Chapter 10

• non-blood substances

  • substances produced by the body
  • can either be LIQUID or SEMI-LIQUID form
  • found within body organs such as bladder and spaces such as the joints
• Urine

  • most analyzed
  • urine analysis helps in (1) monitoring wellness; (2) diagnosing and monitoring UTI; (3) detecting and monitoring the progress of treatment in metabolic diseases; (4) identifying the effectiveness of the administered therapy
  • technician: handles urine collection for the OUTPATIENT
  • nursing department: handles urine collection for the INPATIENT
• Common Urine Tests: Ur Caught Crying Danny Girl, Please Other!

  1. Routine Urinalysis
  2. Urine Culture & Sensitivity (C&S)
  3. Urine Cytology Studies
  4. Urine Drug Testing
  5. Urine Glucose & Ketone Testing (G&K)
  6. Urine Pregnancy Testing
  7. Other Urine Tests
• Routine Urinalysis

  • frequently ordered urine test
  • screens the patients for any urinary or systemic disorders
  • cover physical analysis (color, clarity, and odor), chemical analysis (pH, specific gravity, glucose, protein, etc.), and microscopic analysis (urine components such as cells, crystals, and microorganisms)
  • MIDSTREAM COLLECTION is recommended
• Urine Culture and Sensitivity (C&S)

  • requested if the patient has symptoms of UTI
  • urine specimen should be midstream catch collection (placed in sterile condition)
  • a measured portion of urine is cultured on a special nutrient medium for 18 to 24 hours
  • if a microorganism is present and identified, sensitivity or antibiotic susceptibility is performed
• Urine Cytology Studies

  • requested to detect cancer, cytomegalovirus, and other viral and inflammatory diseases in US
  • for more accurate results, fresh clean-catch specimen is required
  • smear= papanicolaou (PAP)
  • delay= put 50% alcohol to preserve the specimen
• Urine Drug Screening

  • performed to detect: (1) illicit use of recreational drugs; (2) use of anabolic steroids; (3) unwarranted use of prescription drugs
  • monitor therapeutic drug use
• Urine Glucose and Ketone Testing (G&K)

  • performed to screen for diabetes
  • determine the glucose level of a diabetic patient
  • urine ketone level test used to determine patients suffering from diabetic ketoacidosis
• Urine Pregnancy Testing

  • use to confirm pregnancy
  • detect 8 to 10 days after conception
  • 1st-morning urine is preferred because it has the highest concentration of human gonadotropin
• Other Urine Test

  • electrophoresis
  • heavy metals (copper and lead)
  • myoglobin clearance
  • creatinine clearance
  • porphyrins
• Types of Urine Specimens

  • Random
  • First morning/8 hour urine specimen
  • Fasting
  • Timed
• Random- collected at any time
• First morning/8 hour urine specimen- collected immediately upon waking up from 8 hours of sleep
• Fasting- a 2nd morning or second specimen voided after fasting (glucose monitoring)
• Timed- collected at specific times/ pooled through a specific time period

  1. tolerance test (glucose)= fasting, 1/2 hour, 1 hour, etc.
  2. 2-hour Postprandial= 2 hours after meal
  3. 24-hour= collecting and pooling of all urine that is voided in 24 hours
  4. double-voided= waiting time of approximately 30 minutes after emptying the bladder
• Urine Collection Methods: Remember Mid, Middling Can Suppress Pediatric

  • Regular Voided
  • Midstream
  • Midstream Clean Catch
  • Catheterized
  • Suprapubic aspiration
  • Pediatric
• Regular Voided

  • patients void/urinate into a clean container
• Midstream

  • patients void/urinate on the toilet first
  • interrupts the urination for a while
  • restart into the container with the last urine flow voided in the toilet
• Midstream Clean Catch

  • special cleaning is performed on the genital area of the patient before collection
• Catheterized

  • urine of the patient is collected from a sterile catheter inserted through the urethra into the bladder
• Suprapubic Aspiration

  • urine is collected by inserting a needle directly into the bladder and aspirating the urine by the use of a sterile syringe
• Pediatric

  • child is not potty-trained, urine is collected in a plastic bag
  • checked every 15 minutes until the required volume is collected
• Amniotic Fluid

  • clear, colorless to pale yellow fluid
  • surround and cushion the fetus during pregnancy
  • collected by a physician using TRANSABDOMINAL AMNIOCENTESIS (15 weeks after gestation)
  • detect genetic disorders, problems in fetal development, and verify the gestational age
  • collected specimen is protected from light
• Amniotic Fluid Collection

  • guided by the ultrasound machine
  • insert the needle to mother's abdominal wall into the uterus (10 mL AF is aspirated)
• Cerebrospinal Fluid

