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Chapter 47 - Collecting, processing and testing urine specimens. This chapter reviews the function of the urinary system and the formation of urine. You will learn about various types of urine specimens and howto properly instruct or assist patients with the collection of these specimens.
PowerPoint® to accompany Medical Assisting Chapter 47 Second Edition Ramutkowski Booth Pugh Thompson Whicker Copyright © The McGraw-Hill Companies, Inc Permission required for reproduction or display Collecting, Processing and Testing Urine Specimens Objectives 471 Describe the characteristics of urine, including its formation, physical composition, and chemical properties 472 Explain how to instruct patients in specimen collection 473 Identify guidelines to follow when collecting urine specimens 475 Explain the process of urinary catheterization Collecting, Processing and Testing Urine Specimens Objectives (cont.) 476 List special considerations that may require you to alter guidelines when collecting urine specimens 477 Explain how to preserve and store urine specimens 478 Explain how to maintain the chain of custody when processing urine specimens 478 Explain how to preserve and store urine specimens Collecting, Processing and Testing Urine Specimens Objectives (cont.) 479 Describe the process of urinalysis and its purpose 4710 Identify the physical characteristics present in normal urine specimens 4711 Identify the chemicals that may be found in urine specimens 4712 Identify the elements categorized and counted as a result of microscopic examination of urine specimens Introduction Routine urine analysis Simple, noninvasive diagnostic test provides a window to the patient’s health You will learn how to correctly process a specimen, including a random specimen and chain of custody drug screen You will learn about various types of urine specimens and how to properly instruct or assist patients with collection of these specimens Role of the Medical Assistant Help collect, process, and test urine specimens You will need to know: Anatomy and physiology of kidney How urine is formed Normal urine contents The Urinary System Organs of the urinary system: Kidneys Ureters Urinary bladder Urethra Click for larger view Kidney function removes waste products from the blood stream and excess water Urinary bladder stores urine, and ureters, bladder and urethra make up the urinary tract The Urinary System Urethra Aorta Kidneys Liver Urinary bladder Left Ureter Right Ureter Prostate gland Using the OnScreen Pen draw a line to each of the organs Formation of Urine Three processes of The nephron: urine formation: allows for glomerular filtration tubular reabsorption tubular secretion reabsorption of water and electrolytes plays a vital role in maintaining normal fluid balance Physical Composition and Chemical Properties Urine 95% water 5% waste products Other dissolved chemicals Urea, uric acid, ammonia, calcium, creatine, sodium, chloride, potassium, sulfates, phosphates, bicarbonates, hydrogen ions, urochrome, urobilinogen 10 Preservation and Storage Changes that affect the chemical or microscopic properties of urine occur if urine is kept at room temperature for more than 1 hour Refrigeration – most common method for storing and preserving urine It prevents bacterial growth for 24 hours After 24 hours use chemical preservation 24 Normal Values of Urine Normal values of various elements have been established Average adult daily urine output is 1250 mL/24 hours Intake and output should be approximately the same 25 Physical Examination of Urine Visual examination of physical characteristics Color and turbidity Volume Odor Specific gravity The refractometer or a reagent strip is used to measure specific gravity Refractometer Reagent Strips 26 Chemical Testing of Urine You may be asked to perform chemical tests on urine Check for proper identification of urine specimen Usually done with reagent strips or tablets Used to determine body processes such as carbohydrate metabolism, liver or kidney function or acidbase balance Used to determine presence of drug, toxic environmental substances or infections 27 Apply Your Knowledge What is the specific gravity shown on this refractometer screen? 28 Apply Your Knowledge Answer What is the specific gravity shown on this refractometer screen? The specific gravity shown here is 1.030 29 Chemicals Found in Urine Ketone bodies – may indicate that patient is Ketone bodies following a low carbohydrate diet or that patient has conditions such as starvation pH – provides information about metabolic pH status, diet, medication or several conditions Blood (hematuria) – may indicate patient is Blood (hematuria) menstruating, have urinary tract infection or trauma 30 Chemicals Found in Urine (cont.) Bilirubin or urobilinogen – first signs of liver Bilirubin or urobilinogen disease Glucose – common in patients with diabetes Glucose Protein – usually indicates renal disease Protein Nitrite – suggests bacterial infection Nitrite Leukocytes – urinary or renal infection Leukocytes Phenylketones – indicates PKU Phenylketones 31 Microscopic Examination of Urine Microscopic examination used to view elements not visible without microscope Centrifuge spins urine to cause heavier substances to settle to the bottom • Cells • Casts • Crystals • Yeasts • Bacteria • Parasites 32 Pregnancy Tests Used to detect human chorionic gonadotropin (hCG) Secreted by placenta EIA Enzyme immunoassay test 33 Urine Test for STDs CDC recommends that all sexually active females (15 to 25) be screened for Chlamydia Nucleic Acid Amplification Tests (NAATs) have been developed Advantages – highly specific, noninvasive. Organisms do not have to be alive Disadvantages – expensive, no living organism remaining for use in followup culture 34 Apply Your Knowledge A urine analysis has detected that a patient has protein in his urine. Why is this important? 35 Apply Your Knowledge Answer A urine analysis has detected that a patient has protein in his urine. Why is this important? Protein in the urine usually indicates renal disease 36 Summary Medical Assistant The volume and physical, chemical and microscopic characteristics of urine provide a great deal of information about a patient’s health You will have a substantial role in collecting, processing and testing urine specimens 37 End of Chapter 38 ... when processing urine specimens 47 8 Explain how to preserve and store urine specimens Collecting, Processing and Testing Urine Specimens Objectives (cont.) 47 9 Describe the process of urinalysis and its purpose 47 10... Objectives (cont.) 47 6 List special considerations that may require you to alter guidelines when collecting urine specimens 47 7 Explain how to preserve and store urine specimens 47 8 Explain how to maintain the chain of custody ...Collecting, Processing and Testing Urine Specimens Objectives 47 1 Describe the characteristics of urine, including its formation, physical composition, and chemical properties 47 2 Explain how to instruct patients in specimen