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Urinalysis and Body Fluids > Urinalysis and Body Fluids > Flashcards

Urinalysis and Body Fluids Flashcards

1
Q

Function of the urinary system

A
  • regulate fluid, acid-base balance and electrolyte balance of the body
  • eliminate waste products
  • produce hormones
  • formation and excretion of urine
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2
Q

4 organs in the urinary system

A

-kidneys, ureters, urinary bladder and urethra

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3
Q

Ureters

A
  • two narrow tubes, each about 10-12 inches longs

- propels urine into urinary bladder by force of gravity and peristaltic waves

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4
Q

Peristalsis

A

a series of wave like contractions, moves urine down each ureter to the bladder

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5
Q

Purpose of kidneys

A
  • constantly filter the blood to remove waste products and excess water.
  • also help the body maintain the proper level of fluid , produce hormones that control blood pressure and make red blood cells, and activate vitamin D to maintain healthy bones
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6
Q

renal

A

pertaining to the kidneys

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7
Q

renal cortex

A

outer region of the kidney; this layer of tissue contains 1million + microscopic units called nephrons

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8
Q

medula

A

the inner region of the kidney and it contains most of the urine collecting tubules

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9
Q

nephrons

A
  • microscopic functional units of each kidney.
  • each nephron contains a glomerulus which is a cluster of capillaries surrounded by a cup-shaped membrane called he bowman’s capsule and a renal tubule
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10
Q

urethra meatus

A

the external opening of the urethra

note* if we need to collect sample from the urine stream we must clean the urethra meatus

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11
Q

kidneys

A

bean shaped organs, located in lumbar region

  • produces urine
  • note the right kidney is lower than the left kidney bc of liver size
  • note without the kidneys the body cannot maintain homeostasis. we need a stable balance of salts and other substances
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12
Q

anatomy of the kidney

A

cortex, medulla, renal hilus, nephrons

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13
Q

renal hilus

A

the place where the arteries and veins enter into the kidney

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14
Q

purpose of tubules

A

facilate movement of urine drops

*note- coiled to give body time to recognize whether the fluid in the tube should be reabsorbed or if it’s waste

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15
Q

glomerulus

A

the filtration system of the kidneys

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16
Q

What happens in the kidneys?

A
  • blood enters kidney through renal artery and flows intro nephrons
  • after passing the filtration system of the glomerulus, filtered blood containing protein and blood cells leaves the kidney and returns to the bloodstream through renal vein
  • remaining filtrate flows into renal tubules, where some water, sugar and salts are returned to the bloodstream via nearby capillary
  • remaining waste products are continuously converted into urine, which is transported to the renal pelvis and collected in preparation for entry into the ureters.
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17
Q

bowman’s capsule

A

moves the waste into the tubules

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18
Q

Where does urine formation begin?

A

In the kidney’s filtration system, the glomerulus.

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19
Q

Which part of the kidneys collect the fluid?

A

the bowman’s capsule collects all the filtrate fluid.

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20
Q

Purpose of the nephron

A

filters wastes from blood and dilutes them with water to produce urine

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21
Q

substances reabsorbed by the body

A

water, glucose electrolytes

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22
Q

glomerulus is for __________, as tubules is for ______________ and collecting duct is for ___________

A

filtration, reabsorption, secretion

note* 3 steps of urine formation

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23
Q

urinary bladder

A
  • hollow, muscular sac, holds approx. 500 ml of urine

- stores and expels urine

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24
Q

urethra

A

tube that extends from the bladder to outside.

  • males: urethra transports urine and reproductive secretions
  • females- urethra transports urine only

urethra meatus: external opening of urethra

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25
Q

urine is composed of

A

95% water,
-5% organic and inorganic waste products

  • organic: urea, uric acid, ammonia, creatinine
  • inorganic: chloride, sodium, potassium, calcium, magnesium, phosphate, sulfate
  • note: urea is present in greatest amts- derived from breakdown of protein
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26
Q

How can we tell there is a presence of uric acid in urine?

A

a microscopic examination of urine will show crystal particles

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27
Q

high amounts of uric acid could mean that….

A

a patient might develop kidney stones

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28
Q

how much urine does a normal adult excrete daily?

