Chapter 3 Flashcards
(169 cards)
1
Q
caveman drawings & Egyptian hieroglyphics-
A
-color
-turbidity
-odor
-volume
-viscosity
-sweetness
2
Q
5th century BC, Hippocrates wrote-
A
uroscopy books
3
Q
developed in AD 1140-
A
color charts
4
Q
1694, albuminuria determination by-
A
boiling
5
Q
charlatans were also called-
A
pisse prophets
6
Q
charlatans/pisse prophets prompted-
A
the first medical licensure laws
7
Q
invented in 17th century-
A
microscope
8
Q
17th century invention of the microscope led to evaluation of-
A
sediment
9
Q
part of a routine physical in-
A
1827
10
Q
urine contains information, which can be obtained by-
A
inexpensive lab tests to assess many metabolic functions
11
Q
CLSI Urinalysis definition-
A
testing of urine with procedures commonly performed in an expeditious, reliable, safe, & cost effective manner
12
Q
reasons to perform urine test- (4)
A
-aid in disease diagnosis
-screen for asymptomatic diseases
-monitor disease progress
-therapy effectiveness
13
Q
urine formation-
A
ultra filtrate of plasma
14
Q
kidneys convert appx. ____ of filtered plasma-
A
170,000 mL
15
Q
average daily urine output-
A
1,200 mL
16
Q
urine composition-
A
-95% water
-5% solutes
17
Q
solute variations- (4)
A
-diet
-activity
-metabolism
-endocrine functions
18
Q
major organic solute-
A
urea (protein, amino acid breakdown)
19
Q
urea makes up appx.-
A
one half of the dissolved solids
20
Q
inorganic- (3)
A
-chloride
-sodium
- potassium
21
Q
____, _____, ______, & ______ are higher in urine-
A
-creatinine
-urea
-sodium
-chloride
22
Q
urine composition may also containe- (5)
A
-cells
-crystals
-casts
-mucus
-bacteria
23
Q
urine containing cells, casts, crystals, mucus, & bacteria increases-
A
indicative of disease
24
Q
urine volume determined by-
A
body’s state of hydration
25
urine volume is influenced by- (4)
-fluid intake
-nonrenal fluid loss
-antidiuretic hormone variations (ADH)
-excretion of large amounts of dissolved solids (ex. glucose)
26
usual daily urine volume-
1,200 to 1,500 mL
27
normal range of urine volume-
600 - 2,000 mL
28
oliguria-
decrease in urine output
29
oliguria in infants-
<1 mL/kg/h
30
oliguria adults-
<400 mL/day
31
oliguria in children-
<0.5 mL/kg/h
32
nocturia-
-increased urine excretion at night
-normally 2 or 3 times more excretion in the day
33
polyuria in adults-
>2.5 L/day
34
polyuria in children-
>2.5 - 3 mL/kg/day
35
polyuria in diabetes mellitus has an increased volume caused by-
need to excrete the excess glucose not reabsorbed from the ultra filtrate
36
patients with polyuria in diabetes mellitus exhibit-
polydipsia
37
urine with diabetes mellitus appears-
dilute with a high specific gravity
38
polyuria in diabetes insipidus has a decreased production/function of-
antidiuretic hormone (ADH) causing decreased reabsorption of water from ultrafiltrate
39
polyuria in diabetes insipidus urine appears-
dilute with low specific gravity
40
patients with polyuria in diabetes insipidus exhibit-
polydipsia
41
recommended containers for urine-
disposable, wide-mouthed, & flat-bottom containers with screw caps
42
container capacity for specimen collection-
clear containers/50 mL
43
clear containers with at least 50 mL capacity facilitates-
automated analysis
44
minimum amount of urine for analysis-
12 mL
45
allows for sterile transfer of urine into tubes-
BD Vacutainer Urine Transfer Straw
46
info on specimen labels- (3)
-patients name
-ID number
-date
-time
-age
-location
-healthcare provider's name
47
specimen label placement-
on container, NOT lid
48
requisition form (manual/computerized) must accompany-
specimen
49
requisition form (manual/computerized) info must match-
the label
50
stamped on requisition form (manual/computerized)-
time of receipt
51
other info available on requisition form (manual/computerized)-
-type of specimen
-interfering medication
52
reasons to reject specimen- (9)
-in unlabeled containers
-nonmatching labels & requisition forms
-contaminated with feces or toilet paper
-containers with contaminated exteriors
-insuffficient quantity
-improperly transported
-preserved incorrectly
