2. 1 PowerPoint ® to accompany Second Edition Ramutkowski  Booth  Pugh  Thompson  Whicker Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Medical Assisting Chapter 47

3. 2 Objectives 47-1Describe the characteristics of urine, including its formation, physical composition, and chemical properties. 47-2Explain how to instruct patients in specimen collection. 47-3Identify guidelines to follow when collecting urine specimens. 47-5Explain the process of urinary catheterization. Collecting, Processing and Testing Urine Specimens

4. 3 Objectives (cont.) 47-6List special considerations that may require you to alter guidelines when collecting urine specimens. 47-7Explain how to preserve and store urine specimens. 47-8Explain how to maintain the chain of custody when processing urine specimens. 47-8Explain how to preserve and store urine specimens. Collecting, Processing and Testing Urine Specimens

5. 4 47-9Describe the process of urinalysis and its purpose. 47-10Identify the physical characteristics present in normal urine specimens. 47-11Identify the chemicals that may be found in urine specimens. 47-12Identify the elements categorized and counted as a result of microscopic examination of urine specimens. Collecting, Processing and Testing Urine Specimens Objectives (cont.)

6. 5 Introduction Routine urine analysis  Simple, non-invasive diagnostic test provides a window to the patient’s health. You will learn how to correctly process a specimen, including a random specimen and chain of custody drug screen. You will learn about various types of urine specimens and how to properly instruct or assist patients with collection of these specimens.

7. 6 Role of the Medical Assistant Help collect, process, and test urine specimens. You will need to know:  Anatomy and physiology of kidney  How urine is formed  Normal urine contents

8. 7 The Urinary System Organs of the urinary system:  Kidneys  Ureters  Urinary bladder  Urethra Kidney function - removes waste products from the blood stream and excess water Urinary bladder stores urine, and ureters, bladder and urethra make up the urinary tract Click for larger view.

9. 8 The Urinary System Using the On-Screen Pen draw a line to each of the organs. Kidneys Right Ureter Urinary bladder Urethra Prostate gland Left Ureter Liver Aorta

10. 9 Formation of Urine Three processes of urine formation:  glomerular filtration  tubular reabsorption  tubular secretion The nephron:  allows for reabsorption of water and electrolytes  plays a vital role in maintaining normal fluid balance

11. 10 Physical Composition and Chemical Properties Urine  95% water  5% waste products  Other dissolved chemicals Urea, uric acid, ammonia, calcium, creatine, sodium, chloride, potassium, sulfates, phosphates, bicarbonates, hydrogen ions, urochrome, urobilinogen

12. 11 Apply Your Knowledge Components of normal urine include: A A - urea, uric acid and ammonia. B B - chloride, potassium and sugar. C - C - red blood cells, sperm and H 2 O 2 D D - hydrogen ions, urochrome, and uranium.

13. 12 Answer Apply Your Knowledge - Answer Components of normal urine include: A - urea, uric acid and ammonia. B - chloride, potassium and sugar. C - red blood cells, sperm and H 2 O 2 D - hydrogen ions, urochrome, and uranium.

14. 13 Obtaining Specimens General guidelines:  Follow the procedure  Use the type of specimen container indicated by the lab  Label the specimen container before giving it to patient  Explain the procedure to patient  Wash your hands before and after procedure  Complete all necessary paperwork

15. 14 Specimens Types Varies in method used and in time frame in which to collect specimen Types of specimens:  Random  First morning  Clean catch midstream  Timed  24 hour

16. 15 Specimens Types (cont.)  Random – most common, taken anytime of day  First morning – has a greater concentration of substances, taken in morning  Clean catch midstream – genitalia is cleaned, urine is tested for microorganisms or presence of infection  Timed – specific time of day, always discard first specimen before timing  24 hour – used for quantitative and qualitative analysis of substances

17. 16 Catheterization  Urinary catheter  Urinary catheter – plastic tube inserted to provide urinary drainage  Catheterization  Catheterization – procedure during which the catheter is inserted

18. 17 Catheterization (cont.)  Catheterization is used to:  Relieve urinary retention  Obtain a sterile urine specimen  Measure the amount of residual urine in the bladder  Obtain urine specimen if patient cannot void  Instill chemotherapy  Empty bladder before and during surgery and before some diagnostic examinations

19. 18 Catheterization (cont.)  Drainage catheters  Indwelling urethral (Foley)  Retention catheter in the renal pelvis  Ureteral catheter  Drainage through a wound that leads to a bladder  Splinting catheter  Placed to repair ureter and must remain in place for a week

20. 19 Catheterization (cont.)  Not routinely done because can cause infection  Some states do not permit medical assistants to perform catheterization  Usually done in physician's office for diagnostic purposes  Specially prepared catheterization kits have all necessary instruments and supplies.