  • liquids that surround the brain and spinal cord
  • clear and colorless
  • obtained by a physician using LUMBAR PUNCTURE or SPINAL TAP
  • diagnose meningitis and other disorders (brain abscess, CNS cancer, and multiple sclerosis)
  • tests: cell counts, chloride, glucose, and total protein
  • collected in 3 tubes: 1st tube (chemistry & immunology test); 2nd tube (microbiology studies); and 3rd tube (cell counts)
• Gastric Fluid/ Gastric Analysis

  • check the contents of the stomach for abnormal substances
  • evaluate the production of acid by evaluating the gastric acid concentration
  • basal gastric analysis = tube is passed through the mouth and throat (oropharynx) or nose and throat (nasopharynx) into the stomach
  • the sample is aspirated to determine the acidity before stimulation
  • gastric stimulant is administered after collection
  • collected specimens are placed in the sterile container
• Nasopharyngeal (NP) Secretion

  • collected and cultured to determine the presence of bacteria that can cause diphtheria, meningitis, pertussis (whooping cough), and pneumonia
  • insert a dacron or sterile cotton-tipped flexible wire swab through the nose and into the nasopharynx
  • rotate the swab, remove it, then place it in a sterile container
• Saliva

  • fluid secreted by the glands inside the mouth
  • check the hormone levels
  • determine alcohol and drug or substance abuse
  • specimen needs to be frozen
• Semen

  • thick yellowish-white fluid
  • contains sperm
  • evaluate the fertility
  • assess the effectiveness of sterilization after the vasectomy procedure
  • also ordered for forensic or legal reasons
  • put in sterile container and protected from light
• Serous Fluid

  • found between the membrane that encloses the pleural, pericardial, and peritoneal cavities.
  • Serum-like fluid
  • pale-yellow and watery
  • allow the membranes to pass through each other with a minimal friction
  • infusion or increased volume= inflammation, infection, decreased protein level
  • EDTA tube= cell counts and smear
  • heparin or sodium fluoride tube= chemistry tests
  • non-anticoagulant tubes= biochemical tests
  • heparinized tubes= blood cultures
• Sputum (mucous/phlegm)

  • diagnose and monitor lower respiratory tract infections like TB
  • collect the sample early in the morning
  • 1 hour after meal to avoid gagging
  • the patient should gargle and remove the denture (if any)
  • procedure: (1) take 3 to 4 deep breaths, (2) inhale and exhale, (3) cough forcefully in the last breath, and (4) expectorate and expel sputum into the sterile container
  • 3 to 5 mL of specimen needed
• Sweat

  • used to analyze the chloride content of the patient (under 20 YO with symptoms of cystic fibrosis-an exocrine gland disorder)
  • used to determine the illegal use of the drug
  • during the sweat chloride test, electrical stimulation in the forearm or thigh (iontophoresis) is used to transport the pilocarpine (sweat-stimulating drug) into the skin.
  • the sweat is then collected, weight recorded, and the chloride content is analyzed
• Synovial Fluid

  • viscous fluid that lubricates movable joints
  • used to determine conditions such as arthritis, gout, and any other inflammatory conditions
  • the fluid is collected in 3 tubes: (1) EDTA/heparin- cell counts, ID of crystals, smear preparation, (2) sterile- culture and sensitivity; (3) non-additive- macroscopic appearance, chemistry, immunology test, and observing clot formation
• Buccal (cheeks) Swab

  • used to obtain loose cells inside the cheek for DNA analysis
  • less invasive and painless alternative to blood collection
• Bone Marrow (BM)

  • BM is examined to identify blood diseases
  • a physician inserts a large-gauge needle into the sternum (breastbone) or iliac crest (hip bone)
  • aspirate 1.0 to 1.5 mL of BM
  • the hematology technologist makes a special slide from the first BM aspiration
• Breath Sample (C-Urea Test)

  • checks for the presence of Helicobacter pylori (a type of bacteria that damages the stomach lining)
  • the breath specimens are analyzed for carbon-13, which confirms the presence of H. pylori
• Breath Sample (Hydrogen Breathe Test)

  • detects carbohydrate digestion problems such as lactose (milk sugar) and fructose (fruit sugar)
  • detect bacterial overgrowth in the small intestine
  • preparation for the test: (1) no antibiotics for 2 weeks, (2) no food intake for 24 hours before the scheduled test, (3) fasting on the day of the test, (4) no smoking and exercise 30 minutes before the test, (5)
  • baseline sample is taken by breathing into the special bag before the introduction of the special drink
  • add. breath samples every 30 minutes for 3 hours
• Feces (Stool)

  • determine GI disorders
  • analyze for the presence of intestinal ova and parasites
  • to culture to examined for the presence of pathogenic bacteria and viruses
  • check fat and urobilinogen content
  • test for the presence of occult (hidden) blood
  • collected in a clean wide-mouth container
• Hair

  • analyze for the trace and heavy metals
  • detect chronic drug abuse (easy to alter and tamper)
• Throat Swabs

  • used to aid in Streptococcal (strep) infection detection
  • a special kit contains a sterile polyester-tipped swab and a cover transport tube