chapter 43 urinalysis - pima medical...

Urinalysis

Learning Outcomes

43C H A P T E R

795

Cognitive Domain 1. Spell and define the key terms 2. Describe the methods of urine collection 3. List and explain the physical and chemi-

cal properties of urine 4. List confirmatory tests available and

describe their uses 5. List and describe the components that

can be found in urine sediment and describe their relationships to chemical findings

6. Analyze charts, graphs, and/or tables in the interpretation of health care results

7. Identify disease processes that are indi-cations for CLIA-waived testing

Psychomotor Domain 1. Explain to a patient how and/or assist

a patient to obtain a clean-catch mid-stream urine specimen (Procedure 43-1)

2. Explain the method of obtaining a 24-hour urine collection (Procedure 43-2)

3. Determine color and clarity of urine (Procedure 43-3)

4. Accurately interpret chemical reagent strip reactions (Procedure 43-4)

5. Prepare urine sediment for microscopic examination (Procedure 43-5)

6. Practice standard precautions 7. Perform handwashing 8. Use medical terminology, pronouncing

medical terms correctly, to communicate information

9. Instruct patients according their needs to promote health maintenance and disease prevention

10. Prepare a patient for procedures11. Document patient care12. Respond to issues of confidentiality13. Perform within scope of practice14. Practice within the standard of care for a

medical assistant15. Document accurately in the patient

record16. Perform quality control measures17. Perform urinalysis18. Screen test results19. Perform patient screening using estab-

lished protocols20. Report relevant information to others

succinctly and accurately

Affective Domain 1. Distinguish between normal and abnor-

mal test results 2. Display sensitivity to patient rights and

feelings in collecting specimens 3. Explain the rationale for performance of

a procedure to the patient 4. Show awareness of patients’ concerns

regarding their perceptions related to the procedure being performed

5. Demonstrate empathy in communicating with patients, family, and staff

6. Apply active listening skills 7. Use appropriate body language and other

nonverbal skills in communicating with patients, family, and staff

8. Demonstrate awareness of the territorial boundaries of the person with whom you are communicating

9. Demonstrate sensitivity appropriate to the message being delivered

796 PART IV • The Clinical Laboratory

10. Demonstrate recognition of the patient’s level of understanding in communications

11. Recognize and protect personal bound-aries in communicating with others

12. Demonstrate respect for individual diver-sity, incorporating awareness of one’s own biases in areas including gender, race, religion, age, and economic status

13. Demonstrate awareness of the conse-quences of not working within the legal scope of practice

ABHES Competencies 1. Use standard precautions 2. Screen and follow up patient test results 3. Perform selected CLIA-waived urinalysis

testing that assist with diagnosis and treatment

4. Instruct patients in the collection of a clean-catch, midstream urine specimen

797CHAPTER 43 • Urinalysis

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. What color will be observed on the reagent pad if nitrites are present in urine?

a. Blue

b. Pink

c. Red

d. Yellow

e. Green

2. How many tests are required to prove a positive drug result in a urine sample?

a. One

b. Two

c. Three

d. Four

e. Five

3. Why is a 24-hour collection a better indicator of some values than a random specimen?

a. Some substances are excreted with diurnal variation.

b. Some bacteria do not develop fully for 24 hours.

c. A 24-hour collection gives the physician a more accurate idea of the patient’s diet.

d. The higher the volume of urine tested, the more accurate the result.

e. Some substances are excreted only at night.

4. The most common method of urine collection is:

a. suprapubic aspiration.

b. clean-catch midstream.

c. random specimen.

d. first morning void.

e. postprandial specimen.

5. Which official body approves the drug test used to analyze urine samples?

a. Clinical Laboratory Improvement Amendments

b. Centers for Medicare and Medicaid Services

c. Occupational Safety and Health Administration

d. Food and Drug Administration

e. Drug and Alcohol Testing Industry Association

6. Which of these conditions may cause a patient’s urine to smell sweet?

a. Urinary tract infection

b. Kidney infection

c. Diabetes

d. Dehydration

e. Yeast infection

7. What is the specific gravity of a normal urine specimen?

a. 0.900–1.000

b. 1.001–1.035

c. 1.100–1.135

d. 1.500–1.635

e. 2.000–2.001

8. Why is a urinometer no longer used in a laboratory to test specific gravity?

a. It requires a large volume of urine.

b. It is not as accurate as other equipment.

c. It is too expensive to use frequently.

d. It takes longer to process a sample than other equipment.

e. It takes up too much space in the laboratory.

