Urinalysis (P) Flashcards
What is CLSI?
It gives the reference std for the procedure manual containing all the procedures performed in the urinalysis section
What are the information included for CLSI?
1) Principle or purpose of the test
2) Clinical significance
3) Pt prep
4) Sx type and method of collection
5) Sx acceptability and criteria of rejection
6) Reagents, stds, and controls
7) Instrument calibration and maintenance protocols
8) Frequency and tolerance limits for controls and corrective actions
9) Method validation
10) Reference values and critical values
11) Interpretation of results
What are pre examination variables?
Variables that occur before the actual testing of the sx including:
1) Test requests
2) Pt prep
3) Timing
4) Sx collection
5) Handling and storage
Who controls many of the pre examination variables?
Health care personnel outside the clinical lab
Ordering tests and sx collection are controlled (or done by health care personnel)
What is the meaning of TAT?
Turnaround Time
What is TAT?
It is defined as the amount of time required from the point at which a test is ordered by the health-care provider until the results are reported to the health-care provider.
When is TAT determined in the labs?
For tests that are stat and even for routine tests
What is the purpose of TAT?
The TAT can be monitored by labs to determine areas in the process that needs improvement
How are the results of TAT presented?
Via cause and effect diagram
What are the components of requisition forms and computerized entry forms?
1) Should designate the type of urine specimen to be collected
2) Date and time of specimen collection
3) Storage of the specimen (whether the specimen was refrigerated before transporting)
4) Source of the specimen
5) The time the specimen was received in the laboratory
6) The time the test was performed
7) Tests requested
8) Patient identification information (sex, age or date of birth)
What are the general considerations for the application of urinalysis?
1) Patient preparation (fasting or elimination of interfering medications)
2) Type and volume of specimen required
3) Specimen containers (sterile or opaque containers)
4) All urine specimens should be examined within 2 hours. If this is not possible, written instructions for preserving the specimen must be available
5) Instructions of a general nature, such as procedures for collecting clean-catch and timed specimens printed instructions can be given to patients
Can sx be acquired after the pt took his / her medications?
No
Is it okay to collect sx from pts who have done overfasting?
No
What are the characteristics of sx containers used in urinalysis?
Sterile or opaque containers
What is the time duration where all urine sxs should be examined?
Within 2 hrs
What should be done if the urine is not examined within 2 hrs?
Write instructions (or note) Preserve the sx (via refrigeration)
Is it okay to give complete instructions to pts with regards to the process that should be done for urinalysis?
Yes, printed instructions about the procedure can be provided to pts
What are the methods for urine collection are needed to be sufficed with instructions given to pts?
1) Clean-catch
2) Timed sxs
What are examination variables?
These are the variables that directly affect the testing of sxs
What are the variables included in examination variables?
1) Reagents
2) Instrumentation and equipment
3) Testing procedure
4) Quality Control (QC)
5) Preventive maintenance
6) Access to procedure manuals
7) Competency of personnel performing the tests.
What are post examination variables?
These are processes that affect the reporting of results and correct interpretation of data
What are the variables included in post examination variables?
1) Standardized reporting formats and reference ranges should be included with each procedure covered in the procedure manual.
2) A written procedure for reporting, reviewing, and correcting errors must be present
What is urinalysis?
Group of tests that detect and semiquantitatively measure various compounds that are eliminated in the urine, including the byproducts of normal and abnormal metabolism, as well as cells, and cellular fragments.
What are the clinical significances of urinalysis?
1) As a general evaluation of health
2) To screen for disease or infection of GUT
3) To monitor the treatment of certain diseases such as diabetes, kidney stone, UTI, and some types of kidney and liver diseases
4) Screen kidney functions
5) Diagnosis for some metabolic and endocrine disturbances in the body
6) Many disorders can be diagnosed in their early stages by detecting abnormalities in urine
What are the symptoms and conditions that require urine test (or urinalysis)?
1) Discolored or foul-smelling urine
2) Pain during urination
3) Blood in the urine (hematuria)
4) Frequent urination
5) Abdominal pain or back pain
6) Monitoring of the risk of pregnancy toxemia
What should a sx container for urinalysis possess?
1) Specimens must be collected in clean, dry, leak-proof containers.
2) Disposable containers should be used
3) Containers for routine urinalysis should have a wide mouth to facilitate collections from female
4) Made of a clear material to allow for determination of color and clarity.
