SlideShare a Scribd company logo
U R I N A L Y S I S
Chapter 30
Deborah Walker, ARNP, BSN, MN
1
Urine Formation
 Urine forms in
kidneys and
leaves body
through urethra
The urinary system >>
Urine Formation
 How body excretes water and gets rid of waste
 Waste can become toxic if not removed
 Two kidneys eliminate soluble waste products of
metabolism
 Click here for an animation
Deborah Walker, ARNP, BSN, MN
3
Urine Formation
 Filtration
 Glomerulus filters waste products, salts, and excess fluid from
blood
 Tubule concentrates filtered material
 Nephron
 Combination of glomerulus and tubule
 One million nephrons in each kidney
Deborah Walker, ARNP, BSN, MN
4
Urine Formation
 Filtration
 Substances filtered out from body
 Water
 Ammonia
 Electrolytes
 Glucose
 Amino acids
 Creatinine
 Urea
 Diabetes diagnosis
 Routine urinalysis testing
Deborah Walker, ARNP, BSN, MN
5
Urine Formation
 Reabsorption
 About 180 liters of filtrate produced daily
 Only 1–2 liters of urine eliminated
 Much filtrate reabsorbed into body
 Blood cells and most proteins stay in blood
 Concentration of glucose in blood below 180 mg/dl will be
reabsorbed
 Glucose is a threshold substance
Deborah Walker, ARNP, BSN, MN
6
Urine Formation
 Secretion
 Substances not already filtered are secreted into urine through
distal convoluted tubule
 Hydrogen and ammonium ions may be secreted into urine in
exchange of sodium
 *Know the major functions of the urine*
Deborah Walker, ARNP, BSN, MN
7
Urine Composition
 After passing through kidney, urine is 96% water and
4% dissolved substances (urea, salt, sulfates,
phosphates)
Deborah Walker, ARNP, BSN, MN
8
Urine Composition
 Abnormal constituents of urine
 WBC
 Fat
 Glucose
 Casts
 Bile
 Hemoglobin and RBC
Deborah Walker, ARNP, BSN, MN
9
Urine Composition
 Changes in urine production
 Amount of urine excreted can rise or fall
 Urine color can change
 Urine appearance can vary
Deborah Walker, ARNP, BSN, MN
10
Urine Composition
 Changes in urine production
 Urine odor can change
 Cells can be present in urine
 Chemical constituents in urine can change
 Urine concentration (specific gravity) may vary
Deborah Walker, ARNP, BSN, MN
11
Safety
 Standard precautions
 Transmission-based precautions
 Biohazard precautions
 Proper disposal of urine
Deborah Walker, ARNP, BSN, MN
12
Quality Control
 Regulatory agencies
 Written testing protocols
 Maintained testing records
 Recalibration of instruments
Deborah Walker, ARNP, BSN, MN
13
Quality Control
 Documentation of daily control testing must be kept
at least 3 years
 Commercially available urine control samples
 Run positive and negative controls each day on all
tests
Deborah Walker, ARNP, BSN, MN
14
CLIA 88
 Appropriate training in methodology of test being
performed
 Understanding of urine testing quality control
procedures
 Proficiency in the use of instrumentation; being able
to troubleshoot problems
Deborah Walker, ARNP, BSN, MN
15
CLIA 88
 Knowledge of stability and proper storage of reagents
 Awareness of factors that influence test results
 Knowledge of how to verify test results
 CLIA categorizes microscopic exam as a PPMP
Deborah Walker, ARNP, BSN, MN
16
Urine Containers
 Types
 Nonsterile containers for cultures
 24 hour collection containers with added preservatives
Urine Containers
 Label container immediately after specimen
collection
 Patient’s name, age, gender, identifying number
 Date and time of collection
 Physician’s name
 Label the cup, not the lid
Deborah Walker, ARNP, BSN, MN
18
Urine Collection
 Urinalysis is the most frequently performed
procedure done in the medical office lab
 Giving patient instructions
Deborah Walker, ARNP, BSN, MN
19
Urine Collection
 Click to play the video
Deborah Walker, ARNP, BSN, MN
20
Urine Collection
 Urine specimen types
 Random (spot) specimen
 Obtained at any time
 Most common
 If concentrated specimen preferred, first specimen of day is most
concentrated
Deborah Walker, ARNP, BSN, MN
21
Urine Collection
 Urine specimen types
 Fasting/timed specimens
 Used when physician wants to measure substance without