9. What is the expected pH range for urine?

a. 3.0–6.0

b. 4.0–7.0

c. 5.0–8.0

d. 6.0–9.0

e. 7.0–10.0


10. Increased numbers of epithelial cells in urine may indi-cate that:

a. there is an irritation, such as inflammation, some-where in the urinary system.

b. the patient is overly hydrated.

c. the patient is pregnant.

d. the urine sample has sat for too long before exami-nation.

e. the testing was not performed correctly.

11. Which of the following statements is true about bilirubin?

a. Bilirubin is formed in the kidneys.

b. Bilirubin is a dark red pigment.

c. Bilirubin is present in all urine crystals.

d. Bilirubin will break down with exposure to light.

e. Bilirubin in the urine usually results from a urinary tract infection.

12. Which group of people is most at risk of developing galactosuria?

a. Teenagers

b. Newborns

c. Pregnant women

d. Older adult men

e. Older adult women

13. A patient with uric acid crystals in his or her urine possibly has:

a. leukemia.

b. a urinary tract infection.

c. hepatitis.

d. gout.

e. gallbladder cancer.

14. A patient who has been asked to provide a 24-hour specimen should:

a. void at exactly 24 hours and add it to the specimen.

b. collect urine only after mealtimes.

c. gently shake the container after each specimen is added.

d. drink more water than usual during the collection period.

e. avoid drinking soda or alcohol during the collection period.

15. Which of these should be included on a chain-of-custody document?

a. The results of the urine test

b. The reason for the chain of custody

c. Instructions for providing a specimen

d. The date the specimen was collected or transferred

e. The volume of urine in the specimen

16. Which biological pigment gives urine its color?

a. Melanin

b. Hemoglobin

c. Myoglobin

d. Beta-carotene

e. Urochrome

17. Why is a urine test preferable to a blood test for a routine drug test?

a. It is less invasive and has national standards for testing.

b. It is less expensive.

c. There is less risk of contamination.

d. It requires less equipment.

e. A urine specimen will stay fresh longer than a blood sample.

18. Strenuous physical exercise may cause:

a. increased protein in urine.

b. decreased amounts of epithelial cells.

c. increased quantities of ketones.

d. increased glucose in urine.

e. decreased concentration of phosphates.


19. Cast formation occurs in the:

a. liver.

b. small intestine.

c. bladder.

d. pathways of the digestive tract.

e. tubules of the nephron.

20. Sulfosalicylic acid added to normal urine would cause the urine to:

a. turn orange.

b. remain clear.

c. become cloudy.

d. turn pink.

e. form crystals.

COG MATCHING Grade: ___________

Match each key term with the correct defi nition.

Key Terms Definitions21. ____ acidic pH

22. ____ acidosis

23. ____ albumbin

24. ____ bacteriuria

25. ____ basic pH

26. ____ Benedict reaction

27. ____ bilirubin

28. ____ bilirubinuria

29. ____ chain-of-custody pro-cedure

30. ____ Clinitest

31. ____ conjugated bilirubin

32. ____ diurnal variation

33. ____ glucose oxidase

34. ____ glycosuria

35. ____ gross hematuria

36. ____ hematuria

a. variation during a 24-hour period

b. too much acid in the body

c. nonacidic pH

d. presence of glucose in the urine

e. abnormally high level of glucose

f. most common test for reducing sugars

g. group of chemicals produced during fat and protein metabolism

h. blood in urine

i. large amount of blood in the urine

j. formed during breakdown of hemoglobin

k. one of the proteins that rarely passes through healthy kidneys

l. bilirubin in the urine

m. the written policy for maintaining an accurate written record to track the posses-sion, handling, and location of samples and data from collection through reporting

n. copper reduction test

o. diazo tablet method to detect bilirubin

p. too much ketone in the blood and urine

q. chemical reaction to detect the presence of glucose in the urine

r. type of bilirubin that does dissolve into the bloodstream

s. presence of bacteria in urine

t. pH from 1–6


37. ____ hyperglycemia

38. ____ ictotest

39. ____ ketoacidosis

40. ____ ketones


Match each key term with the correct defi nition.

