WPCB ̀AgQӟwWYP>+‹o 7waF=M"'s2Vh = [ׂZ!yq(6E@>[h{qybxaeuGW#47ep(PG^Oi##s~{Ʋ9>eA`Nk)x2!,Q#8J׶ڌ%HY,n!B\ȦΔ:I,ϼe{Ut1""a|O882hf(즗2K EX=Th*r:sDCp(KTS]nz0)ve,~W>DA-Dɍ>jqF!j`}JՔHTYܬ<m- vM\5R7ׅ:I{{ciQ=/zG'1D@LU6T %   n" 04 N U : 1? w 4 1u ~S 0.c 724f 0Pk 0U#ff?aAU W m]^tE` B &C D3 < 0UN^ 3 0? C 0 0 0 0I 0 0 0> 0 0 0! 04" 0" 0|# 0$ 0$ 09% 0% 0& 0y' 0#( i7( 0( 0) 04* 0* 0P+ 0, 0, 0>~- 0- 0. 0/ 0x0 0Z1 0<2 03 03 024 04 0:5 0Y6 0_k6 0 6 07 0V9 B*\; D/; D-; 0; D/= 0> 06> 0? 0:#@ 0^]@ 0<@U6@U >-AU*kAeA 0PA 0JBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJBJB iB<\  `(Roman 10cpiX' "Lab #11: Chemical Examination of Urinelab11&sq  0 .   3|x<\  `(Roman 10cpiXx\  @ X@( U$  ,@AZ"Arial Regular(5hCEKQW]cioAutoList11.1.1.1.1.1.1.1.`,= 3#37=CIQYag1.a.i.(1)(a)(i)1)a) t    \R'3 Letter Landscape\(;3$2#  0  .3  0   i) )   _HHA) xd!EHWH!A X Exercise_13:_ԀUrinePregnancyTest((3$ U!   *+ (_2623  ..HPE438C7 (HP Officejet J6400 series)0 \\R3' Letter\TABLE AHU T )   HHLevel 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5 dLevel 1Level 2Level 3Level 4Level 5'dxdLevel 1Level 2Level 3Level 4Level 5*G+G (_25   /%` ` hp x /23  ../%` ` hp x /   (9 Z6Times New Roman Regularn=  *8+8 (_24  ," hp x ,23  ..," hp x ,   d*5+5 (_23 ` ) hp x )23  ..) hp x ) ` *2+2 (_22  &hhp x &23  ..&hhp x &  */+/ (_21  #p x #23  ..#p x #  *,+, (_20 h  p x 23  .. p x h *)+) (_19  pp x 23  ..pp x   *&+& (_18   x 23  .. x   *AA (_17  5+ ` hp x 523  Ԁ5+ ` hp x 5  *GG (_16   /%` ` hp x /23  Ԁ/%` ` hp x /   *88 (_15  ," hp x ,23  Ԁ," hp x ,  *55 (_14 ` ) hp x )23  Ԁ) hp x ) ` *22 (_13  &hhp x &23  Ԁ&hhp x &  *// (_12  #p x #23  Ԁ#p x #  *,, (_11 h  p x 23  Ԁ p x h *)) (_10  pp x 23  Ԁpp x   (&& &_9   x 23  Ԁ x   (AA &_8  5+ ` hp x 523  5+ ` hp x 5  (GG &_7   /%` ` hp x /23  /%` ` hp x /   (88 &_6  ," hp x ,23  ," hp x ,  (55 &_5 ` ) hp x )23  ) hp x ) ` (22 &_4  &hhp x &23  &hhp x &  !'-%(// &_3  #p x #23  #p x #  (,, &_2 h  p x 23   p x h ()) &_1  pp x 23  pp x   &&& $_   x 23   x   0AA.Normal  5+ ` hp x 55+ ` hp x 5  <AA:Definition T  5+ ` hp x 55+ ` hp x 5  <AA:Definition L , 5+ ` hp x 5  5+ ` hp x 586Definition(hh&H1  5+ ` hp x 5      5+ ` hp x 5  (]]&H2  5+ ` hp x 5  5+ ` hp x 5  (]]&H3  5+ ` hp x 5  5+ ` hp x 5  (]]&H4  5+ ` hp x 5 XXX 5+ ` hp x 5  (]]&H5  5+ ` hp x 5  5+ ` hp x 5  (]]&H6  5+ ` hp x 5  5+ ` hp x 5  2DD0Address  5+ ` hp x 55+ ` hp x 5  8MM6Blockquote , , 5+ ` hp x 5   5+ ` hp x 5,*CITE,dl*CODEK`<6X9`(Courier NewKSa\  `&Times New RomanS42Emphasis64Hyperlink    <:FollowedHype    4go2Keyboard K`<6X9`(Courier NewKSa\  `&Times New RomanS <:Preformatted  /%  ,Kk %#/K`<6X9`(Courier NewKSa\  `&Times New RomanS/%  ,Kk %#/  <:zBottom of 7V(X7    5+ ` hp x 5?b%2A`Arial?  