21. 20 Apply Your Knowledge A patient has returned to the office and is complaining of not being able to empty her bladder after her hysterectomy. The physician has asked you do a catheterization of her bladder. Why?

22. 21 Answer Apply Your Knowledge - Answer Catheterization is used to empty a bladder if the patient is unable to do so. A patient has returned to the office and is complaining of not being able to empty her bladder after her hysterectomy. The physician has asked you do a catheterization of her bladder. Why?

23. 22 Chain of Custody  You may need to obtain urine specimens for drug and alcohol analysis for medicolegal matters  If procedure not followed exactly, you have broken the chain and urine is not admissible.  Thoroughly explain procedure and have the patient sign consent form

24. 23 Urinalysis Evaluation of urine to obtain information about body health and disease Three types of testing:  Physical  Chemical  Microscopic

25. 24 Preservation and Storage Changes that affect the chemical or microscopic properties of urine occur if urine is kept at room temperature for more than 1 hour Refrigeration – most common method for storing and preserving urine It prevents bacterial growth for 24 hours. After 24 hours use chemical preservation

26. 25 Normal Values of Urine  Normal values of various elements have been established  Average adult daily urine output is 1250 mL/24 hours  Intake and output should be approximately the same

27. 26 Physical Examination of Urine Visual examination of physical characteristics  Color and turbidity  Volume  Odor  Specific gravity  The refractometer or a reagent strip is used to measure specific gravity Reagent Strips Refractometer

28. 27 Chemical Testing of Urine  You may be asked to perform chemical tests on urine  Check for proper identification of urine specimen  Usually done with reagent strips or tablets  Used to determine body processes such as carbohydrate metabolism, liver or kidney function or acid-base balance.  Used to determine presence of drug, toxic environmental substances or infections

29. 28 Apply Your Knowledge What is the specific gravity shown on this refractometer screen?

30. 29 Answer Apply Your Knowledge - Answer The specific gravity shown here is 1.030 What is the specific gravity shown on this refractometer screen?

31. 30 Chemicals Found in Urine  Ketone bodies  Ketone bodies – may indicate that patient is following a low carbohydrate diet or that patient has conditions such as starvation  pH  pH – provides information about metabolic status, diet, medication or several conditions  Blood (hematuria)  Blood (hematuria) – may indicate patient is menstruating, have urinary tract infection or trauma

32. 31 Chemicals Found in Urine (cont.) Bilirubin or urobilinogen Bilirubin or urobilinogen – first signs of liver disease Glucose Glucose – common in patients with diabetes Protein Protein – usually indicates renal disease Nitrite Nitrite – suggests bacterial infection Leukocytes Leukocytes – urinary or renal infection Phenylketones Phenylketones – indicates PKU

33. 32 Microscopic Examination of Urine  Microscopic examination used to view elements not visible without microscope  Centrifuge spins urine to cause heavier substances to settle to the bottom Casts Yeasts Parasites Cells Crystals Bacteria

34. 33 Pregnancy Tests  Used to detect human chorionic gonadotropin (hCG)  Secreted by placenta  EIA- Enzyme immunoassay test

35. 34 Urine Test for STDs  CDC recommends that all sexually active females (15 to 25) be screened for Chlamydia  Nucleic Acid Amplification Tests (NAATs) have been developed  Advantages – highly specific, non-invasive. Organisms do not have to be alive  Disadvantages – expensive, no living organism remaining for use in follow-up culture

36. 35 Apply Your Knowledge A urine analysis has detected that a patient has protein in his urine. Why is this important?

37. 36 Answer Apply Your Knowledge - Answer Protein in the urine usually indicates renal disease A urine analysis has detected that a patient has protein in his urine. Why is this important?

38. 37 Summary Medical Assistant The volume and physical, chemical and microscopic characteristics of urine provide a great deal of information about a patient’s health You will have a substantial role in collecting, processing and testing urine specimens

39. 38 End of Chapter