LABORATORY 5: The Complete Urinalysis

Transcription

1 LABORATORY 5: The Complete Urinalysis Notes 1. This lab combines the objectives and activities of the macroscopic and microscopic lab activities. Students are expected to review those labs for reference. 2. Students are expected to review the corresponding information in the course textbook(s) as well as the classroom notes in preparation for this lab and to aid in answering the study questions. Points Points are awarded for prelab assessments, skills, as well as successful and timely completion of study questions. Objectives According to the standards set by the instructor, the student will be able to: 1. perform complete routine urinalysis on five specimens within the level of accuracy determined in the macroscopic and microscopic labs. 2. recognize abnormal dipstick and microscopic results as have been outlined in previous lab exercises. 3. record results accurately. 4. analyze quality control results to determine quality control acceptability. Purposes of testing Routine complete urinalysis is done for a number of reasons: 1. Screen for asymptomatic, congenital, and inherited diseases such as diabetes mellitus, galactosemia, renal and liver disease. 2. To aid in diagnosis of diseases such as urinary tract infections, diabetes, and types of jaundice. 3. To determine the progress of a disease and the effectiveness of treatment. Equipment and Supplies 1. Appropriate urine dipstix (Multistix) 2. Urine specimens (5 or more) 3. Centrifuge, Centrifuge tubes & racks 4. Microscope 5. Sharpie marker, Kim-wipes, microscope slides and cover glasses. 6. Color reference pictures of urinary sediment-textbook. Trouble-shooting correlation discrepancies There are many possible reasons that a specimen s physical/chemical characteristics do not correlate with the microscopic results. Among the first thing to be considered is a mix-up in samples where the microscopic was not performed on the same sample as the physical and/or chemical analysis. Another possibility to consider is deterioration in the sample. This is most commonly seen when there is a significant lag period between the different phases of testing or if the sample is very alkaline. Regardless of the reason, the best course of action is to recollect the sample and repeat the testing ASAP. Procedures Refer to UA Macroscopic and Microscopic labs for specific procedures. Follow the Urinalysis Reporting Standardization Guide to appropriately report results using blue or black ink. Result forms not using appropriate format will have a 50% penalty assessment. RECORDING RESULTS Record all results in appropriate place. Use appropriate format for recording patient and performance control results on the report form provided. Result forms not using appropriate format will have a penalty and may be completely rejected! See example report form in Lab Exercises 2 & 3. Recording of any laboratory result MUST be in black or blue ink. Acceptable recording for positive results: Positive OR Pos Acceptable recording for negative results: Negative OR Neg Other results are to be as indicated on the manufacturer s chart or by the instructor s direction. 1

2 URINALYSIS REPORT SHEET XYZ Medical Clinic 2243 Round Rock Road Austin, Texas Name Date /10 points Control 1 Lot # Control 1 Exp Date Control 2 Lot # Control 1 Control 1 expected results Control 2 Control 2 expected results Control 2 Exp Date Multistix: Glucose Negative mg/dl Trace 3+ Within Range? Yes or No (If No, must bring to instructor s attention and add a comment - as to course of action.) Whether yes or no, you must include your initials! Bilirubin Negative Small Large Lot#: Exp Date: Ketones Negative mg/dl Trace Large Sp. Gravity Blood Negative cells/ul Trace Large ph Protein Negative Trace ->= 300 mg/dl Trace 3+ Urobilinogen 0.2 mg/dl 2 8 mg/dl Nitrite Negative Positive Leukocyte Esterase Negative Trace - Large Controls performed by: Date: 2

3 XYZ Medical Clinic, Austin, Texas Student Name Date / 25 points Specimen Patient Name Patient ID # Physical Properties Multistix 10SG: Lot#: Exp Date: (Results read at differing intervals. Leukocytes read positive at 60 seconds, make final determination at 120 seconds.) Color Transparency Specific Gravity Refractometer Glucose (mg/dl) Bilirubin (negative) Ketone (mg/dl) Specific Gravity Blood (negative) ph ( ) Protein (mg/dl) Urobilinogen (mg/dl) Nitrate (negative) Leukocyte (negative) Microscopic (With the exceptions of Casts and Mucous, all microscopic elements are quantified under hpf. Elements listed in Other must be identified as well as quantified.) WBC (hpf) RBC (hpf) Squamous epi (hpf) Other epi (hpf) Bacteria (hpf) Crystals (hpf) Mucus (lpf) Casts (lpf) Other Back-up / Confirmatory Tests (Identify which, if any, confirmatory tests to be performed on this sample.) Testing performed by: Date: 3

4 Exercise #5: Study Questions Student Name Date / 30 points Instructions: Answer the following questions using related lecture notes and textbook reading assignments. Each question is worth one point unless otherwise stated. 1. A yellow-brown urine which produces yellow foam when shaken can be suspected of containing what substance? 2. The technician refrigerates a yellow, clear freshly voided urine specimen. Several hours later she retrieves the sample for testing, but sees white turbid sediment in the bottom of the cup. Upon testing, the sample is noted to have a ph of 7.5. Which of the following is the most likely reason for the turbid sediment? A. Uroerythrin B. Many WBCs C. Few triple phosphate crystals D. 3+ amorphous phosphate crystals E. 4+ amorphous urate crystals 3. A urine sample has a specific gravity of What normal color would you expect it to be? 4. What is the name of the gelatinous - like substance makes up the matrix of casts? 5. What is the most frequently found cast? (2 points) 6. RBC casts often have serious diagnostic implications. What two (2) minimum criteria should be met before calling a structure an RBC cast? 7. Finding WBC casts is primarily associated with what condition? 8. What type of epithelial cell is found in an epithelial cell cast? 9. List two (2) structures that usually accompany a fatty cast? 10. What two (2) types of casts are most often associated with chronic renal failure? 4 Revised 8/3/15

5 11. The following terms are common or trivial names sometimes given to common urine crystals. For each one, indicate the correct or reportable name and indicate whether it is most commonly associated with an acid or alkaline environment. In the third column, indicate whether or not this crystal is considered pathological keeping in mind that nearly all crystals have been associated with the formation of kidney stones. (12 total pts) You must correctly complete all parts of the row for credit. Trivial name Reportable name (1 pt each) Brick dust Thorn apples Envelopes Coffin lids Dumbbells Normally found in ACID / ALKALINE? (1/2 point each) Considered pathological? YES / NO? (1/2 point each) Notched plates (with 90 degree corners) 12. List three (3) crystals that are NEVER found in normal urine in any amount. (3 points) 13. Which of the following abnormal crystals is NOT associated with severe liver disease? A. Leucine B. Tyrosine C. Cystine D. Bilirubin 14. I am a substance that can form a huge amount of precipitate in the urine of a patient who has recently undergone kidney x-ray. I will cause of the specific gravity reading to be incredibly high if it is measured with a refractometer. I am not pathological, but my structural appearance is sometimes confused with a pathological crystal. 1. Who am I? 2. What pathological crystal do I look like? 15. What are oval fat bodies? 16. What is the significance of finding oval fat bodies? 5 Revised 8/3/15