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Random urine collection:
pateint prep
how to collect
what testing can be done
minimal/optimal volume
clear directions and proper cleansing
done at any time, avoid fluid intake and exercise, drink normal amount
routine screening
25-50mLs (udeally 50)
Random urine collection:
pateint prep
how to collect
what testing can be done
minimal/optimal volume
clear directions and proper cleansing
collect first thing in the morning, patient should empty bladder prior to bed night before
routine analysis (preferred b/c it’s most conc.)
25-50 mLs (50 preferred)
timed urine collection
pateint prep
how to collect
what testing can be done
minimal/optimal volume
clear directions
collected for a specific predetermined time (usually 24 hours), patient should arise and discard first sample, then collect throughout the next 24 hours, the next day, arise at same time as the first day and keep sample
measuring chemicals
N/A
routine voided specimens (random or first morning):
pateint prep
how to collect
what testing can be done
minimal/optimal volume
clear instructions and proper cleansing
have pateint void into appropriate container
routine analysis
25-50 mLs (ideally 50)
what is included in a routine analysis
chemical and physical
clean-catch midstream urine specimen:
patient prep
how to collect
what testing can be done
minimal/optimal volume
cleanse hands and urinary opening
urinate about 1/3 into the toilet then collect midstream until sterile container is half way to ¾ of the way full then urinate last portion into toilet
routine analysis, miroscopic analysis, and bacterial cultures
25-50 mLs (ideally 50 mL)
what method prevents contamination from normal bacterial flora near the urethral opening
clean-catch midstream urine specimens
catheterized specimens:
pateint prep
how to collect
what testing can be done
sterile catheter is enserted through urethra into bladder
specimen can be collected at any time from the bag by medical personnel
routine analysis, micrscopic analysis, and culture
suprapubic aspirations:
pateint prep
how to collect
what testing can be done
the abdominal wall and distended bladder is punctured using a needle and syringe
collected by medical personnel via syringe
anaerobic cultures (normally for infants), routine analysis, and microscopic analysis
how long can an unpresevered urine specimen sit until it must be analyzed
2 hours
what can happen to urine if it is not preserved within 2 hours of collection
alteration of solutes (some may metabolize to different forms causing false (+) and (-)
bacterial growth (bacteria multiply quickly esp. if there’s glucose)
solute precipitation (causes turbidity and seeing sediments under microscope becomes hard)
prevent degradation of formed elements in urine (they can dissolve overtime)
temperature changes and light
four most common types of urine preservatives
refridgeration, boric acid, formalin, and thymol
refridgeration advanatages and disadvantages
advantages: most common, easiest, preserves for 24 hours at 4-8 C, can do physical, chemical, microscopic, and culture, inhibits bacteria growth
disadvantages: change in temp causes crystals to precipitate out, increase in amorphus crystal formation
boric acid advanatages and disadvantages
advantages: good for 24-72 hours, can do physical, chemical, microscopic, and culture, amount used depends on how much urine you have
disadvantages: can’t do the pH portion of chemical because it decreases the pH
formalin advanatages and disadvantages
advantages: preserves for microscopic analysis
disadvantages: it is a reducing agent so it interferes with the chemical analysis
thymol advanatages and disadvantages
advantages: used for microscopic analysis
disadvantages: inhibits yeast and bacteria, interfere’s with protein precipitation
when should urine be rejected
unlabeled/mislabeled
wrong collection technique for test ordered
mismatch of specimen name/ID #
imrpoper specimen preservation
contamination
QNS (quanity not sufficient)
pigment responsible for color of urine
urochrome
normla range of colors of urine in a healthy person
light yellow → yellow → dark yellow
pink (or wine) urine is caused by
hgb in RBCs or porphyrin products (breakdown of heme)
red urine is caused by
a lot of hgb, myoglobin, dye in foods/candy, menstruation, fresh bleed
dark amber urine is caused by
increased amounts of bilirubin or biliverdin
brown urine is caused by
hgb in RBCs or myoglobin that have been oxidized from an old wound
black urine is caused by
decomposing RBCs, the conversion of hgb → methgb, alkaptonuria (genetic disease where body can’t breakdown homogenistic acid from the breakdown of amino acids because of missing enzyme), and increased levels of melanin (esp in melanoma)
yellow-green urine is caused by
biliverdin, chlorophyll, and certain UTI’s from Pseudomonas
orange-yellow urine is caused by
urobilin (product of bilirubin metabolism) and phenoazopyrudine (AZO)
other (blue, wine, etc) urine is caused by
food dyes
purpose of the foam test
to see if there’s an increased amount of protein in the urine (if the foam stays then there’s a lot of protein in the urine)
why do we assess urine clarity
can help in diagnosis of different diseases/conditions
normal range of clarity for healthy individual
clear → hazy
what can cuase cloudy/turbid urine specimens
bacteria (UTIs)
cells, casts, and crystals
mucus (protein strands)
yeast
sperm
precipitation of solutes (chemicals)
vaginal, fecal, or skin contamination
medications and x-ray contrast media
what should a normal urine smell like in a healthy individual
faintly aromatic
why would a urine smell like ammonia
due to bacteria (converts urea → ammonia) usually because it’s been unpreserved but can be due to UTI
why would a urine smell sweet or fruity
because of ketones (lipid metabolism converts fats → keto acids) due to diabetes, a keto diet, or starvation
why would a urine smell foul
because of a bad UTI
why would a urine smell like bleach
because it has bleach in it (lol)
why would a urine smell musty
because a perosn has phenylketonuria (PKU) where they lack the enzyme that breaks down phenylalanine so it accumulates and spills into the blood
why would a urine smell like maple syrup
because a person has maple syrup urine disease where a person is missing enzymes needed to break down three amino acids so they accumulate and spill into the urine
why would a urine smell rancid or like rotting fish
because a person has triethylaminuria where they lack the enzymes- needed to breakdown four amino acids so they accumulate and spill into the urine
why would a urine smell like cabbage or sweaty feet
lots of perspiration causing dehydration
why would a urine smell like ionion, asparagus, or garlic
due to eating these foods
osmolality vs specific gravity
osmolality measures the number of particles only
specific gravity measures the number of particles and their weight (expression of density)
normal range of speecific gravity in normal healthy individuals
1.002 to 1.035
principle of preforming specific gravity with a refractometer
it is an indirect measurement of a refractive index of light
as light bends and speeds up/slows down as it bends and is measured
a greater concentration has what angle, velocity, and SG
decreased angle
decreased velocity
increased specific gravity
a diluted concentration has what angle, velocity, and SG
increased angle
increased velocity
decreased specific gravity
what effects the refractive index of a solution
temperature (automatically corrects, 15-30C)
wavelength (automatically set, 589nm)
conc of the solution