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What are the basic observations used to give diagnostic information?
color, turbidity, odor, volume, viscosity, sweetness)
Uroscopy
the visual examination of urine
What are pre-examination variables?
specimen collection, handling, storage
Examination variables:
reagent and test performance, instrument, personnel and competency
Post-examination variables:
reporting of results and interpretation
3 qualities a urinalysis procedure manual must be/have:
- contain all procedures performed in this section of the lab
-comply w/ CLSI guidelines
-any changes must be taught/reviewed by performing staff
QA
overall process of guaranteeing quality in pt care and regulates throughout the whole system
What needs to bee on the requisition form?
-date/time of collection and recieved
-refrigeration
-tests requested
-special instructions
-patient identifiers
Why would a doctor order testing on a urine sample (advantages)?
-readily available and easy to collect
-contains diagnostic info (metabolic function)
Current methods of urine testing
-physical
-chemical
-microscopic
-confirmatory
Urine formation:
continuously formed by the kidneys as an ultra filtrate of plasma
What is the normal urine output and how much plasma is filtered daily?
urine output: 1200 to 1500 mL/day
plasma filtered: 170,000 mL
Urine composition:
-depends on diet, activity, metabolism
-95% water + 5% solutes
What solutes can be found in urine?
urea, creatinine, uric acid, and inorganic Cl and Na (also hormones, vitamins, and meds)
What would you check in a suspicious urine sample?
urea and creatinine
Oliguria
decreased urine output (dehydration)
Anuria
cessation of urine flow (possible damage to kidneys)
Nocturia
increased urination at night
polyuria
increased urine output (diabetes and diuretics)
Polydipsia
increased ingestion of water
Diabetes Mellitus
-dec insulin production
-HIGH specific gravity, increased glucose
Diabetes Insipidus
-dec in ADH
-LOW specific gravity
What factors can be considered when testing sample integrity?
-within 2 hours of collection
-increased bacteria, nitrite, odor, or pH
-decreased cells, casts, glucose, ketones, bilirubin, urobilinogen
What is the ideal temperature to store urine specimens?
2-8 degrees C (must return to room temp before testing)
Specimen rejection criteria
-unlabeled container
-label/requisition don't match
-contamination w/ feces or tp
-containers are contaminated on the outside
-QNS
-improper transport/handling
What is the ideal preservative for urine samples?
bactericidal (inhibits urease and preserves formed elements in the sediment)
purpose of Random specimen
routine testing
purpose of First morning (concentrated urine)
routine testing, pregnancy tests, and orthostatic protein
Purpose of 24 hour urine
quantitative chemical tests
Purpose of catheterized specimen
bacterial culture, or Drugs of Abuse on adolescents who are unwilling or unconscious)
Midstream clean-catch purpose
routine testing or bacterial cultures
Purpose of suprapubic aspiration
bladder urine for bacterial cultures, cytology
purpose of three and four glass collection
prostatic infection
Chain of custody
documentation from the time of specimen collection until the time of receipt of lab results
Points to consider when collecting a drug specimen
-photo ID of urine donor
-no unauthorized access to specimen
-no adulteration, subs, or dilution of specimen
-chain of custody
Witnessed vs. unwitnessed collection
-witness must be the same gender
-determined by test ordered
-both specimens must be handed immediately to collector
Adulteration tests
- temp taken within 4 minutes
- must be 32.5 - 37.7 C
- report temperatures outside range
- inspect urine color for anything unusual