Lesson 12 — Urinalysis

Half A · HLT420A·Kinn's Ch 32·POC Testing & Lab (6%)

Source

All procedural steps, PURPOSE rationales, and topic content below are verbatim from MedCerts HLT420A Storyline modules. Quiz items have been normalized to multiple-choice format with verbatim source rationales. Reference textbook: Niedzwiecki & Pepper, Kinn's The Clinical Medical Assistant, 15th ed., Chapter 32. No outside material added.

Learning Objectives — NHA-aligned

Define urinalysis and discuss collection and handling of a urine specimen
Differentiate physical and chemical examination of urine
Discuss quality assurance and control with performance of urinalysis
Demonstrate urinalysis and list other types of urine testing
Summarize the potential role of the medical assistant in urine testing

Module L12-01 · Procedural skill

Clean-Catch Urine Specimen

Goal: To collect a contaminant-free urine sample for culture or analysis using the clean-catch midstream specimen (CCMS) technique.

Equipment

Patient's record
Sterile container with lid and label
Antiseptic towelettes

Greet the patient by name and confirm his or her identity using two identifiers (typically have patients spell their name and give their date of birth).

Purpose
To make sure you have the right patient.
Label the sterile, sealed container and give the patient the towelette supplies.

Purpose
Labeling the container prevents a possible mix-up of specimens.
Explain the following instructions to adult patients or to the guardians of pediatric patients, making sure you show sensitivity to privacy issues.

Purpose
Instructions must be understood if they are to be followed correctly. By talking to the patient, you can determine whether the patient understands or has any questions.
Wash your hands and open the towelette packages for easy access.
Remove the lid from the specimen container, being careful not to touch the inside of the lid or the inside of the container. Place the lid, facing up, on a paper towel.

Purpose
The lid and the container must be handled carefully to maintain the internal sterility of the container and prevent contamination of the urine sample.
Lower your underclothing and sit on the toilet.
Expose the urinary meatus by spreading apart the labia with one hand.
Cleanse each side of the urinary meatus with a front-to-back motion, from the pubis toward the anus. Use a separate antiseptic wipe to cleanse each side of the meatus.

Purpose
Cleansing the area around the urinary meatus prevents contamination of the urine sample. Wiping in one stroke from front to back prevents the passage of microorganisms from the anal region to the area around the urinary meatus.
Cleanse directly across the meatus, front to back, using a third antiseptic wipe.
Hold the labia apart throughout this procedure.
Void a small amount of urine into the toilet.

Purpose
Allowing the initial flow of urine to pass into the toilet flushes the opening of the urethra.
Move the specimen container into position and void the next portion of urine into it. Fill the container halfway. Remember, this is a sterile container. Do not put your fingers on the inside of the container.
Remove the cup and void the last amount of urine into the toilet. (This means that the first part and the last part of the urinary flow have been excluded from the specimen. Only the middle portion of the flow is included.)
Place the lid on the container, taking care not to touch the interior surface of the lid. Wipe in your usual manner, redress, wash your hands and return the sterile specimen to the place designated by the medical facility.
Wash your hands and expose the penis.
Retract the foreskin of the penis (if not circumcised).
Cleanse the area around the glans penis (tip of the penis) and the urethral opening (meatus) by washing each side of the glans with a separate antiseptic wipe.
Cleanse directly across the urethral opening using a third antiseptic wipe.
Void a small amount of urine into the toilet or urinal
Collect the next portion of the urine in the sterile container, filling the container halfway without touching the inside of the container with the hands or the penis.
Void the last amount of urine into the toilet or urinal.
Place the lid on the container, taking care not to touch the interior surface of the lid. Wipe, wash your hands, and redress.
Return the specimen to the designated area.
Document the date, time, and collection type.
Process the specimen according to the provider's orders. Perform urinalysis in the office or prepare the specimen for transport to the laboratory. If it is to be sent to an outside laboratory, complete the following steps: Make sure the label is properly completed with the patient's information and the date, time, test ordered, and your initials.
Place the specimen in a biohazard specimen bag.
Complete a laboratory requisition and place it in the outside pocket of the specimen bag.
Keep the specimen refrigerated until pickup.
Document that the specimen was sent.

Module L12-02 · Procedural skill

Routine Urinalysis

Goal: To assess and record the color and clarity of a urine specimen; to perform quality control on chemical reagent strips; and to perform a CLIA-waived urinalysis using chemical reagent strips.

Equipment

Patient's record
Urine specimen
Centrifuge tube
Fluid-impermeable lab coat and disposable gloves
Biohazard container
Chek-Stix Control Strips with reference ranges for urinalysis
Distilled water
Capped tube with milliliter markings
Test tube rack
Forceps
Timer
Urine chemical strips for urine testing
Color chart for interpreting the chemical strip results
Control reference sheet and control flow sheet
Reagent strips

Sanitize your hands. Put on the fluid-impermeable lab coat and disposable gloves.
Mix the urine by swirling.

