Ua-Teaching-Plan-2.pdf

Republic of the Philippines TARLAC STATE UNIVERSITY COLLEGE OF SCIENCE Department of Nursing Lu...

Republic of the Philippines TARLAC STATE UNIVERSITY COLLEGE OF SCIENCE Department of Nursing Lucinda Campus, Brgy. Ungot, TarlacCityPhilippines 2300 Tel.no.: (045) 493-1865 Fax: (045) 982-0110 website: www.tsu.edu.ph Awarded Level 2 Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines Inc (AACCUP) TEACHING PLAN TOPIC: Urine Specimen Collection and Testing LEARNING OBJECTIVES: Upon completion of this topic, the students will be able to: Define what is a urine specimen. Describe the characteristics of the recommended urine specimen containers. Describe the correct methodology for labeling urine specimens. State four possible reasons why a laboratory would reject a urine specimen. List 10 changes that may take place in a urine specimen that remains at room temperature for more than 2 hours. Instruct a patient in the correct procedure for collecting a timed urine specimen and a midstream clean-catch specimen. Describe the type of specimen needed for optimal results when a specific urinalysis procedure is requested. Describe the proper technique for performing clinitest, reagent strip testing, and benedict’s solution test. Differentiate the results of clinitest, reagent strip test, and benedict’s solution test. Discuss and identify the results for each test done. Discuss microalbuminuria including significance, acetic acid test and its principles. Discuss and identify the results of acetic acid test. CONTENT: Urine Specimen Urine is a biohazardous substance that requires the observance of Standard Precautions. Gloves should be worn at all times when in contact with the specimen. Specimen Container Specimens must be collected in clean, dry, leak-proof containers and should have a wide mouth to facilitate collections from female patients and a wide, flat bottom to prevent overturning. Containers should be made of a clear material to allow for determination of color and clarity. The recommended capacity of the container is 50 mL, which allows 12 mL of specimen needed for microscopic analysis, additional specimen for repeat analysis, and enough room for the specimen to be mixed by swirling the container. Disposable containers are recommended because they eliminate the chance of contamination due to improper washing. Specimen Labeling Labels must be attached to the container, not to the lid, and should not become detached if the container is refrigerated or frozen. All specimen label must contain: Patient’s name Patient’s identification number Date and time of collection Patient’s age 1  Physician’s name A requisition form must accompany specimens delivered to the laboratory. The information on the form must match the information on the specimen label. Additional information on the form can include: Method of collection/type of specimen Possible interfering medications Patient’s clinical information. The time the specimen is received in the laboratory should be recorded on the form. Improperly labeled and collected specimens should be rejected, and appropriate personnel should be notified to collect a new specimen. Unacceptable situations include: Specimens in unlabeled containers Nonmatching labels and requisition forms Specimens contaminated with feces or toilet paper Containers with contaminated exteriors Specimens of insufficient quantity Specimens that have been improperly transported. Specimen Handling The fact that a urine specimen is so readily available and easily collected often leads to laxity in the treatment of the specimen after its collection. Following collection, specimens should be delivered to the laboratory promptly and tested within 2 hours. A specimen that cannot be delivered and tested within 2 hours should be refrigerated or have an appropriate chemical preservative added. Specimen Preservation Urine specimens must be preserved at 2 – 8 degrees Celsius, which decreases bacterial growth and metabolism. If the urine is to be cultured, it should be refrigerated during transit and held refrigerated until cultured up to 24 hours. The specimen must return to room temperature before chemical testing by reagent strips. Types of Specimen 2  To obtain a specimen that is representative of a patient’s metabolic state, regulation of certain aspects of specimen collection is often necessary. Special conditions may include: Time, length, and method of collection; and The