Key Terms Definitions41. _____ leukocyte esterase

42. _____ lyse

43. _____ microalbumin

44. _____ microhematuria

45. _____ myoglobin

46. _____ neutral pH

47. _____ nitrite

48. _____ nitroprusside

49. _____ phagocytes

50. _____ proteinuria

51. _____ pyuria

52. _____ reducing sugars

53. _____ sediment

54. _____ specific gravity

55. _____ sulfosalicylic acid (SSA)

56. _____ supernatant

57. _____ Tamm-Horsfall mucoprotein

58. _____ threshold

59. _____ turbidity

a. the external opening of the urethra

b. a protein in heart and skeletal muscle

c. cloudiness

d. reflects the ability of the kidney to concentrate or dilute the urine

e. neither an acid or a base

f. the level that must be reached for an effect to be produced

g. reagent test strip

h. sugars including glucose

i. increased amounts of protein in the urine

j. white cells in urine

k. the amount of blood in the urine is so small that the color of the specimen is not affected

l. rupture

m. one of the parts of bilirubin when enzymes break it into parts

n. cells that fight the infection

o. enzyme reaction that detects pyuria

p. tiny bits of albumin

q. reaction is used to detect ketones

r. common confirmation test for protein in urine

s. the button of cells and other particulate matter that collects in the bottom of the tube when centrifuging a urine specimen

t. urine above the sediment when the tube of urine is centrifuged

u. mucoprotein that cements urinary casts together

v. positive test that indicates bacteriuria, which occurs with urinary tract infections


60. _____ urethral meatus

61. _____ urine dipstick

62. _____ urobilinogen


Match each type of specimen collection method with the correct description.

Collection Methods Descriptions

63. _____ Random specimen a. A specimen that is collected two hours after a patient consumes a meal

64. _____ First morning void b. A specimen that is voided into a sterile container after the urinary meatus and surrounding skin have been cleansed

65. _____ Postprandial specimen c. A specimen that is formed over a 6–8 hour period

66. _____ Clean-catch urine specimen d. A specimen voided into a clean, dry container

67. _____ Suprapubic aspiration e. A specimen consisting of all urine voided over a 24-hour period

68. _____ 24-hour collection f. A specimen that is taken directly from the bladder using a needle

COG AFF MATCHING Grade: ___________

Read the descriptions of fi ve of Dr. Philbin’s patients. From your knowledge of chemical and physical properties of urine, match each patient with the correct diagnosis.

Patients Diagnoses

69. _____ Mr. Himmel is a 45-year-old father who is suffering from a stomach upset. His urine sample has a high specific gravity and is a deep yellow color.

a. Urinary tract infection

70. _____ Mrs. Lincoln is a 33-year-old receptionist. Her urine sample is alkaline and contains leukocytes and a small amount of blood.

b. Diabetes mellitus

71. _____ Mr. Ackton is a 60-year-old gardener. His urine sample is dark yellow and contains bilirubin.

c. Dieting until protein break-down

72. _____ Mrs. Franklin is a 75-year-old widow. Her urine sample has a high spe-cific gravity, contains a high level of glucose, and is very acidic.

d. Pregnancy

73. _____ Mrs. Taylor is a 29-year-old surgeon who has little time to exercise. She has a large quantity of protein in her urine.

e. Cirrhosis

74. _____ Ms. Sheffield is a 20 year-old college student. She has a large quantity of ketones in her urine.

f. Dehydration

75. _____ Mrs. Kotizky is a 43 year-old homemaker. Her urine is cloudy with a positive nitrite reaction.

g. Hepatitis

76. _____ Mr. Kubik is a 67-year-old retiree. He has been a heavy drinker for 30 years and has increased his intake of alcohol significantly since retire-ment. His urine has an elevated urobilinogen level.


