Pearsons Comprehensive Medical Assisting Administrative and Clinical Competencies

Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies THIRD EDITION CHAPTER 46 Urinalysis Lesson 1: Urinalysis Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Lesson Objectives Upon completion of this lesson, students should be able to: 1. Define and spell the terms to learn for this chapter. 2. List nine types of urine specimens that can be collected. 3. Understand the purpose of routine urinalysis. 4. Describe the steps for collecting a clean-catch urine specimen. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Lesson Objectives Upon completion of this lesson, students should be able to: 5. Describe the physical components of urine. 6. Describe the chemical components of urine. 7. State normal values for physical and chemical examination of urine. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Lesson Objectives Upon completion of this lesson, students should be able to: 8. Demonstrate the procedure for glucose testing using tablets. 9. Demonstrate the procedure for preparing urine for microscopic examination. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Lesson Objectives Upon completion of this lesson, students should be able to: 10. Describe some of the cellular and noncellular elements that might be found during a urine microscopic examination. 11. Demonstrate a method for pregnancy testing. 12. Discuss quality control as it applies to urinalysis. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Urinalysis • Refers to testing of urine for presence of infection or disease • Performed for routine evaluation or diagnostic purposes, or to monitor course of treatment Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Urinalysis • MAs play a key role in urinary testing and evaluation. • MA must understand basic anatomy and physiology as well as normal components of urine. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Asepsis • Condition of being free of diseasecausing contaminants • Very important in urinalysis • Maintain good handwashing techniques. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Asepsis • Standard precautions § Wear gloves. § Avoid contacting other surfaces with urine. § Wear protective clothing when splashing may occur. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Collecting the Specimen • Maintain the integrity of the specimen. • Clearly instruct patient regarding methods of collection in easily understood terms. • Generally, at least 10 m. L of urine is needed for testing depending on test ordered. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

FIGURE 46 -1 A Midstream collection kit. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