5) 50 mL - recommended capacity of the container which allows 12 mL of specimen needed for microscopic analysis, additional specimen for repeat analysis
6) Sterile containers should be used for microbiology
What are the characteristics of a sx container used in urinalysis?
1) Clean
2) Dry
3) Leak proof
4) Wide mouthed (for female pts)
5) Made of clear material
Can disposable containers be used in urinalysis?
Yes
Why should sx containers for urinalysis needed to be clear?
To allow for determination of color and clarity
What is the recommended volume capacity of a urine container?
50 mL
What is the volume capacity of sx that allows (or needed) for microscopic analysis?
12 mL
What is the purpose of additional sx?
For repeating urinalysis
What type of containers should be used for microbiology?
Sterile containers
What are the components of labelling in urinalysis (pt’s POV)?
1) Pt’s name
2) ID number or medical record number
3) Date and time of collection
4) Pt’s age and location
Where should labels be placed for urinalysis?
Labels must be putted on the container (body of container) not to the lid of the container
Why should labels be placed on the container (body of container)?
Because sx switching may occur if labels are placed on the lid of the container (occurs especially when processing multiple sxs simultaneously)
What are the 2 types of requisition forms?
1) Manual
2) Computerized
Should requisition forms accompany the sxs in the lab?
Yes
Is it okay if the information on the form does not match the information labeled on the sx (or its container)?
No, information from the requisition form must match the information from sx (or sx containers)
What are the other additional information that can be placed in the requisition form?
1) Method of collection or type of sx
2) Possible interfering medications
3) Pt’s clinical information
4) Time the sx is collected
What are the considerations to be observed for sx rejection for urinalysis?
1) Improperly labeled and unlabeled containers
2) Improperly collected specimens
3) Nonmatching labels and requisition forms
4) Specimens contaminated with feces or toilet paper
5) Containers with contaminated exteriors
6) Specimens of insufficient quantity
7) Specimens that have been improperly transported
How to preserve the integrity of the sx?
1) Following collection, specimens should be delivered to the laboratory promptly and tested within 2 hours.
2) A specimen that cannot be delivered and tested within 2 hours should be refrigerated or have an appropriate chemical preservative added.
3) Bacterial growth causes significant changes in urine composition
4) Improper preservation can seriously affect the results of a routine urinalysis
What is the effect of bacterial growth to urine sx?
It causes significant changes in the composition of urine
What is the effect of improper preservation of urine?
It can seriously affect the results of urinalysis
What happens to color if urine is unpreserved?
Change: modified or darkened
Cause: oxidation or reduction of metabolites
What happens to clarity if urine is unpreserved?
Change: decreased
Cause: bacterial growth and precipitation of amorphous material
What happens to odor if urine is unpreserved?
Change: increased
Cause: bacterial multiplication causing breakdown of urea to ammonia
What happens to pH if urine is unpreserved?
Change: increased
Cause: breakdown of urea to ammonia by urease-producing bacteria or loss of CO2
What happens to glucose if urine is unpreserved?
Change: decreased
Cause: glycolysis and bacterial use
What happens to ketones if urine is unpreserved?
Change: decreased
Cause: votalization and bacterial metabolism
What happens to bilirubin if urine is unpreserved?
Change: decreased
Cause: exposure to light or photo oxidation to biliverdin
What happens to urobilinogen if urine is unpreserved?
Change: decreased
Cause: oxidation to urobilin
What happens to nitrite if urine is unpreserved?
Change: increased
Cause: multiplication of nitrate-reducing bacteria
What happens to red and white blood cells and casts if urine is unpreserved?
Change: decreased
Cause: disintegration in dilute alkaline urine
What happens to bacteria if urine is unpreserved?
Change: increased
Cause: multiplication
What happens to trichomonas if urine is unpreserved?
Change: decreased
Cause: loss of motility, death
What is the most routinely used method of preservation of urine?
Refrigeration (2 DC to 8 DC)
What should be done to urine if it is to be cultured?
It should be refrigerated during transit and kept refrigerated until cultured up to 24 hrs
What is the use of chemical preservatives?
These are used for long distance transport and refrigeration is impossible
What type of containers can be used for transport of urine?
Commercially prepared transport tubes
What are the characteristics of an ideal preservative for urine?
An ideal preservative should:
1) Be bactericidal
2) Inhibit urease
3) Preserve formed elements in the sediment
4) Not interfere with chemical tests
5) Decrease oxidation and evaporation
What should be done when preserving sxs that will be transported to another lab?
