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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
Q

fasting specimens

A
  • 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)
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26
Q

collecting urine after a meal

A

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
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27
Q

GTT specimen

A

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
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28
Q

GTT for pregnant women

A
  • 2h glucose tolerance state is preferred
  • use 75g glucose load
  • done to check for gestational diabetes
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29
Q

GTT procedure

A
  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
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30
Q

the most vulnerable part of drug testing program

A

Drug specimen collection

- correct collection procedure & documentation are necessary to ensure validity of results

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31
Q

Chain of Custody (COC)

A
  • 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
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32
Q

T/F:

drug specimen collection may be witnessed or unwitnessed

A

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
Q

Drug Specimen Collection:

why should urine temperature be taken first?

A
  • to confirm that the specimen has not been adulterated

- temperature should be between 32.5-37.7 degrees Celsius

34
Q

Drug Specimen Collection:

possible cause/s of adulteration

A

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
Q

Specimen Containers:

routine screening

A
  • disposable plastic with lids
  • corkscrew-capped container
  • capped plastic disposable tubes
  • 100-200mL, 12mL
36
Q

Specimen Containers:

rigid, brown plastic containers with wide mouths & screw caps

A

for 24h collection

  • should contain preservatives
  • 3000mL (3L)
37
Q

Specimen Containers:

pediatric collection

A
  • pediatric collector (bag) of clear pliable polyethylene

- to be taped to the butt area

38
Q

Specimen Containers:

culture

A
  • sterile containers

- sealed with sticker or in a plastic

39
Q

when to refrigerate specimen?

A
  • when sample is not tested within 2h; to decrease bacterial growth
  • most routinely used refrigerator temp.: 2-8 degrees Celsius
40
Q

T/F:

many substances for quanti/quali chemical determinations are best preserved at basic pH with preservatives

A

FALSE

.. best preserved at ACIDIC pH (about pH 6) WITHOUT PRESERVATION

41
Q

specimen handling for aliquots of urine to be used for quantitative chemical tests

A

freezing

42
Q

light-sensitive pigments are preserved in __________________

A

Dark (amber)-colored containers

  • to help retard the loss of labile substances (eg. urobilinogen, bilirubin, porphobilinogen)
  • containers may be wrapped with foil
43
Q

commonly used chemical preservatives

A

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
Q

effect/s of excess formalin

A

a. precipitation of urea
b. false (+) results for:
- - Clinitest (copper reduction test for sugar)
- - Fehling’s Test

45
Q

effect/s of thymol

A

a. false (+) results for:

- - protein with heat & acetic acid test

46
Q

preservative that delays the decomposition of chemical & formed elements

A

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
Q

sodium fluoride preservative

A
  • PROS:
      • good for drug analyses
      • preserves glucose in 24h collection by inhibiting glycolysis by cells & bacteria
  • CONS:
      • inhibit reagent strip for glucose
48
Q

cytologic preservative for evaluation of tumor cells

A

50% alcohol

49
Q

SACCOMANOS fixative

A
  • preserves cellular elements

- used for cytology studies

50
Q

preserves glucose & other constituents by releasing formaldehyde

A

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
Q

T/F:

formaldehyde will not react with copper reduction test

A

TRUE

52
Q

preservative effect of adjusting the pH

A

At very low pH (pH 3)

  • bacterial growth is prevented
  • substances (eg. catecholamines, vanillylmandelic acid, 5HIAA) are stabilized
53
Q

changes in urine COLOR with delayed testing, when allowed to stay at room temp.

A

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
Q

changes in urine ODOR with delayed testing, when allowed to stay at room temp.

A

Ammoniacal

  • due to bacterial growth, decomposition, contamination
  • unsuitable
55
Q

changes in urine TURBIDITY with delayed testing, when allowed to stay at room temp.

A

Increased turbidity

- due to bacterial multiplication, crystal formation, precipitation of amorphous material

56
Q

changes in urine pH with delayed testing, when allowed to stay at room temp.

A

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
Q

changes in KETONES with delayed testing, when allowed to stay at room temp.

A

False (-) ketones

- due to volatilization of acetone, breakdown of acetoacetate by bacteria

58
Q

changes in BILIRUBIN, UROBILINOGEN with delayed testing, when allowed to stay at room temp.

A

False (-)

- destroyed by light, oxidation of bilirubin to biliverdin

59
Q

changes in NITRITE with delayed testing, when allowed to stay at room temp.

A

False (+)

  • due to bacterial multiplication
  • bacteria produces nitrite

OR

False (-)

  • in patients with bacterial infection
  • nitrite is converted to nitrogen & evaporates
60
Q

bacteriuria

A

Increased bacteria in urine

  • test parameters affected:
      • turbidity
      • odor
      • pH
      • ketones
      • nitrite
61
Q

changes in urine CELLS/CASTS with delayed testing, when allowed to stay at room temp.

A

Disintegration of cells/casts

- due to unsuitable environment (exp. in alkaline urine, hypotonic urine or both)

62
Q

Tests to identify urine

A

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
Q

routine UA components

A

a. specimen evaluation before testing
b. physical tests
- - color
- - clarity
- - odor
- - volume
- - pH
- - specific gravity & osmolality
c. sediment examination
d. chemical tests

64
Q

specimen evaluation before testing

A
  • 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
Q

situation:

requested tests for a urine specimen are glucose, ketones, proteins, bacteriologic exams; what test to perform first?

A

Bacteriologic exam

- performed first to avoid contamination

66
Q

normal urine color

A

Yellow

  • urochrome pigment
  • small amounts of urobilin & uroerythrin
  • variations may be caused by diet, medication, disease
67
Q

most common abnormal urine color

A

Red

  • maybe due to ingested foods eg. beets, candy dyes, etc.
  • may also indicate the presence of blood
68
Q

describe hematuria

A
  • cloudy, smoky, pink, red, brown urine
  • commonly caused by:
      • infections
      • tumors
      • trauma from stones/injury
      • poisoning
69
Q

describe hemoglobinuria

A
  • 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
Q

T/F:

urine color does not indicate degree of hydration & urine concentration

A

FALSE

- urine color indicates hydration & concentration

71
Q

seen in normal people with high fluid intake

A

Pale urine

- can be an indication of low SG

72
Q

indications of darker urine

A

a. fluids are withheld

b. presence of other substances eg. bilirubin

73
Q

how to check for the presence of bilirubin in urine

A

Shake (foam) test

  • yellow foam = bilirubin
  • white foam = withheld urine
74
Q

pale urine, but with high SG

A

a. in patients with DM

b. after use of radiographic media

75
Q

urine color often associated with bile pigments, chiefly bilirubin

A

yellow-brown/greenish-brown urine

76
Q

indication of dark green urine

A

severe obstructive jaundice

77
Q

orange-red/orange-brown urine color

A

due to large amounts of urobilin

78
Q

dark brown/black urine color

A

acid urine with hemoglobin/homogentisic acid/melanin

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