COG IDENTIFICATION Grade: ___________

List and explain the physical and chemical properties of urine.

PROPERTY EXPLANATION

77.

78.

79.

80.

81.

82.

83.

84.

85.

86.

87.


Match each of the following types of confi rmation tests with its correct description.

Tests Descriptions

88. _____ Copper reduction method a. A test to confirm a protein on the reagent strip

89. _____ Nitroprusside test b. A test that uses a tablet to detect bilirubin

90. _____ Precipitation test c. A test used to detect any reducing sugar

91. _____ Diazo test d. A reaction test used to detect ketones



Match the components that can be found in urine sediment to their related chemical fi ndings (you may use items more than once or not at all).

Components Chemical Findings

92. _____ Red blood cells a. Leukocyte esterase

93. _____ White blood cells b. Blood

94. _____ Bacteria c. pH >7.0

95. _____ Renal epithelial cells d. Protein

96. _____ Calcium oxalate crystals e. Nitrites

97. _____ Casts


As a medical assistant, you’ll probably be asked to assist in the urinalysis procedure. Study the list of tasks below and decide which duties are within the scope of practice for a medical assistant. Place a check in the “Yes” box for tasks you would complete yourself and in the “No” box for tasks that would be completed by another member of the team.

Task Yes No

98. Prepare urine sediment for microscopic examination.

99. Instruct patient on how to provide urine sample.

100. Perform microscopic examination of urine sediment.

101. Ensure that urine is tested or refrigerated within the correct time period.

102. Use suprapubic aspiration to collect a urine sample.

103. Perform confirmatory tests on urine samples.

104. Label specimens for clear identification.

105. Assemble equipment needed for urinalysis procedures.

COG AFF SHORT ANSWER Grade: ___________

106. A patient provides a sample of urine for testing. You know that everyone in the medical office is extremely busy and that it will not get tested for at least three hours. What should you do with the sample?


107. A patient gives a urine sample at 11 AM, and the physician asks you to perform a urinalysis on the specimen. Before you can analyze the sample, there is an emergency situation in the office, and you become distracted. At 2 PM you remember that the specimen has still not been analyzed, and it is in a container that is not refrigerated. What should you do? Explain your answer.

108. A female patient visits the physician’s office and tells you that she thinks she is pregnant. The physician tells her that it is possible to confirm this by from a urine sample. Which collection method would is easiest for you to determine the result? Explain your answer.

109. A severely underweight 15-year-old girl comes into the physician’s office to give a urine sample. The test reveals that there are ketones in the patient’s urine. Explain why this may be the case.

110. A urine sample has tested positive for protein. What procedure would be used to confirm the reagent strip reaction? Explain how the procedure works.


111. During an initial urine test, a specimen tests positive for ketones. The physician asks you to perform a confirmatory test on the specimen to make sure the diagnosis is correct. Explain what you would do to confirm the presence of ketones in urine and what you would expect to happen if the test is positive.

112. You are instructing your female patient how to collect a clean-catch specimen. She says she has diarrhea and is con-cerned about contaminating the specimen. How do you instruct her to collect the specimen? How do you use this information to coach her about her ongoing general health?


COG IDENTIFICATION Grade: ___________

The chain-of-custody process is used to ensure that all urine specimens are identifi able and have not been tampered with. Read the scenarios in the table below and decide whether the correct chain-of-custody patient screening and procedure have taken place. Place a check mark in the appropriate box.

ScenarioCorrect

Procedure UsedPossibility of

Contamination

113. A patient faxes you her identification in advance to save time at the recep-tion desk.

114. A patient enters the bathroom to give a urine sample wearing jeans and a T-shirt.

115. A patient selects his own sealed collection container from the cupboard.

116. A patient empties her pockets and enters the bathroom to give a urine sample while carrying a bottle of water.

117. A patient enters the bathroom to give a urine sample wearing cargo pants, a sweater, and a baseball cap.

118. A patient washes and dries his hands before entering the bathroom to give a urine sample.

119. A patient has forgotten her ID, but an employer representative verifies that she is the correct person.

COG PSY AFF CASE STUDIES Grade: ___________

1. One of your patients needs to provide a 24-hour urine collection. She has never done it before and is unsure how to carry out the procedure. Write the patient a list of instructions, explaining what she should do in order to provide an accurate specimen. Why is it important that the patient thoroughly understands and complies with your instructions?