patient’s dietary and medicinal intake. a. Random Specimen Random specimen is the most commonly received specimen because of its ease of collection and convenience for the patient. It may be collected at any time, but the actual time of voiding should be recorded on the container. The random specimen is useful for routine screening tests to detect obvious abnormalities. However, it may show erroneous results resulting from dietary intake or physical activity just before collection. b. First Morning Specimen The first morning specimen, or 8-hour specimen, is the ideal screening specimen. It is also essential for preventing false-negative pregnancy tests and for evaluating orthostatic proteinuria. The first morning specimen is a concentrated specimen, thereby assuring detection of chemicals and formed elements that may not be present in a dilute random specimen. The patient should be instructed to collect the specimen immediately on arising and to deliver it to the laboratory within 2 hours. c. Fasting Specimen (Second Morning) A fasting specimen differs from a first morning specimen by being the second voided specimen after a period of fasting. This specimen will not contain any metabolites from food ingested before the beginning of the fasting period. It is recommended for glucose monitoring. d. 2-Hour Postprandial Specimen The patient is instructed to void shortly before consuming a routine meal and to collect a specimen 2 hours after eating. The specimen is tested for glucose, and the results are used primarily for monitoring insulin therapy in persons with diabetes mellitus. e. Glucose Tolerance Specimens Glucose tolerance specimens are sometimes collected to correspond with the blood samples drawn during a glucose tolerance test (GTT) as an aid to interpreting the patient’s ability to metabolize a measured amount of glucose and are correlated with the renal threshold for glucose. f. 24-Hour (Timed) Specimen To obtain an accurate timed specimen, the patient must begin and end the collection period with an empty bladder. Addition of urine formed before the start of the collection period or failure to include urine produced at the end of the collection period will produce inaccurate results. On its arrival in the laboratory, a 24-hour specimen must be thoroughly mixed and the volume accurately measured and recorded. If a specimen is collected in two containers, the contents of the containers should be combined and thoroughly mixed before aliquoting. g. Catheterized Specimen This specimen is collected under sterile conditions by passing a catheter through the urethra into the bladder. The most commonly requested test on a catheterized specimen is a bacterial culture. h. Midstream Clean-Catch Specimen 3  As an alternative to the catheterized specimen, the midstream clean-catch specimen provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis. Patients must be provided with appropriate cleansing materials, a sterile container, and instructions for cleansing and voiding. Instruct patients to wash their hands before beginning the collection. Male patients should clean the glans, which begins at the urethra, and withdraw the foreskin, if necessary. Female patients should separate the labia and clean the urinary meatus and surrounding area. When cleansing is complete, patients are to void first into the toilet, then collect an adequate amount of urine in the sterile container, and finish voiding into the toilet. i. Suprapubic Aspiration Occasionally urine may be collected by external introduction of a needle through the abdomen into the bladder. Because the bladder is sterile under normal conditions, suprapubic aspiration provides a sample for bacterial culture that is completely free of extraneous contamination. j. Prostatitis Specimen The three-glass collection procedure is used to determine prostatic infection. Instead of discarding the first urine passed, it is collected in a sterile container. Next, the midstream portion is collected in another sterile container. The prostate is then massaged so that prostate fluid will be passed with the remaining urine into a third sterile container. k. Pediatric Specimen Collection of pediatric specimens can present a challenge. Soft, clear plastic bags with hypoallergenic skin adhesive to attach to the genital area of both boys and girls are available for collecting routine specimens. l. Drug Specimen Collection Urine specimen collection is the most vulnerable part of a drug-testing program. Correct collection procedures and documentation are necessary to ensure that the results are those of the specific individual submitting the specimen. For urine specimens to withstand legal scrutiny, it is necessary to prove that no tampering of the specimen occurred, such as substitution, adulteration, or dilution. Urine Glucose Test A urine glucose test measures the level of glucose, or sugar, in the urine. It is less invasive than a blood glucose test, but it also tends to be less accurate. It is often performed to check for diabetes and may also be done to check for kidney problems or a urinary tract infection. Types of Urine Glucose Tests a. Clinitest The clinitest is a method of urine testing for sugar (glucose) using a tablet that is dropped into the urine in a test tube. It uses an alkaline copper sulfate reagent tablet to test for reducing substances; e.g. sugars, in urine. Gives a quantitative result by color changes from green (0.5% glucose) to orange (2% glucose) Clinitest has two methods: o 5-drop method – most common o 2. 2-drop method – detect more extract percentages when high levels of glucose are found in the urine. 4  b. Reagent Strip Test The reagent strip test is a method of urine testing for sugar (glucose) using strips that are dipped into the urine in a test tube. c. Urinalysis Using Benedict’s Solution Benedict’s Test is used to test for simple carbohydrates. It identifies reducing sugars (monosaccharide’s and some disaccharides), which have free ketone or aldehyde functional groups. Benedict’s quantitative reagent contains potassium thiocyanate and is used to determine how much reducing sugar is present. Benedict’s solution is a deep-blue alkaline solution used to test for the presence of the aldehyde functional group, – CHO. One liter of Benedict’s solution can be prepared from 100 g of anhydrous sodium carbonate, 173 g of sodium citrate and 17.3 g of copper (II) sulfate pentahydrate. The color of the mixture serves as a guide to the amount of sugar in the urine: o blue-sugar absent; o green-0.5% sugar; o yellow-1% sugar; o orange-1.5%sugar; o brick red-2 % or more sugar. 5 Urine Albumin Test An albumin test checks the urine for a protein called albumin. Albumin is normally found in the blood and filtered by the kidneys. It is a protein your body uses for tissue growth and repair. Ideally, waste products end up in the urine while albumin and other proteins stay in the blood vessels. If albumin shows up in the urine, it may be a sign of kidney damage. Albumin in the urine is called albuminuria (proteinuria). Signs of Albumin in the Urine Early stages of kidney damage will mostly be asymptomatic. The only way to know if albumin is present in the urine is to have a urine test. When kidney damage gets worse and large amounts of protein escape through the urine, the following symptoms may be noticed: o Foamy, frothy or bubbly-looking urine o Swelling in your hands, feet, abdomen or face Urinalysis Using Acetic Acid In a community setting, urinalysis using acetic acid is a good tool for nurses to have an idea about the albumin in the urine. This is done for people with history of hypertension. The turbidity of the mixture serves as a guide to the amount of albumin in the urine: No turbidity: negative Faint turbidity: (+)1 Heavy Turbidity: (+)2 Solid (opaque): (+)3 PROCEDURAL CHECKLIST Performance Evaluation Checklist Urinalysis Using Acetic Acid Description: Urine test Acetic acid is a test that detects the presence of albumin proteins in the urine. Purpose: To detect the presence of albumin in sample urine (may indicate PIH in pregnant woman) Materials: 1 test tube Test tube holder 10% acetic acid Alcohol lamp Dropper (2 pieces) Urine specimen (early morning urine, midstream flow) Match SCORE Assessment 2 1 0 REMARKS 1. Assess if the collected urine specimen is taken before meals and midstream flow for more accurate results. Planning 2. Prepare the place and all the materials needed for the procedure. Implementation 6  3. Introduce yourself and explain to the client what you are going to do and why it is necessary. 4. Place the paper lining on a table or any clean, flat surface from the client. (clean side out). 5. Place the plastic lining (clean side in) over the paper thing. 6. Place the CHN bag over the plastic lining, tucking the handles beneath the bag. 7. Open the bag, take out soap in dish, apron and towel. 