CHAPTER 3: INTRO TO URINALYSIS Flashcards
1
Q
References to the study of urine can be found in the drawings of
A
Cavemen and in Egyptian hieroglyphics, such
as the Edwin Smith Surgical Papyrus.
2
Q
Although ancient physicians
lacked the sophisticated testing mechanisms now available,
they were able to obtain diagnostic information from such
basic observations as:
A
- Color
- Turbidity
- Color
- Volume
- Viscosity
- Sweetness (by noting that certain specimens attracted ants or tasted sweet)
3
Q
During the ___________, physicians concentrated their efforts very
intensively on the art of uroscopy, receiving instruction in urine examination as part of their training
A
Middle Ages;
3
Q
Wrote a book on “uroscopy” in the 5th Century
A
Hippocrates
3
Q
In _____, Chemical testing progressed from “ant testing” and “taste testing” for glucose to __________ discovery of ___________ by boiling urine
A
1694; Frederik Dekkers’s; albuminuria
3
Q
By _________, color charts had been developed that described the significance of 20 different colors
A
1140 CE
3
Q
The credibility of urinalysis became compromised when
these charlatans without medical credentials began offering their predictions to the public for a healthy fee
A
Pisse Prophets
4
Q
“Pisse Prophets,” became the subject of a book published by?
A
Thomas Bryant in 1627
4
Q
The revelations in this book inspired the passing of the first medical licensure laws in England another contribution of urinalysis to the field of medicine
A
Thomas Bryant’s book
5
Q
He introduced the concept of urinalysis as part of a doctor’s routine patient examination in 1827
A
Richard Bright
5
Q
By the _____, however, the number and complexity of the tests performed in a urinalysis had reached a point of impracticality, and urinalysis began to disappear from routine examinations.
A
1930s
5
Q
The invention of the microscope in the _______ led to the examination of urinary sediment and the development by ______________ of methods for quantitating the microscopic
sediment
A
17th century; Thomas Addis
6
Q
Two unique characteristics of a urine specimen account
for this continued popularity:
A
- A urine specimen is readily available and easily
collected. - Urine contains information, which can be obtained by
inexpensive laboratory tests, about many of the body’s
major metabolic functions.
7
Q
The kidneys continuously form urine as an?
A
ultrafiltrate of plasma
8
Q
Reabsorption of water and filtered substances essential
to body function converts approximately __________ of
filtered plasma to the average daily urine output of ________,
depending on fluid intake.
A
170,000 mL; 1200 mL
9
Q
Urine is normally 95%
_____ and 5% _______,
A
water; solutes
10
Q
Factors that influence the variations in the concentrations of solutes in urine
A
- Dietary intake
- Physical activity,
- Body metabolism, and
- Endocrine function
11
Q
A metabolic waste product produced in the liver from the breakdown of protein and amino acids
A
Urea
12
Q
This accounts for nearly half of the total dissolved solids in urine
A
Urea
12
Q
The major inorganic solid dissolved in urine is
A
Chloride
13
Q
Inorganic components in urine (in order)
A
- Chloride
- Sodium
- Potassium
- Phosphate
- Ammonium
- Calcium
14
Q
This greatly influences the concentrations of these inorganic compounds, making it difficult to establish normal levels
A
Dietary intake
15
Q
Organic components in urine (in order)
A
- Urea
- Creatinine
- Uric Acid
16
Q
Other substances found in urine include:
A
hormones, vitamins, and medications
17
Used to determine whether a fluid is a urine
The specimen can be tested for urea and creatinine content.
18
Both these substances are present in much higher concentrations in urine than in other body fluids, a fluid that is high in content of these can be identified as urine.
urea and creatinine
18
A decrease in urine output
Oliguria
19
Seen commonly when the body enters a state of dehydration as a result of excessive water loss
from vomiting, diarrhea, perspiration, or severe burns.
Oliguria
20
In Oliguria, how much decrease in urine output in:
- Infants
- Children
- Adults
- Infants: less than 1 mL/kg/hr
- Children: less than 0.5 mL/kg/hr in children
- Adults: less than 400 mL/day
20
This may result from any serious damage to the kidneys or from a
decrease in the flow of blood to the kidneys.
