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AUBF > UA 1: PHYSICAL EXAMINATION OF URINE PT. 1 > Flashcards

UA 1: PHYSICAL EXAMINATION OF URINE PT. 1 Flashcards

1
Q

describe urine

A
  • liquid tissue biopsy of the urinary tract

- painlessly obtained

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2
Q

reasons for performing urinalysis

A

a. diagnosis & management of renal or urinary tract diseases
b. detection of metabolic or systemic diseases not related to the kidney (e.g. liver disorders, pregnancy)
c. monitor progress of disease & effectiveness of therapy

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3
Q

Urine Collection T/F:

sample must be collected in a clean, dry, chemical-free container

A

TRUE

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4
Q

time at which sample should be examined

A

Within 2h after collection

  • samples must be freshly voided for them to be examined
  • if analysis is delayed, sample should be refrigerated or placed with preservative
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5
Q

most common urine examination

A

Routine UA

  • METHOD of urine COLLECTION = midstream collection
  • TYPES of urine SPECIMEN = first morning; random
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6
Q

describe first morning specimens

A
  • first urine excreted after waking up
  • specimen of choice for routine UA; urine is more concentrated & stable
  • recommended for:
      • pregnancy testing (bec. hcG is more concentrated)
      • evaluation of orthostatic proteinuria
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7
Q

T/F:

urine has a basic pH in early mornings

A

FALSE

  • urine pH is ACIDIC in early mornings
  • because of its acidity, formed elements (eg. urinary casts, WBC, RBC) are better preserved
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8
Q

urine that can be collected any time of the day

A

Random urine specimen

  • concentration of formed elements will be affected by one’s state/degree of hydration:
      • patient takes in a lot of fluid = dilute urine
      • patient takes less water = concentrated urine
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9
Q

specimen of choice for quantitative analysis of urine

A

Timed specimens

a. 2h
- usually for urobilinogen determination
- collect urine between 2-4PM (time of peak of urobilinogen excretion)

b. 12h
- for quantitative cell count (Addis counting)

c. 24h
- for clearance testing (of glucose, proteins, or CREA)

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10
Q

Addis counting

A

cells, RBC & WBCs are counted

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11
Q

T/F:

for quantitative urine analysis, collection instructions are very important

A

TRUE

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12
Q

Situation:
Patient is asked to collect 24h urine specimen, how to instruct the patient, and what are the pre-examination procedures?

A

a. instruct patient to discard the first urine excreted in the morning, take note of the time; collect the succeeding urine until the same time on the next day; tell patient to refrigerate after every collection; transport when 24h is over
b. check labels & determine urine volume; take aliquots for performing different tests; store in freezer if not examined right away

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13
Q

collection errors for 24h urine collection

A

a. loss of voided specimen
- when patient fails to collect urine sample
- reject sample; discontinue & start over

b. failure to discard first urine
- always remind patient to discard

c. poor preservation
- preservatives should be added to avoid inaccurate results

d. inadequate refrigeration
- sample should not stay at room temp.

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14
Q

specimen of choice for bacteriologic/microbiologic examination

A 
Clean catch (midstream) specimen
- if patient is unable to void, catheterization or suprapubic aspiration of bladder is necessary
  • private area should be cleaned before collecting urine; use mild antiseptic towelettes (NOT strong bacterial agents eg. povidone-iodine, hexachlorophene)
  • cleaning private areas:
      • female: cleanse genitals with mild antiseptic
      • uncircumcised male: refract foreskin
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15
Q

methods of collection that is done by physician/nurse

A

a. catheterization (ureteral/urethral)

b. suprapubic aspiration

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16
Q

T/F:

for bacteriologic examination, urine should be collected in a clean, dry, chemical-free container

A

FALSE

- urine should be collected in a STERILE container

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17
Q

bacterial cultures should be done immediately, however, if delayed, specimen should be refrigerated at ___________ until cultured

A

4 degrees Celsius

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18
Q

special collection techniques

A

a. urethral catheterization
b. suprapubic aspiration
c. 3-glass collection
d. ureteral catheterization

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19
Q

urethral catheterization

A
  • catheter is introduced into urethra & bladder

- should not be done by MTs

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20
Q

urine is aspirated with a needle & syringe above the symphysis pubis through the abdominal wall into the full bladder

A

Suprapubic aspiration

  • invasive; should not be done by MTs
  • used for anaerobic cultures, problem cultures (contamination cannot be ruled out), infants (collection is difficult & may be contaminated)
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21
Q

collection technique used to determine prostatic infection

A

3-Glass collection

1st glass
- 1st urine passed; examine microscopically

2nd glass
- midstream urine; examine microscopically; used as “control” for kidney/bladder infection

3rd glass

  • remaining urine collected after massaging prostate
  • in prostatic infection, WBC/hpf & bacterial count is 10 times that of the urine in 1st glass

*quantitative cultures are made after collection

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22
Q

why should prostate be massaged before collecting in 3rd glass?