interference from food intake
 Length of fast varies
 Give patient written directions
 Use regular urinalysis container
Deborah Walker, ARNP, BSN, MN
22
Urine Collection
 Urine specimen types
 24-hour specimen
 Circadian rhythm and intake of food and water determine
concentration of substances at different times during day/night
 Requested when quantitative tests for different substances are
desired
 Expressed in units per 24 hours
 Use of preservatives and refrigeration
 Sometimes use 2-hour or 12-hour collection instead
Deborah Walker, ARNP, BSN, MN
23
Urine Collection
 Urine specimen types
 Catheterized specimen
 Insert sterile tube directly into bladder through urethra
 Not contaminated
 Can cause infection if not done correctly
 Use only when other methods are contraindicated or show
repeated positive testing for bacteria
Deborah Walker, ARNP, BSN, MN
24
Urine Collection
 Collection methods
 Random collection
 Clean-catch method; midstream collection
 Catheterized
Deborah Walker, ARNP, BSN, MN
25
Examination of Urine
 Best when fresh, even still warm
 Test within 30 minutes, or refrigerate
Deborah Walker, ARNP, BSN, MN
26
Routine Urinalysis Procedure
 Physical examination of urine
 Assess volume of urine specimen, making sure specimen is
sufficient for testing
 Note any unusual urine odor
 Measure specific gravity of specimen
 Normal specific gravity (SG) of urine varies slightly, but 1.005-
1.030 (some may say 1.000-1.035)
Deborah Walker, ARNP, BSN, MN
27
Routine Urinalysis Procedure
 Physical examination of urine
 Observe and record color and transparency of specimen
Measuring Specific Gravity
 Urinometer
 Measures specific gravity
 Reading the meniscus
 Take temperature of urine into account
Deborah Walker, ARNP, BSN, MN
29
Measuring Specific Gravity
 Refractometer
 Most common tool for
measuring specific gravity
of liquids
 Measures refractive index
of urine
 Reads about 0.002 below
that of true specific gravity
 Needs 1 drop of urine
 Easy to use but more
expensive
Routine Urinalysis Procedure
 Chemical examination of urine
 Use of multistix reagent strips with color-coded chart
 Chemical testing available on urine reagent test strips
 See Table 30-3, 30-4
Routine Urinalysis Procedure
 Chemical
examination of
urine
 Reagent test strip
quality control
 Automated urine
analyzers >>
Routine Urinalysis Procedure
 Microscopic examination of urine sediment
 Classified as PPMP
 Sediment is forced to the bottom of centrifuged tube
 Helps determine kidney disease, disorders of urinary tract, and
systemic disease
 Need fresh urine
 Use of urine color atlas
 Use of urine stains
Deborah Walker, ARNP, BSN, MN
33
Preparing for Microscopic
Examination
 Centrifuge 10–15 mL
of urine
 Pour off supernatant
urine
 Resuspend sediment
by tapping
 Stain (optional) >>
 Put drop of sediment
on slide
Urine Sediment Cells and
Microorganisms
 RBC
 WBC
 Renal epithelial cells
 Bacteria
 Yeast-most common is
candida albicans
 Parasites- most
common is
Trichomonas
 Sperm
 Artifacts
 Squamous epithelial
cells- skin cells;
normal; report as few,
moderate, or many
Deborah Walker, ARNP, BSN, MN
35
Crystals in Urine Sediment
 Require little attention
 Form as urine specimens stand
 Uric acid, cystine, and sulfa drug crystals can
indicate disease states
Deborah Walker, ARNP, BSN, MN
36
Casts in Urine Sediment
 Important to note
 Formed when protein accumulates and precipitates
in kidney tubules
 Appearance of casts
 Hyaline cast most common kind seen
 Granular casts and cellular casts also seen
 Takes an experienced eye to identify
Deborah Walker, ARNP, BSN, MN
37
Urinalysis Report
 Include patient’s name, type of specimen,
collection method, ordering provider, MA
name, date and time of collection, date and
time of testing, findings
Drug Screening
 Becoming more common for employment
 Test itself is CLIA waived, but detailed protocols
must be followed
 Chain of custody
Deborah Walker, ARNP, BSN, MN
39
Medical Terminology
 Part VII Urinary System handouts
Deborah Walker, ARNP, BSN, MN
40