FIGURE 46 -1 B–C (B) Urine collection cup; (C) 24 -hour urine container. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Collecting the Specimen • Urine Test Categories • Time-Specific Tests § Random sample § Morning specimen • First void § Timed specimen • 24 hour specimen • Two-hour postprandial specimen Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Collecting the Specimen • Specialized Collection § Catheterized specimen (sterile specimen) § Clean-catch midstream (sterile specimen) § Pediatric specimen § Suprapubic specimen Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Collecting the Specimen • Labeling § MA responsible for proper labeling of all specimens being sent to lab § Essential information includes: • Patient's first and last names • Identifying information such as the chart number or date of birth • The date and time of collection • Initials of the person collecting it Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Collecting the Specimen • Labeling § Never place labels on specimen lids. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Time-Specific Tests • Random Sample § Most commonly collected type of urine sample § Can be collected at any time of day § Collected in a nonsterile container in the medical office during the patient's visit or brought from home § Generally used only for routine screenings Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Morning Specimen: First Void • Most concentrated specimen because urine has remained in the bladder overnight • Used for pregnancy testing, urine cultures, and microscopic examinations Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Morning Specimen: First Void • Patient is given a specimen container and collects the urine when he or she first arises in the morning § Specimen should be brought to the office for testing within 30 -60 minutes Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Critical Thinking Question 1. Why is it better to give a patient the container rather than letting them him or her use one from home? Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Morning Specimen: First Void • If examination cannot be performed within 2 hours, either the sample should be refrigerated or a preservative should be added to the container (depending on the test procedure). Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • Necessary for quantitative analysis of substances such as protein, creatinine, or glucose in urine • Urine specimens must be obtained at specific time intervals. • Most common timed specimens are 24 hour and two-hour postprandial specimen. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • 24 -Hour Specimen § Used to determine the glomerular filtration rate of the kidneys, to check specific hormone levels, and to check for other metabolic abnormalities Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • 24 -Hour Specimen § Instructions should be discussed with the patient and provided in writing to ensure consistency. § Patient is given a large, clean, and properly- labeled container to take home. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • 24 -Hour Specimen § Collection begins the next day § Explain to the patient that the first void in the morning at the beginning of the 24 -hour period is not to be included in the container. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • 24 -Hour Specimen § After flushing first urination in the commode, the patient should collect every drop of urine in the container for the next 24 hours, up to and including the first voided specimen on the second morning. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • 24 -Hour Specimen § Often preservatives are added by the facility before giving the container to the patient; some may be caustic. § Label containers appropriately to prevent injury to patient and anyone else handling the specimen § Instruct patient not to handle or discard preservatives Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • 24 -Hour Specimen § Patient should collect the urine in a separate container, then pour it into the 24 -hour container. § In lieu of preservatives, collection container may be stored in a refrigerator or kept on ice Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • 24 -Hour Specimen § To prevent excessive bacteria contamination, the specimen should be delivered at once to the laboratory or physician's office. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • Two-Hour Postprandial Specimen § A single voided specimen that is collected two hours after a meal has been eaten § Used as screening for glucose that may be spilled into the urine once the blood levels exceed the renal threshold Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Timed Specimen • Two-Hour Postprandial Specimen § Renal threshold • Concentration at which a substance excreted by the kidneys, such as glucose, begins to appear in urine § After renal threshold is surpassed, excess glucose is excreted in the urine Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Collecting a Routine Urine Specimen • Refer to Guidelines 46 -1: Collecting a Routine Urine Specimen for instructions in this technique. • Refer to Procedure 46 -1: Collecting a 24 -Hour Urine Specimen for detailed instructions in this technique. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -1 Collecting a 24 -Hour Urine Specimen FIGURE A Mix the urine sample carefully by swirling. Measure the total volume of urine collected, then pour off a portion to be sent for testing. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Clean-Catch Midstream Specimen § Preferred method of collecting a urinary specimen § Patient can collect his or her own specimen without the need for an invasive procedure Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Clean-Catch Midstream Specimen § Technique designed to prevent germs from the genital area from contaminating the specimen § Frequently used to detect UTIs and other dysfunctions Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Clean-Catch Midstream Specimen § Urine sample may be evaluated for cytology or cultured for microorganisms § Tests can determine what antibiotics, if any, will provide effective treatment for the patient Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Clean-Catch Midstream Specimen § Patient will need clear instructions to obtain a urine specimen that is free of contamination § Not all urine tests require clean-catch collection. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Collecting a Clean-Catch Midstream Urine Specimen • Refer to Procedure 46 -2: Collecting a Clean-Catch Midstream Urine Specimen in Chapter 46 for instructions on the clean-catch technique for both males and females. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -2 Collecting a Clean-Catch Midstream Urine Specimen FIGURE A The patient is instructed to cleanse the head of the penis in preparation for a clean-catch midstream urine collection. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -2 (continued) Collecting a Clean-Catch Midstream Urine Specimen FIGURE B Begin urinating into the toilet. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -2 (continued) Collecting a Clean-Catch Midstream Urine Specimen FIGURE C Continue urinating into the sterile cup provided for the clean-catch midstream urine specimen. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -2 (continued) Collecting a Clean-Catch Midstream Urine Specimen FIGURE D Instruct the patient to spread the labia and expose the urinary meatus, then use towelettes to clean first one side from front to back and then to do the same on the other side. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -2 (continued) Collecting a Clean-Catch Midstream Urine Specimen FIGURE E Begin urinating into the toilet, then stop. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -2 (continued) Collecting a Clean-Catch Midstream Urine Specimen FIGURE F Urinate into the sterile clean-catch container until it is 2⁄3 full. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Catheterization Specimen § Performed to prevent or treat bladder distention when other measures fail § Performed after voiding to determine how much residual urine remains in the bladder § Used to irrigate or medicate the inside of a bladder § May be used for diagnostic purposes Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Catheterization Specimen § Typically this procedure is performed by a nurse via sterile technique. § There are many sizes, lengths, and types of catheters. § Intake of fluids and output of urine are often measured in patients for whom monitoring the body's fluid balance is important. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

