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CHAPTER 47 Processing and Testing Urine and Stool Samples © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-2 Learning Outcomes 47.1 Discuss the role of the medical assistant in collecting, processing, and testing urine and stool samples. 47.2 Carry out procedures for following guidelines when collecting urine specimens. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-3 Learning Outcomes 47.3 Describe the process of urinalysis and its purpose. 47.4 Carry out the proper procedure for collecting and processing a stool sample for fecal occult blood testing. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-4 Introduction • Proper collection of urine and stool specimens key to diagnosing • Medical assistant – Learn about urine and fecal specimens – Instruct or assist patient in collection of a specimen – Constituents of urine samples – Chain of custody for drug screening © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-5 The Role of the Medical Assistant • Collect, process, and test urine samples • Knowledge necessary – Anatomy and physiology of kidneys – How urine is formed – Normal components of urine © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-6 Role of the Medical Assistant • Potentially hazardous waste – Standard Precautions – PPE as needed – Handle and dispose of specimens properly – Dispose of used supplies and equipment properly – Sanitize, disinfect, and/or sterilize reusable equipment © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-7 Apply Your Knowledge What does the medical assistant need to know related to collecting, processing, and testing urine specimens? ANSWER: The medical assistant needs to know the anatomy and physiology of the urinary system, how urine is formed, and normal components of urine. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-8 Obtaining Urine Specimens • General guidelines – Follow procedure for specified test – Use appropriate specimen container – Label specimen container correctly – Explain the procedure to patient – Wash your hands before and after; wear gloves – Complete paperwork © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-9 Obtaining Urine Specimens (cont.) • Instruct patients – Test-specific – General • Use correct container • Do not discard preservative • Refrigerate the collection container • Keep lid on the container © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-10 Specimen Types • Quantitative analysis • Qualitative analysis • Vary in – The method used to collect a specimen – The time frame in which to collect a specimen • Follow procedure exactly © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-11 Specimen Types (cont.) • Random urine specimen – Most common – Obtained any time during the day • First morning specimen – Collected after a night’s sleep – Contains greater concentration of substances © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-12 Specimen Types (cont.) • Clean-catch midstream – Used for culturing urine – External genitalia must be cleansed – A small amount of urine is discarded prior to collecting specimen © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-13 Specimen Types (cont.) • Timed urine specimen – Discard first specimen – Collect all urine for specified time – Refrigerate • 24-hour specimen – Timed collection – Instruct as for a timed specimen © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-14 Catheterization • Procedure by which the catheter is inserted into the bladder © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-15 Catheterization (cont.) • Reasons – Relieve urinary retention – Obtain a sterile urine specimen – Measure the amount of residual urine – Obtain a specimen if patient cannot void – Instill chemotherapy – Empty bladder before and during procedures © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-16 Catheterization (cont.) • Drainage catheters – Indwelling urethral catheter – Retention catheter – Ureteral catheter – Cystostomy tube – Straight catheter • Splinting catheter – inserted after repair of ureter © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-17 Catheterization (cont.) • Not a routine procedure due to risk of infection • Not typically performed by medical assistants – Check scope of practice – Assemble supplies © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-18 Special Considerations • Male and female patients – Differences in collecting clean-catch midstream specimen – Questions during history • Pregnant patients – Frequency – Prone to urinary tract infection – Urine checked for glucose and protein © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-19 Establishing Chain of Custody • Do not alter the procedure • Explain procedure • Consent form gives permission to – Collect the specimen – Prepare it for transport to laboratory – Release the results to agency requesting test © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-20 Preservation and Storage • Changes can occur if urine is left at room temperature for more than 1 hour • Preservation Specimen s only – Refrigeration • Prevents growth for 24 hours • Return to room temperature before testing – Chemical preservatives © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-21 Apply Your Knowledge True or False: ANSWER: T A random urine specimen can be collected any time. F A clean-catch midstream urine specimen should be collected the first thing in the morning. first morning T Instruct the patient to discard the first specimen when collecting a timed or 24-hour specimen. T A chain of custody form gives you permission to release F the results to the agency requesting the test. Urine specimens should be refrigerated if they will not be tested within one four hours. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-22 Urinalysis • Evaluation of urine to obtain information about body health and disease • Types of testing – Physical – Chemical – Microscopic © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-23 Urinalysis (cont.) • Values – Negative or none, normal, or a range of concentration – Within normal limits indicate health and normality • Screening – must have follow-up testing © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-24 Urinalysis (cont.) • Average adult daily urine output is 1250 mL/24 hours • Intake and output should be approximately the same • Dysfunctions of other body systems can affect urinary function © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Physical Examination and Testing of Urine Specimens • Check label • Check for visible contamination • Check time since collection 47-25 • Visual examination – Color and turbidity – Volume – Odor – Specific gravity © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Physical Examination and Testing of Urine Specimens (cont.) 47-26 • Color – Pale yellow to dark amber – Concentration • Turbidity – clear or cloudy © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Physical Examination and Testing of Urine Specimens (cont.) 47-27 • Volume – 600 to 1800 mL/24 hours – Oliguria – Anuria • Odor – Not typically recorded – Distinct, aromatic © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Physical Examination