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Chapter 44

Chapter 44. Urinalysis. Blood Type Questions. What is an antigen? What is an antibody? What happens in agglutination? Why can it be deadly? A patient with type A blood needs a blood transfusion. Identify the blood types that are compatible with hers. TRUE OR FALSE…

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Chapter 44

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  1. Chapter 44 Urinalysis

  2. Blood Type Questions • What is an antigen? • What is an antibody? • What happens in agglutination? Why can it be deadly? • A patient with type A blood needs a blood transfusion. Identify the blood types that are compatible with hers. • TRUE OR FALSE… • ______ Type O blood is considered to be a universal donor. • ______ Agglutination is a form of blood clotting in the body. • ______ An individual who has no antigens attached to the membrane of their RBC are referred to as blood type O. • ______ A person with blood type AB is considered to be a universal donor.

  3. 12/8/15 • Objective: Identify the various tests used in the clinical examination of urine • Standard: Evaluate data from research articles encompassing the reliability of home testing kits (i.e., pregnancy test) and portable diagnostic equipment (i.e., glucometers). • Medical Minute: Define anuria, dysuria, polyuria, hematuria, proteinuria, nocturia – Begin reading chap 44 in PMA book • Turn in blood types homework and open book quiz to tray in the back!

  4. Learning Objectives • Understand the basic structures of the urinary system • Describe the importance of urinalysis • Explain the importance of medical terms related to the urinary system • Explain the importance of the different methods of urine collection

  5. Learning Objectives • Explain and educate the patient in the proper method of urine collection • Identify the various tests included in the physical and chemical examination of urine • Explain the basis for urine pregnancy testing • Recognize the basic structures or elements that may be found in normal and abnormal urine under the microscope

  6. Urinary System Structures • Kidneys—filter waste from blood, regulate water, electrolyte, and acid–base content of blood, production of urine • Ureters—tubes carrying urine from kidneys to bladder

  7. Urinary System Structures • Urinary bladder— collects urine and stores until released from body • Urethra—tube connecting bladder to outside of body

  8. Characteristics of Urine • Urine is sterile inside of body • Urine becomes contaminated when released from the body • Urine is 95% water, 5% organic and inorganic wastes • Humans typically produce 1,000–1,500 ml urine in 24 hours

  9. 12/9/15 • Objective: Identify the various tests used in the clinical examination of urine • Standard: Evaluate data encompassing the reliability of home testing kits (i.e., pregnancy test) and portable diagnostic equipment (i.e., glucometers). • Medical Minute: Define turbid, specific gravity, and renal threshold • Sit in assigned seats! 

  10. Urine Collection Procedure • Instruct patient • Use proper collecting containers • Label correctly • Determine if specimen is adequate amount for test • Test specimen within 30–60 minutes, refrigerate up to 8 hours • Gently mix before testing

  11. Preparation for Urinalysis • Medical assistant should familiarize self with equipment: • Reagent strip—color pads dipped into urine • Analyzer—automated machine to read reagent strip • Quality control—assures accuracy of testing

  12. Reagent Strip • Test strip contains individual color pads that correlate with a urine component such as glucose or blood • After dipping urine, color is compared to chart

  13. Analyzer • Computer printout of reagent strip • Abnormal values are flagged • Can do more urinalysis in short period of time

  14. Urinalysis • Three components to urinalysis: • Physical—CLIA waived test • Chemical—CLIA waived test • Microscopic—CLIA non-waived test

  15. Urine color changes • Foods • Carrots – orange • Beets – red tinged • Blackberries – red tinged • Vitamins • Vitamin C or B - bright yellow/orange • Medications • Certain antibiotics – yellowish brown

  16. 12/10/15 Medical Minute Finish review questions and turn in! • What is the function of the kidneys, ureters, bladder and urethra? • How much urine does a person normally produce in one day? • Describe 3 types of urine specimens. • Identify the hormone present in urine if a female is pregnant • Describe reasons for the color of urine to be abnormal • Provide 2 examples of the physical components of urine and 2 examples of the chemical components of urine. What does it mean if they are abnormal?