FIGURE 46 -5 The medical assistant is measuring the urine output from a patient who has an indwelling Foley catheter that drains into a collecting bag. This urine is for measurement only, not to be used for routine testing. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Pediatric Specimen § Catheterization or obtaining a cleancatch midstream specimen may not be alternatives for the pediatric patient. § Attaching an adhesive pediatric urine specimen bag is often the method of choice. § Refer to Pediatrics chapter. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Suprapubic Specimen § Collection obtained by using a sterile needle and syringe § Needle is inserted into the patient's bladder through the abdominal wall just above the pubic bone and the urine sample withdrawn Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Suprapubic Specimen § Shown to be more reliably free of contamination than clean-catch specimens § Procedure is performed by a physician; used for cytology examinations Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Specialized Collection • Refer to Procedure 46 -3: Assisting with Straight Catheter Insertion and Collecting a Sterile Urine Specimen for detailed instructions on performing this technique. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Typically performed on large numbers of patients to identify potential health problems • Physical analysis may include a description of the appearance, odor, and volume of urine. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Chemical analysis may include tests for p. H, specific gravity, glucose, bacteria, protein, and other chemical elements. • If results are abnormal, more specific testing can be ordered to determine a diagnosis and treatment. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Appearance • Clear or cloudy? • If cloudy, slightly cloudy, cloudy with sediment, or turbid? • Turbidity caused by bacterial infection; white blood cells, red blood cells, or epithelial cells; pus (pyuria); or yeast or vaginal contaminants Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Appearance • Always report exactly what is seen in the sample, using appropriate terms. • Always observe the appearance of the specimen before it begins to cool. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Color • Normal color is straw—a pale yellow color • Concentrated urine can cause urine colors to range from pale yellow to amber. • Diuretics may cause urine to be so diluted that it appears clear. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Color • Brown or black urine indicates a serious illness. • Reddish-brown color may indicate bleeding, either in the urinary tract or from menstruation. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Color • Orange urine may be a result of Pyridium (medication used for bladder spasms or pain). • Large quantities of B vitamins can cause the urine to appear bright yellow. • Some medications, such as amitriptyline, can turn urine blue or green. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Odor • Any abnormal aroma should be documented. • Individuals testing positive for ketones may have a "fruity" odor to their urine; could be indicative of uncontrolled diabetes Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Odor • Putrid or foul odors might indicate infection. • Ammonia odors usually result from urine breaking down over time; they are similar to the odor of old urine on a diaper. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Odor • Foods, such as asparagus, and some vitamins can affect the odor of urine. • Patients with phenylketonuria (PKU) produce urine with a mousy odor. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Quantity • Quantity measured when timed urine specimens are collected, but not for routine samples • 24 -hour urine specimen should measure between 700 and 2, 000 m. L with the average being 1, 500 m. L (3 pints) • Varies depending on amount of fluid ingested by patient Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Physical Characteristics § Quantity • Polyuria may indicate disorders such as diabetes or kidney disease • Oliguria can be indicative of dehydration, bleeding, decreased fluid intake, or kidney disease • Anuria may be result of renal failure or an obstruction Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Specific Gravity § A rough estimate of the concentration of urine § The weight of a substance in relation to the weight of the same amount of distilled water Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Specific Gravity § Normal specific gravity ranges between 1. 010 and 1. 030 § Presence of protein, glucose, or X-ray dyes may increase the specific gravity of urine Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Possible causes of abnormal specific gravity include: § Low Specific Gravity • • • Diabetes insipidus Glomerulonephritis Pyelonephritis Chronic renal disorders Excessive hydration Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Possible causes of abnormal specific gravity include: § High Specific Gravity • • • Dehydration Diabetes mellitus Adrenal insufficiency Hepatic disease Heart failure Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Dipstick (Reagent Strip) Method § Most commonly used method of measuring specific gravity § Performed by dipping a chemically treated piece of plastic (the dipstick) into the sample of urine and then reading the chemical reaction that takes place on the dipstick Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Dipstick (Reagent Strip) Method § Test strip is evaluated by a chemical analyzer or by visual comparison with the results on the side of the test strip bottle Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -6 Testing the Chemical Characteristics of Urine with Reagent Strips FIGURE A Dip reagent strip into urine and withdraw. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -6 (continued) Testing the Chemical Characteristics of Urine with Reagent Strips FIGURE B Compare color changes on the reagent strip to chart on the side of container without contaminating the container. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Refractometer Method § Less common than the dipstick method § A refractometer may be used to determine specific gravity. § Refractometer uses light, a prism, and a calibrated scale to measure the concentration level of the specimen § Method may be seen in older offices or cost efficient clinics Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

FIGURE 46 -6 Portable digital refractometer. © warren mcconnaughie/Alamy Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Refer to Procedure 46 -4: Evaluating the Physical Characteristics of Urine for detailed instructions in this technique. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -4 Evaluating the Physical Characteristics of Urine FIGURE A Colors of urine. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -4 (continued) Evaluating the Physical Characteristics of Urine FIGURE B Appearance of urine (clear to very cloudy). Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Refer to Procedure 46 -5: Measuring the Specific Gravity of Urine with a Refractometer for instructions in this technique. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -5 Measuring the Specific Gravity of Urine with a Refractometer FIGURE A Refractometer with parts labeled. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -5 (continued) FIGURE B Refractometer scale. Measuring the Specific Gravity of Urine with a Refractometer Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Chemical Characteristics § Dipstick Method • Dipstick has small chemically treated pads that react with specific chemicals in the urine to allow for measurement of specific elements • Color changes caused by the chemical reactions are compared to charts on the outside of the reagent strip container. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Dipstick tests are available for: § § § p. H Protein Glucose Ketones Blood Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Dipstick tests are available for: § § § Bilirubin Urobilinogen Nitrites Leukocytes Specific gravity Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Dipstick Method § Normal and abnormal value of each provided or evaluated by chemical urine analyzers § Provides information on functioning of kidneys, liver, and other organs Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Dipstick Method § Physicians decide which chemical elements they want to test for based on the patient's status and possible diagnosis. § Read each test at a specific time; information appears on side of reagent strip container Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