and Testing of Urine Specimens (cont.) 47-28 • Urine Specific gravity – 1.002 to 1.028 – Fluctuates in response to fluid intake – Methods • Refractometer • Reagent strips © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-29 Chemical Testing of Urine Specimens • Check label • Reagent strip testing – Color change – Follow instructions carefully © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-30 Chemical Testing of Urine Specimens • Quality assurance – Keep bottle tightly closed – Remove strip just prior to use – Do not touch pads – Check for discoloration and expiration date – Date new bottles and discard after 6 months © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Chemical Testing of Urine Specimens (cont.) • Ketone bodies 47-31 • Urinary pH – Products of fat and protein metabolism – Measure of acidity or alkalinity – Normally none in urine – Normal 5.0 to 8.0 © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Chemical Testing of Urine Specimens (cont.) 47-32 • Blood – Use a strip that reacts with hemoglobin – Hematuria – Hemoglobinuria – Myoglobinuria © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Chemical Testing of Urine Specimens (cont.) 47-33 • Bilirubin – Breakdown of hemoglobin – Bilirubinuria ~ early sign of liver disease • Urobilinogen – Elevated – increased RBC destruction – Lacking – bile duct obstruction © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Chemical Testing of Urine Specimens (cont.) 47-34 • Glucose – Normally in small amounts – Glycosuria – diabetes • Protein – Normally excreted in small amounts – Proteinuria – excess protein in the urine © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Chemical Testing of Urine Specimens (cont.) • Nitrite – suggests bacterial infection • Leukocytes – urinary tract or renal infection 47-35 • Phenylketones – Phenylketonuria (PKU) – Blood testing is more routine for newborns © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Chemical Testing of Urine Specimens (cont.) 47-36 • Pregnancy tests – Detect human chorionic gonadotropin (HCG) – Quick, easy to perform and interpret – Enzyme immunoassay (EIA) test © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Chemical Testing of Urine Specimens (cont.) 47-37 • Presence of STDs – Screening for chlamydia – Nucleic acid amplification tests (NAATs) • Detect nucleic acid in urine • Chlamydia and gonorrhea • Advantages vs. disadvantages © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Microscopic Examination of Urine Specimens 47-38 • View elements only visible with microscope • Centrifuge – Spins urine ~ heavier substances settle to the bottom of the tubes – Sediment examined © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Microscopic Examination of Urine Specimens (cont.) 47-39 • Cells – Epithelial cells • Renal • Transitional • Squamous – White blood cells – Red blood cells © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Microscopic Examination of Urine Specimens (cont.) 47-40 • Casts – Cylindrical elements – Protein – Classification • Hyaline • • • • • Granular RBC casts WBC casts Epithelial cell casts Waxy © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Microscopic Examination of Urine Specimens (cont.) 47-41 • Crystals – Naturally produced solids of definite form – Common in urine – Determine pH before identifying © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Microscopic Examination of Urine Specimens (cont.) • Yeast cells – May be confused with RBCs – Associated with genitourinary tract infection, diabetes 47-42 • Bacteria – A few are normal – Infection if odor and WBCs are present • Parasites – may indicate infection © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-43 Apply Your Knowledge 1. What is the specific gravity shown on this refractometer screen? ANSWER: The specific gravity shown here is 1.030. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-44 Apply Your Knowledge 2. Matching: ANSWER: A. Casts C pale yellow to dark amber F cloudiness B. Specific gravity I absence of urine B measure of concentration of urine H acidity or alkalinity of urine D. Renal epithelial cells G genetically inherited disorder D may indicate tubular damage F. Turbidity C. Normal color E. Crystals G. PKU H. pH cylinder-shaped sediment of proteins A E naturally produced solids in cool urine I. Anuria © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Collecting and Processing Stool Specimens 47-45 • Screening for colorectal cancer – Fecal occult blood test • Tests for hidden blood • Foods and medication may cause false-positives • Patient instruction important © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Collecting and Processing Stool Specimens (cont.) 47-46 • Suspected Bacterial Infection – Shigella or Salmonella – Loose, bloody or mucus-tinged stools – Culture media • Promote growth of intestinal pathogen • Suppress growth of other microorganisms © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a Collecting and Processing Stool Specimens (cont.) 47-47 • Suspected Protozoal or Parasitic Infection – O & P specimen – Three separate sets of fresh and preserved specimens – Special kits available © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-48 Apply Your Knowledge Besides how to collect the stool sample for FOBT testing, what else do you need to tell the patient? ANSWER: The patient need to know to follow all pretest dietary and medication instructions. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-49 In Summary 47.1 Your role as a medical assistant includes collecting, processing, and testing urine samples, and processing and testing stool samples. You will also be responsible for teaching patients proper collection methods for urine and stool samples. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-50 In Summary (cont.) 47.2 The general guidelines for collecting a urine specimen include: – following the procedure specified for the urine test that will be performed; – using the type of specimen container indicated by the laboratory; – properly labeling the specimen container; – explaining the procedure to the patient when assisting in the collection process; – washing your hands before and after the procedure and wearing gloves during the procedure; and – complete all necessary paperwork. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-51 In Summary (cont.) 47.3 Urinalysis is the evaluation of urine by various types of testing methods to obtain information about body health and disease. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-52 In Summary (cont.) 47.4 The general guidelines for collecting a stool specimen include: – instructing the patient about the need to follow all collection procedures including when to collect, how to collect, and how to return the specimen to the office; – following the testing procedure for fecal occult blood testing, using Standard Precautions when performing the test; and – documenting the test and results in the patient’s chart. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a 47-53 End of Chapter 47 A human being: an ingenious assembly of portable plumbing. ~ Christopher Morley, 1890-1957 © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a