-not collected in sterile containers
-inappropriate collection for type of test needed
53
labs must have what for rejection of specimens-
written policies
54
changes in urine composition take place in- (2)
-vivo
-vitro
55
changes in urine composition tests taken within-
2 hours of collection
56
proper placement if testing for changes in urine composition is delayed-
refrigerate or chemically preserve
57
most problems in change of urine composition are caused by-
bacterial growth
58
color change by modified/darkened in urine is caused by-
oxidation or reduction of matabolites
59
if clarity is decreased in urine it is caused by-
bacterial growth & precipitation of amorphous material
60
odor increase in urine is caused by-
bacterial multiplication causing breakdown of urea to ammonia
61
pH increase in urine is caused by-
breakdown of urea to ammonia by urease-producing bacteria/loss of CO2
62
glucose decrease in urine is caused by-
glycolysis & bacterial use
63
ketones decreased in urine is caused by-
violatilization & bacterial metabolism
64
bilirubin decrease in urine is caused by-
exposure to light/photooxidation to biliverdin
65
urobilinogen decrease in urine is caused by-
oxidation to urobilin
66
nitrite increase in urine is caused by-
multiplication of nitrate-reducing bacteria
67
RBCs, WBCs, & casts decrease in urine is caused by-
disintegration in dilute alkaline urine
68
bacteria increase in urine is caused by-
multiplication
69
trichomonads decrease in urine is caused by-
loss of motility, death
70
routine specimen preservation is refrigerated at-
2 - 8 degrees C
71
routine specimen preservation is refrigerated at 2 - 8 degrees C because-
decreases bacterial growth & metabolism (must be returned to room temp. for chemical testing)
72
chemical specimen preservation ideal is-
bactericidal: inhibits urease & preserves formed elements (should not interfere with chemical tests)
73
appropriate specimen preservation must be used when-
transporting specimen to another lab
74
refrigeration preservation advantages-
does not interfere with chemical tests
75
boric acid preservation advantages-
prevents bacterial growth & metabolism
76
formaline preservation advantages-
excellent sediment preservative
77
refrigeration preservation disadvantages-
precipitates amorphous phosphates & urates
78
boric acid preservation disadvantages-
interferes with drug & hormone analyses
79
formalin preservation disadvantages-
acts as a reducing agent, interfering with chemical tests for glucose, blood, leukocyte esterase, & copper reduction
80
refrigeration preservation additional info-
prevents bacterial growth for 24 hours
81
boric acid preservation additional info-
-keeps pH about 6.0
-can be used for urine culture transport
82
formalin preservation additional info-
rinse specimen container with formalin to preserve cells & casts
83
sodium fluoride preservation advantages-
good preservative for drug analyses
84
commercial preservative tablets preservation advantages-
-convenient when refrigeration not possible
-have controlled concentration to minimize interference
85
urine collection kits (becton Dickinson, Rutherford, NJ) preservation advantages-
contains collection cup, transfer straw, C&S preservative tube or UA tube
86
sodium fluoride preservation disadvantages-
inhibits reagent strip tests for glucose, blood, & leukocytes
87
commercial preservation tablets preservation disadvantages-
check tablet composition to determine possible effects on desired tests
88
Light gray & gray C&S tube preservation advantages-
-sample stable at room temp for 48 hours
-prevents bacterial growth & metabolism
89
yellow UA Plus tube preservation advantages-
use on automated insturments
90
light gray & gray C&S tube preservation disadvantages-
do not use if urine is below minimum fill line
91
yellow UA plus tube preservation disadvantages-
must refrigerate within 2 hours
92
light gray & gray C&S tube preservation additional info-
-preservative is boric acid, sodium borate, & sodium formate
-keeps pH at about 6.0
93
yellow UA plus tube preservation additional info-