A

750-2000 ml

*note varies based on amt of fluid consumed, and amt lost through perspiration or feces

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29
Q

What is the size of the 24 hr urine collection container?

A

3000 ml

note it will already contain 2ml of colorless preservative

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30
Q

polyuria

A

excessive increase in urine output

-caused by:
-excessive intake of fluids
-fluids that contain caffeine
-drugs (diuretic)
pathological condition (diabetes, renal disease)

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31
Q

oliguria

A

decreased output of urine, less than 400 ml in 24 hrs

  • caused by:
  • decreased fluid intake
  • dehydration
  • profuse perspiration
  • vomiting
  • diarrhea
  • kidney disease
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32
Q

micturition

A

normal act of voiding urine

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33
Q

constant vomiting and diarrhea is dangerous because

A

it may cause dehydration, and change the acid balance, and electrolyte balance of the body

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34
Q

anuria

A

failure of the kidneys to produce urine

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35
Q

diuresis

A

secretion and passage of large amounts of urine

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36
Q

dysuria

A

difficult or painful urination

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37
Q

frequency

A

the condition of having to urinate often

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38
Q

hematuria

A

blood present in urine

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39
Q

nocturia

A

excessive voluntary urination during the night

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40
Q

nocturnal enuresis

A

the inability of the patient to control urination at night during sleep (bedwetting)

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41
Q

pyuria

A

pus present in urine

42
Q

retention

A

the inability to empty the bladder

-the urine is being produced normally but is not being voided

43
Q

urgency

A

the immediate need to urinate

44
Q

urinary incontinence

A

the inability to retain urine

45
Q

stress incontinence

A

inability to control urination when sneeze

46
Q

Which bacteria usually causes UTI?

A

E.coli

47
Q

How do C&S tests help diagnose UTI?

A

Cultures help detect the micro organisms and bacteria in the urine and sensitivities tell us which antibiotics will be more effective.

48
Q

hormones influencing kidney function

A

calcitonin: thyroid , inhibit calcium reabsorption by kidney tubules leading to increased calcium loss in urine
- parathyroid hormone: parathyroid; regulate calcium reabsorption, increase calcium in blood
- aldosterone: adrenal cortex; regulate electrolytes especially by reabsorption sodium and potassium
- antidiuretic hormone: hypothalamus, regulate water reabsorption
- atrial natriuretic peptide: heart; influence sodium excretion
* note* these hormones are not produced by the kidney, but they influence kidney functions: filtration, reabsorption, secretion

49
Q

hormones produced by kidney functions

A
  • erythropoietin: to stimulate rbc production in the bone marrow
  • renin: influence blood pressure
  • active vitamin D3: helps regulate bone calcium and phosphates by increasing absorption of dietary calcium and phosphorus

note*these hormones are secreted by the kidney

50
Q

Dialysis

A

a procedure to remove waste products from the blood of a patient whose kidneys no longer function

remember* external kidney

51
Q

What are the two types of dialysis? and which is the most common?

A

hemodialysis and peritoneal dialysis

hemodialysis is more common

52
Q

Advantages or urine testing:

A
  • urine is easily available
  • noninvasive procedure
  • don’t need special equipment
  • collected at any time of day
53
Q

types of urine collection

A
  • random collection (anytime of day)
  • fasting or first morning (routine urinalysis), best for pregnancy tests
  • clean-catch midstream ( for bacterial culture, c&s)
  • timed, 24-hr (hormones)
  • special collections-catheter, pediatric
54
Q

Guidelines for Urine collection

A
  • make sure to obtain adequate amount, usually 30-50 ml
  • properly label each specimen with patient’s name, DOB, date and time of collection, type of specimen
  • record patient’s current medications in patient chart
  • do not collect specimen during menstruation
  • may need to use another collection method (urine collection bag, suprapubic aspiration, catheterization)
55
Q

suprapubic aspiration and catheterization are good urinary collection methods for

A

C&S

note*suprapubic aspiration is the best

56
Q

What determines the collection method of urine?