Anuria
20
Cessation of urine flow,
Anuria
21
The kidneys excrete ________more urine during the day than during the night
two to three times
22
An increase in the nocturnal excretion of urine is termed
nocturia
23
An increase in daily urine volume
Polyuria
24
Often associated with diabetes mellitus and diabetes insipidus
Polyuria
25
Polyuria may be induced artificially by:
- Diuretics
- Caffeine
- Alcohol
All of which suppress the secretion of ADH
26
In Polyuria, how much increase in urine output in:
- Children
- Adults
- Children: 2.5 to 3 mL/kg/day
- Adults: greater than 2.5 L/day
27
Primary organic component. Product of metabolism of protein and amino acids
Urea
28
Product of metabolism of creatine by muscles
Creatinine
29
Product of breakdown of nucleic acid in food and cells
Uric acid
30
Primary inorganic component. Found in combination with sodium (table salt) and many other inorganic substances
Chloride
30
Regulates blood and tissue fluid acidity
Ammonium
30
Combines with chloride, sulfate, and phosphate
Calcium
31
Primarily from salt, varies by intake
Sodium
32
Combined with chloride and other salts
Potassium
32
Combines with sodium to **buffer** the blood
Phosphate
33
Caused by a *defect* either in the **pancreatic production of insulin** or in the **function of insulin**, which results in an increased concentration of body glucose
Diabetes mellitus
*The kidneys do not reabsorb
excess glucose, necessitating the excretion of increased amounts
of water to remove the dissolved glucose from the body*
34
Results from a decrease in the production or function of ADH; thus, the water necessary for
adequate body hydration is not reabsorbed from the plasma
filtrate.
Diabetes insipidus
35
Polyuria accompanied by increased fluid intake is often the first symptom of either disease.
Diabetes mellitus or insipidus
36
________ should be used because they eliminate the chance of contamination due to improper washing
Disposable containers
37
Urine specimens must be collected in?
clean, dry, leakproof containers
38
______containers are suggested if more than 2 hours elapse between specimen collection and analysis.
Sterile
38
All specimens must be labeled immediately after collection
with the:
1. Patient’s last and first name
2. Identification number
3. date and time of collection
38
The recommended capacity of urine container is _____, which
allows _____ of specimen needed for microscopic analysis,
additional specimen for repeat analysis, and enough room for
the specimen to be mixed by swirling the container
50 mL; 12 mL
39
Labels must be...
attached to the container, not to
the lid, and should not become detached if the container is
refrigerated or frozen
40
Caused by oxidation or reduction of metabolites
Color
40
These increase in unpreserved urine
**OPeN Bacteria**
Odor, pH, Nitrite, and Bacteria
40
These decrease in unpreserved urine
1. Clarity
2. Glucose
3. Ketones
4. Bilirubin
5. Urobilinogen
6. Red and white blood cells and casts
7. Bacteria
8. Trichomonas
41
Decrease in this is caused by bacterial growth and precipitation of amorphous material
Clarity
41
Increase is caused by bacterial multiplication causing breakdown of urea to ammonia
Odor
42
Decrease of this is caused by glycolysis and bacterial use
Glucose
43
Decrease in this is caused by volatilization and bacterial metabolism
Ketones
44
Decrease in this is caused by exposure to light/photo oxidation to biliverdin
Bilirubin
45
Increase in this is caused by multiplication of nitrate-reducing bacteria
Nitrite
45
Decrease in this is caused by oxidation to urobilin
Urobilinogen
46
Increase in this is caused by B\breakdown of urea to ammonia by urease-producing bacteria/loss of CO2
pH
47
Decrease in this is caused by disintegration/lyse in dilute alkaline urine
Red and white blood
cells and casts
48
Increase in this is caused by Multiplication
Bacteria
49
After collection, specimens should be delivered to the laboratory promptly and tested within?
