * collected in the morning after 8 hours of sleep * most concentrated sample, higher sp. gravity

first morning/8-hour specimen

# Type of urine specimen * second specimen voided after fasting * usually used for glucose monitoring

fasting (fasting - second morning)

# Type of urine specimen * collected at specific times or * collected and pooled throughout a specific time period

Timed

# Type of urine specimen * collection of urine at specific times * traditional standard GTT spx collected serially at specific times that correspond with the timing of blood collection * fasting, 1/2 hour, 1 hr, 2 hrs

Tolerance Test Specimen

# Type of urine specimen * **2 hours after a meal** and tested for glucose * to monitor the insulin therapy of patients with diabetes mellitus * void shortly before consuming a normal meal then collect a specimen 2hrs later * compare glucose results on fasting urine and fasting blood spx

2 hour post prandial

# Type of urine specimen * quantitative analysis * collect and pool urine voided in 24hrs * container: large, clean, preferably wide-mouth * add preservative prior to collection * or refrigerate throughout collection period

24-hour Specimen

# 24-hour Urine Collection Procedure 1. Void into toilet as usual on ________ 2. Note ________ on label, place on container 3. Collect all ________ voided for the next 24 hrs 4. ________ spx throughout collection period 5. Collect all urine before ____________ 6. Drink ________ amnt of fluid unless instructed otherwise 7. Void one last time at the end of 24 hrs. ***Keep _____*** 8. Seal container, place in ____, transport to lab ASAP

1. waking 2. time & date 3. urine 4. Refrigerate 5. anticipated bowel movement 6. normal 7. last void 8. cooler

# Urine collection method * patient voids the initial urine flow into the toilet * mid flow urine is collected into a specimen container * last of the urine flow is voided into the toilet

midstream

# Type of urine specimen * requires emptying the bladder then waiting a specified amnt of time (typically 30 mins) before collecting the specimen * for glucose and ketones

Double-voided Specimen

# Urine collection method * sterile container for microbial analysis or culture and sensitivity testing * special cleaning of the genital area is required

midstream clean-catch specimen

# Urine collection method * collected from a sterile catheter inserted through the urethra into the bladder * collected when a patient is having trouble voiding or is already catheterized

catheterization

# Urine collection method * aspirate the urine directly from the bladder using a needle * transfer into a sterile urine container or tube * uncontaminated samples from infants and young children

suprapubic collection

What test is suprapubic collection used for?

* microbial analysis or * cytology studies

# Urine collection method * plastic urine collection bag with hypoallergenic skin adhesive * patient's genital area is cleaned and dried before the bag is taped to the skin * 24-hour specimen: special collection bag with a tube attached that allows the bag to be emptied periodically

Pediatric Urine Collection

# What non-blood specimen? * clear, colorless to pale-yellow fluid in amniotic sac * surrounds and cushions a fetus in the uterus

amniotic fluid

Amniotic blood is collected using what?

transabdominal amniocentesis after 15 weeks of gestation

How many amniotic fluid is collected by a physician?

About 10 mL

What are 5 things that can be discovered by testing amniotic fluid?

* genetic disorders * hemolytic disease * gestational age * fetal development * fetal lung maturity

# Amniotic fluid How can genetic disorders be discovered?

Chromosome studies

# Amniotic fluid How is hemolytic diseases discovered?

bilirubin levels

# Amniotic fluid How is gestational age tested?

amniotic fluid creatinine levels

# Amniotic fluid How is fetal development checked?

* alpha-fetoprotein (AFP) * neural tube defects or Down's syndrome

# Amniotic fluid How is fetal lung maturity tested?

Phospholipids

# Amniotic fluid This acts as a surfactants to keep the alveoli of the fetus' lungs inflated

Phospholipids

# Specimen handling and storage **amniotic fluid**: Bilirubin test

protect from light

# Specimen handling and storage **amniotic fluid**: chromosome analysis

keep at room temperature

# Specimen handling and storage **amniotic fluid**: FLM/Chemistry tests

Keep on ice/refrigerate

# Specimen handling and storage **amniotic fluid**: Amniotic fluids in general

Deliver to the laboratory ASAP

# Identify the non-blood specimen * clear, colorless fluid (similar to water) * surrounds the brain and spinal cord

Cerebrospinal fluid

How is cerebrospinal fluid collected?

Lumbar puncture (spinal tap)

# Identify the non-blood specimen Used to diagnose meningitis, brain abscess, centran nervous system cancer, and multiple sclerosis

Cerebrospinal fluid

4 routine tests done on cerebrospinal fluid

* cell counts * chlroide * glucose * total protein

How immediate is cerebrospinal fluid needed to be analyzed?

It should be analyzed immediately ***within 1 hour***

# Cerebrospinal fluid collection Where is lumbar/spinal tap done **for adults**?

between the **3rd and 4th lumbar vertebrae**

# Cerebrospinal fluid collection Where is lumbar/spinal tap done for **young/neonates**?

between the **4th and 5th lumbar vertebrae**

How many tubes are filled when collecting cerebrospinal fluid?