Check the concerning lab with regards to the appropriate preservative
What are the different types of preservatives that can be used for preserving urine?
1) Refrigeration
2) Boric acid
3) Formalin (aldehydes)
4) Sodium fluoride
What are the advantages of using refrigeration as means of preserving urine?
It does not interfere with chemical tests
What are the disadvantages of using refrigeration as means of preserving urine?
It precipitates amorphous phosphates and urates
What are the additional information about using refrigeration as means of preserving urine?
It prevents bacterial growth for 24 h^2 (hrs?)
What are the advantages of using boric acid as means of preserving urine?
It prevents bacterial growth and metabolism
What are the disadvantages of using boric acid as means of preserving urine?
It interferes with drug and hormone analyses
What are the additional information about using boric acid as means of preserving urine?
It keeps pH at about 6.0
It can be used for urine culture transport
What are the advantages of using formalin (formaldehyde) as means of preserving urine?
It is an excellent sediment preservative
What are the disadvantages of using formalin (formaldehyde) as means of preserving urine?
It acts as a reducing agent, interfering with chemical tests for glucose, blood, leukocyte esterase, and copper reduction
What are the additional information about using formalin (formaldehyde) as means of preserving urine?
Rinse sx container with formalin to preserve cells and casts
What are the advantages of using sodium fluoride as means of preserving urine?
It is a good preservative for drug analyses
What are the disadvantages of using sodium fluoride as means of preserving urine?
It inhibits reagent strip tests for glucose, blood, and leukocytes
What is the most commonly received sx for urinalysis?
Random sx
Why is random sx the most commonly received sx for urinalysis?
Because of its ease of collection and convenience for the pt
What should be done for random sx?
The actual time of voiding the urine should be recorded to the container even though that random sx can be collected anytime
What is the purpose of random sx?
It is useful for routine screening tests to detect obvious abnormalities
Can random sx present erroneous results?
Yes
What are the causes of having erroneous results for random sx?
1) Due to dietary intake
2) The pt finished physical activity prior to sx collection
What is the ideal screening sx for urinalysis?
First Morning Sx
What are the uses of first morning sx?
1) Essential for preventing false (-) PTs
2) For evaluating orthostatic proteinuria
3) It assures the detection of chemicals and formed elements that may not be present in a diluted random sx
Why is there an assurance of detecting presence of chemicals and formed elements in first morning sx?
Because first morning sx is concentrated (or highly concentrated)
When should first morning sx be collected?
First morning sx should be collected immediately after arising from bed
What are the purposes of midstream clean-catch sx?
1) It provides a safer, less traumatic method for obtaining urine for bacterial culture and routine UA
2) Midstream clean-catch sx is less contaminated by epithelial cells and bacteria
What should be done to pts if they are going to collect midstream clean-catch sx for UA?
1) Pts must be provided with appropriate cleansing materials
2) Pts must be provided with a sterile container
3) Pts must be provided with clear instructions for cleansing and voiding of urine
What agents should not be used as cleansing agents when it comes to midstream clean-catch sx for UA?
Strong bacterial agents such as hexachlorophene or povidone-iodine
What are recommended to be used (for cleaning) for midstream clean-catch sx for UA?
Mild antiseptic towelettes
What is the purpose of 24 hour (or timed) sx?
Accurate quantitative results can be achieved by utilization of 24 hour (or timed) sx
When do the concentration 24 hour sx change?
1) Changes with diurnal variations
2) Changes with daily activities (such as exercise, meals, and body metabolism)
What should be done for the pt to acquire an accurate 24 hour sx?
The pt must begin and end the collection period with an empty bladder
What should be done to a 24 hour sx when it already arrived in the lab?
The 24 hour sx must be thoroughly mixed and the volume is accurately measured and recorded
Does all sx must be refrigerated during collection period when it comes to 24 hour sx?
Yes
How is catheterized sx collected for UA?
It should be collected under sterile conditions by passing a hollow tube (catheter) through the urethra into the bladder
What is the most commonly requested test for using catheterized sx for UA?
Bacterial culture
When is catheterized sx obtained from pts for UA?
When pts are on prolonged bedrest
What is the purpose of catheterized sx?
For diagnosis of catheter-associated UTIs
What are the different entry points for bacteria for catheterized sx?