FIGURE 46 -7 Variety of chemical reagents strips. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Refer to Procedure 46 -6: Testing the Chemical Characteristics of Urine with Reagent Strips for detailed instructions on this technique. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Reaction p. H § p. H of a solution indicates acidity and alkalinity § Measured on a scale of 0 to 14; 0 is most acidic; 14 is most basic (alkaline); 7 is neutral § Normally, urine is slightly acidic at about 6. 0. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Reaction p. H § Urine samples must be examined when fresh to avoid bacteria multiplying and causing inaccurate results. § Protein is normally not found in urine of healthy individuals. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Reaction p. H § Urine may contain a small quantity of protein after: • • • Exposure to cold Strenuous muscular activity Acute stress Eating large amounts of protein Note: These are considered physiologic responses, and are not symptoms of disease. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Reaction p. H § Proteins are relatively large compounds that are typically filtered out of urine by the glomerulus of the kidneys. § Presence of protein can indicate renal dysfunction. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

BOX 46 -2 Common Factors Affecting Urinary p. H (Other Than Medications) Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Glucose § May be indicative of: • • • Diabetes Gestational diabetes in pregnancy Stress Infection Cushing's syndrome Or, it may be caused by the use of some medications Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Glucose § Glycosuria • Any abnormal sugar in the urine § Sugar typically spills into the urine when the blood sugar levels exceed the renal threshold for glucose § Renal threshold for glucose is approximately 160– 180 mg/d. L of glucose in the blood stream Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Hematuria § Blood in the urine § Abnormal unless a contamination from menses § Occasionally caused by medications Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Hematuria § Occult blood may indicate • • Anemia Urinary tract infections Kidney stones Trauma Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Ketones § By-products of fat metabolism § Typically only seen in conditions such as: • Poorly controlled diabetes • Dehydration • Starvation Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Ketones § By-products of fat metabolism § Typically only seen in conditions such as: • Ingestion of large quantities of aspirin • High protein diets • Occasionally after general anesthesia § Tend to evaporate at room temperature Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Bilirubin § Product of the breakdown of hemoglobin § Presence in urine may be one of the first signs of liver disease, obstructive biliary disease, or mononucleosis Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Bilirubin § Large amounts in the urine will cause the urine to turn yellow-brown to dark orange. § Specimen with large amounts of bilirubin should be stored away from light, which causes breakdown Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Urobilinogen § Result of RBC destruction § Elevated in any condition causing an increase in bilirubin § Present in small quantities under normal conditions Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Urobilinogen § If no urobilinogen is present, there may be a bile duct obstruction § Reagent strips usually are not sensitive enough to detect an absence of urobilinogen. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Nitrites § Measurement of nitrites is a method for detection of bacturia § Presence often indicates a UTI § By-product of chemical breakdown by certain bacteria Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Nitrites § False positives can happen if specimen sits at room temperature too long § Specimens that cannot be immediately tested should be refrigerated. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Leukocytes § Under normal conditions few leukocytes are found in urine. § When present in sufficient quantity, they are usually indicative of a UTI. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Leukocytes § Leukocyte esterase test • Reagent strip detects the esterase released by white blood cells § The darker the color on the strip, the greater the number of WBCs. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Leukocytes § When test is positive, always check to see if the results correlate with the rest of the patient's report. • Protein test should be positive, and it is likely that an elevated p. H and microscopic bacteria would also be present Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Reagent Tablet Testing § May be used to verify the presence of glucosuria § Routinely performed when reagent test for glucose is positive § Sometimes used in place of reagent strip Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Reagent Tablet Testing § Chemically treated tablets may be used to test for glucose and acetone § Clinitest tablets § Acetest tablets § Sulfosalicylic acid turbidity test Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -7 Testing for Glucose in Urine Using the Tablet Method FIGURE A Do not touch the bottom of the tube when testing with tablets for glucose. The tube is hot from the chemical reaction. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Automated Urine Chemical Analyzers § Use light photometry to test the strips § Some analyzers read the test strips and report the results on a printout sheet. § Quality control protocols must be followed. § Refer to Table 46 -2 in the student text. