1. Collecting, Processing, and Testing Urine Specimens
Chapter 47
Collecting, Processing, and Testing Urine Specimens
PowerPoint® presentation to accompany:
Medical Assisting
Third Edition
Booth, Whicker, Wyman, Pugh, Thompson

2. Learning Outcomes
47.1 Describe the characteristics of urine, including its formation, physical composition, and chemical properties.
47.2 Explain how to instruct patients in specimen collection.
47.3 Identify guidelines to follow when collecting urine specimens.
47.4 Describe proper procedures for collecting various urine specimens.

3. Learning Outcomes (cont.)
47.5 Explain the process of urinary catheterization.
47.6 List special considerations that may require you to alter guidelines when collecting urine specimens.
47.7 Explain how to maintain the chain of custody when processing urine specimens.
47.8 Explain how to preserve and store urine specimens.

4. Learning Outcomes (cont.)
47.9 Describe the process of urinalysis and its purpose.
47.10 Identify the physical characteristics present in normal urine specimens.
47.11 Identify the chemicals that may be found in urine specimens.
47.12 Identify the elements categorized and counted as a result of microscopic examination of urine specimens.

5. Introduction Routine analysis of a urine specimen Medical assistant
Noninvasive
Used to diagnose significant conditions
Medical assistant
Learn about types of urine specimens
Instruct or assist patient in collection of a sample
Learn to process urine specimens
Learn about normal / abnormal components of urine

6. Role of the Medical Assistant
Collect, process, and test urine samples
Knowledge necessary
Anatomy and physiology of kidneys
How urine is formed
Normal components of urine

7. Role of the Medical Assistant
Safety
Standard Precautions
PPE as needed
Handle and dispose of specimens properly
Dispose of used supplies and equipment properly
Sanitize, disinfect, and/or sterilize reusable equipment

8. Anatomy and Physiology of the Urinary System
Organs
Kidneys – remove excess water and waste products
Ureters – drain urine into bladder
Bladder – stores urine
Urethra – drains urine to outside of the body

9. Anatomy and Physiology of the Urinary System: Formation of Urine
Nephron
Functional unit of the kidney
Removes end products of metabolism
Allows for reabsorption of water and electrolytes
Maintains normal fluid balance
Processes in urine formation
Glomerular filtration
Tubular reabsorption
Tubular secretion

10. Physical Composition and Chemical Properties of Urine
95% water
5% waste products
Other dissolved chemicals
Urea
Uric acid
Ammonia
Calcium
Creatinine
Sodium
Chloride
Potassium
Sulfates
Phosphates
Hydrogen ions
Urochrome
Urobilinogen
A few RBCs
A few WBCs

11. Apply Your Knowledge Very Good!
What knowledge is needed by the medical assistant related to collecting, processing, and testing urine specimens?
ANSWER: The medical assistant needs to know the anatomy and physiology of the urinary system, how urine is formed, and normal components of urine.
Components of normal urine include
A. urea, uric acid, and ammonia.
B. chloride, potassium, and sugar.
C. red blood cells, sperm, and H2O2
D. hydrogen ions, urochrome, and uranium.
ANSWER:
Very Good!

12. Obtaining Specimens General collection guidelines
Follow the procedure for specified test
Use an appropriate specimen container
Label the specimen container correctly
Explain the procedure to patient
Wash your hands before and after the procedure; wear gloves during the procedure
Complete all necessary paperwork

13. Obtaining Specimens: Types
Quantitative analysis – measures amount of a specific substance in the urine
Qualitative analysis – simply determines if a substance is present in the urine
Types vary in the method used to collect a specimen and in the time frame in which to collect a specimen

14. Obtaining Specimens: Types (cont.)
Random urine specimen
Most common
Obtained any time during the day
First morning specimen
Contains greater concentration of substances
Clean-catch midstream
Used for culturing urine
External genitalia must be cleansed
Discard small amount of urine prior to collecting specimen
Can also obtain by catheterization

15. Obtaining Specimens: Types (cont.)
Timed urine specimen
Discard first specimen
Collect all urine for specified time
Refrigerate
24-hour specimen
Collected as a timed specimen
Both are used for qualitative and quantitative analysis

16. Obtaining Specimens: Catheterization
Urinary catheter – a plastic tube inserted to provide urinary drainage
Catheterization – procedure by which the catheter is inserted

17. Obtaining Specimens: Catheterization (cont.)
Reasons for catheterization
Relieve urinary retention
Obtain a sterile urine specimen
Measure the amount of residual urine
Obtain a specimen if patient cannot void
Instill chemotherapy
Empty bladder before and during procedures

18. Obtaining Specimens: Catheterization (cont.)
Drainage catheters
Indwelling urethral (Foley) catheter – bladder
Retention catheter – renal pelvis
Ureteral catheter – drainage through a wound into the bladder (cystostomy tube)
Straight catheter – bladder
Splinting catheters – inserted after repair of ureter

19. Obtaining Specimens: Catheterization (cont.)
Not a routine procedure due to risk of infection
Not typically performed by medical assistants
Check scope of practice
Assemble supplies – catheterization kits

20. Obtaining Specimens: Special Considerations
Male and female patients
Differences in collecting clean-catch midstream specimen
Questions during history
Pregnant patients
Frequency
Prone to urinary tract infection
Urine checked for glucose and protein

21. Obtaining Specimens: Special Considerations (cont.)
Elderly
Bladder muscles weaken
Uterine supports weaken – pulls on bladder
Loss of bladder control
May need assistance in obtaining a specimen
Repeat explanation as necessary
Pediatric patients
Involve child if possible
Questions
Diaper rash?
Excessively thirsty?
Difficulty urinating?
Cry when urinating?
How many diapers a day?
Change in bladder control?
Problems toilet training?