-round or cortical bottom, no preservative
-preservative is sodium
94
cherry red/yellow preservative plus tube preservation advantages-
-specimen stable for 72 hrs at RT
-instrument compatible
95
cherry red/yellow preservative plus tube disadvantages-
-must be filled to minimum fill line
-bilirubin & urobilinogen may be decreased if specimen is exposed to light & left at RT
96
Cherry red/yellow preservative plus tube preservation additional info-
-preservative is sodium propionate ethyl paraben & chlorhexidine
-round or conical bottoms
97
composition of urine depends on-
patient's metabolic state
98
specimen conditions may include-
time, length, & method of collection & patient's dietary intake & medicine intake
99
patients must be instructed when special techniques are-
required
100
most common type of specimen received-
random specimen
101
when is a random specimen collected-
at any time
102
random specimen has routine screenings for-
obvious abnormalities
103
random specimen collection times must be-
recorded
104
dietary intake & physical activity for a random specimen may-
alter results
105
for a random specimen, patients may have to collect an additional specimen under-
controlled conditions
106
for ideal screening first morning specimens, the patient is-
in a basal state
107
first morning specimens are used for-
orthostatic protein confirmation & urine pregnancy tests
108
first morning specimens are more concentrated than-
a random specimen
109
patients collect first morning specimens-
immediately among arising & delivers to the lab within 2 hours
110
alternative placement to first morning specimens-
refrigeration
111
glucose tolerance specimens are collected at the same time as-
blood samples
112
glucose tolerance testing include fasting periods-
1 hour, 2 hour, 3 hour, & sometimes 4 hour, 5 hour, & 6 hour specimens
113
glucose tolerance specimen results are correlated with-
renal threshold for glucose
114
carefully timed 24-hour specimens will produce-
accurate quantitative results
115
24 hour timed specimens are good for-
diurnal variation solutes
116
diurnal variation solutes include- (3)
-catecholamines
-17 hydroxysteroids
-electrolytes
117
for 24 hour timed specimens, the patient must remain-
adequately hydrated during short collection periods
118
for 24 hour timed specimens, the patient must be instructed-
on the procedure for collecting a timed specimen
119
during a 24 hour timed specimen, concentration of a substance in a particular period must be-
calculated from the urine volume produced during that time
120
24 hour specimens must be-
thoroughly mixed & the volume accurately measured & recorded
121
in 24 hour specimens, multiple containers of the same collection must be-
combined & mixed thoroughly
122
24 hour timed specimens should be kept-
refrigerated or kept on ice during the collection period
123
24 hour timed specimen additives should not-
interfere with the tests to be performed
124
common errors associated with timed urine collections- (5)
-loss of urine specimen
-inclusion of two first morning specimens
-inaccurate measurement of total urine volume
-inadequate urine preservation
-transcription error
125
sterile catheterized specimens are collected from the bladder with-
a hollow tube (catheter)
126
most common tests for catheterized specimens-
bacterial culture
127
opposed to catheterized specimens, midstream clean-catch specimens are-
safer & less traumatic
127
midstream clean-catch specimens are an alternative to-
catheterized specimens
128
midstream clean-catch specimens are less contaminated than-
routine collection
129
during midstream clean-catch tests, provide patients with-
-mild antiseptic towelettes
-sterile container
-instructions
130
during midstream clean-catch tests ______ shouldn't be used-
strong bacterial cleansing agents
131
patient instructions for midstream clean-catch tests- (8)
-wash hands
-remove lid from sterile container without touching the insides
-females will separate the skin folds apart & begin to void into the toilet
-males will cleanse the tip of the penis with antiseptic towelette & let dry. retract the foreskin if uncircumcised