Sa\  `&Times New RomanS7W(X75+ ` hp x 5  &  d dU)1dxd)!dxdx<:zTop of For7Y(X7    5+ ` hp x 5?b%2A`Arial?  Sa\  `&Times New RomanS7W(X75+ ` hp x 5  U)2dxd0KS.SampleK`<6X9`(Courier NewKSa\  `&Times New RomanS0.Strong 8dl6TypewriterK`<6X9`(Courier NewKSa\  `&Times New RomanS42Variable: 8HTML MarkupB      2 0CommentB  <6X9`(Courier New\  `&Times New Roman%2A`Arial [ d*   _    1  ((3$ U!   (b$0  0` (#(#2#   .3  0 ` (#` (#!'  U!   _XXHH XEXXX XXE/ z__8EXXdd8cEXERCISE_13:_0 #XEX # XXEURINEPREGNANCYTEST #XEX #X $ $ $XXXXETextbook:0  None~&$$      P     X   Skill:0  0$$20pointsV$$ Objectives:0  .$$  (#33 "3"  32#  1  .3  0    Statethesubstancebeingdetectedintheurinepregnancytest.3݌ $$ Ќ  "3"  32#  2  .3  0    Statetheprincipleoftheurinepregnancytest.3݌ $$ Ќ  "3"  32#  3  .3  0    Statethesampleofchoiceforapregnancytest.3݌  $$ Ќ  "3"  32#  4  .3  0    Describethetemperatureandamountoftimeaurinemaybestoredforapregnancytest.3݌ $$ Ќ  "3"  32#  5  .3  0    Describethequalitycontrolwhichmustbeperformedonpregnancytestkitsandtheexpectedresults.3/݌ r $$ Ќ  "3"  30 2#  6  .3  0    Describethecourseofactionwhichmustbetakenifthecontrolsdonotgivetheexpectedresults.30 ] ݌ ^ $$ Ќ  "3"  3\ 2#  7  .3  0    falsepositiveasitrelatestopregnancytestingandlisttwocauses.3\ ݌J $$ Ќ  "3"  3s 2#  8  .3  0    Define falsenegativeasitrelatestopregnancytestingandlisttwocauses.3s ݌6 $$ Ќ  "3"  3 2#  9  .3  0    Describetheproperhandlingofspecimensforurinepregnancytestswhichcannotbetestedright z" away.3 ݌f$$ Ќ  "3 "  3 2#  10  .3  0    Performurinepregnancytestingontwosamplesandevaluatetheresultsforvaliditybasedonthe R resultsofthequalitycontrol.3 ݌>$$ Ќ  Discussion    Humanchorionicgonadotropin (_HCG_)isahormoneproducedbytheplacentashortlyafterimplantationof  theembryointotheuterinewall.Since_HCG_Ԁispresentintheurineofpregnantwomen,itisanexcellent  markerforconfirmingpregnancy. n  Principleofthetest  F Thetestmethodologyusediscalled_Enzme_ԀLinkedImmunoassayor_ELISA_.Theteststripisbrieflydipped v intheurinesampleorurineisappliedtoaspecificlocationonthetest_casette_.Thesamplemigratesby b  capillaryactionthroughapadcontainingamonoclonalanti_HCG_Ԁantibody;ifthesamplecontains_HCG_,a N complexisformedwiththeanti_HCG_Ԁantibody.Thecomplexwillcontinuetomigrateandbeboundbya : _polyclonal_Ԁanti_HCG_Ԁantibodyspottedonthetestline.If_HCG_Ԁispresentinthesampleatalevelof25 &   _mIU_/mLorgreateracolorchangewilloccur,thismaybealine, plussign,etc..Thevisiblereactionwhich !! occurswillbedeterminedbythemanufactureritiscriticaltoreadtheproceduretointerprettheresults !" correctly.Mosttestshaveabuiltincontrolwhichmustreact,whetherornotthepatientdoes.If_HCG_Ԁisnot " # presentinthesample,orpresentatverylowlevels,onlythecontrolwillreact. #~!