More Related Content

Similar to Chapter 30 Urinalysis.ppt

Urine analysis pnnnnpt-MG.pptx
Urine analysis pnnnnpt-MG.pptxUrine analysis pnnnnpt-MG.pptx
Urine analysis pnnnnpt-MG.pptx
NabdNabd
 
Value of urinalysis in clinical medicine copy
Value of urinalysis in clinical medicine   copyValue of urinalysis in clinical medicine   copy
Value of urinalysis in clinical medicine copy
Sahar Hamdy
 

Similar to Chapter 30 Urinalysis.ppt (20)

Evaluation of kidney function
Evaluation of kidney functionEvaluation of kidney function
Evaluation of kidney function
 
Genito Urinary System
Genito Urinary SystemGenito Urinary System
Genito Urinary System
 
Analysis of Normal Urine.pptx
Analysis of Normal Urine.pptxAnalysis of Normal Urine.pptx
Analysis of Normal Urine.pptx
 
urine analysis.pptx
urine analysis.pptxurine analysis.pptx
urine analysis.pptx
 
URINE EXAMINATION- overview (2).pptx
URINE EXAMINATION- overview (2).pptxURINE EXAMINATION- overview (2).pptx
URINE EXAMINATION- overview (2).pptx
 
Value of urinalysis in clinical medicine
Value of urinalysis in clinical medicineValue of urinalysis in clinical medicine
Value of urinalysis in clinical medicine
 
Urological laboratory investigations
Urological laboratory investigationsUrological laboratory investigations
Urological laboratory investigations
 
Urine analysis pnnnnpt-MG.pptx
Urine analysis pnnnnpt-MG.pptxUrine analysis pnnnnpt-MG.pptx
Urine analysis pnnnnpt-MG.pptx
 
Urine FEME
Urine FEMEUrine FEME
Urine FEME
 
URINE & STOOL EXAMINATION.pptx
URINE & STOOL EXAMINATION.pptxURINE & STOOL EXAMINATION.pptx
URINE & STOOL EXAMINATION.pptx
 
urine analysis labortory diagnosisn work ppt
urine analysis labortory diagnosisn work ppturine analysis labortory diagnosisn work ppt
urine analysis labortory diagnosisn work ppt
 
MA114 Chapter 46 analysis of urine
MA114 Chapter 46 analysis of urineMA114 Chapter 46 analysis of urine
MA114 Chapter 46 analysis of urine
 
Urine Examination in paediatrics PPT.pptx
Urine Examination in paediatrics PPT.pptxUrine Examination in paediatrics PPT.pptx
Urine Examination in paediatrics PPT.pptx
 
Specimens collection part 2
Specimens collection part 2Specimens collection part 2
Specimens collection part 2
 
5094 excretion 2014
5094 excretion 20145094 excretion 2014
5094 excretion 2014
 
Urine -Physical and Chemical Examination and Reagent Strips
Urine  -Physical and Chemical Examination and Reagent StripsUrine  -Physical and Chemical Examination and Reagent Strips
Urine -Physical and Chemical Examination and Reagent Strips
 
Value of urinalysis in clinical medicine copy
Value of urinalysis in clinical medicine   copyValue of urinalysis in clinical medicine   copy
Value of urinalysis in clinical medicine copy
 
Urine and urinalysis
Urine and urinalysisUrine and urinalysis
Urine and urinalysis
 
