Lecture Medical assisting: Administrative and clinical procedures with anatomy and physiology (4e) – Chapter 47

– Learn about types of urine specimens– Instruct or assist patient in collection of a sample – Learn to process urine specimens – Learn about normal/abnormal components of urine... Role

Collecting,

Processing, and

Testing Urine

Learning Outcomes

47.1 Describe the characteristics of urine, including

its formation, physical composition, and chemical properties.

47.2 Explain how to instruct patients in specimen

collection.

47.3 Identify guidelines to follow when collecting

urine specimens.

47.4 Describe proper procedures for collecting

various urine specimens

Learning Outcomes (cont.)

47.5 Explain the process of urinary catheterization.

47.6 List special considerations that may require

you to alter guidelines when collecting urine specimens.

47.7 Explain how to maintain the chain of custody

when processing urine specimens.

47.8 Explain how to preserve and store urine

specimens

Learning Outcomes (cont.)

47.9 Describe the process of urinalysis and its

purpose.

47.10Identify the physical characteristics present

in normal urine specimens.

47.11 Identify the chemicals that may be found in

urine specimens.

47.12Identify the elements categorized and

counted as a result of microscopic examination of urine specimens

– Learn about types of urine specimens

– Instruct or assist patient in collection of a sample

– Learn to process urine specimens

– Learn about normal/abnormal components of urine

Role of the Medical Assistant

• Collect, process, and test urine samples

• Knowledge necessary

– Anatomy and physiology of kidneys – How urine is formed – Normal components of urine

Role of the Medical Assistant

• Safety

– Standard Precautions – PPE as needed

– Handle and dispose of specimens properly

– Dispose of used supplies and equipment properly

– Sanitize, disinfect, and/or sterilize reusable equipment

Anatomy and Physiology of the Urinary System

• Organs

– Kidneys – remove excess water

and waste products– Ureters – drain urine into

bladder– Bladder – stores urine

– Urethra – drains urine to

outside of the body

– Glomerular filtration– Tubular reabsorption– Tubular secretion

Apply Your Knowledge

1 What knowledge is needed by the medical assistant

related to collecting, processing, and testing urine

specimens?

ANSWER: The medical assistant needs to know the anatomy and

physiology of the urinary system, how urine is formed, and normal

components of urine.

2 Components of normal urine include

A urea, uric acid, and ammonia.

B chloride, potassium, and sugar.

C red blood cells, sperm, and H2O2

D hydrogen ions, urochrome, and

uranium.

ANSWER:

Obtaining Specimens

• General collection guidelines

– Follow the procedure for specified test

– Use an appropriate specimen container

– Label the specimen container correctly

– Explain the procedure to patient

– Wash your hands before and after the procedure;

wear gloves during the procedure– Complete all necessary paperwork

Specimen Types

• Quantitative analysis – measures

amount of a specific substance

in the urine

• Qualitative analysis – simply

determines if a substance is

present in the urine

• Types vary in the method used to collect a

specimen and in the time frame in which to

collect a specimen

Specimen Types (cont.)

• Random urine

specimen

– Most common

– Obtained any time

during the day

• First morning

specimen

– Contains greater

concentration of substances

of urine prior to collecting specimen– Can also obtain by catheterization

Specimen Types (cont.)

• Timed urine specimen

– Discard first specimen

– Collect all urine for specified time

– Refrigerate

• 24-hour specimen

– Collected as a timed specimen

• Both are used for qualitative and quantitative analysis

Catheterization (cont.)

• Reasons for catheterization

– Relieve urinary retention

– Obtain a sterile urine specimen

– Measure the amount of residual urine

– Obtain a specimen if patient cannot

void – Instill chemotherapy

– Empty bladder before and during

procedures

Catheterization (cont.)

• Drainage catheters

– Indwelling urethral (Foley) catheter – bladder

– Retention catheter – renal pelvis

– Ureteral catheter – drainage through a wound into the

bladder (cystostomy tube)– Straight catheter – bladder

• Splinting catheter – inserted after repair of ureter

Catheterization (cont.)

• Not a routine procedure due to risk of infection

• Not typically performed

by medical assistants

– Check scope of practice

– Assemble supplies –

catheterization kits

– Prone to urinary tract infection

– Urine checked for glucose and protein

Special Considerations (cont.)

• Elderly

– Bladder muscles

weaken– Uterine supports

weaken – pulls on bladder

– Loss of bladder control

– May need assistance

in obtaining a specimen

– Repeat explanation as

necessary

• Pediatric patients

– Involve child if possible

– Questions

• Diaper rash?

• Excessively thirsty?

• Difficulty urinating?

• Cry when urinating?

• How many diapers a day?

• Change in bladder control?

• Problems toilet training?

Establishing Chain of Custody

temperature

• Complete documentation

Preservation and Storage

• Chemical, physical, and microscopic changes

occur if urine is left at room temperature for

more than 1 hour

• Preservation

– Refrigeration

• Prevents growth for 24 hours

• Return to room temperature before testing

– Chemical preservatives

Specimens only

Apply Your Knowledge

A patient has returned to the office and is complaining of

not being able to empty her bladder fully after her

hysterectomy The physician has asked you measure

the patient’s residual urine How do you do this and why?

ANSWER: A residual urine is done to measure the amount of urine in

the bladder after voiding You will ask the patient to empty her

bladder and then perform a straight catheterization to measure any

urine remaining in her bladder.

Correct!

• Evaluation of urine to obtain information about body

health and disease

• Types of testing

– Physical

– Chemical

– Microscopic

Urinalysis (cont.)

