Urinalysis and Body Fluids Flashcards
(102 cards)
1
Q
Function of the urinary system
A
- regulate fluid, acid-base balance and electrolyte balance of the body
- eliminate waste products
- produce hormones
- formation and excretion of urine
2
Q
4 organs in the urinary system
A
-kidneys, ureters, urinary bladder and urethra
3
Q
Ureters
A
- two narrow tubes, each about 10-12 inches longs
- propels urine into urinary bladder by force of gravity and peristaltic waves
4
Q
Peristalsis
A
a series of wave like contractions, moves urine down each ureter to the bladder
5
Q
Purpose of kidneys
A
- constantly filter the blood to remove waste products and excess water.
- also help the body maintain the proper level of fluid , produce hormones that control blood pressure and make red blood cells, and activate vitamin D to maintain healthy bones
6
Q
renal
A
pertaining to the kidneys
7
Q
renal cortex
A
outer region of the kidney; this layer of tissue contains 1million + microscopic units called nephrons
8
Q
medula
A
the inner region of the kidney and it contains most of the urine collecting tubules
9
Q
nephrons
A
- microscopic functional units of each kidney.
- each nephron contains a glomerulus which is a cluster of capillaries surrounded by a cup-shaped membrane called he bowman’s capsule and a renal tubule
10
Q
urethra meatus
A
the external opening of the urethra
note* if we need to collect sample from the urine stream we must clean the urethra meatus
11
Q
kidneys
A
bean shaped organs, located in lumbar region
- produces urine
- note the right kidney is lower than the left kidney bc of liver size
- note without the kidneys the body cannot maintain homeostasis. we need a stable balance of salts and other substances
12
Q
anatomy of the kidney
A
cortex, medulla, renal hilus, nephrons
13
Q
renal hilus
A
the place where the arteries and veins enter into the kidney
14
Q
purpose of tubules
A
facilate movement of urine drops
*note- coiled to give body time to recognize whether the fluid in the tube should be reabsorbed or if it’s waste
15
Q
glomerulus
A
the filtration system of the kidneys
16
Q
What happens in the kidneys?
A
- blood enters kidney through renal artery and flows intro nephrons
- after passing the filtration system of the glomerulus, filtered blood containing protein and blood cells leaves the kidney and returns to the bloodstream through renal vein
- remaining filtrate flows into renal tubules, where some water, sugar and salts are returned to the bloodstream via nearby capillary
- remaining waste products are continuously converted into urine, which is transported to the renal pelvis and collected in preparation for entry into the ureters.
17
Q
bowman’s capsule
A
moves the waste into the tubules
18
Q
Where does urine formation begin?
A
In the kidney’s filtration system, the glomerulus.
19
Q
Which part of the kidneys collect the fluid?
A
the bowman’s capsule collects all the filtrate fluid.
20
Q
Purpose of the nephron
A
filters wastes from blood and dilutes them with water to produce urine
21
Q
substances reabsorbed by the body
A
water, glucose electrolytes
22
Q
glomerulus is for __________, as tubules is for ______________ and collecting duct is for ___________
A
filtration, reabsorption, secretion
note* 3 steps of urine formation
23
Q
urinary bladder
A
- hollow, muscular sac, holds approx. 500 ml of urine
- stores and expels urine
24
Q
urethra
A
tube that extends from the bladder to outside.
- males: urethra transports urine and reproductive secretions
- females- urethra transports urine only
urethra meatus: external opening of urethra
25
urine is composed of
95% water,
-5% organic and inorganic waste products
- organic: urea, uric acid, ammonia, creatinine
- inorganic: chloride, sodium, potassium, calcium, magnesium, phosphate, sulfate
* note: urea is present in greatest amts- derived from breakdown of protein
26
How can we tell there is a presence of uric acid in urine?
a microscopic examination of urine will show crystal particles
27
high amounts of uric acid could mean that....
a patient might develop kidney stones
28
how much urine does a normal adult excrete daily?
750-2000 ml
*note varies based on amt of fluid consumed, and amt lost through perspiration or feces
29
What is the size of the 24 hr urine collection container?
3000 ml
*note* it will already contain 2ml of colorless preservative
30
polyuria
excessive increase in urine output
-caused by:
-excessive intake of fluids
-fluids that contain caffeine
-drugs (diuretic)
pathological condition (diabetes, renal disease)
31
oliguria
decreased output of urine, less than 400 ml in 24 hrs
- caused by:
- decreased fluid intake
- dehydration
- profuse perspiration
- vomiting
- diarrhea
- kidney disease
32
micturition
normal act of voiding urine
33
constant vomiting and diarrhea is dangerous because
it may cause dehydration, and change the acid balance, and electrolyte balance of the body
34
anuria
failure of the kidneys to produce urine
35
diuresis
secretion and passage of large amounts of urine
36
dysuria
difficult or painful urination
37
frequency
the condition of having to urinate often
38
hematuria
blood present in urine
39
nocturia
excessive voluntary urination during the night
40
nocturnal enuresis
the inability of the patient to control urination at night during sleep (bedwetting)
41
pyuria
pus present in urine
42
retention
the inability to empty the bladder
-the urine is being produced normally but is not being voided
43
urgency
the immediate need to urinate
44
urinary incontinence
the inability to retain urine
45
stress incontinence
inability to control urination when sneeze
46
Which bacteria usually causes UTI?