Kidney function test physical macroscopic and microscopic tests
Kidney function test   physical macroscopic and microscopic testsKidney function test   physical macroscopic and microscopic tests
Kidney function test physical macroscopic and microscopic tests
 
Renal Function Tests (RFTs)
Renal Function Tests (RFTs)Renal Function Tests (RFTs)
Renal Function Tests (RFTs)
 

More from Ytchechy

More from Ytchechy (8)

varicjvivose veiuvug8ns 9.ppt
varicjvivose veiuvug8ns 9.pptvaricjvivose veiuvug8ns 9.ppt
varicjvivose veiuvug8ns 9.ppt
 
8159968.ppt
8159968.ppt8159968.ppt
8159968.ppt
 
2_2019_04_16!05_54_09_AM.ppt
2_2019_04_16!05_54_09_AM.ppt2_2019_04_16!05_54_09_AM.ppt
2_2019_04_16!05_54_09_AM.ppt
 
Anatomy of oesophagus.ppt
Anatomy of oesophagus.pptAnatomy of oesophagus.ppt
Anatomy of oesophagus.ppt
 
esophagus.pptx
esophagus.pptxesophagus.pptx
esophagus.pptx
 
66_15575_EC410_2014_1__2_1_LECTURE 9.ppt
66_15575_EC410_2014_1__2_1_LECTURE 9.ppt66_15575_EC410_2014_1__2_1_LECTURE 9.ppt
66_15575_EC410_2014_1__2_1_LECTURE 9.ppt
 
04usdoppler.ppt
04usdoppler.ppt04usdoppler.ppt
04usdoppler.ppt
 
1a_Sources_of_Radiation.ppt
1a_Sources_of_Radiation.ppt1a_Sources_of_Radiation.ppt
1a_Sources_of_Radiation.ppt
 

Recently uploaded

NewBase 24 May 2024 Energy News issue - 1727 by Khaled Al Awadi_compresse...
NewBase   24 May  2024  Energy News issue - 1727 by Khaled Al Awadi_compresse...NewBase   24 May  2024  Energy News issue - 1727 by Khaled Al Awadi_compresse...
NewBase 24 May 2024 Energy News issue - 1727 by Khaled Al Awadi_compresse...
Khaled Al Awadi
 
What is social media.pdf Social media refers to digital platforms and applica...
What is social media.pdf Social media refers to digital platforms and applica...What is social media.pdf Social media refers to digital platforms and applica...
What is social media.pdf Social media refers to digital platforms and applica...
AnaBeatriz125525
 

Recently uploaded (20)

How to Maintain Healthy Life style.pptx
How to Maintain  Healthy Life style.pptxHow to Maintain  Healthy Life style.pptx
How to Maintain Healthy Life style.pptx
 
Cracking the Change Management Code Main New.pptx
Cracking the Change Management Code Main New.pptxCracking the Change Management Code Main New.pptx
Cracking the Change Management Code Main New.pptx
 
TriStar Gold Corporate Presentation May 2024
TriStar Gold Corporate Presentation May 2024TriStar Gold Corporate Presentation May 2024
TriStar Gold Corporate Presentation May 2024
 
Global Interconnection Group Joint Venture[960] (1).pdf
Global Interconnection Group Joint Venture[960] (1).pdfGlobal Interconnection Group Joint Venture[960] (1).pdf
Global Interconnection Group Joint Venture[960] (1).pdf
 
NewBase 24 May 2024 Energy News issue - 1727 by Khaled Al Awadi_compresse...
NewBase   24 May  2024  Energy News issue - 1727 by Khaled Al Awadi_compresse...NewBase   24 May  2024  Energy News issue - 1727 by Khaled Al Awadi_compresse...
NewBase 24 May 2024 Energy News issue - 1727 by Khaled Al Awadi_compresse...
 
Series A Fundraising Guide (Investing Individuals Improving Our World) by Accion
Series A Fundraising Guide (Investing Individuals Improving Our World) by AccionSeries A Fundraising Guide (Investing Individuals Improving Our World) by Accion
Series A Fundraising Guide (Investing Individuals Improving Our World) by Accion
 
How Do Venture Capitalists Make Decisions?
How Do Venture Capitalists Make Decisions?How Do Venture Capitalists Make Decisions?
How Do Venture Capitalists Make Decisions?
 
