MMSC 402 Exam 1 (Body Fluid Analysis)

QA

Quality Assurance
- preanalytical
-analytical
-post analytical
- internal QC
-external QC

Pre-analytical

Pre testing
-Proper ordering
-Specimen collection
-Patient prep/education
-Accurate procedure
-Adequate personal training
-Documentation of problems

analytical

testing
-Equipment
-Reagent/supplies
-Standardized procedures
-Analytical methods
-Monitor QC
-Lab personnel tech skills

Postanalytical

after testing
-Result communication
-Standard reporting format
-Appropriate documentation
-Reporting of critical values

internal QC

-Monitor analytical errors
-Mimic patient samples
-Commercially obtained
-Results recorded, troubleshoot if necessary
-Monitor analysis of same specimen

External QC (proficiency testing)

-Proficiency testing in multiple labs
-Reports useful for detecting quantitative small changes
-Accredited labs must participate and pass PT

Saftey

-biological + chemical

Biological Saftey

transmission precautions
-contact
-droplet
-airborne

routes of infection
-inhalation
-ingestion
-direct inoculation

Chemical Safety

label, date
always dispose properly in correct container

other hazards

Flammable substances
Compressed gas tanks
Electrical hazards

OSHA (Occupational Safety and Health Administration)

Requires facilities to have chemical hygiene plan

Educate personnel
-Proper labeling
-Lab safety manual
-PPE
-Safety equipment

SDS

Safety Data Sheet

urine formation process + purpose

- filter plasma though glomeruli
-reabsorbed + selective secretion by renal tubules

- get rid of waste from the blood

-Largest Components ogfH2OF

-solutes eliminates (urea, chloride, Na, K, P, sulfate, Creatinine, Uric acid)

- glucose, bicarbonate, albumin completely eliminated

anatomy of kidney

-nephron
-medulla
-renal pelvis
-papilla
-cortex

flow of urine through kidney

enters thought ureter
- ureter to bladder
-once 150 ml urine collected signals brain
- contraction of bladder and relaxation of urinary sphincter push urine into urethra

renal circulation

Afferent arteriole = supply blood to each glomeruli per nephron

efferent arteriole = bring filtered blood from glomerulus to kidney/ into circulation

peritubular capillaries (fine capillary plexus)

vasa recta (long u shaped vessel)

renin a
-enzyme
-when released forms angiotensin
-actively retains NA and passively retains H2O

Glomerlus

-form barrier
-plasma ultrafiltration
-glomerular filtration barrier (permeable to H2O + low molecule weight solutes)
-shield of negativity repels plasma proteins

structural components
-mesangium
-fenestrated endothelia cells
-podocytes
-trilayer basement membrane

Tubular function / process

parts
-proximal tubes
-macula densa, distal convoluted tubes
-collecting tubes (final urin concentration -, ADH present)

tubular transport

active
- against gradient
-direct requires anergy
-indirect = coupled with another substance

passive
-no energy required

tubular function

reabsorption
- H2O, salts, glucose, AA, proteins
-excrete creatine and metabolic acids

secretion
- eliminates waste
-adjusts acid base equilibrium

acid-base equilibrium

H+ ions secreted into proximal tubular lumen
-->prevent bicarbonate loss

Phosphate acid converts to salts (Titratable acids)

Ammonia secretion, exchange of Na ions for ammonia ions

7.35-7.54 pH

renal threshold level

blood concentration

Antiduretic hormone (ADH)

-vasopressin
-controls H2O reabsorption in colleting tubes
- produced in hypothalamus and released into blood from posttrial pituitary gland
-change in tubule epithelium increases H2O reabsorbtion
- ADH release is controlled by negative feedback w/ arterial blood pressure
and
positive feedback w/ plasma osmolarity

diabetes insipidus

low ADH

diabetes mellitus

insulin is not secreted adequately or tissues are resistant to its effects

alderstone

Hormone produced by renin

- causes kidneys to retain sodium

-BP rises as s result

organic constituents of urine

urea, uric acid, creatinine

Inorganic constituents of urine

ammonia, sodium, chloride, traces of iron, phosphorus, sulfur, potassium, and calcium

oliguria

Decreased urine output

less than 400ml per day

anuria

No urine
renal frailer

polyuria

excessive urination

greater than 3 L per day

conditions w/ H2O and Solute diuresis

labeling urine specimens

-label on side not cap
so caps can be switched

reason for lab to reject specimen

1. mislabeled
2.. improper collection method
3. improper preserved
4. viable contaminated
5. insufficient volume (need 10-15 ml)

changed that happen to urine after two hours

- pH will become alkaline
-color ill become darker
-false neg glucose
-false neg ketones
-increased nitrate and pH

midstream clean catch

Routine screening
Bacterial culture

catheterized (urethral) sample

bacteria fungi culters or kidney infection

Suprapubic aspiration

the passing of a sterile needle through the abdominal wall into the bladder to remove urine

pediatric collection bag

plastic used for babies to get quantitative assays

routine void

collected by having patient void into container; sterile specimen NOT required

specimen types

-first mornings --> most concentrated
-random --> most common
-times --> intervals

test used to evaluate glomerular filtration rate

-blood test
-based on serum creatinine levels
-greater then 60ml/min = normal
- specify if under 60

test to evaluate tubular reabsorption

creatinine clearance test

-renal clearance = (urine concentration x volume urine)/ plasma concentration

creatinine clearance test

Measures the rate at which creatinine is cleared from the blood by the kidney.

-renal clearance = (urine concentration x volume urine)/ plasma concentration

use of calculated glomeruli filtration rate

measure kidney function

Osmolarity

Concentration of solution expressed in osmoles of solute particles per kg of solvent

urine to serum = 1:3

SG

1.002-1.035

Density of urine to density of equal volume pure H2O