2. You instruct a patient how to perform a clean-catch midstream urine specimen. When you test the sample, you dis-cover that the urine is cloudy, with a pH level of 7.5, and contains traces of red blood cells, nitrites, and leukocytes. How would you document this information on the patient’s chart?

3. A patient asks you what types of drugs can be detected in urine. Two weeks later, the same patient comes into the office to provide a urine specimen. He appears to be acting suspiciously and you think you see him pick up a bottle before entering the bathroom. What should you do next?

4. Your patient, Sharon, has never collected a clean-catch midstream urine specimen before. As you describe the proce-dure, her facial expressions begin to change, and she becomes aloof. What are the possible reasons for her response? How do you adjust your behavior to support the patient’s understanding of the procedure? How do you demonstrate empathy to this patient?

5. You are the patient at a medical office. The medical assistant greets you as you arrive in the laboratory to collect a spec-imen. The medical assistant is slumped and does not meet your gaze. The radio in the laboratory is blaring music. You ask questions about the collection process, and the medical assistant responds in a murmur. She looks over your head and grins at someone coming up behind you. She interrupts your questions and abruptly repeats the instructions. How does this make you feel? How would you suggest that the medical assistant change her body language? What expected skills is the medical assistant not using? What other coaching instructions would you provide the medical assistant?


6. You call your next patient to give her instructions for collecting a 24-hour urine specimen. She enters the area and tosses her handbag into the phlebotomy chair. What is the patient conveying to you with her body language?

7. Performing a microscopic analysis of a urine specimen is not a CLIA-waived test. You complete a reagent stick analy-sis of the urine with a positive nitrite result. The physician tells you to perform a follow-up microscopic analysis of that urine. Why is he asking you to do this? What is the risk to the practice if you comply with that instruction?

8. In the laboratory, you perform a chemical reagent strip analysis. In the medical office, what should be completed prior to testing patients with this procedure? How do you analyze and respond to this action?

9. The results have come back from the testing laboratory on a drug screen test you collected. The medical assistant working the front office comes to you asking about this patient’s test results. She says the woman babysits her chil-dren after school, and she wants to know if the patient is taking drugs. How do you respond?


PSY PROCEDURE 43-1 Obtaining a Clean-Catch Midstream Urine Specimen

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile urine container labeled with patient’s name, cleansing towelettes (two for males, three for females), gloves if you are to assist patient, hand sanitizer

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with % accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin practicing.)

KEY : 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies.

3. AFF Identify the patient and explain the procedure. Ask for and answer any questions.

4. AFF Demonstrate recognition of the patient’s level of understand-ing communications. Apply active listening skills. Modify communication to the patient’s level of understanding, or obtain assistance with language differences.

Note: Many offi ces prepare illustrated directions that may be helpful if the patient can see and read.

5. If the patient is to perform the procedure, provide the necessary supplies.

6. Have the patient perform the procedure.

a. Instruct the male patient:

(1) If uncircumcised, expose the glans penis by retracting the foreskin, then clean the meatus with an antiseptic wipe. The glans should be cleaned in a circular motion away from the meatus. A new wipe should be used for each cleaning sweep.

(2) Keeping the foreskin retracted, initially void a few seconds into the toilet or urinal.

(3) Bring the sterile container into the urine stream and collect a sufficient amount (about 30–60 mL). Instruct the patient to avoid touching the inside of the container with the penis.

(4) Finish voiding into the toilet or urinal.

b. Instruct the female patient:

(1) Kneel or squat over a bedpan or toilet bowl. Spread the labia minora widely to expose the meatus. Using an antiseptic wipe, cleanse on either side of the meatus, then the meatus itself. Use a wipe only once in a sweep from the anterior to the pos-terior surfaces, then discard it.