A

so that prostatic fluid will be passed with the urine

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23
Q

collection technique used to differentiate bladder infection from kidney infection

A

Ureteral catheterization

  • catheters are inserted (via a cytoscope) into each ureter
  • collect bladder urine & bladder washout specimens on each side of the kidney pelvis (LABEL “RIGHT”/”LEFT”)
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24
Q

types of specimens for diabetic monitoring

A

a. fasting specimen
b. 2h postprandial specimen
c. glucose tolerance test specimen

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25
fasting specimens
- 2nd morning specimen (2nd void after a period of fasting) - patient must have a fasting period of 6-10/12 h - should not contain any metabolite from ingested food (prior to beginning of fasting period)
26
collecting urine after a meal
Postprandial specimen - patient is instructed to collect 2h after eating (routine meal) - used to test for glucose; primarily for monitoring insulin therapy in patients with DM
27
GTT specimen
Glucose Tolerance Test - tests include fasting, after 1/2, 1, 2, 3 hours - should correspond with blood samples drawn during the same test - used to test for glucose & ketones
28
GTT for pregnant women
- 2h glucose tolerance state is preferred - use 75g glucose load - done to check for gestational diabetes
29
GTT procedure
1. ask patient to fast 2. collect fasting urine & blood 3. ask patient to drink glucose load (usu. 100g); wait 30 minutes after completion 4. (after 30 minutes) collect blood & urine 5. collect again after 1, 2, 3 hours
30
the most vulnerable part of drug testing program
Drug specimen collection | - correct collection procedure & documentation are necessary to ensure validity of results
31
Chain of Custody (COC)
- process that provides documentation of proper sample ID from time of collection to receipt of results - a standardized form must document & accompany every step of drug testing
32
T/F: | drug specimen collection may be witnessed or unwitnessed
TRUE - collect approx. 30-45mL of urine - take urine temperature first (w/in 4 minutes of collection) - inspect urine color to identify any sign of contaminants
33
Drug Specimen Collection: | why should urine temperature be taken first?
- to confirm that the specimen has not been adulterated | - temperature should be between 32.5-37.7 degrees Celsius
34
Drug Specimen Collection: | possible cause/s of adulteration
Access to water - causes dilution of specimen - toilet lid & faucet handles should be taped to eliminate source of water - toilet water reservoir should be added with bluing agent/dye
35
Specimen Containers: | routine screening
- disposable plastic with lids - corkscrew-capped container - capped plastic disposable tubes - 100-200mL, 12mL
36
Specimen Containers: | rigid, brown plastic containers with wide mouths & screw caps
for 24h collection - should contain preservatives - 3000mL (3L)
37
Specimen Containers: | pediatric collection
- pediatric collector (bag) of clear pliable polyethylene | - to be taped to the butt area
38
Specimen Containers: | culture
- sterile containers | - sealed with sticker or in a plastic
39
when to refrigerate specimen?
- when sample is not tested within 2h; to decrease bacterial growth - most routinely used refrigerator temp.: 2-8 degrees Celsius
40
T/F: | many substances for quanti/quali chemical determinations are best preserved at basic pH with preservatives
FALSE | .. best preserved at ACIDIC pH (about pH 6) WITHOUT PRESERVATION
41
specimen handling for aliquots of urine to be used for quantitative chemical tests
freezing
42
light-sensitive pigments are preserved in __________________
Dark (amber)-colored containers - to help retard the loss of labile substances (eg. urobilinogen, bilirubin, porphobilinogen) - containers may be wrapped with foil
43
commonly used chemical preservatives
a. toluene - preserves acetone, diacetic acid, reducing substances, protein b. 40% formalin - preserves formed elements c. thymol - good for most chemical tests - does not affect dipstick method
44
effect/s of excess formalin
a. precipitation of urea b. false (+) results for: - - Clinitest (copper reduction test for sugar) - - Fehling's Test
45
effect/s of thymol
a. false (+) results for: | - - protein with heat & acetic acid test
46
preservative that delays the decomposition of chemical & formed elements
Boric acid - PROS: - decreases pH - CONS: - - does not stop yeast growth - - precipitates uric acid - used as preservative for the urine C&S transport kit - - for UA & C/S on the same specimen
47
sodium fluoride preservative
- PROS: - - good for drug analyses - - preserves glucose in 24h collection by inhibiting glycolysis by cells & bacteria - CONS: - - inhibit reagent strip for glucose
48
cytologic preservative for evaluation of tumor cells
50% alcohol
49
SACCOMANOS fixative
- preserves cellular elements | - used for cytology studies
50
preserves glucose & other constituents by releasing formaldehyde
