1. 46
Urinalysis
Lesson 1:

2. Lesson Objectives
Upon completion of this lesson, students should be able to …
Define and spell the terms to learn for this chapter.
List nine types of urine specimens that can be collected.
Understand the purpose of routine urinalysis.
Describe the steps for collecting a clean-catch urine specimen.

3. Lesson Objectives Describe the physical components of urine.
Describe the chemical components of urine.
Demonstrate the procedure for glucose testing using tablets.
Demonstrate the procedure for preparing urine for microscopic examination.
Describe some of the cellular and non-cellular elements that might be found during a urine microscopic examination.

4. Lesson Objectives
State normal values for physical and chemical examination of urine.
Demonstrate a method for pregnancy testing.
Discuss quality control as it applies to urinalysis.

5. Overview of Urinalysis
Purpose
Check for presence of disease or infection
Provides information about body functions
Properties of urine examined
Physical
Chemical
Microscopic 5

6. Asepsis Very important in urinalysis Standard precautions Wear gloves
Avoid contacting other surfaces with urine
Wear lab coat and goggles when splashing may occur 6

7. Critical Thinking Question
How does implementing universal precautions relate to asepsis? 7

8. Types of Urinalyses Routine (random) sample
Morning sample (first voided)
Timed specimen
24-hour specimen
2-hour postprandial
Catheterized specimen (sterile specimen)
Clean-catch specimen (sterile specimen)
Pediatric specimen
Suprapubic specimen 8

9. Types of Urinalyses Routine (random) sample
Most commonly collected sample
Collected in a non-sterile container
Collected in office or brought in from home
Provide patient with a specimen container
Used only for routine screenings 9

10. Critical Thinking Question
Why is it better to give a patient the container rather than letting them use one from home? 10

11. Types of Urinalyses Morning sample Most concentrated urine
Collected immediately on arising in morning
Used for:
Pregnancy testing
Urine cultures
Microscopic examinations 11

12. Types of Urinalyses Provide patient with container
Specimen should be brought in within 30 minutes to 1 hour
Refrigerate if examination cannot be done within 2 hours or add preservative (depending on test) 12

13. Types of Urinalyses Timed Specimen
Necessary for quantitative analysis of substances
Used to analyze:
Protein
Creatine
Glucose
Specimens must be obtained at specific time intervals
Typically 24-hour and 2-hour postprandial 13

14. Critical Thinking Question
Why would a glucose test need to be timed? 14

15. Types of Urinalyses 24-hour specimen Ensure clear patient instructions
Specimen must be delivered at once to the lab or physician’s office after collection is complete
Provide patient with container
Collection begins after patient voids for the first time in the morning 15

16. Types of Urinalyses
After flushing first voided urine in the commode, every drop of urine is collected for the next 24 hours, up to and including the first voided specimen of the second morning
Used to:
Determine glomerular filtration rate
Check specific hormone levels
Check for metabolic abnormalities 16

17. Types of Urinalyses 2-hour Postprandial
Collected 2 hours after a meal has been eaten
Used to screen for glucose that may be spilled into the urine once the blood levels exceed the renal threshold
Renal threshold
The concentration at which a substance excreted by the kidneys begins to appear in the urine. 17

18. Types of Urinalyses Catheterized specimen
Used to collect a sterile urine specimen
Collecting from a catheter ensures that it is free of contamination
A nurse or medical assistant will perform this procedure
The urethra and its surrounding tissues are cleaned to create sterile field
A small, sterile tube is inserted through the urethra to the bladder
The urine is collected in the sterile container 18

19. Types of Urinalyses Clean-Catch Specimen Pediatric Specimen
Alternative to catheterization
Used to detect UTIs and other dysfunctions
Patient requires clear instructions
Pediatric Specimen
A good alternative for a pediatric patient is to attach a pediatric urine specimen bag 19

20. Types of Urinalyses Suprapubic Specimen
A suprapubic puncture is performed using a sterile needle and syringe
The resulting urine specimen is sterile
This procedure is performed by a physician
Used for cytology examinations 20

21. General Rules for Collection
Remember!
Test results are only as accurate as the integrity of the collection process!
Typically need at least 10 mL of urine for most tests
Typically store refrigerated if not tested within 2 hours
Check with the lab for instructions on specific tests 21

22. Urinalysis
Stop here and watch the video on urinalysis provided on the textbook DVD. 22

23. Review of the Basics Purpose of urinalysis Properties evaluated
Physical characteristics
Chemical composition
Microscopic elements
Importance of asepsis and standard precautions
Awareness of types of urinalysis and the procedures for each 23

24. Elements of a Routine Urinalysis
Examination of the physical characteristics of urine
Appearance
Color
Odor
Quantity
Specific gravity 24

25. Review of Urine Chemistry
Testing for chemical characteristics: pH
Protein
Glucose
Ketones
Blood
Bilirubin
Urobilirubin
Nitrites
Leukocytes
Methods of testing:
Reagent strips
Clinitest tablets 25

26. Reagent Strips
Used to test for several chemicals as well as specific gravity
Strip is dipped in urine sample
Urine reacts to chemicals on strip
Color changes indicate presence and concentration of substances in urine 26

27. Clinitests
Chemically treated tablets that are added to urine to determine amounts of sugar in urine
Tablets change color according to substances in the urine
Checks for:
Glucose
Acetone
Lactose
Galactose 27

28. Steps for Preparing a Urine Sample for Microscopic Analysis
Perform required physical and chemical tests
Place urine in centrifuge tube and the tube into a centrifuge
Pour off supernatant (the liquid portion of the sample found after it is removed from the centrifuge) 28

29. Steps for Preparing a Urine Sample for Microscopic Analysis
Microscopically analyze the amorphous material (sediment remaining after liquid is removed)
Amorphous material may be stained for certain tests 29

30. Microscopic Analysis Evaluates formed elements in urine Cells Casts
Bacteria
Yeast
Parasites
Spermatozoa
Crystals
Contaminants 30

31. Calculating Formed Elements
Examine under the low power field (lpf)
Locate casts
Scan fields
Note number of cells or casts in each field
Report numerical range of observations
Process is the same at the high power field (hpf) 31

32. Reporting Ranges of Formed Elements
Examples of descriptions of numerical ranges
Descriptive Term
Numerical Range
Occasional
0-3
Few
3-6
Moderate
6-12
Many
12 or more
TNTC
Too numerous to count 32

33. Normal Urine Values
Color: straw, pale yellow, yellow, darker yellow, amber
Appearance: clear, slightly cloudy
Specific gravity:
Odor: aromatic
Reaction/pH:
Protein: negative to trace
Glucose: negative
Ketones: negative
Blood: negative
Nitrites: negative
Bilirubin: negative
Urobilinogen: less than 2 Ehrlich units/dL
Leukocytes: negative 33

34. Questions? 34