(2) Keeping the labia separated, initially void a few seconds into the toilet.

(3) Bring the sterile container into the urine stream and collect a sufficient amount (about 30–60 mL).

(4) Finish voiding into the toilet or bedpan.

7. Cap the filled container and place it in a designated area.

8. Transport the specimen in a biohazard container for testing.

9. Properly care for or dispose of equipment and supplies. Clean the work area. Remove gloves and wash your hands.

CALCULATION

Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date


PSY PROCEDURE 43-2 Obtaining a 24-Hour Urine Specimen


EQUIPMENT/SUPPLIES: Patient’s labeled 24-hour urine container (some patients require more than one container), preservatives required for the specifi c test, chemical hazard labels, graduated cylinder that holds at least 1 L, serologi-cal or volumetric pipettes, clean random urine container, fresh 10% bleach solution, gloves, hand disinfectant, surface disinfectant




1. Wash your hands.

2. Assemble the equipment.

3. Identify the type of 24-hour urine collection requested and check for any special requirements, such as any acid or preservative that should be added. Label the container appropriately.

4. Add to the 24-hour urine container the correct amount of acid or preservative using a serological or volumetric pipette.

5. Use the provided label or make a label with spaces for the patient’s name, beginning time and date, and ending time and date so that the patient can fill in the appropriate information.

6. AFF Demonstrate recognition of the patient’s level of understand-ing communications. Apply active listening skills. Modify communication to the patient’s level of understanding, or obtain assistance with language differences.

Note: Offi ces often prepare written instructions for the patient to take with them. This is helpful with some communication issues. Transla-tions make this tool more versatile.

7. Instruct the patient to collect a 24-hour urine sample as follows:

a. Void into the toilet, and note this time and date as beginning.

b. After the first voiding, collect each voiding and add it to the urine container for the next 24 hours.

c. Precisely 24 hours after beginning collection, empty the bladder even if there is no urge to void and add this final volume of urine to the container.

d. Note on the label the ending time and date.

8. Explain to the patient that, depending on the test requested, the 24-hour urine may have to be refrigerated the entire time. Instruct the patient to return the specimen to you as soon as possible after collection is complete.


9. Record in the patient’s chart that supplies and instructions were given to collect a 24-hour urine specimen and the test that was requested.

10. When you receive the specimen, verify beginning and ending times and dates before the patient leaves. Check for any acids or preserva-tives to be added before the specimen goes to the testing laboratory.

11. Put on gloves.

12. Pour the urine into a cylinder to record the volume. Pour an aliquot of the urine into a clean container to be sent to the laboratory. (Label the specimen with the patient’s identification.) Record the volume of the urine collection and the amount of any acid or preservative added on the sample container and on the laboratory requisition. If permit-ted, you may dispose of the remainder of the urine.

13. Record the volume on the patient’s test requisition and chart.

14. Clean the cylinder with fresh 10% bleach solution, then rinse with water. Let it air dry. If you are using a disposable container, be sure to dispose of it in the proper biohazard container.

15. Clean the work area and dispose of waste properly. Remove protec-tive equipment and wash your hands.Note: Some containers come with the preservative already added. In either case, be sure the patient is instructed not to discard preservative and not to allow it to be handled.Warning! Use caution when handling acids and other hazardous mate-rials. Be familiar with the material safety data sheets for each chemical in your site.

CALCULATION



PASS FAIL COMMENTS:




PSY PROCEDURE 43-3 Determining Color and Clarity of Urine


EQUIPMENT/SUPPLIES: Gloves, impervious gown, 10% bleach solution, patient’s labeled urine specimen, clear tube, usually a centrifuge, white paper scored with black lines, hand disinfectant, surface disinfectant




1. Wash your hands.


3. Put on personal protective equipment.

4. Verify that the names on the specimen container and the report form are the same.

5. Pour about 10 mL of urine into the tube.

6. In bright light against a white background, examine the color. The most common colors are straw (very pale yellow), yellow, dark yel-low, and amber (brown-yellow).

7. Determine clarity. Hold the tube in front of the white paper scored with black lines. If you see the lines clearly (not obscured), record as clear. If you see the lines but they are not well delineated, record as hazy. If you cannot see the lines at all, record as cloudy.