-males will void into the toilet & hold back the foreskin if necessary
-bring the urine container into the middle stream of urine & collect an adequate amount of urine, do not touch the inside of the container or allow the container to touch the genital area
-finish voiding into the toilet
-cover the specimen with the lid, touch only the outside of the lid & container
132
for midstream clean-catch tests, confirm the container is-
labeled correctly with the patient's first & last name, time of collection, & place it in the specified area or follow facility policy
133
suprapubic aspiration is completely free of-
extraneous contamination for culture & cytology
134
suprapubic aspiration has external introduction of needle for-
aspiration from the bladder
135
prostatitis collection is similar to-
midstream clean-catch
136
prostatitis 3 glass collection container 1-
first urine passed in sterile container
137
prostatitis 3 glass collection container 2-
-midstream urine in sterile container
-massage prostate to obtain prostatic fluid
138
prostatitis 3 glass collection container 3-
remaining urine & fluid in sterile container
139
prostatitis 3 glass collection quantitative cultures on all 3 specimens-
examine 1 & 3 microscopically
140
prostatic infection-
-higher WBC/hps count in specimen 1
-bacterial count in specimen 3 is 10 times higher than specimen 1
141
prostatitis specimen 2 is a control for-
bladder or kidney infection
142
positive culture in prostatitis specimen 2 invades-
positive culture in specimen 3 (cannot differentiate urinary tract infection from prostate infection)
143
pre- & post- massage prostatitis specimen 1 test-
midstream clean catch specimen
144
pre- & post- massage prostatitis specimen 2-
post- massage specimen
145
positive result is significant in the prostatitis post massage specimen of-
>10 times the pre massage count
146
Stanmey-Mears tests include exams of-
4 urine specimens
147
first urine prostatitis specimen is-
voided bladder (VB1) & represents the urethral specimen
148
second urine prostatitis specimen is-
voided bladder 2 (VB2) & represents the bladder specimen
149
third urine prostatitis specimen is-
expressed prostatic specimen (EPS)
150
fourth urine prostatitis specimen is-
voided bladder (BV3) collected after EPS
151
10 mL of urine for a prostatitis specimen is used for-
both the first & second specimens
152
all 4 prostatitis specimens are sent for-
culture
153
after centrifugation for prostatitis specimens, the sediment is examined for- (4)
-WBC/aggregates & macrophages
-oval fat bodies
-bacteria
-fungal hypha
154
urethral infection or inflammation is tested for by-
VB1
155
urinary bladder infection is tested for by-
VB2
156
prostatic secretions are-
cultured & examined for WBC
157
___-____ WBC is considered abnormal-
10-20
158
pediatric specimen collection process- (5)
-soft, clear, plastic bags with hypoallergenic tape applied to the genital area
-diaper is placed over the collection bag
-check the bag every 15 minutes
-remove bag after specimen has been collected
-label the bag or collection container
159
during drug specimen collection, what needs to be documented?
proper collection, labeling, & handling
160
chain of custody-
documentation from the time of specimen collection until the time of receipt of lab results
161
drug specimen standardized form always-
accompanies specimen
162
drug specimens must withstand-
legal scrutiny
163
drug specimen collection points to consider- (2)
-photo ID of urine donor or ID by employer
-no unauthorized access to specimen
164
witnessed versus unwitnessed drug specimen collection- (2)
-determined by test orderer
-both specimens must be handed immediately to collector
165
adulteration tests temp taken-
-within 4 minutes
-32.5 - 37.7 degrees C
166
drug specimen adulteration tests report temperatures-
outside of range immediately & collect another specimen ASAP
167
drug specimen adulteration tests inspect urine color for-
anything unusual
168
drug specimen collection follow lab instructions for-
labeling, packaging, & transport