E.coli
47
How do C&S tests help diagnose UTI?
Cultures help detect the micro organisms and bacteria in the urine and sensitivities tell us which antibiotics will be more effective.
48
hormones influencing kidney function
calcitonin: thyroid , inhibit calcium reabsorption by kidney tubules leading to increased calcium loss in urine
- parathyroid hormone: parathyroid; regulate calcium reabsorption, increase calcium in blood
- aldosterone: adrenal cortex; regulate electrolytes especially by reabsorption sodium and potassium
- antidiuretic hormone: hypothalamus, regulate water reabsorption
- atrial natriuretic peptide: heart; influence sodium excretion
* note* these hormones are not produced by the kidney, but they influence kidney functions: filtration, reabsorption, secretion
49
hormones produced by kidney functions
- erythropoietin: to stimulate rbc production in the bone marrow
- renin: influence blood pressure
- active vitamin D3: helps regulate bone calcium and phosphates by increasing absorption of dietary calcium and phosphorus
note*these hormones are secreted by the kidney
50
Dialysis
a procedure to remove waste products from the blood of a patient whose kidneys no longer function
remember* external kidney
51
What are the two types of dialysis? and which is the most common?
hemodialysis and peritoneal dialysis
hemodialysis is more common
52
Advantages or urine testing:
- urine is easily available
- noninvasive procedure
- don't need special equipment
- collected at any time of day
53
types of urine collection
- random collection (anytime of day)
- fasting or first morning (routine urinalysis), best for pregnancy tests
- clean-catch midstream ( for bacterial culture, c&s)
- timed, 24-hr (hormones)
- special collections-catheter, pediatric
54
Guidelines for Urine collection
- make sure to obtain adequate amount, usually 30-50 ml
- properly label each specimen with patient's name, DOB, date and time of collection, type of specimen
- record patient's current medications in patient chart
- do not collect specimen during menstruation
- may need to use another collection method (urine collection bag, suprapubic aspiration, catheterization)
55
suprapubic aspiration and catheterization are good urinary collection methods for
C&S
note*suprapubic aspiration is the best
56
What determines the collection method of urine?
type of test
57
Random specimen testing
- urine testing is often performed on a freshly voided specimen
- mla instructs patient to void into clean, dry, wide-mouthed container
- urine is tested immediately within 1-2 hrs or store at 4 degrees to 6 degrees for up to 4 hrs
58
When urine has been stored in the refrigerator, what must you do before testing it?
Bring urine to room temperature and mix well
why? the dipstick is saturated by a dry chemical substance; if you test a cold sample, it will yield false negative results
59
First-Voided Morning Specimen
- Contains greatest concentration of dissolved substances.
- small amount of a substance detected more easily
- instruct patient to collect first specimen of the morning, preserve it in refrigerator
- provide patient with specimen container, to prevent use of a contaminated container
60
Where can microorganisms be found in the urinary system?
- microorganisms are NOT normally present in urinary bladder and most of the urethra
- microorganisms are normally present in distal urethra and urinary meatus
61
Clean-catch midstream specimen
- required when urine is cultured and examined for bacteria
- to prevent contamination of specimen with normally present microorganisms
- usually ordered for detection of UTI
62
Procedure of Clean-catch midstream specimen
- sterile container is used
- patient must cleanse the meatus
- patient should void small amount into toilet first, then collect the midstream urine into container, to flush out distal urethra microorganisms
- test sample within 1-2 hr or refrigerate up to 4 hrs
63
How to properly clean the urethra meatus, before clean-catch midstream specimen?
By cleaning the urethra meatus from the front to the back
64
bladder catheterization
passing of a sterile catheter through the urethra into the bladder
65
suprapubic aspiration of bladder
passing of a sterile needle through the abdominal wall into the bladder
66
24 Hour Urine specimen is used to
- diagnose the cause of kidney stone formation
| - assist in the control and prevention of new stone formation
67
How to store 24 hr urine specimen?
specimen must be kept refrigerated or placed in an ice chest
68
Guidelines for 24-hour urine specimen
- drink normal amount of fluid during collection period
- avoid alcohol for 24 hours before and during collection
- choose a 24 hr period when you'll be at home
- do not perform during menstruation
- physician might instruct patient to discontinue medications for a week prior to collection
69
Some urine preservative chemicals for urine:
hydrochloric acid, sodium carbonate, sodium hydroxide, boric acid, acetic acid
70
urinalysis
analysis of urine
| -consists of physical examination, chemical examination and microscopic examination
71
Urinalysis is performed with
fresh or preserved specimen
72
What happens if urine specimen stands out for more than 1 hour?