Inside the Black Box of Venture Capital (VC)
Inside the Black Box of Venture Capital (VC)Inside the Black Box of Venture Capital (VC)
Inside the Black Box of Venture Capital (VC)
 
A Brief Introduction About Jacob Badgett
A Brief Introduction About Jacob BadgettA Brief Introduction About Jacob Badgett
A Brief Introduction About Jacob Badgett
 
Hyundai capital 2024 1q Earnings release
Hyundai capital 2024 1q Earnings releaseHyundai capital 2024 1q Earnings release
Hyundai capital 2024 1q Earnings release
 
Unleash Data Power with EnFuse Solutions' Comprehensive Data Management Servi...
Unleash Data Power with EnFuse Solutions' Comprehensive Data Management Servi...Unleash Data Power with EnFuse Solutions' Comprehensive Data Management Servi...
Unleash Data Power with EnFuse Solutions' Comprehensive Data Management Servi...
 
Revolutionizing Industries: The Power of Carbon Components
Revolutionizing Industries: The Power of Carbon ComponentsRevolutionizing Industries: The Power of Carbon Components
Revolutionizing Industries: The Power of Carbon Components
 
What is social media.pdf Social media refers to digital platforms and applica...
What is social media.pdf Social media refers to digital platforms and applica...What is social media.pdf Social media refers to digital platforms and applica...
What is social media.pdf Social media refers to digital platforms and applica...
 
Unveiling the Dynamic Gemini_ Personality Traits and Sign Dates.pptx
Unveiling the Dynamic Gemini_ Personality Traits and Sign Dates.pptxUnveiling the Dynamic Gemini_ Personality Traits and Sign Dates.pptx
Unveiling the Dynamic Gemini_ Personality Traits and Sign Dates.pptx
 
Potato Flakes Manufacturing Plant Project Report.pdf
Potato Flakes Manufacturing Plant Project Report.pdfPotato Flakes Manufacturing Plant Project Report.pdf
Potato Flakes Manufacturing Plant Project Report.pdf
 
Equinox Gold Corporate Deck May 24th 2024
Equinox Gold Corporate Deck May 24th 2024Equinox Gold Corporate Deck May 24th 2024
Equinox Gold Corporate Deck May 24th 2024
 
Evolution and Growth of Supply chain.pdf
Evolution and Growth of Supply chain.pdfEvolution and Growth of Supply chain.pdf
Evolution and Growth of Supply chain.pdf
 
Byrd & Chen’s Canadian Tax Principles 2023-2024 Edition 1st edition Volumes I...
Byrd & Chen’s Canadian Tax Principles 2023-2024 Edition 1st edition Volumes I...Byrd & Chen’s Canadian Tax Principles 2023-2024 Edition 1st edition Volumes I...
Byrd & Chen’s Canadian Tax Principles 2023-2024 Edition 1st edition Volumes I...
 
Raising Seed Capital by Steve Schlafman at RRE Ventures
Raising Seed Capital by Steve Schlafman at RRE VenturesRaising Seed Capital by Steve Schlafman at RRE Ventures
Raising Seed Capital by Steve Schlafman at RRE Ventures
 
PitchBook’s Guide to VC Funding for Startups
PitchBook’s Guide to VC Funding for StartupsPitchBook’s Guide to VC Funding for Startups
PitchBook’s Guide to VC Funding for Startups
 