  17. 12/10/15 • Objective: Identify the various tests used in the clinical examination of urine • Standard: Evaluate data encompassing the reliability of laboratory testing kits (i.e., pregnancy test) and portable diagnostic equipment (i.e., glucometers).

  18. Chemical Components of Urine • Protein—protein may be present temporarily • If present referred to as proteinuria • Can be caused by fever, stress, or strenuous exercise • Chronic proteinuria may be due to renal failure

  19. Chemical Components of Urine • Ketones—by-products of fat metabolism • should not be present in urine • If present referred to as ketonuria • Can result from starvation, high fat diet, pregnancy, or diabetes

  20. 12/11/15 Medical Minute: All of the following medical terms represent the presence of a substance in the urine EXCEPT: A) polyuria B) ketonuria C) hematuria D) glycosuria Which of the following is the function of the ureters? A) filters waste materials from the blood B) discharges urine to outside the body C) carries urine from kidneys to the bladder D) received urine from the kidneys

  21. 12/11/15 • Objective: • Identify the various tests used in the clinical examination of urine. • Assess clinical symptoms related to renal dysfunction. • Standard: Evaluate data encompassing the reliability of laboratory testing kits (i.e., pregnancy test) and portable diagnostic equipment (i.e., glucometers).

  22. Urine Specimens • Random urine specimen—most common type of urine specimen, used for routine screening • First-morning urine specimen—most concentrated specimen • Clean-catch midstream urine specimen (CCMS)—proper collection technique is necessary, used for urine culture

  23. Urine Specimens • Catheterized urine specimen—catheter is placed into bladder to collect sterile urine – ASEPTIC technique • Suprapubic aspirate urine specimen— syringe used to directly collect urine • Sometimes used on pediatric patients • Provides sterile specimen

  24. Physical Components - Color • urochrome (pigment), varies due to dilution or concentration of urine • 1st urine in the morning tends to be darker • Orange/brown – liver disease (hepatitis) • Red – UTI, trauma, renal disorder • Milky – UTI • Certain foods can change the color of urine as well

  25. Clarity—appearance or transparency of urine Fresh urine is usually clear or transparent Mucus, bacteria, and cells can contribute to the cloudy appearance of urine Terms to use: clear, cloudy, slightly cloudy, or turbid Turbid – thick or opaque Physical Components - Clarity

  26. Physical Components of Urine • Odor—varying odors, not generally recorded • Specific gravity— measures concentration of dissolved substances in urine, varies according to dilution or concentration of urine • Normal is 1.005-1.030 • Concentrated urine has a higher specific gravity • Dehydration, heart disease, renal disease and diabetes

  27. Chemical Components of Urine • pH—measures acidity or alkalinity of urine • Scale 0.0–14.0 • 0.0–6.0 is acidic • could indicate diabetes or starvation • 8.0–14.0 is alkaline • could indicate a UTI • Normal range for urine is 4.5-8.0

  28. Chemical Components of Urine • Glucose—no glucose should be present in urine • If present referred to as glycosuria • Normally the kidneys will filter and reabsorb glucose back into the bloodstream • Main cause of glucose in the urine is diabetes

  29. Chemical Components of Urine • Blood—not normally found in urine • Can be found as a contaminant during menstruation • Graded as negative, trace, small, moderate, or large • If found can indicate trauma, UTI, or kidney stones

  30. Chemical Components of Urine • Leukocytes—should not be present in urine • If present suggests infection (UTI)

  31. Objective • Identify the various tests used in the clinical examination of urine. • Assess clinical symptoms related to renal dysfunction.

  32. Group Time • Find your partner, and continue reading the case studies • Come up to each station to assess your patients. • Work on Case Study 3 while others are rotating through the stations. TURN IN CASE STUDIES AT THE END OF CLASS!

  33. Further Expansion • What are the chemical components of urine? • Describe what abnormal values can indicate.

  34. 12/11/15 Exit Ticket Identify two components of urine assessed in the urinalysis. Turn in to the blue basket! Have a great weekend 

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