2 hours
50
Decrease in this is caused by loss of motility, death
Trichomonas
51
A specimen that cannot be
delivered and tested within 2 hours should be ______ or have an appropriate _____________ added.
refrigerated; chemical preservative
52
The method of preservation used most routinely is refrigeration
at
2°C to 8°C
53
If the urine is to be cultured, it should be refrigerated during transit and kept refrigerated until cultured, up to _______.
24 hours
54
Specimens must be returned to
____________ before chemical testing by reagent strips because the enzyme reactions on the strips perform best at room temperature
room temperature
55
Can cause precipitation of amorphous urate and phosphate crystals.
Refrigeration
55
Does not interfere with
chemical tests however, this precipitates amorphous phosphates and urates
Refrigeration
56
The ideal preservative should be:
bactericidal, inhibit urease, and preserve formed elements in the sediment, does not interfere with chemical tests
56
Prevents bacterial growth
for 24 hours
Refrigeration
57
Keeps pH at about 6.0
Can be used for transport
of urine cultures
Acids (boric acid, HCL, acetic acid, tartaric acid)
58
Prevents bacterial growth
and metabolism
Acids (boric acid, HCL, acetic acid, tartaric acid)
59
interferes with analysis of
drugs and hormones
Acids (boric acid, HCL, acetic acid, tartaric acid)
60
Excellent sediment
preservative
Formalin (formaldehyde)
60
Acts as a reducing agent,
interfering with chemical
tests for glucose, blood,
leukocyte esterase, and
copper reduction
Formalin (formaldehyde)
61
Rinse specimen container
with formalin to preserve cells and casts
Formalin (formaldehyde)
62
Good preservative for drug
analyses
Sodium fluoride
63
Inhibits reagent strip tests
for glucose, blood, and
leukocytes
Sodium fluoride
64
Convenient when refrigeration is not possible. Have controlled concentration to minimize interference
Commercial preservative
tablets
65
Check tablet composition to
determine possible effects
on desired tests
Commercial preservative
tablets
66
It contains collection cup,
transfer straw, culture and
sensitivity (C&S) preservative tube, or UA tube
Urine Collection Kits4
(Becton, Dickinson,
Rutherford, NJ)
67
Do not use if urine is below
minimum fill line
Light gray and gray
C&S tube or Cherry red/yellow
Preservative Plus tube
68
Specimen stable at room
temperature (RT) for 48 hours; prevents bacterial growth and
metabolism
Light gray and gray
C&S tube
69
Preservatives in Light gray and gray C&S tube
- Boric acid
- Sodium borate
- Sodium formate
70
Keeps pH at about 6.0
Acids (boric acid, HCL, acetic acid, tartaric acid) or Light gray and gray C&S tube
71
Has round or conical bottom,
Yellow UA Plus tube or Cherry red/yellow Preservative Plus tube
72
Use on automated
instruments
Yellow UA Plus tube
73
Must refrigerate within 2 hours
Yellow UA Plus tube
74
Specimen stable for
72 hours at RT;
instrument-compatible
Cherry red/yellow
Preservative Plus tube
74
Bilirubin and urobilinogen
may be decreased if specimen is exposed to light and left at RT
Cherry red/yellow
Preservative Plus tube
75
This has no preservative
Yellow UA Plus tube
76
Preservatives in Cherry red/yellow Preservative Plus tube
Sodium propionate, ethyl paraben, and chlorhexidine
77
The specimen received most commonly because of
its ease of collection and convenience for the patient
Random specimen
78
This specimen is essential for preventing false-negative pregnancy tests and for evaluating orthostatic proteinuria
First Morning Specimen
79
______ must be used to produce an accurate quantitative result
24-Hour (or Timed) Specimen
80
Solutes that exhibit diurnal variations. They lowest concentration is in the early morning and the highest concentration occurs in the afternoon.
catecholamines, 17-hydroxysteroids, and electrolytes
81
When the concentration of the substance to be measured
changes with diurnal variations and with daily activities,
such as exercise, meals, and body metabolism, __________ is required.