Preservative tablet - contains benzoate & mercury - have an acid reaction - used for transportation of urine for routine screening UA - will slightly increase the specific gravity of urine - - ideal volume: 95mg tablet with 20mL urine specimen - - subtract 0.002 from the specific gravity
51
T/F: | formaldehyde will not react with copper reduction test
TRUE
52
preservative effect of adjusting the pH
At very low pH (pH 3) - bacterial growth is prevented - substances (eg. catecholamines, vanillylmandelic acid, 5HIAA) are stabilized
53
changes in urine COLOR with delayed testing, when allowed to stay at room temp.
Color darkens - due to the breakdown or alteration of chromogen/other urine constituents: - - Hgb = converted to Hi = brown urine - - homogentisic acid = black urine - - porphyrins - - melanin
54
changes in urine ODOR with delayed testing, when allowed to stay at room temp.
Ammoniacal - due to bacterial growth, decomposition, contamination - unsuitable
55
changes in urine TURBIDITY with delayed testing, when allowed to stay at room temp.
Increased turbidity | - due to bacterial multiplication, crystal formation, precipitation of amorphous material
56
changes in urine pH with delayed testing, when allowed to stay at room temp.
False low pH - bacteria converts glucose to acids & alcohols --> NH3 is produced, CO2 is lost * common/normal pH = increases (basic) * urine pH of patients with increased glucose = decreases (acidic)
57
changes in KETONES with delayed testing, when allowed to stay at room temp.
False (-) ketones | - due to volatilization of acetone, breakdown of acetoacetate by bacteria
58
changes in BILIRUBIN, UROBILINOGEN with delayed testing, when allowed to stay at room temp.
False (-) | - destroyed by light, oxidation of bilirubin to biliverdin
59
changes in NITRITE with delayed testing, when allowed to stay at room temp.
False (+) - due to bacterial multiplication - bacteria produces nitrite OR False (-) - in patients with bacterial infection - nitrite is converted to nitrogen & evaporates
60
bacteriuria
Increased bacteria in urine - test parameters affected: - - turbidity - - odor - - pH - - ketones - - nitrite
61
changes in urine CELLS/CASTS with delayed testing, when allowed to stay at room temp.
Disintegration of cells/casts | - due to unsuitable environment (exp. in alkaline urine, hypotonic urine or both)
62
Tests to identify urine
a. Urea (Nitrogen) - in urine = 600mg/100mL - in blood = 20mg% b. Creatinine - in urine = 50mg/100mL - in blood = 1-2mg% BOTH urea & creatinine - waste products of metabolism - most other body fluids contain only small amounts - when liquid has high levels of both, it is highly suggestive of urine
63
routine UA components
a. specimen evaluation before testing b. physical tests - - color - - clarity - - odor - - volume - - pH - - specific gravity & osmolality c. sediment examination d. chemical tests
64
specimen evaluation before testing
- purpose: to evaluate its acceptability a. proper labelling - name, DOB of patient, date, time of collection b. proper specimen for the requested test c. proper preservative used - for timed specimens d. visible signs of contamination e. transportation delays - reject when delivered to the lab after 2h - ask for new sample
65
situation: | requested tests for a urine specimen are glucose, ketones, proteins, bacteriologic exams; what test to perform first?
Bacteriologic exam | - performed first to avoid contamination
66
normal urine color
Yellow - urochrome pigment - small amounts of urobilin & uroerythrin - variations may be caused by diet, medication, disease
67
most common abnormal urine color
Red - maybe due to ingested foods eg. beets, candy dyes, etc. - may also indicate the presence of blood
68
describe hematuria
- cloudy, smoky, pink, red, brown urine - commonly caused by: - - infections - - tumors - - trauma from stones/injury - - poisoning
69
describe hemoglobinuria
- clear, red, red-brown, or dark brown urine - caused by: - - severe burns, - - incompatible blood transfusion - - fever - - snake venom - - congenital erythropoietic porphyria - - drugs & dyes in diagnostic tests
70
T/F: | urine color does not indicate degree of hydration & urine concentration
FALSE | - urine color indicates hydration & concentration
71
seen in normal people with high fluid intake
Pale urine | - can be an indication of low SG
72
indications of darker urine
a. fluids are withheld | b. presence of other substances eg. bilirubin
73
how to check for the presence of bilirubin in urine
Shake (foam) test - yellow foam = bilirubin - white foam = withheld urine
74
pale urine, but with high SG
a. in patients with DM | b. after use of radiographic media
75
urine color often associated with bile pigments, chiefly bilirubin
yellow-brown/greenish-brown urine
76
indication of dark green urine
severe obstructive jaundice
77
orange-red/orange-brown urine color
due to large amounts of urobilin
78
dark brown/black urine color
acid urine with hemoglobin/homogentisic acid/melanin

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