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Cm6 ua intro

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    Cm6 ua intro Cm6 ua intro Presentation Transcript

    • Crizelda D. Liwanag URINALYSIS: Introduction
    • History • Hieroglyphics • Uroscopy (Hippocrates) • Ant & taste testing (Sasruta) • Urine boiling (F. Dekkers)
    • History • Pisse prophets (charlatans) • Thomas Bryant • Microscope • Thomas Addis • Richard Bright • Modern urinalysis
    • Rationale of Urine testing • (Relatively) readily collected and easily available specimen • Contains information about the body’s major metabolic fxns • inexpensive
    • Rationale of Urine testing ? Disease conditions ? Hormonal activity ? Ruling out, ruling in, screening & prognosis
    • Urine Composition • How do the ff. affect composition: –Dietary intake –Physical activity –Body metabolism –Endocrine functions –Body position
    • Urine Composition • Substances readily reabsorbed – GANaCaKUP • Substances readily excreted – UCUA
    • Urine Composition • Organic • Inorganic – Urea – Cl2, K, Na – Creatinine – Uric acid • Formed elements – Urobilinogen – Cells & casts • Other substances – Crystals – Hormones – Mucus – Vit & meds – bacteria
    • Urine volume • Factors • Definition & – Fluid intake associated cond – Oliguria – Non-renal – Anuria fluid loss – Nocturia – ADH – Polyuria – Solute – Pollakiuria concentration – Incontinence – Residual urine
    • Specimen • What was used in the collection? – answered by COLLECTION TECH / MTD • When was the specimen collected? – answered by TYPE OF SPECIMEN • What are the criteria for acceptance & rejection of specimen for processing & analysis? • What is meant by QNS & COC? • Patient preparation?
    • Collection technique / method 1. Bottle method a. Routine void b. Midstream clean catch c. Drug testing 2. BD Vacutainer (gray, cherry red & yellow stopper) 3. Gauze method / pediatric bag 4. Catheterization 5. Suprapubic aspiration
    • Collection technique / method 1. Wash hands thoroughly. Do not open the sterile container until it is absolutely necessary. 2. Wash the vulva and surrounding area with soap and water. 3. Begin urinating into the toilet and stop after a few drops. 4. Position the container to catch the middle portion of the stream. Make sure that at least ¾ of the container has been filled up. 5. Urinate the remainder into the toilet. 6. Securely & immediately replace the cap without touching the inside rim of the container.
    • Collection technique / method
    • Types of Specimen 1. First morning 1. Advantages specimen 2. Disadvantages 2. Random 3. Reminders / 3. Fractional precautions 4. Timed 4. Uses 1. Pre-determined length 5. Subtypes 2. Pre-determined time
    • Specimen handling • Integrity • Preservation
    • Physical changes Color • Due to oxidation or reduction of substances Clarity • Falsely decreased • Due to bacterial proliferation, solute ppt’n Odor • Falsely increased • Due to bacterial proliferation
    • Chemical Changes pH • Falsely increased • Due to bacterial decomposition of urea to ammonia • Falsely decreased • Due to bacterial or yeast conversion of glucose to form acids
    • Chemical Changes glucose • Falsely decreased • Due to cellular or bacterial hydrolysis ketones • Falsely decreased • Due to bacterial metabolism of acetoacetate to acetone • volatilization of acetone
    • Chemical Changes bilirubin • Falsely decreased • Due to photo-oxidation to biliverdin and hydrolysis to free bilirubin urobilinogen • Falsely decreased • Due to oxidation to urobilin
    • Chemical Changes Nitrite • Falsely increased • Due to bacterial production following spx collection • Falsely decreased • Due to conversion to nitrogen
    • Microscopic Changes RBC, WBC, casts • Falsely decreased • Disintegration of cellular & formed elements, esp in dilute alkaline urine Bacteria • Falsely increased • Due to bacterial proliferation ff spx collection
    • Preservation WHY IS IT NECESSARY TO: • Maintain the pH? • Avoid bacterial contamination? • Avoid conversion of urea to ammonia? HOW DO YOU ACCOMPLISH THE AFOREMENTIONED STEPS?
    • Preservation A. Physical B. Chemical Methods Methods PRINCIPLE ? PRINCIPLE ? A&D? A&D? 1. Refrigeration 1. Toluol 2. Dry Ice 2. Thymol 3. Formalin 4. Chloroform 5. NaF
    • Preservation B. Chemical Methods 6. Benzoic acid 11. Na carbonate 7. Phenol / 12. Acetic Acid tricresol 13. Saccomanno’s 8. 6N Hcl fixative 9. Boric Acid 10. H2SO4