1) In urethral meatus and around catheter
2) In the junction between catheter and collection tube
3) In the connection to drainage bag and reflux from bag to tubing
How is suprapubic aspiration sx for UA collected?
There is an external introduction of a needle through the abdomen into the bladder
What is the advantage of utilizing suprapubic aspiration sx for bacterial culture?
The sx is completely free from extraneous contamination
What is the other use of suprapubic aspiration sx?
It can also be used for cytologic examination
How are pediatric sxs for UA are collected?
1) Collection in a soft, clear plastic bags with hypoallergenic skin adhesive to attach to the genital area of both boys and girls are available for collecting routine specimens.
2) Attach the bag firmly over the genital area avoiding the anus. When enough specimen has been collected, remove the bag and label it or pour the specimen into container
Is it okay to touch the inside of bag when applying it to the pt for collection of urine sx?
No, care must be taken not to touch the inside of the bag when applying it to the pt
How to label pediatric urine sxs?
Via following the institutional policy
What should be done to the site of urine collection for pediatric sxs?
The site or area of collection must be cleaned with the use of soap and water and sterilely dry the area. Remove any residual soap residue. Firmly apply a sterile bag. Transfer collected sx into a sterile container and label the container
What should be performed first (to a catheterized or midstream method of sx collection) when the ff tests are requested:
1) Routine UA
2) Culture
Perform culture first
Why is culture performed first and not routine UA (for catheterized or midstream method of sx collection)?
To prevent contamination of the sx
What is the method of sx collection used to collect prostatitis sx?
Three-Glass collection
How to perform Three-Glass collection (of prostatitis sx)?
1) Prior to collection, the area is cleansed
2) The first urine passed is collected in a sterile container
3) Then, midstream portion is collected in another sterile container
4) The prostate is then massaged so that prostate fluid will be passed w/ the remaining urine into a third sterile container
5) Quantitative cultures are performed on all sxs, and the first and third sxs are examined microscopically
How to evaluate 3rd and 2nd sx and what are the results of these evaluations (for prostatitis sx)?
3rd sx: (+) WBC / hpf (high power field) count and a bacterial count 10 times that of the 1st sx indicates prostatic infection
2nd sx: acts as a control for bladder and kidney infection
-> if (+): the results from 3rd sx are invalid because infected urine has contaminated the sx
What are the different results (for prostatitis sx) and its corresponding interpretations?
1st sx: (-) WBC
2nd sx: (-) WBC
3rd sx: (+) WBC
-> (all) interpretation: prostatic infection
1st sx: (-) WBC
2nd sx: (+) WBC
3rd sx: (+) WBC
-> (all) interpretation: UTI, invalid for prostate evaluation
What is the meaning of PPMT (for prostatitis sx)?
Pre and post-massage test
What type of sx is collected for PPMT (for prostatis sx)?
Clean-catch midstream urine
When is the 2nd urine sample collected in PPMT (for prostatitis sx)?
After the prostate is massaged (post-massage)
What is the indication of (+) result for post-massage sx (for prostatitis sx)?
Significant bacteriuria
Compare post-massage sx and pre-massage sx (for prostatitis sx)
Post-massage sx is greater than 10 times than pre-massage sx
What is the most vulnerable part of drug testing program?
Urine sx collection
What are needed to ensure that the results of urine test for drug testing came from the proper individual?
1) Correct collection procedures
2) Documentation
What is the meaning of COC (in drug testing)?
Chain of custody
What is COC (for drug testing)?
It is a standardized form that provides documentation of proper sx identification from the time of collection to the receipt of lab results
What is required for urine testing in drug testing?
Proper indication of the individual whose information is indicated on the label
Can urine sx collections be witnessed or unwitnessed?
Yes, it may be either witnessed or unwitnessed
When is the proper time to record the temperature of urine?
Within 4 mins from the time of collection
What is the temp of urine?
32.5 DC to 37.7 DC
What is the reason why the temp of urine is recorded within 4 mins from the time of collection?
To confirm the sx has not been aldulterated
What factor of UA is inspected to identify any signs of contaminants?
Urine color
What are the types of tampering that can be done to urine sx?
1) Substitution
2) Adulteration
3) Dilution
Is it necessary to prove that no tampering of sx occurred?
Yes
What should be done to a urine sx?
Sx must be:
1) Labeled
2) Packaged
3) Transported (following lab-specific instructions)