22. Obtaining Specimens: Chain of Custody
Do not alter established procedure
Positively identify patient
Explain procedure and have patient sign a consent form
Examine specimen and check temperature
Complete documentation

23. Obtaining Specimens: Preservation and Storage
Chemical, physical, and microscopic changes occur if urine is left at room temperature for more than 1 hour
Preservation
Refrigeration
Prevents growth for 24 hours
Return to room temperature before testing
Chemical preservatives
Specimens only

24. Correct! Apply Your Knowledge
A patient has returned to the office and is complaining of not being able to empty her bladder fully after her hysterectomy. The physician has asked you measure the patient’s residual urine. How do you do this and why?
ANSWER: A residual urine is done to measure the amount of urine in the bladder after voiding. You will ask the patient to empty her bladder and then perform a straight catheterization to measure any urine remaining in her bladder.
Correct!

25. Urinalysis
Evaluation of urine to obtain information about body health and disease
Types of testing
Physical
Chemical
Microscopic

26. Urinalysis (cont.) Values
Negative or none, normal, or a range of concentration
Within normal limits indicate health and normality
Screening test – must have follow-up testing

27. Urinalysis (cont.)
Average adult daily urine output is 1250 mL/24 hours
Intake and output should be approximately the same
Dysfunctions of other body systems can affect urinary function

28. Urinalysis: Physical Examination and Testing
Check label
Check for visible contamination
Check time since collection
Visual examination
Color
Volume
Normal
Oliguria
Odor
Specific gravity

29. Urinalysis: Physical Examination and Testing (cont.)
Visual examination
Color / turbidity – pale yellow to dark amber; clear
Volume
Normal range – 600–1800 mL/24 hours
Oliguria – insufficient production of urine
Anuria – absence of urine production

30. Urinalysis: Physical Examination and Testing (cont.)
Odor
Distinct, aromatic
Standing at room temperature – ammonia
Affected by disease and foods
Specific gravity
1.002 to 1.028
Fluctuates in response to fluid intake
Methods
Refractometer
Reagent strips

31. Urinalysis: Chemical Testing
Check label on specimen
Determine the status of
Carbohydrate metabolism
Liver or kidney function
Acid-base balance
Presence of drugs, toxins, or infections
Reagent strip testing
Changes indicate presence of concentration of a substance
Follow instructions carefully

32. Urinalysis: Chemical Testing (cont.)pH
Normal 5.0 to 8.0
Alkaline
UTI
Metabolic / respiratory alkalosis
Acidic
Phenylketonuria
Acidosis
Ketone bodies
Normally none in urine
Presence
Patient on a low-carbohydrate diet
Starvation
Excessive vomiting
Diabetes mellitus

33. Urinalysis: Chemical Testing (cont.)
Glucose
Normally in small amounts
Glycosuria – diabetes
Protein
Excess – renal disease
Proteinuria – common in pregnancy and after heavy exercise
Blood – normally none
Bilirubin – early sign of liver disease
Urobilinogen
Elevated – increased RBC destruction
Lacking – bile duct obstruction

34. Urinalysis: Chemical Testing (cont.)
Phenylketones
Presence indicates PKU – genetic disorder
Blood testing is more routine for newborns
Nitrite – suggests bacterial infection
Leukocytes – urinary tract or renal infection

35. Urinalysis: Chemical Testing (cont.)
Pregnancy test
Detect human chorionic gonadotropin (HCG)
Peak at 8 weeks
Quick, easy to perform and interpret
Enzyme immunoassay (EIA)
Newer technology
Antigen / antibody reaction

36. Urinalysis: Chemical Testing (cont.)
Presence of STDs
Screening for chlamydia – 15- to 25-year-old sexually active females
Nucleic acid amplification tests (NAATs)
Detect nucleic acid in urine
Chlamydia and gonorrhea
Advantage – highly specific, non-invasive
Disadvantage – expensive, no organism remains for culture

37. Urinalysis: Microscopic Examination
View elements only visible with microscope
Centrifuge
Obtain sediment
Spins fluid – heavier substances settle to the bottom of the tubes

38. Urinalysis: Microscopic Examination (cont.)
Cells
Epithelial cells
White blood cells
Red blood cells
Casts
Cylindrical elements
Types
Hyaline
Granular
RBC casts
WBC casts
Epithelial cell casts
Waxy

39. Urinalysis: Microscopic Examination (cont.)
Crystals
Naturally produced solids of definite form
Common in urine
Determine pH before testing
Yeast cells
May be confused with RBCs
Associated with genitourinary tract infection, diabetes

40. Urinalysis: Microscopic Examination (cont.)
Bacteria
A few are normal
Infection if urine also has
Putrid odor
WBCs
Parasites
Infection or contamination
Trichomonas vaginalis – most common

41. Apply Your Knowledge Super!
What is the specific gravity shown on this refractometer screen?
ANSWER: The specific gravity shown here is
Super!

42. Apply Your Knowledge Super!
A urinalysis has detected that a patient has protein in his urine. Why is this important?
ANSWER: Protein in the urine usually indicates renal disease.
Super!

43. In Summary
Characteristics of urine provide information about a patient’s health
Medical assistant
Collects, processes, and tests urine specimens
Must understand the urinary system and characteristics of urine
Assists and instructs patients in specimen collection

44. End of Chapter
End of Chapter 47
A human being: an ingenious assembly of portable plumbing.
~ Christopher Morley,