$  SpecimenCollectionandPreparation  %V#& CollectatleastonemLofurineinaclean,dry,plasticorglasscontainerwithnopreservatives.Specimens '.%( maybecollectedatanytimeoftheday,howeverthefirstmorningsamplegenerallyhasthehighest r(&) concentrationof_HCG_Ԁandisthespecimenofchoice. Urinesamplesmayberefrigeratedandstoredupto ^)'* 72hourspriortotesting. Samplesmayalsobefrozenforlongtermstorage.Ifsamplesarerefrigeratedor J*'+ frozen,theymustbebroughttoroomtemperaturebeforetesting.IMPORTANT:Refertothepackageinsert 6+(, forappropriatestoragetimes.Therecommendationsgivenherearegeneral.Ifthepackageinsertstatesa ",)- differentallowablestoragetimeyoumustfollowthoserecommendations.Urinesampleswithvisible -*. precipitatesshouldbefiltered,centrifugedorallowedtosettlesothatclearaliquotscanbeusedfortesting. -+/ Ї QualityControl  X Personnelperforminglaboratorytestingmustfollowacceptedguidelinestoensureaccurateresults.Itis 0 requiredthatthekitbetestedwithcommerciallyavailablepositiveandnegativecontrolsamplesbetested  uponeachdayofuseandgiveacceptableresults,i.e.,thepositivecontrolmustbepositiveandthenegative  controlmustbenegative.Alternativelysomelaboratorieswilltestanewlotnumberofanewkitwith  controlsthenrelyonthebuiltincontrolsintheteststriptovalidatetheprocedure.Youmustfollowthe  proceduredictatedinthelaboratoryProcedureManual.Ifcommercialpositiveandnegativecontrolsdonot t giveexpectedreactionsORiftheinternalcontrolsdonotgiveexpectedreactions,repeatthetest.Ifinvalid  ` resultsarestillobtainedthemanufacturermustbenotifiedanddocumentationoftheseactionsmustbe  L  performed.  8   LimitationsoftheProcedure  h   A  falsepositive pregnancytestisoneinwhichthepregnancytestispositivebut thepatientisnotpregnant . @  _HCG_Ԁhasbeenfoundinpatientswithbothgestationalandnongestational_trophoblastic_Ԁdisease.Since_HCG_ ,  of_trophoblastic_Ԁneoplasmissimilartothatfoundinpregnancy,conditionssuchas_choriocarcinonma_Ԁand  _hydatidiform_Ԁmolesshouldberuledoutbeforeapregnancyisdiagnosed.aXXX$XFalsepositivetestsarevery  uncommon,especiallywiththenewertests(usingmonoclonalantibodiesto_hCG_).#$XXXaX]"#  A  falsenegative pregnancytestisoneinwhichthepatientispregnantbuttheresultofthepregnancytest p isnegative.aXXX$XFalsenegativeresultsaremorecommonandareespeciallyundesirablebecausetheydelayonset \ ofcareforwomenwhomaythenusepotentiallyhazardousmedicationsafterbeingfalselyreassuredthatthey H arenotpregnant.Theprimarycauseoffalsenegativepregnancytestsisinaccuraciesintimingofthetestor 4 intheprocedureitself.Followingkitinstructionstotheletterisveryimportantbuteventhenfalsenegatives x  dooccur.#$XXXaX##ԀAsecondcauseofafalsenegativetestisthatthesamplewasnotafirstmorningandthepatientis d  recentlypregnant(_HCG_Ԁlevelsaretoolow).aXXX$XThetestshouldberepeatedweeklyifthewomanstilldoesnot P haveaperiod.#$XXXaX'# < Anormalpregnancycannotbedistinguishedfroman_ectopic_Ԁpregnancybasedon_HCG_Ԁlevelsalone.Also,  aspontaneousmiscarriagemaycauseconfusionininterpretingtestresults.Ifnegativeorquestionableresults  areobtainedandpregnancyissuspected,thetestshouldberepeatedonafreshurinespecimenatleast48  hoursafterinitialtesting.Mosturinepregnancytestscandetect(becomepositive)asearlyas2or3days   beforethenextexpectedmenses.  l!      P    S"!X Sӹ  aXXX$X S#$XXXaX*# -a+. _ XEXX$X XXEEXERCISE13:0 #XEX V+# XXEURINEPREGNANCYTEST#$ T 7+##$XX$ T+#$4 X$XXP $P $ #$XX $4),# Name :________________________0  0X$$0X$X$Date:__________________________0!$$0$!$!$0@$!$!$0@$!$!$b$$$$ Followtheinstructionsonthereagentpackageinsertprovidedbytheinstructortoproperlyperformthe : test..$SN X$X ~& #$XX $SN.# InterpretationofResults:  j  Basedonthepackageinsertcorrectlyinterprettheresultsofthepregnancytestonthe2patientsamples B  $4 X$XRecordresultsas  PositiveN/ or  Negative/ #$XX $4/#   *ddd Xdd Xdd XH$H$,dd ,A dd ,dd +  ) )$4 X$X  SAMPLETESTED#$XX $41#$!X$X 'j  '#$XX$!x1#<1$4 X$X  PATIENTID j NUMBER '~&" '2  RESULT#$XX $41# #j"  #x2POSITIVECONTROL  & NOTANY &"   & NEGATIVECONTROL  N NOTANY N"  5+ N  ?1.?51. 4*(&  ?1. ? 4  &  5+ &  @2.@52. 4*(N  @2. @ 4  N  N   EVALUATIONOFRESULTS:  r# Basedontheresultsobtainedcantheybereportedouttothepatientsphysician:YESNO J%   $4 X$X  2,)3   EXERCISE_13:_ԀURINEPREGNANCYTEST#$XX $4v5#$4 X$XԄSTUDYQUESTIONS #$XX $46# X Name:_________________________Date:____________________ X Points:8 0   (#33 "3"  372#  1  .3  0    Statetheprincipleoftheurinepregnancytest,includingthesubstancebeingdetectedwhich  indicatesapositivetest.(2point)377݌ $$ Ќ  "3"  392#  2  .3  0    Define falsepositiveasitrelatestopregnancytestingandlisttwocauses.(2points)3909݌,$$ Ќ  "3"  34:2#  3  .3  0    Define falsenegativeasitrelatestopregnancytestingandlisttwocauses.(2points)34:a:݌d $$ Ќ  "3"  3f;2#  4  .3  0    Statewhenaurinesampleshouldbecollectedforthemostaccurateresult(1point)3f;;݌$D"%$$ Ќ  "3"  3<2#  5  .3  0    Describetheproceduretofollowiftheurinepregnancytestcannotbeperformedrightaway.(1 $*'+ point)%  3<<݌+(,$$ Ќ