A

type of test

57
Q

Random specimen testing

A
  • urine testing is often performed on a freshly voided specimen
  • mla instructs patient to void into clean, dry, wide-mouthed container
  • urine is tested immediately within 1-2 hrs or store at 4 degrees to 6 degrees for up to 4 hrs
58
Q

When urine has been stored in the refrigerator, what must you do before testing it?

A

Bring urine to room temperature and mix well

why? the dipstick is saturated by a dry chemical substance; if you test a cold sample, it will yield false negative results

59
Q

First-Voided Morning Specimen

A
  • Contains greatest concentration of dissolved substances.
  • small amount of a substance detected more easily
  • instruct patient to collect first specimen of the morning, preserve it in refrigerator
  • provide patient with specimen container, to prevent use of a contaminated container
60
Q

Where can microorganisms be found in the urinary system?

A
  • microorganisms are NOT normally present in urinary bladder and most of the urethra
  • microorganisms are normally present in distal urethra and urinary meatus
61
Q

Clean-catch midstream specimen

A
  • required when urine is cultured and examined for bacteria
  • to prevent contamination of specimen with normally present microorganisms
  • usually ordered for detection of UTI
62
Q

Procedure of Clean-catch midstream specimen

A
  • sterile container is used
  • patient must cleanse the meatus
  • patient should void small amount into toilet first, then collect the midstream urine into container, to flush out distal urethra microorganisms
  • test sample within 1-2 hr or refrigerate up to 4 hrs
63
Q

How to properly clean the urethra meatus, before clean-catch midstream specimen?

A

By cleaning the urethra meatus from the front to the back

64
Q

bladder catheterization

A

passing of a sterile catheter through the urethra into the bladder

65
Q

suprapubic aspiration of bladder

A

passing of a sterile needle through the abdominal wall into the bladder

66
Q

24 Hour Urine specimen is used to

A
  • diagnose the cause of kidney stone formation

- assist in the control and prevention of new stone formation

67
Q

How to store 24 hr urine specimen?

A

specimen must be kept refrigerated or placed in an ice chest

68
Q

Guidelines for 24-hour urine specimen

A
  • drink normal amount of fluid during collection period
  • avoid alcohol for 24 hours before and during collection
  • choose a 24 hr period when you’ll be at home
  • do not perform during menstruation
  • physician might instruct patient to discontinue medications for a week prior to collection
69
Q

Some urine preservative chemicals for urine:

A

hydrochloric acid, sodium carbonate, sodium hydroxide, boric acid, acetic acid

70
Q

urinalysis

A

analysis of urine

-consists of physical examination, chemical examination and microscopic examination

71
Q

Urinalysis is performed with

A

fresh or preserved specimen

72
Q

What happens if urine specimen stands out for more than 1 hour?

A
  • bacteria in environment can contaminate specimen
  • urea converts to ammonia alkaline)
  • may result in false positive result in protein test
  • bacteria multiply causing cloudy specimen, increase in nitrite
73
Q

If glucose present in specimen amount __________

A

decreases

-microorganisms use glucose for food

74
Q

Most important physical examination characteristics of urine are:

A

color and appearance

75
Q

Color of urine indication

A

ranges from almost colorless to dark yellow

  • lighter yellow (dilute)
  • darker yellow (concentrated, ie. first-void specimen)
  • yellow color comes from urochrome
  • color assists in determining additional tests that may be necessary
76
Q

Abnormal Urine Color Indications

A
  • reddish: presence of blood
  • yellow-brown or greenish: bile pigments
  • milky color: fat droplets or pus
77
Q

Appearance of Urine

A

Transparency or clarity

Fresh Urine: usually clear or transparent

Cloudiness (turbid) is fresh specimen indicates presence of bacteria, pus, blood, fat or fecal contaminants

78
Q

Urine odor

A

freshly voided: slightly aromatic

  • Urine standing too long: ammonia odor
  • urine of diabetic patients: fruity odor

note* odor not generally used in diagnosis of patient’s condition

79
Q

Specific gravity of urine

A

measures weight of urine as compared with the weight of an equal volume of distilled water

  • indicates amount of dissolved substances present in urine
  • provides information on ability of kidney to dilute or concentrate the urine
  • dilute urine has lower SG
  • concentrated urine has higher SG
80
Q