Purpose
Suspended substances settle when urine stands. If urine is not mixed before its appearance is assessed, the finding will be incorrect.
Label a centrifuge tube if a complete urinalysis is to be done.

Purpose
If a complete urinalysis is to be done, a portion of the specimen will be centrifuged for microscopic examination. The centrifuged specimen must be labeled to prevent specimen confusion.
Pour the specimen into a standard-sized centrifuge tube.

Purpose
Standard-sized containers are better for assessing color and clarity results.
Assess and record the color: Pale straw, Yellow, Amber

Purpose
To identify dehydration or disease processes
Assess the clarity by placing a piece of white paper with fine and dark black print behind the specimen and see if you can see the print: Clear—Able to read through the specimen; no cloudiness; Slightly turbid—Can barely see fine print on white paper through the tube; Moderately turbid—Cannot see fine print; only dark print can be seen through the tube; Very turbid—Cannot see any print on white paper through the tube
Clean the work area, and dispose of gloves and procedure supplies in the biohazard waste container. Remove lab coat and sanitize your hands.

Purpose
To ensure infection control.
Record the results in the patient's record.

Purpose
A procedure is considered not done until it is recorded
Assemble the equipment and supplies. Record the lot number and the expiration date of the Chek-Stix on the control log sheet.

Purpose
Chek-Stix cannot be used if the expiration date has passed. Recording the lot number and expiration date is an important part of quality assurance.
Sanitize your hands. Put on the fluid-impermeable lab coat and disposable gloves.

Purpose
To ensure infection control.
Place a conical tube in the rack and remove the cap.
Pour 15 mL of distilled water into the tube.
Using forceps, remove one strip from the Chek-Stix bottle. Inspect the strips for mottling or discoloration.

Purpose
The control strips have chemicals that you should not handle or contaminate with your hands. Any mottling or discoloration may mean that the strips have been exposed to moisture, light, or solvents. Improperly stored control strips should not be used.
Place the strip into the water and tightly cap the tube.
Invert the tube for 2 minutes.

Purpose
Chemicals embedded in the pads must be thoroughly dissolved in the water.
Allow the tube to sit in the rack for 30 minutes.
Invert the tube one time and remove the strip with forceps.
Discard the strip in the biohazard waste container. Once reconstituted, the control solution is stable for 8 hours at room temperature.

Purpose
To ensure infection control.
Perform quality control of the chemical reagent strip by dipping it into the control solution.
Read and record the results.
Compare the results with the control reference ranges provided on the Chek-Stix package insert.

Purpose
Results should fall within a given range provided by the manufacturer. If they do not, the chemical reagent strips cannot be used to test patients' urine.
Discard the chemical reagent strip and the control solution in the biohazard waste container.
Clean up the work area, remove lab coat, and discard gloves in the biohazard waste container, and sanitize your hands.

Purpose
To ensure infection control.
Sanitize your hands. Put on the fluid-impermeable lab coat and nonsterile gloves.

Purpose
To ensure infection control.
Check the time of collection, the container, and the mode of preservation.

Purpose
Proper specimen identification and screening of specimens for appropriate collection containers and collection procedures prevent testing of inappropriate specimens.
If the specimen has been refrigerated, allow it to warm to room temperature.

Purpose
Certain tests are temperature dependent. Testing of cold specimens may cause false-negative results.
Check the reagent strip container for the expiration date.

Purpose
Do not use expired reagents.
Remove the reagent strip from the container. Hold it in your hand or place it on a clean paper towel. Recap the container tightly.

Purpose
Test strips are sensitive to moisture and light and must be stored in tightly sealed containers. Contamination from chemical residues on countertops can affect results.
Compare nonreactive test pads with the negative color blocks on the color chart on the container.

Purpose
Discolored pads indicate that the product has not been properly stored and must not be used for testing.
Thoroughly mix the specimen by swirling.

Purpose
If settling occurs, certain elements may not be detected.
Following the manufacturer's directions, note the time, dip the strip into the urine, and then remove it.

Purpose
Tests are time dependent. Some pads darken over time.
Quickly remove the excess urine from the strip by pulling the back of the strip across the lip of the specimen container and then blotting the edge of the strip on a paper towel or the side of the specimen container.

Purpose
Excess urine on the strip or prolonged dipping time affects test results.
Hold the strip horizontally. At the required time, compare the strip with the appropriate color chart on the reagent container. Do not touch the strip to the bottle. Alternately, the strip can be placed on a paper towel.

Purpose
Holding the strip horizontally prevents runover from one test pad to another and prevents interference from mixing of chemicals in the test pads.
Read and record the first two results 30 seconds after dipping the strip (the indicated time to read the "Glucose" and "Bilirubin"). Compare the two reagent pads closest to your hand with the bottom two rows of the color chart.
Continue reading and recording each row of possible results with its appropriate reagent pad at its designated time.

Purpose
Timing is critical. Allowing the strip to come in contact with the bottle contaminates the bottle.
Clean the work area and remove gloves. If a paper towel was used, dispose of it, the reagent strip, and the gloves in the biohazard container. Remove lab coat and sanitize your hands.