Chapter 30 Urinalysis.ppt

  • 1. U R I N A L Y S I S Chapter 30 Deborah Walker, ARNP, BSN, MN 1
  • 2. Urine Formation  Urine forms in kidneys and leaves body through urethra The urinary system >>
  • 3. Urine Formation  How body excretes water and gets rid of waste  Waste can become toxic if not removed  Two kidneys eliminate soluble waste products of metabolism  Click here for an animation Deborah Walker, ARNP, BSN, MN 3
  • 4. Urine Formation  Filtration  Glomerulus filters waste products, salts, and excess fluid from blood  Tubule concentrates filtered material  Nephron  Combination of glomerulus and tubule  One million nephrons in each kidney Deborah Walker, ARNP, BSN, MN 4
  • 5. Urine Formation  Filtration  Substances filtered out from body  Water  Ammonia  Electrolytes  Glucose  Amino acids  Creatinine  Urea  Diabetes diagnosis  Routine urinalysis testing Deborah Walker, ARNP, BSN, MN 5
  • 6. Urine Formation  Reabsorption  About 180 liters of filtrate produced daily  Only 1–2 liters of urine eliminated  Much filtrate reabsorbed into body  Blood cells and most proteins stay in blood  Concentration of glucose in blood below 180 mg/dl will be reabsorbed  Glucose is a threshold substance Deborah Walker, ARNP, BSN, MN 6
  • 7. Urine Formation  Secretion  Substances not already filtered are secreted into urine through distal convoluted tubule  Hydrogen and ammonium ions may be secreted into urine in exchange of sodium  *Know the major functions of the urine* Deborah Walker, ARNP, BSN, MN 7
  • 8. Urine Composition  After passing through kidney, urine is 96% water and 4% dissolved substances (urea, salt, sulfates, phosphates) Deborah Walker, ARNP, BSN, MN 8
  • 9. Urine Composition  Abnormal constituents of urine  WBC  Fat  Glucose  Casts  Bile  Hemoglobin and RBC Deborah Walker, ARNP, BSN, MN 9
  • 10. Urine Composition  Changes in urine production  Amount of urine excreted can rise or fall  Urine color can change  Urine appearance can vary Deborah Walker, ARNP, BSN, MN 10
  • 11. Urine Composition  Changes in urine production  Urine odor can change  Cells can be present in urine  Chemical constituents in urine can change  Urine concentration (specific gravity) may vary Deborah Walker, ARNP, BSN, MN 11
  • 12. Safety  Standard precautions  Transmission-based precautions  Biohazard precautions  Proper disposal of urine Deborah Walker, ARNP, BSN, MN 12
  • 13. Quality Control  Regulatory agencies  Written testing protocols  Maintained testing records  Recalibration of instruments Deborah Walker, ARNP, BSN, MN 13
  • 14. Quality Control  Documentation of daily control testing must be kept at least 3 years  Commercially available urine control samples  Run positive and negative controls each day on all tests Deborah Walker, ARNP, BSN, MN 14
  • 15. CLIA 88  Appropriate training in methodology of test being performed  Understanding of urine testing quality control procedures  Proficiency in the use of instrumentation; being able to troubleshoot problems Deborah Walker, ARNP, BSN, MN 15
  • 16. CLIA 88  Knowledge of stability and proper storage of reagents  Awareness of factors that influence test results  Knowledge of how to verify test results  CLIA categorizes microscopic exam as a PPMP Deborah Walker, ARNP, BSN, MN 16
  • 17. Urine Containers  Types  Nonsterile containers for cultures  24 hour collection containers with added preservatives
  • 18. Urine Containers  Label container immediately after specimen collection  Patient’s name, age, gender, identifying number  Date and time of collection  Physician’s name  Label the cup, not the lid Deborah Walker, ARNP, BSN, MN 18
  • 19. Urine Collection  Urinalysis is the most frequently performed procedure done in the medical office lab  Giving patient instructions Deborah Walker, ARNP, BSN, MN 19
  • 20. Urine Collection  Click to play the video Deborah Walker, ARNP, BSN, MN 20
  • 21. Urine Collection  Urine specimen types  Random (spot) specimen  Obtained at any time  Most common  If concentrated specimen preferred, first specimen of day is most concentrated Deborah Walker, ARNP, BSN, MN 21