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Microscopic Examination § Not a CLIA-waived test § PPM certificate issued to POL that is qualified to perform waived tests, moderate complexity tests, and microscopic procedures Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Preparing a Urine Specimen for Microscopic Examination • After physical and chemical analysis, fresh urine is placed into tubes to prepare for microscopic evaluation. • Centrifuge rotates urine tubes at high speeds, using centrifugal force, to separate substances of different densities Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Preparing a Urine Specimen for Microscopic Examination • Sediment is solid material remaining in urine after supernatant is poured off • Special stain may be used to provide better contrast Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Preparing a Urine Specimen for Microscopic Examination • Using a pipette, a drop of suspended sediment is placed on a microscope slide and covered with a slip for viewing. • Refer to Procedure 46 -8: Preparing a Urine Specimen for Microscopic Examination for detailed instruction on this technique. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -8 Preparing a Urine Specimen for Microscopic Examination (for Classroom Evaluation Only) FIGURE A The centrifuge is used to spin urine specimens in preparation for a microscopic examination. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -8 (continued) Preparing a Urine Specimen for Microscopic Examination (for Classroom Evaluation Only) FIGURE B Pour out most of the liquid supernatant from the tube but keep the sediment. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -8 (continued) Preparing a Urine Specimen for Microscopic Examination (for Classroom Evaluation Only) FIGURE C After mixing the sediment well, use a dropper to place a drop of urine on the slide. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Urine Microscopic Examinations § Low-power field • Shows less detail but allows a larger area to be evaluated for counting § High-power field • Evaluates a smaller area in greater detail for better identification Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Urine Microscopic Examinations § Preferable to use a numerical range when reporting formed elements § Slide is moved several times to evaluate different fields of view Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Urine Microscopic Examinations § Cells or casts counted and overall range given § Preferable to use numerical range when reporting formed elements Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Urine Microscopic Examinations § Other Elements • • • Occasional 0– 3 Few 3– 6 Moderate 6– 12 Many 12 or more TNTC – too numerous to count Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Microscopic analysis evaluates formed elements in urine including: § § Cells – epithelial, RBCs, WBCs Casts Bacteria Yeast Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Routine Urinalysis • Microscopic analysis evaluates formed elements in urine including: § § Parasites Spermatozoa Crystals Contaminants Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Urine Pregnancy Testing • Tested through blood test or urine test • Dipstick or midstream • Must be sent to a laboratory for analysis Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Urine Pregnancy Testing • Generally more accurate earlier than urine tests • CLIA-waived pregnancy tests performed in POLs § Agglutination § Enzyme immunoassay Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Urine Pregnancy Testing • Tests also available over-the-counter • Positive result usually indicates woman is pregnant • Positive result may also mean woman was pregnant and had recent miscarriage or abortion Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Urine Pregnancy Testing • Physician should confirm diagnosis • Some h. CG tests used to screen for cancer • Urine test may incorrectly appear negative Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

PROCEDURE 46 -9 Performing a Urine Pregnancy Test Using the Enzyme Immunoassay Method FIGURE A Urine pregnancy control test—positive and negative. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Drug Analysis • Drug testing can be performed on blood or urine. • Many FDA-approved tests to choose from • Commonly requested before employment or state licensure • Important component is the procedure involved in the collection and testing of urine Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Performing a Chain of Custody Urine Collection for Drug Analysis • Refer to Procedure 46 -10: Performing a Chain of Custody Urine Collection for Drug Analysis for detailed instructions in this process Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Quality Control • System that ensures patients' test results are accurate and reported in a timely manner • Products are sold with a quality control testing program Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Quality Control • Conduct testing on a regular basis. • Review the expiration date before any test. • Precisely follow directions. • Document quality control in the quality control log. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Quality Control • Tests used for urinary p. H, protein, blood, glucose, ketones, bilirubin, nitrite, urobilinogen, and specific gravity should be checked periodically by using solutions that contain a known amount of each of these substances. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Quality Control • Train all new employees. • Clean and maintain all instrumentation on a regular basis, and document accordingly. Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly

Questions? Pearson's Comprehensive Medical Assisting: Copyright © 2015, 2011 by Pearson Education, Inc. Administrative and Clinical Competencies, 3/e All Rights Reserved Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly