Bài giảng Medical Assisting - Chapter 47: Collecting, Processing and Testing Urine Specimens

ChapterPowerPoint® to accompany Second EditionRamutkowski  Booth  Pugh  Thompson  WhickerCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.Medical AssistingChapter 471Objectives47-1 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.47-5 Explain the process of urinary catheterization.Collecting, Processing and Testing Urine Specimens2Objectives (cont.)47-6 List special considerations that may require you to alter guidelines when collecting urine specimens.47-7 Explain how to preserve and store urine specimens.47-8 Explain how to maintain the chain of custody when processing urine specimens.47-8 Explain how to preserve and store urine specimens.Collecting, Processing and Testing Urine Specimens347-9 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.Collecting, Processing and Testing Urine SpecimensObjectives (cont.)4Introduction Routine urine analysisSimple, 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.5Role of the Medical AssistantHelp collect, process, and test urine specimens.You will need to know:Anatomy and physiology of kidneyHow urine is formedNormal urine contents6The 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 tractClick for larger view.7The Urinary SystemUsing the On-Screen Pen draw a line to each of the organs.KidneysRight UreterUrinary bladderUrethraProstate glandLeft UreterLiverAorta8Formation 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 balance9Physical Composition and Chemical Properties Urine 95% water5% waste productsOther dissolved chemicalsUrea, uric acid, ammonia, calcium, creatine, sodium, chloride, potassium, sulfates, phosphates, bicarbonates, hydrogen ions, urochrome, urobilinogen10Apply Your KnowledgeComponents of normal urine include:A - urea, uric acid and ammonia.B - chloride, potassium and sugar.C - red blood cells, sperm and H2O2D - hydrogen ions, urochrome, and uranium.11Apply Your Knowledge -AnswerComponents of normal urine include:A - urea, uric acid and ammonia.B - chloride, potassium and sugar.C - red blood cells, sperm and H2O2D - hydrogen ions, urochrome, and uranium.12Obtaining Specimens General guidelines:Follow the procedureUse the type of specimen container indicated by the labLabel the specimen container before giving it to patientExplain the procedure to patient Wash your hands before and after procedureComplete all necessary paperwork13Specimens Types Varies in method used and in time frame in which to collect specimenTypes of specimens:RandomFirst morningClean catch midstreamTimed24 hour14Specimens Types (cont.)Random – most common, taken anytime of dayFirst morning – has a greater concentration of substances, taken in morningClean catch midstream – genitalia is cleaned, urine is tested for microorganisms or presence of infectionTimed – specific time of day, always discard first specimen before timing24 hour – used for quantitative and qualitative analysis of substances15CatheterizationUrinary catheter – plastic tube inserted to provide urinary drainageCatheterization – procedure during which the catheter is inserted16Catheterization (cont.)Catheterization is used to:Relieve urinary retentionObtain a sterile urine specimenMeasure the amount of residual urine in the bladderObtain urine specimen if patient cannot voidInstill chemotherapyEmpty bladder before and during surgery and before some diagnostic examinations17Catheterization (cont.)Drainage cathetersIndwelling urethral (Foley)Retention catheter in the renal pelvisUreteral catheterDrainage through a wound that leads to a bladder Splinting catheterPlaced to repair ureter and must remain in place for a week18Catheterization (cont.)Not routinely done because can cause infectionSome states do not permit medical assistants to perform catheterizationUsually done in physician's office for diagnostic purposesSpecially prepared catheterization kits have all necessary instruments and supplies.19Apply Your KnowledgeA 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?20Apply Your Knowledge -AnswerCatheterization is used to empty a bladder ifthe 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?21Chain of CustodyYou may need to obtain urine specimens for drug and alcohol analysis for medicolegal mattersIf procedure not followed exactly, you have broken the chain and urine is not admissible.Thoroughly explain procedure and have the patient sign consent form22UrinalysisEvaluation of urine to obtain information about body health and diseaseThree types of testing:PhysicalChemicalMicroscopic23Preservation and StorageChanges that affect the chemical or microscopic properties of urine occur if urine is kept at room temperature for more than 1 hourRefrigeration – most common method for storing and preserving urine It prevents bacterial growth for 24 hours.After 24 hours use chemical preservation24Normal Values of UrineNormal values of various elements have been establishedAverage adult daily urine output is 1250 mL/24 hoursIntake and output should be approximately the same25Physical Examination of UrineVisual examination of physical characteristicsColor and turbidityVolume OdorSpecific gravityThe refractometer or a reagent strip is used to measure specific gravityReagent StripsRefractometer26Chemical Testing of Urine You may be asked to perform chemical tests on urineCheck for proper identification of urine specimenUsually done with reagent strips or tabletsUsed 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 infections27Apply Your KnowledgeWhat is the specific gravity shown on this refractometer screen?28Apply Your Knowledge -AnswerThe specific gravity shown here is 1.030What is the specific gravity shown on this refractometer screen?29Chemicals Found in UrineKetone bodies – may indicate that patient is following a low carbohydrate diet or that patient has conditions such as starvationpH – provides information about metabolic status, diet, medication or several conditionsBlood (hematuria) – may indicate patient is menstruating, have urinary tract infection or trauma30Chemicals Found in Urine (cont.)Bilirubin or urobilinogen – first signs of liver disease Glucose – common in patients with diabetesProtein – usually indicates renal diseaseNitrite – suggests bacterial infectionLeukocytes – urinary or renal infectionPhenylketones – indicates PKU31Microscopic Examination of UrineMicroscopic examination used to view elements not visible without microscopeCentrifuge spins urine to cause heavier substances to settle to the bottomCastsYeastsParasitesCellsCrystalsBacteria32Pregnancy TestsUsed to detect human chorionic gonadotropin (hCG)Secreted by placentaEIA- Enzyme immunoassay test 33Urine Test for STDsCDC recommends that all sexually active females (15 to 25) be screened for ChlamydiaNucleic Acid Amplification Tests (NAATs) have been developedAdvantages – highly specific, non-invasive. Organisms do not have to be aliveDisadvantages – expensive, no living organism remaining for use in follow-up culture34Apply Your KnowledgeA urine analysis has detected that a patient has protein in his urine. Why is this important?35Apply Your Knowledge -AnswerProtein in the urine usually indicates renal diseaseA urine analysis has detected that a patient has protein in his urine. Why is this important?36Summary 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 specimens37End of ChapterEnd of Chapter38