• Values

– Negative or none, normal,

or a range of concentration– Within normal limits

indicate health and normality– Screening test – must have

follow-up testing

body systems can

affect urinary function

Physical Examination and Testing of Urine Specimens

• Normal

• Oliguria

– Odor – Specific gravity

Physical Examination and Testing of Urine

• Visual examination

– Color/turbidity – pale yellow to dark

amber; clear – Volume

• Normal range – 600–1800 mL/24 hours

• Oliguria – insufficient production of urine

• Anuria – absence of urine production

Physical Examination and Testing of Urine

– Odor

• Distinct, aromatic

• Standing at room

temperature – ammonia

• Affected by disease and foods

– Specific gravity

• 1.002 to 1.028

• Fluctuates in response to fluid intake

• Methods

– Refractometer

– Reagent strips

Chemical Testing of Urine Specimens

function– Acid-base balance

– Presence of drugs,

toxins, or infections

• Reagent strip testing

– Changes indicate presence of

concentration of a substance

– Follow instructions carefully

• Ketone bodies

– Normally none in

urine – Presence

• Patient on a carbohydrate diet

• UTI

• Metabolic/

respiratory alkalosis

– Acidic

• Phenylketonuria

• Acidosis

– Myoglobinuria

• Myoglobin in urine

• Injured or damaged muscles

• Bilirubin

– From the breakdown

of hemoglobin

– Bilirubinuria – early sign of liver disease

• Urobilinogen

– Elevated – increased RBC destruction

– Lacking – bile duct obstruction

– Excess – renal disease

– Proteinuria – common in pregnancy and after heavy

exercise

Chemical Testing of Urine Specimens

(cont.)

• Pregnancy test

– Detect human chorionic gonadotropin (HCG)

• Peak at 8 weeks

• Quick, easy to perform and interpret

– Enzyme immunoassay (EIA)

• Newer technology

• Antigen/antibody reaction

• Presence of STDs

– Screening for chlamydia – 15- to 25-year-old sexually

active females

– Nucleic acid amplification tests (NAATs)

• Detect nucleic acid in urine

• Chlamydia and gonorrhea

• Advantage – highly specific, non-invasive

• Disadvantage – expensive, no organism remains for culture

Microscopic Examination of Urine

Microscopic Examination of Urine

• Cells

– Epithelial cells

– White blood cells

– Red blood cells

• Casts

– Cylindrical elements – Types

Microscopic Examination of Urine

• Crystals

– Naturally produced

solids of definite form

– Associated with genitourinary

tract infection, diabetes

Microscopic Examination of Urine

– Trichomonas

vaginalis – most

common

Apply Your Knowledge

1. What is the specific gravity shown on this

refractometer screen?

ANSWER: The specific gravity shown here is 1.030.

Apply Your Knowledge

2 A urinalysis has detected that a patient

has protein in his urine Why is this

important?

ANSWER: Protein in the urine usually indicates renal

disease.

In Summary

47.1 Urine is formed during a filtration process that occurs

in the nephron It is made up of 95% water and 5%

waste products and other dissolved chemicals, including urea, uric acid, ammonia, calcium, creatinine, sodium, chloride, potassium, sulfates, phosphates, bicarbonates, hydrogen ions, urochrome, urobilinogen, a few red blood cells, and a few white blood cells

In Summary (cont.)

47.2 Instructions for obtaining specific types of specimens

will vary according to the test The general instructions for urine specimen collection are: urinate into the container indicated by the laboratory; if the collection container contains liquid or powdered

preservative, do not pour it out; always refrigerate the labeled collection container or keep it in a cooler or pail filled with ice; be sure to keep the lid on the

container

In Summary (cont.)

47.3 The general guidelines for collecting a urine specimen

include: follow the procedure that is specified for the urine test that will be performed; use the type of

specimen container indicated by the laboratory;

properly label the specimen container; explain the procedure to the patient when assisting in the

collection process; wash your hands before and after the procedure and wear gloves during the procedure;

and complete all necessary paperwork

In Summary (cont.)

47.4 Several types of urine specimens are collected in the

medical office Each specimen has a slightly different collection method The various specimens include random, first morning, clean-catch midstream, timed, and 24-hour

47.5 Urinary catheterization involves inserting a plastic

drainage tube into the kidney, the ureter, or the bladder

47.6 When the medical assistant obtains a urine specimen

from a patient or takes a history of a patient who may have a urinary problem, she or he needs to consider the patient’s sex, condition, and age

In Summary (cont.)

47.7 When collecting a chain-of-custody specimen, the

following safeguards should be used: positively identify the donor; have the donor remove outer clothing and empty pockets, displaying all items; add bluing agent to the water in the toilet and turn off

other water sources; remain by the door while the specimen is being obtained; measure and record the temperature of the specimen within four minutes;

have the donor witness the specimen transfer;

complete additional information on the form; sign the CCF; give a copy of the CCF to the donor; place the specimen in a leak-proof bag with a copy of the form;

and release the specimen to the courier service

In Summary (cont.)

47.8 Proper preservation and storage of specimens are

essential A specimen should not be left unpreserved for more than 1 hour Refrigerate a specimen if it

cannot be tested within an hour Bring the specimen back to room temperature before testing

47.9 Urinalysis is the evaluation of urine by various types

of testing methods to obtain information about body health and disease

In Summary (cont.)

47.10 The physical characteristics of normal urine include

color and turbidity, volume, odor, and specific gravity

47.11 The chemicals that may be found in urine specimens

include ketones, nitrite, bilirubin, glucose, and protein

47.12 During microscopic urine examination, elements that

are categorized and counted include the cells, casts, crystals, yeast, bacteria, and parasites

End of Chapter 47

A human being: an ingenious assembly of portable plumbing

~ Christopher Morley,

1890-1957