Purpose
To ensure infection control.
Document the results in the patient's record, and reassure the patient of the accuracy of the test results.

Purpose
A procedure is considered not done until it is recorded.

Module L12-03 · Procedural skill

Microscopic Urine Prep

Goal: To prepare a urine specimen for the provider's microscopic examination to determine the presence of normal and abnormal elements.

Equipment

Patient's record
Urine specimen
Centrifuge tube
Centrifuge
Disposable pipet
Sedi-Stain
Microscope slide and coverslip
Microscope
Permanent marker
Fluid-impermeable lab coat and disposable gloves
Face protection
Biohazard waste container

Sanitize your hands. Put on the fluid-impermeable lab coat and disposable gloves.

Purpose
To ensure infection control.
Gently mix the urine specimen by swirling the covered specimen container.

Purpose
If the urine is not well mixed, elements that have settled to the bottom of the specimen container will be missed.
Pour 10 mL of urine into a labeled centrifuge tube and cap the tube.
Place the tube in the centrifuge.
Place another tube containing 10 mL of urine or water in the opposite cup.

Purpose
For proper operation, centrifuges must be carefully balanced. If not properly balanced, damage to the instrument can occur.
Secure the lid and centrifuge for 5 minutes or for the time specified for your instrument.

Purpose
Timing varies according to the speed and the size of the centrifuge head.
Remove the tube from the centrifuge after the instrument has come to a full stop.
Pour off the clear supernatant from the top of the specimen by inverting the centrifuge tube over the sink drain while allowing the running water from the faucet to flush the urine down.
Turn the tube upright when the supernatant has been decanted, allowing a small amount to return to the sediment on the bottom of the tube without losing sediment down the drain.

Purpose
The sediment will be examined under the microscope.
Thoroughly mix the sediment with a drop of Sedi-Stain by grasping the tube near the top and rapidly flicking it with the fingers of the other hand until all sediment is thoroughly resuspended.

Purpose
Elements centrifuge at different rates. Failure to mix the entire sediment completely results in quantification errors. Sedi-Stain colors the sediment for easier viewing.
Transfer 1 drop of sediment to a clean, labeled slide using a clean, disposable transfer pipet.
Place a clean coverslip over the drop and place the slide on the microscope stage. Remove face protection.
Examination under the microscope will be performed by a trained healthcare provider

Practice quiz · verbatim from MedCerts

Knowledge-check items

Click an answer to lock it in — you'll see the rationale below. Reset any time to re-attempt. Items originally formatted as true/false, fill-in-blank, or drag-and-drop have been normalized to multiple choice; the source format is noted in the eyebrow.

L12-01 · Clean-Catch Urine Specimen

Q1 · L12-01 · normalized from tf

Cleansing the area around the urinary meatus prevents contamination of the urine sample.

Rationale

"Cleansing the area around the urinary meatus prevents contamination of the urine sample."

This procedure is a critical step in the clean-catch technique for both male and female patients to remove microorganisms that could compromise the specimen.

Source: L12-01 Knowledge Check

Q2 · L12-01 · normalized from tf

When collecting a clean-catch urine specimen from a pediatric patient, you should explain the instructions to the parents or guardians while showing sensitivity to privacy issues.

Rationale

"Explain the following instructions to adult patients or to the guardians of pediatric patients, making sure you show sensitivity to privacy issues."

Sensitivity to privacy is especially important when explaining intimate collection procedures to guardians of pediatric patients.

Source: L12-01 Knowledge Check

Q3 · L12-01 · normalized from tf

After collecting a urine specimen, the patient should place the lid on the container while being careful not to touch the interior surface of the lid.

Rationale

"Place the lid on the container, taking care not to touch the interior surface of the lid."

Touching the interior surface would compromise the sterility of the container and contaminate the specimen, affecting test results.

Source: L12-01 Knowledge Check

Q4 · L12-01 · normalized from tf

When a urine specimen is collected for laboratory testing, it must be placed in a biohazard specimen bag before transport.

Rationale

"Place the specimen in a biohazard specimen bag."

Biohazard bags are a standard requirement for safe transport of all patient specimens to protect laboratory personnel and prevent cross-contamination.

Source: L12-01 Knowledge Check

Q5 · L12-01 · normalized from tf

A collected urine specimen can be stored at room temperature on a counter or in a cabinet until it is transported to the laboratory for testing.

Rationale

"Keep the specimen refrigerated until pickup."

Refrigeration is required to prevent bacterial growth and degradation of cellular elements in the urine specimen, which would compromise test accuracy.

Source: L12-01 Knowledge Check

L12-02 · Routine Urinalysis

Q1 · L12-02 · normalized from fitb

To ensure infection control after assessing urine color and turbidity, what type of waste container should be used to dispose of gloves and procedure supplies?

Rationale

"Clean the work area, and dispose of gloves and procedure supplies in the biohazard waste container."

Biohazard containers are required for all potentially contaminated materials including gloves and supplies used during urinalysis procedures to prevent cross-contamination.