If the concentration of a particular substance remains constant, the specimen may be collected over a ________ period.
24-hour collection; shorter
82
Common Errors Associated with Timed Urine Collections
* Loss of urine specimen
* Inclusion of two first morning specimens
* Inaccurate measurement of total urine volume
* Inadequate urine preservation
* Transcription error
82
To obtain an accurate timed specimen, the patient must
begin and end the collection period with?
an empty bladder
83
In collecting 24-hour urine spx, it should be _______ or kept on _______ during the collection period and may require addition of a ___________
refrigerated; ice; chemical preservative
83
As an alternative to the catheterized specimen, the _____________ specimen provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis
midstream clean-catch
84
Adding urine formed before the start of the collection period (24-hour collection) will falsely _______ the results, and failure to include the urine produced at the end of the collection period will falsely _______ the results
elevate; decrease
85
This specimen is collected under sterile conditions by passing
a hollow tube through the urethra into the bladder.
Catheterized Specimen
86
What should not be used as cleansing agents for midstream clean-catch?
Strong bacterial agents, such as
hexachlorophene or povidone-iodine
87
Cleansing agent used for midstream clean-catch
Mild antiseptic towelettes
88
This urine collection method may be collected by external introduction of a needle through the abdomen into the bladder
Suprapubic Aspiration
89
T/F: The bladder is sterile under normal conditions
True
90
This method is used for used for cytological examination and/or bacterial culture
Suprapubic Aspiration
91
This method is used for used for routine screening and/or bacterial culture
Midstream Clean-Catch Specimen
92
Methods used to detect the presence of prostatitis
Three-Glass Collection, Pre- and Postmassage Test, Stamey-Meares Test for Prostatitis
93
The test requested most commonly on a catheterized specimen is?
bacterial culture
94
The first urine passed for three-glass collection is collected in a?
sterile container
95
The first and third specimens for three-glass collection are?
examined microscopically
95
The midstream portion for three-glass collection is collected in?
another sterile container
96
In prostatic infection, the third specimen will have a ___________ and a ________ 10 times that of the first specimen
white blood cell/high power field count; bacterial count
97
The second specimen for three-glass collection is used as a **control** for __________. If it is positive, the results from the ________ are invalid because infected urine has contaminated the specimen.
bladder and kidney infection; third specimen
97
When both a routine urinalysis
and a culture are requested on a catheterized or midstream collection, what should be performed first?
The culture should be performed first to prevent contamination of the specimen.
98
A clean-catch midstream urine specimen is collected. A second urine sample is collected after the prostate is massaged
Pre- and Postmassage Test
99
Positive result for Pre- and Postmassage Test
Postmassage specimen of greater than 10 times the premassage count (bacteriuria).
100
What is used for collecting urine of pediatric patients?
Clear plastic bags, hypoallergenic skin adhesive to attach to the
cleaned genital area of both boys and girls
101
They describe the traditional four-glass urine collection technique
Meares and Stamey
102
In Stamey-Meares Test for Prostatitis, this represents the urethral spx
The first urine specimen, *voided bladder (VB1), the first 10 mL of urine*
102
In Stamey-Meares Test for Prostatitis, this represents the bladder spx
The second specimen, voided bladder 2 (VB2), another 10 mL of urine *(after the px voids 100-150 mL of urine after the first 100 mL)*
102
In Stamey-Meares Test for Prostatitis, this consists
of the first 10 mL of urine collected after EPS; it contains
any EPS trapped in the prostatic urethra
The fourth specimen
103
In Stamey-Meares Test for Prostatitis, this expressed prostatic specimen
(EPS), which is the fluid collected during prostatic massage
Third specimen
104
In Stamey-Meares Test for Prostatitis, Urethral infection or inflammation is tested for by the?
VB1
105
In Stamey-Meares Test for Prostatitis, The VB2 tests for?
urinary bladder infection
106
These are cultured and examined for white blood cells. Having more than 10 to 20 white blood cells per high-power field is considered abnormal
Prostatic secretions in Stamey-Meares Test for Prostatitis