In correct order, what tests are done to the 3 tubes collected/filled with cerebrospinal fluid?

1. Chemistry/serology 2. microbiology 3. hematology

# Preservation of cerebrospinal fluid for specific tests Chemistry/serology

freeze

# Preservation of cerebrospinal fluid for specific tests microbiology

room temperature

# Preservation of cerebrospinal fluid for specific tests Hematology

refrigerate

# Cerebrospinal fluid collection What are the 3 possible tests that can be done to a 4th tube?

* Microbiologic tests * cytologic studies * additional tests

If you accidentally had a short-draw in collecting cerebrospinal fluid [small volume, and 1 tube only], what test should you perform first?

Microbiologic test

# Identify the non-blood specimen * Examines stomach contents for abnormal substances * evaluates stomach acid production

Gastric analysis [Gastric fluid (stomach fluid)]

# What sample is this? Obtained by aspirating gastric fluid by means off a tube passed through the mouth and throat (oropharynx) or nose and throat (nasopharynx) into the stomach after a period of **fasting**

Basal sample

How is stimulation done for gastric fluid?

Histamine or pentagastrin intravenously

# Gastric fluid (stomach fluid) What is done after stimulating a basal sample?

Sample is collected at timed intervals

4 diseases that can be diagnosed using a nasopharyngeal swab?

* diphtheria * meningitis * pertussis * pneumonia

# How is nasopharyngeal swab done? 1. Instert swab gently into the nose and passed into the nasopharynx until ________ 2. Rotate gently, then ________ 3. Place in a ________ containing transport medium 4. Label, and deliver to the ______

1. resistance is encountered 2. Carefully remove 3. sterile tube 4. laboratory

# What material is this? * uses only synthetic fiber swabs within thin plastic or wire shafts

Nasopharyngeal swab

Should you use calcium alginate swabs or swabs with wooden shafts for nasopharyngeal swab?

Why should you not use calcium alginate swabs or swabs with wooden shafts for nasopharyngeal swabs?

It may contain substances that inactivate some viruses and may inhibit molecular tests

# nasopharyngeal/oropharyngeal swabs CDC recommends collecting only the ________ specimen, although ____________ specimen is an acceptable specimen type

* nasopharyngeal * oropharyngeal

What to do when both nasopharyngeal and oropharyngeal specimens are collected?

Combine them in a single tube to maximize test sentivity and limit use of testing resources

What disease is diagnosed with the use of oropharyngeal swab (throat swab)?

Streptococcal (strep) infections

# Identify the non-blood specimen collected using a special kit containing a sterile polyester-tipped swab in a covered transport tube containing transport medium

oropharyngeal swab (throat swab)

# Oropharyngeal swab procedure 1. Ask the patient to tilt his head back and ________ 2. Use a ________ to depress the tongue and ask the patient to say "Ah" to raise uvula and get it out of the way 3. Swab the ________, ________ , ________, and any area that has ulceration and inflammation but avoid touching the lips, tongue, and uvula 4. Discard the tongue depresor only after the swab has been ________ 5. The swab is placed in the ________ (dpiied in the medium) and then covered carefully

1. open his mouth wide 2. tongue depressor 3. tonsils, tonsilar crypts, back of the throat 4. taken out of the mouth 5. transport tube

# Specimen handling of NP and OP swabs Place immediately into a sterile vial containing ______________

2 ml of viral transport media

# Specimen handling of NP and OP swabs T/F: Both swabs can be placed in the same vial

true

# Specimen handling of NP and OP swabs * ________, cut or break applicator sticks off near the tip to permit tightening of the cap * label the vial with the ________, ________, ________, and ________

* aspetically * patient's name, ID number, specimen type, date collected

# Specimen handling of NP and OP swabs * if transported in ***less than 72 hours***, how should we handle the specimen?

* keep at 4ºC * ship on wet ice or refrigerant gel-packs

# Specimen handling of NP and OP swabs If specimen is transported ***after/more than 72 hours***, how should we handle the specimen?

* keep at -70ºC * Ship on dry ice

# Identify the non-blood specimen * fluid secreted by the glands inside the mouth

Saliva

2 things tested/monitored using saliva?

* hormone levels * alcohol and drug abuse

What does drugs in saliva indicate?

recent drug use

How is saliva handled for hormone tests

typically frozen to ensure stability and sent to a laboratory for testing

# Identify the non-blood specimen * sperm-containing thick, yellowish-white fluid * discharged during male ejaculation

sperm (seminal fluid)

Preferred method of collection for semen (seminal fluid)?

masturbation

3 things assessed/usage of semen (seminal fluid)

* assess fertility * determine the effectiveness of vasectomy * examined for forensic (or legal) reasons [eg. in cases of rape, the semen left inside the female is tested to identify suspect]

What container is semen (seminal fluid) stored in?

sterile or chemically clean containers

How should semen (seminal fluid) be handled?

* Must be kept warm (body temperature) * protected from light

How immediate should a semen (seminal fluid) specimen be transported to the lab?