  • 22. Urine Collection  Urine specimen types  Fasting/timed specimens  Used when physician wants to measure substance without interference from food intake  Length of fast varies  Give patient written directions  Use regular urinalysis container Deborah Walker, ARNP, BSN, MN 22
  • 23. Urine Collection  Urine specimen types  24-hour specimen  Circadian rhythm and intake of food and water determine concentration of substances at different times during day/night  Requested when quantitative tests for different substances are desired  Expressed in units per 24 hours  Use of preservatives and refrigeration  Sometimes use 2-hour or 12-hour collection instead Deborah Walker, ARNP, BSN, MN 23
  • 24. Urine Collection  Urine specimen types  Catheterized specimen  Insert sterile tube directly into bladder through urethra  Not contaminated  Can cause infection if not done correctly  Use only when other methods are contraindicated or show repeated positive testing for bacteria Deborah Walker, ARNP, BSN, MN 24
  • 25. Urine Collection  Collection methods  Random collection  Clean-catch method; midstream collection  Catheterized Deborah Walker, ARNP, BSN, MN 25
  • 26. Examination of Urine  Best when fresh, even still warm  Test within 30 minutes, or refrigerate Deborah Walker, ARNP, BSN, MN 26
  • 27. Routine Urinalysis Procedure  Physical examination of urine  Assess volume of urine specimen, making sure specimen is sufficient for testing  Note any unusual urine odor  Measure specific gravity of specimen  Normal specific gravity (SG) of urine varies slightly, but 1.005- 1.030 (some may say 1.000-1.035) Deborah Walker, ARNP, BSN, MN 27
  • 28. Routine Urinalysis Procedure  Physical examination of urine  Observe and record color and transparency of specimen
  • 29. Measuring Specific Gravity  Urinometer  Measures specific gravity  Reading the meniscus  Take temperature of urine into account Deborah Walker, ARNP, BSN, MN 29
  • 30. Measuring Specific Gravity  Refractometer  Most common tool for measuring specific gravity of liquids  Measures refractive index of urine  Reads about 0.002 below that of true specific gravity  Needs 1 drop of urine  Easy to use but more expensive
  • 31. Routine Urinalysis Procedure  Chemical examination of urine  Use of multistix reagent strips with color-coded chart  Chemical testing available on urine reagent test strips  See Table 30-3, 30-4
  • 32. Routine Urinalysis Procedure  Chemical examination of urine  Reagent test strip quality control  Automated urine analyzers >>
  • 33. Routine Urinalysis Procedure  Microscopic examination of urine sediment  Classified as PPMP  Sediment is forced to the bottom of centrifuged tube  Helps determine kidney disease, disorders of urinary tract, and systemic disease  Need fresh urine  Use of urine color atlas  Use of urine stains Deborah Walker, ARNP, BSN, MN 33
  • 34. Preparing for Microscopic Examination  Centrifuge 10–15 mL of urine  Pour off supernatant urine  Resuspend sediment by tapping  Stain (optional) >>  Put drop of sediment on slide
  • 35. Urine Sediment Cells and Microorganisms  RBC  WBC  Renal epithelial cells  Bacteria  Yeast-most common is candida albicans  Parasites- most common is Trichomonas  Sperm  Artifacts  Squamous epithelial cells- skin cells; normal; report as few, moderate, or many Deborah Walker, ARNP, BSN, MN 35
  • 36. Crystals in Urine Sediment  Require little attention  Form as urine specimens stand  Uric acid, cystine, and sulfa drug crystals can indicate disease states Deborah Walker, ARNP, BSN, MN 36
  • 37. Casts in Urine Sediment  Important to note  Formed when protein accumulates and precipitates in kidney tubules  Appearance of casts  Hyaline cast most common kind seen  Granular casts and cellular casts also seen  Takes an experienced eye to identify Deborah Walker, ARNP, BSN, MN 37
  • 38. Urinalysis Report  Include patient’s name, type of specimen, collection method, ordering provider, MA name, date and time of collection, date and time of testing, findings
  • 39. Drug Screening  Becoming more common for employment  Test itself is CLIA waived, but detailed protocols must be followed  Chain of custody Deborah Walker, ARNP, BSN, MN 39
  • 40. Medical Terminology  Part VII Urinary System handouts Deborah Walker, ARNP, BSN, MN 40