- bacteria in environment can contaminate specimen
- urea converts to ammonia alkaline)
- may result in false positive result in protein test
- bacteria multiply causing cloudy specimen, increase in nitrite
73
If glucose present in specimen amount __________
decreases
-microorganisms use glucose for food
74
Most important physical examination characteristics of urine are:
color and appearance
75
Color of urine indication
ranges from almost colorless to dark yellow
- lighter yellow (dilute)
- darker yellow (concentrated, ie. first-void specimen)
- yellow color comes from urochrome
- color assists in determining additional tests that may be necessary
76
Abnormal Urine Color Indications
- reddish: presence of blood
- yellow-brown or greenish: bile pigments
- milky color: fat droplets or pus
77
Appearance of Urine
Transparency or clarity
Fresh Urine: usually clear or transparent
Cloudiness (turbid) is fresh specimen indicates presence of bacteria, pus, blood, fat or fecal contaminants
78
Urine odor
freshly voided: slightly aromatic
- Urine standing too long: ammonia odor
- urine of diabetic patients: fruity odor
note* odor not generally used in diagnosis of patient's condition
79
Specific gravity of urine
measures weight of urine as compared with the weight of an equal volume of distilled water
- indicates amount of dissolved substances present in urine
- provides information on ability of kidney to dilute or concentrate the urine
- dilute urine has lower SG
- concentrated urine has higher SG
80
Decreased Specific Gravity indicates
chronic renal insufficiency, diabetes insipidus, malignant hypertension
81
Increased Specific Gravity indicates
adrenal insufficiency, congestive heart failure, hepatic disease, diabetes mellitus, conditions causing dehydration
82
normal range for specific gravity of urine
1.003 to 1.030
83
We measure specific gravity by
- reagent strip method for color comparison determination, strip dipped in urine
- urinometer
- refractometer
note* not common to use reagent strip now because it requires a lot of urine and takes longer
84
Chemical Examination of Urine assists in diagnosis of
kidney function, urinary tract infections, carbohydrate metabolism (diabetes mellitus), liver function
85
chemical tests are routinely performed for:
ph, glucose, protein, ketone, blood, bilirubin, nitrite, leukocytes
note* these tests are all qualitative except for ph and specific gravity which is quantitative
86
interpreting chemical tests usually
- involve a color comparison chart
- qualitative test results
- negative or positive
- useful as a screening test
87
urine testing kits
most frequently used in medical office
Advantages: contain premeasured reagent, easy to perform, provide immediate results
-most are qualitative test results
88
Test strips that contain more than one _______, may require different _________ for reading results
reagent, time intervals
89
guidelines for chemical examination of urine:
- read and follow manufacturer's instruction sheet
- more than one reagent requires readings at different time intervals
- certain medications may affect results
- check expiration date
- store in cool, dry area
- never transfer from original container to another
- indicate brand name of test
90
PH of urine range from
4.6-8 (usually around 6)
91
Glucose chemical test of urine
- normally negative
- *sugar should not be present in urine
- If glucose concentration in blood is high, renal threshold is exceeded, kidneys unable to reabsorb glucose back to blood
-glucose reagent pad contains enzymes glucose oxidase and peroxidase plus a chromagen
92
Renal Threshold
- concentration at which a substance in the blood not normally excreted by the kidney begins to appear in the urine
- generally between 160 and 180 mg/dL
93
Protein Chemical Test
- proteinuria: presence of protein in the urine, temporary increase may be caused by stress or strenuous exercise
- conditions causing proteinuria: glomerular filtration problem, renal diseases, bacterial infections of the urinary tract
94
Purpose of protein chemical test
to see what is causing the protein to be in the patients urine
positive result protein in urine are due to presence of Albumen
-for globulin (protein) use the sulfosalicylic acid turbidity test
95
three types of ketone bodies:
-beta-hydroxybutyric acid
-acetoacetic acid
acetone
96
ketosis
accumulation of large amounts of ketone bodies in tissues
-when more than normal amounts of fat are metabolized, muscles can't handle all the ketones
97
ketonuria
presence of ketone bodies in the urine
caused by:
- uncontrolled diabetes
- starvation
- diet composed entirely of fat
- test acetest confirms strip test result
*note urine container should be kept tightly to prevent evaporation of ketones
98
bilirubin chemical test
with certain liver conditions, liver cant accept bilirubin, bilirubin transported to kidneys, then excreted in urine (bilirubinuria); causes yellow brown to greenish color
-note keep urine sample away from light until test is complete to prevent false negative result
99
conditions causing bilirubinuria
gallstones, hepatitis, cirrhosis of liver
100
urobilinogen
a bilirubin degradation product
-causes: excessive hemolysis of rbcs, infectious hepatitis, cirrhosis, congestive heart failure, mononucleosis
101
blood chemical test
- blood in urine is abnormal, unless due to menstruation
hematuria: presence of blood in urine
causes: injury, cystitis, tumors of bladder, urethritis, kidney stones
102
Nitrite chemical test
indicates presence of pathogen in UTI
bacteria causes nitrite to be present in urine