Decreased Specific Gravity indicates

A

chronic renal insufficiency, diabetes insipidus, malignant hypertension

81
Q

Increased Specific Gravity indicates

A

adrenal insufficiency, congestive heart failure, hepatic disease, diabetes mellitus, conditions causing dehydration

82
Q

normal range for specific gravity of urine

A

1.003 to 1.030

83
Q

We measure specific gravity by

A
  • reagent strip method for color comparison determination, strip dipped in urine
  • urinometer
  • refractometer

note* not common to use reagent strip now because it requires a lot of urine and takes longer

84
Q

Chemical Examination of Urine assists in diagnosis of

A

kidney function, urinary tract infections, carbohydrate metabolism (diabetes mellitus), liver function

85
Q

chemical tests are routinely performed for:

A

ph, glucose, protein, ketone, blood, bilirubin, nitrite, leukocytes

note* these tests are all qualitative except for ph and specific gravity which is quantitative

86
Q

interpreting chemical tests usually

A
  • involve a color comparison chart
  • qualitative test results
  • negative or positive
  • useful as a screening test
87
Q

urine testing kits

A

most frequently used in medical office

Advantages: contain premeasured reagent, easy to perform, provide immediate results

-most are qualitative test results

88
Q

Test strips that contain more than one _______, may require different _________ for reading results

A

reagent, time intervals

89
Q

guidelines for chemical examination of urine:

A
  • read and follow manufacturer’s instruction sheet
  • more than one reagent requires readings at different time intervals
  • certain medications may affect results
  • check expiration date
  • store in cool, dry area
  • never transfer from original container to another
  • indicate brand name of test
90
Q

PH of urine range from

A

4.6-8 (usually around 6)

91
Q

Glucose chemical test of urine

A
  • normally negative
  • *sugar should not be present in urine
  • If glucose concentration in blood is high, renal threshold is exceeded, kidneys unable to reabsorb glucose back to blood

-glucose reagent pad contains enzymes glucose oxidase and peroxidase plus a chromagen

92
Q

Renal Threshold

A
  • concentration at which a substance in the blood not normally excreted by the kidney begins to appear in the urine
  • generally between 160 and 180 mg/dL
93
Q

Protein Chemical Test

A
  • proteinuria: presence of protein in the urine, temporary increase may be caused by stress or strenuous exercise
  • conditions causing proteinuria: glomerular filtration problem, renal diseases, bacterial infections of the urinary tract
94
Q

Purpose of protein chemical test

A

to see what is causing the protein to be in the patients urine

positive result protein in urine are due to presence of Albumen

-for globulin (protein) use the sulfosalicylic acid turbidity test

95
Q

three types of ketone bodies:

A

-beta-hydroxybutyric acid
-acetoacetic acid
acetone

96
Q

ketosis

A

accumulation of large amounts of ketone bodies in tissues

-when more than normal amounts of fat are metabolized, muscles can’t handle all the ketones

97
Q

ketonuria

A

presence of ketone bodies in the urine

caused by:

  • uncontrolled diabetes
  • starvation
  • diet composed entirely of fat
  • test acetest confirms strip test result

*note urine container should be kept tightly to prevent evaporation of ketones

98
Q

bilirubin chemical test

A

with certain liver conditions, liver cant accept bilirubin, bilirubin transported to kidneys, then excreted in urine (bilirubinuria); causes yellow brown to greenish color

-note keep urine sample away from light until test is complete to prevent false negative result

99
Q

conditions causing bilirubinuria

A

gallstones, hepatitis, cirrhosis of liver

100
Q

urobilinogen

A

a bilirubin degradation product

-causes: excessive hemolysis of rbcs, infectious hepatitis, cirrhosis, congestive heart failure, mononucleosis

101
Q

blood chemical test

A
  • blood in urine is abnormal, unless due to menstruation
    hematuria: presence of blood in urine
    causes: injury, cystitis, tumors of bladder, urethritis, kidney stones
102
Q

Nitrite chemical test

A

indicates presence of pathogen in UTI

bacteria causes nitrite to be present in urine

Urinalysis and Body Fluids (1 decks)

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