8. Properly care for or dispose of equipment and supplies. Clean the work area using a surface disinfectant. Remove personal protective equipment. Wash your hands.Notes: Rapid determination of color and clarity is necessary because some urine turns cloudy if left standing. Bilirubin, which may be found in urine in certain conditions, breaks down when exposed to light.Protect the specimen from light if urinalysis is ordered but testing is delayed. If further testing is to be done but is delayed more than an hour, refrigerate the specimen to avoid alteration of chemistry.

CALCULATION



PASS FAIL COMMENTS:





PSY PROCEDURE 43-4 Chemical Reagent Strip Analysis


EQUIPMENT/SUPPLIES: Patient’s labeled urine specimen, chemical strip (such as Multistix™ or Chemstrip™), manufacturer’s color comparison chart, stopwatch or timer, personal protective equipment, hand disinfectant, surface disinfectant




1. Wash your hands.




5. Mix the patient’s urine by gently swirling the covered container.

6. Remove the reagent strip from its container and replace the lid to prevent deterioration of strips by humidity.

7. Immerse the reagent strip in the urine completely, then immediately remove it, sliding the edge of the strip along the lip of the container to remove excess urine.

8. Start your stopwatch or timer immediately.

9. Compare the reagent pads to the color chart, determining results at the intervals stated by the manufacturer. Example: Glucose is read at 30 seconds. To determine results, examine that pad 30 seconds post dipping and compare with color chart for glucose.

10. Read all reactions at the times indicated and record the results.

11. Discard the reagent strips in the proper receptacle. Discard urine unless more testing is required.

12. Clean the work area with surface disinfectant. Remove personal pro-tective equipment. Wash your hands.

Warning: Do not remove the desiccant packet in the strip container; it ensures that minimal moisture affects the strips. The desiccant is toxic and should be discarded appropriately after all of the strips have been used.

Notes: The manufacturer’s color comparison chart is assigned a lot number that must match the lot number of the strips used for testing. Record this in the quality assurance (QA/QC) log.


CALCULATION



PASS FAIL COMMENTS:




False-positive and false-negative results are possible. Review the manufacturer’s package insert accompanying the strips to learn about factors that may give false results and how to avoid them.

Aspirin may cause false-positive ketones. Document any medications the patient is taking. If the patient is taking phenazopyridine (Pyrid-ium™), do not use a reagent strip for testing, because the medication will interfere with the color. Outdated materials give inaccurate results. If the expiration date has passed, discard the materials.


PSY PROCEDURE 43-5 Preparing Urine Sediment


EQUIPMENT/SUPPLIES: Patient’s labeled urine specimen, urine centrifuge tubes, transfer pipette, centrifuge (1,500–2,000 rpm), personal protective equipment, hand disinfectant, surface disinfectant




1. Wash your hands.




5. Swirl specimen to mix. Pour 10 mL of well-mixed urine into a labeled centrifuge tube or standard system tube. Cap the tube with a plastic cap or Parafilm.

6. Centrifuge the sample at 1,500 rpm for 5 minutes.

7. When the centrifuge has stopped, remove the tubes. Make sure no tests are to be performed first on the supernatant. Remove the caps and pour off the supernatant, leaving 0.5–1.0 mL of it. Suspend the sediment again by aspirating up and down with a transfer pipette, or follow manufacturer’s directions for a standardized system.

8. Properly care for and dispose of equipment and supplies. Clean the work area with surface disinfectant. Remove personal protective equipment. Wash your hands.

Notes: If the urine is to be tested by chemical reagent strip, perform the dip test before spinning the urine. Preparing a urine specimen of less than 3 mL for sediment is not recommended because that is not enough urine to create a true sediment. However, some patients can-not provide a large amount of urine.

In such cases, document the volume on the chart under sediment to ensure proper interpretation of results. Centrifuge maintenance requires periodic checks to ensure that the speed and timing are correct.

Document this information on the maintenance log.


CALCULATION



PASS FAIL COMMENTS:




chapter 43 urinalysis - pima medical...

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