Within 30 minutes

According to WHO, what are 3 things tested for semen (seminal fluid) specimens?

* sperm concentration * motility * morphology percentage

# Identify the non-blood specimen * pale-yellow, watery, serum-like fluid * found between the double-layered membranes enclosing the pleural, pericardial, and peritoneal cavities * normally present in small amounts

Serous fluid

# Identify the non-blood specimen Volume increases in inflammation or infection

serous fluid

# Serous fluid-related terms Increase in fluid volume

effusion

# Serous fluid in... Pleural cavity (lungs)

pleural fluid

# Serous fluid in... abdominal cavity

peritoneal fluid

# Serous fluid in... pericardial cavity (heart)

pericardial fluid

# What is the tubes/additives done in this test done to serous fluid Cell counts and smears

EDTA tubes

# What is the tubes/additives done in this test done to serous fluid chemistry tests

heparin or sodium fluoride tubes

# What is the tubes/additives done in this test done to serous fluid biochemical tests

non-anticoagulant tubes

# What is the tubes/additives done in this test done to serous fluid culture

sterile heparinized

# Identify the non-blood specimen * mucus and phlegm * ejected from the trachea, bronchi, and lungs through deep coughing

Sputum

Which part of the respiratory system is sputum from?

Lower respiratory tract

Two diagnosis or monitoring of sputum

* lower respiratory tract infections * tuberculosis TB (mycobacterium tuberculosis)

# Sputum What type of specimen is collected

first morning specimen

# In collecting sputum specimen... * rinse mouth and ____________ with water * take ____________ slow, deep breaths, then cough up and expel sputum into a sterile container

* gargle * three or four

# Sputum minimum of how much specimen is typically required?

3 to 5 mL

At what temperature/state is sputum transported?

room temperature

How immediate is sputum processed to the laboratory

Immediately

How is sweat specimen collected?

Pilocarpine into the skkin by iontophoresis

________ is analyzed for chloride

sweat

high levels of sweat chloride is seen in _____________

cystic fibrosis (exocrine gland disorder)

Aside from detecting exocrine gland disorder, sweat is also used to detect ________________

Illegal drug use

In ____________, a patch is placed on the skin for the extended period of time

Sweat chloride test

# Identify the non-blood specimen * joint fluid * clear, paley-yellow, viscous fluid * lubricates and decreases friction in movable joints

Synovial fluid

# Identify the non-blood specimen * normally occurs in small amounts

synovial fluid

Synovial fluid increases when ________ is present

inflammation

What are three things that synovial fluid help to identify or differentiate

* arthritis * gout * and other inflammatory conditions

How many tubes is collected from synovial fluid

# 3 synovial fluid tubes. Identify the additive for each test cell counts, crystals

EDTA or heparin

# 3 synovial fluid tubes. Identify the additive for each test culture and sensitivity

sterile tube

# 3 synovial fluid tubes. Identify the additive for each test * macroscopic appearance * chemistry * immunology tests * observe formation

Non-additive tube

# Identify the non-blood specimen * less invasive, painless alternative to blood collection for obtaining cells for DNA analysis

Buccal (cheek) swab

What is the purpose of obtaining cells from buccal swab?

DNA analysis

Site of blood cell production

bone marrow

# Identify the non-blood specimen * Used to detect and identify blood diseases * physician inserts a special large-gauge needle into the bone marrow in the iliac crest (hip bone) or sternum (breastbone)

bone marrow aspirate

# Bone marrow * ________ makes special slides * ________ tubes for other laboratory studies * Remaining aspirate allowed to clot and placed in formalin for histology examination * biopsy specimen and several slides are sent to the ____________ department

* hematology technologists * EDTA tubes * formalin * histopathology department

# Breath samples * rapid, noninvasive to detect Helicobacter pylori * H. pylori damages lining of the stomach; causes chronic gastritis

Urea breath test

This damages lining of the stomach; causes chronic gastritis

H. pylori

# Breath samples * detects problems with digestion of lactose and fructose * **most accurate lactose tolerance test** * used to detect bacterial overgrowth in small intestine

hydrogen breath test

# Identify the non-blood specimen * evaluation of gastrointestinal disorders

Feces or stool

# Identify the non-blood specimen * evaluated for presence of intestinal parasites and eggs * checked for fat and urobilinogen content * cultured to detect presence of pathogenic bacteria and viruses * tested for presence of occult blood

feces or stool

how much feces is collected for testing?

at least 5 g (pea-sized)

In feces/stool collection, if blood, mucus, or pus is present in the stool, what should the patient do to it?

collect it

In stool/feces, what body fluid should it not be contaminated with?

urine

# Identify the non-blood specimen * for trace and heavy metal analysis * detection of **drug abuse** * easy to obtain and cannot be easily altered or tampered * shows evidence of **chronic drug use** rather than recent use

hair

# Identify the non-blood specimen * from biopsies

tissues

what preservative is used for tissue specimens?

Formalin

# TRUE OR FALSE Tissues for genetic analysis should not be put in formalin

true

# TRUE OR FALSE Improper handing of tissue specimen can ruin it

True