8. Do thorough hand washing. Dry hands. Put on apron, right side out. Wear gloves for added protection. 9. Take out the kidney basin and place 3 cotton balls with alcohol. 10. Take out 2 droppers and place them in the kidney basin, same with the test tube and test tube holder. Take out the match, alcohol lamp, acetic acid and place them near the kidney basin. 11. Place the waste receptacle at one of the work areas. 12. Light the lamp. 13. Fill the test tube about 2/3 full of urine. 14. Heat the upper portion of the test tube to boiling point. (Mouth of the tube should not face the examiner and client) 15. Add 5 drops of 10% acetic acid one drop at a time. Heat again. (Used droppers should be placed near the waste receptacle) 16. Note for changed in color. Interpretation: No turbidity: negative Faint turbidity: (+)1 Moderate turbidity: (+)2 Heavy Turbidity: (+)3 Solid (opaque): (+)4 17. Put off the flame. 18. Wash and drain all the articles used. Discard waste receptacle 19. Do thorough hand washing, dry hands. 20. Return all articles in their proper places in the bag. 21. Remove apron away from the body, folding contaminated part in place in the pocket of the bag. 22. Fold the plastic lining used top in. Insert in between the bag and its cover. 23. Close the bag. 24. Document test result. Evaluation 25. Ensure that you educate your client about the procedure and result. Total Score: Transmuted Grade: Descriptive Interpretation for Actual Score: 2- Very Good 1- Good 0- Not Performed Performance Evaluation Checklist Urinalysis Using Benedict’s Solution Description: Urine test using benedict’s solution is a test to determine the presence of glucose in urine. Glucose found to be present in urine is an indication of Diabetes mellitus. Purpose: 7  To detect for the presence of glucose in urine. Materials: Benedicts solution Test tube Alcohol lamp Droppers (2 pieces) Urine (Early morning, midstream flow) Match Assessment SCORE REMARKS 2 1 0 1. Assess if the collected urine specimen is taken before meals and midstream flow for more accurate results. Planning 2. Prepare the place and all the materials needed or for the procedure. Implementation 3. Introduce yourself and explain to the client what you are going to do and why it is necessary. 4. Place the paper lining on a table or any clean, flat surface away from the client (clean side out). 5. Spread the plastic lining over the paper lining (clean side in). 6. Place the CHN bag over the plastic lining, tucking the handles beneath the bag. 7. Open the bag, take out soap in dish, apron and towel. 8. Do thorough hand washing. Dry hands. Put on apron, right side out. Wear gloves for added protection. 9. Take out the kidney basin and place 3 cotton balls with alcohol. 10. Take out 2 droppers, a test tube and holder, and place them in the kidney basin. Take out the alcohol lamp, match. Benedict’s solution and place them on the work area. 11. Place the waste receptacle at one corner of the work area. 12. Light the lamp. 13. Place 6-8 drops of urine in the test tube. 14. Add 3-5 ml. of Benedict’s solution to the urine. Used droppers should be placed near the waste receptacle. 15. Hold the test tube with the holder, pass the test tube with mixture over the flame. Mouth of the test tube should be away from you and the client. 16. Boil for 2 minutes or keep it in the boiling water bath for 5 minutes. 17. Remove from flame and stand for one minute. Put off flame. 18. Observe and note for any changes in color Interpretation Clean blue -negative Bluish green - (+) 0.5% sugar Yellowish green - (++) 1% sugar Orange - (+++) 1.5% sugar Brick red - (++++) 2% or more sugar 19. Wash and drain all the articles used. Discard waste receptacle 20. Do thorough hand washing, dry hands. 21. Return all articles in their proper places in the bag. 22. Remove apron away from the body, folding contaminated part in place in the pocket of the bag. 8  23. Fold the plastic lining used top in. Insert in between the bag and its cover. Close the bag. 24. Document test result. Evaluation Ensure that you educate your client about the procedure 25. and result. Total Score: Transmuted Grade: Descriptive Interpretation for Actual Score: 2- Very Good 2- Good 1- Not Performed Prepared By: Mr. Joey Albert David, MSN, RN Clinical Instructor Noted By: Prof. Adora N. Obregon RLE Chairperson, Department of Nursing Ms. Regie S. Jimenez RN, MSN Chairperson, Department of Nursing Approved By: Prof. MARY JANE N. RIGOR Dean, College of Science 9