Unit 4 Part 1 - Urinalysis Flashcards
oldest and most common test order
urinalysis
composition of urine
95% water
5% solutes (urea, Na, K, P and S ions, creatinine, uric acid)
absence of urine production
anuria
excessive urination at night
nocturia
decreased production of urine
oliguria
increased production of urine
polyuria
blood in the urine
hematuria
the yellow pigment that gives urine its color
urochrome
excessive beets and rhubarb (in alkaline urine) give urine a ___ color
red
excessive carrots and some antibiotics give urine a ___ color
yellow-orange
excessive clorets and amitryptiline give urine a ___ color
green, blue-green
excessive methyldopa and metronidazole give urine a ___ color
brown-black
presence of RBCs, hgb and myoglobin in urine gives it a ___ color
red, red-brown
presence of blood in urine gives it a ___ color
wine-red
presence of melanin and hgb in acid urine gives it a ___ color
brown-black
presence of bilirubin in urine gives it a ___ color
dark yellow, green-brown
normal volume of urine in newborns
25-350 ml/day
normal volume of urine in 1 year olds
300-600 ml/day
normal volume of urine in 10 year olds
750-1500 ml/day
normal volume of urine in adults
750-2000 ml/day
regulate the volume of fluid in the blood
keeps chemical components of the blood at constant level
kidneys
urine collected at any time and anywhere in a urine container, collected for routine urinalysis
random
specimen of choice for urinalysis and microscopic analysis
generally more concentrated, has higher levels
first morning specimen
collected in the middle of the process
patient urinates in the toilet, then the bottle, then toilet again
midstream
similar collection method as midstream, but urine contact with skin is prevented, and an antimicrobial wipe is used
midstream clean catch
collected using a sterile container, sterile straw and gray stopper tube with boric acid as preservative
urine for C&S
delay in urine processing and prolonged exposure at RT may result in microbial ___ and changes in pH (shift to __)
urine glucose may ___
growth, alkaline
decrease
urine is collected for a 24 hour period
patient discards first morning void, but all other ones are placed in container (including first morning specimen of the next day)
preservative may be added depending on the chemistry testing
24-hr collection
Do not void directly in the 24-hr container as it might contain a ___ preservative, and cause splashing
caustic
When measuring the volume of a 24 hr urine specimen, use a ___ to record the volume
graduated cylinder
what is the color of urine containers and why?
amber to protect from light in case of bilirubin
urine preservatives
tartaric acid
boric acid
sodium carbonate
hydrochloric acid
acetic acid
best specimen collection method
first morning (most concentrated)
specimens exceeding the 2 hour limit and have not been refrigerated is rejected due to
potential bacterial overgrowth and disintegration of cells and casts
could lead to errors in chemical urinalysis
should be done within 2 hours after collection
routine urinalysis
3 parts of routine urinalysis
- physical examination
- chemical testing
- microscoping examination
tests in routine urinalysis under physical examination
color
turbidity
specific gravity
measures the weight of urine compared to the weight of water
1.000 - very dilute
1.030 - very concentrated
specific gravity
specific gravity is done at the __ only when the chemical strip does not have specific gravity on the strip
physical
physical examinations of urine are ___
subjective (personal impressions)
___ is not done in routine urinalysis because it is unsafe and reliable, and volume is done in other special collections
odor
device used to measure specific gravity, no longer used due to danger
refractometer
chemical examination tests in routine urinalysis
- pH
- protein
- glucose
- ketones
- bilirubin
- blood
- nitrites
- urobilinogen
- leukocytes
- specific gravity
main abnormalities being looked at in chemical examination, if urine is normal the rest should be negative
pH and SG
tests the acidity or alkalinity of urine
pH
increase of this in urine indicatedf kidney disease
protein
presence in urine indicates increased blood glucose (diabetes)
glucose
increased amounts of this in urine indicates diabetes or starvation
ketones
checked in urine to test for liver disease
bilirubin
present in urine during infection, trauma, cancer, kidney stones or other bleeding (menstruation)
blood
presence of this in urine indicates presence of bacteria
nitrites
tests urine for jaundice and other liver disorders
urobilinogen
presence in urine could indicate kidney disease and UTI
leukocytes
time for reading the urine strip starts at the time of __
blot
performed when urinalysis renal workup is ordered (positive for blood, protein or leukocyte esterase)
urine microscopy
provides information on presence of casts, cells, and other formed elements (crystals no longer reported)
urine renal workup
microscopy is done on the ___ of centrifuged urine
sediment
urine microscopy is examined under
high power (400x)
oil immersion is used when examining
stains
normal amount of epithelial cells, RBCs and WBCs (usually neutrophils) found in urine per high power field
1-3
formed in the kidney tubules and expelled during kidney damage
main component is gel-like protein
casts
4 factors that lead to formation of a cast
- decreased urine flow
- increased acidity (low pH)
- increased concentration (high SG)
- increased plasma proteins
types of cells that can be found in urine
RBC
WBC
epithelial
types of casts
RBC/WBC
Hyaline (most common)
Granular
Waxy (square ends)
- most casts share rounded edges and parallel lines
formed by the precipitation of urine salts when changes occur in the pH, temperature (form at low temperatures) or concentration of the urine
crystals
most important aid in identification of urine crystals is
pH of urine
2 kinds of crystals found in urine
form in acid
form in alkaline
most common crystal found in acid pH, look like stars
calcium oxalate crystals
type of crystal(s) that form in acidic urine
calcium oxalate (star-shaped, most common)
cystine crystals (hexagon-shaped)
type of crystal(s) that form in alkaline urine
triple phosphate crystals (coffin-shaped)
leading cause of UTI
E. coli
parasite found in urine that is an indicator of an STD
trichomonas vaginalis
examples of things that can be found in urine
fat droplets
debris from fibre
oil/air bubble
mucous
sperm
trichomonas vaginalis
bacteria
yeast (Candida albicans)
crystals - alkaline/acidic
casts - RBC/WBC, hyaline, granular, waxy
cells - WBC, RBC, epithelial
very common and curable STD, passed from person to person during vaginal, oral and anal sex
chlamydia
bacterial cause of chlamydia
chlamydia trachomatis
test done for chlamydia and gonorrhea before
cervix/urethra samples sent for cultures
chlamydia tests now
first catch urine test
rapid method for detection of red blood cells in stool
fecal occult blood test (FOBT)
FOBT is used for detection of
colorectal cancer
diet for FOBT follows high ___ for ___ before test
fiber, 48 hrs/2 days
Things to avoid when doing FOBT
vit C (excess of 250 mg per day)
iron supplements
aspirin/other medications that can cause GI irritation
toilet bowl cleaner
red meat
protect slides from heat, light or volatile liquids
do not collect FOBT specimen when
during or 3 days after menstrual period
blood in urine
blleding hemorrhoids
iron supplements
false positives for FOBT
red meat
aspirin (> 325 mg/dl) and ibuprofen and naproxen
alcohol in excess
bleeding
false negatives for FOBT
an excessive amount of Vit C
2 drops of __ is added to each slide and control area when doing FOBT
developer
trace of __ color is positive for occult blood
blue
FOBT usually repeated for __ consecutive bowel movements
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