WPC [zRaCaK-$@T KӾ̊` Uةң1UTq+c#b"'N:]tPSjqC(AbǙڒ6ĥJR Tp>/k[>-pvIpĄSY_\cUtmg=*.os7ʉ!5)q%RS9$j]y9Aʺě44Y,r6-(rY7kJb51,a3A?c/=,ߺv?ΓN|LJqov8ȁt}bL\A`f,9F'0.)ŰXO"HƷJJL=4ZםrP %2{̵Ozxc)$ y4r]Nfvk }Oƴ A{ #T U0N %k 0:q U: UV UB; 1u} 1 72y^ w4 0=c2A mC Z 0VeEk 0V(f~~Nfafa B  D3////// Cbbbbbbbbbbbbbbbbbbbbb i7||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| iHPE438C7 (HP Officejet J6400 series)0(9 Z6Times New Roman RegularX($USUS.,,@AZ"Arial Regular)c >Times New Roman Bold Italic0rA*Arial Bold Italic3#37=CIQYag1.a.i.(1)(a)(i)1)a)(5hCEKQW]cioAutoList11.1.1.1.1.1.1.1.i)In=  `,= |(;3$2#  0  .3  0  3|x U  )USUS.,  _A) xdEA   Exercise14:ChemicalExaminationofUrine   D     (.3$ !USUS.,   a *USUS.,  _    2  (.3$ !USUS.,   \\R'3Letter Landscape\TABLE B(YTABLE A d'dxd d!'-%!'  !USUS.,  _ X XXX XX 8XXdd8EXERCISE14:0  #X X _# XX CHEMICALEXAMINATIONOFURINE (#(# # UE @##XX UE#Textbook: 0 ` Chapter14Urinalysis,BodyFluidsandOtherSpecimens$t` (#` (#  Skill: 0  0` (#(#20pointsd` (#` (# Objectives:  @  (#33"3"  32#  1  .3  0    Statethespecimenofchoiceforchemicalanalysisofurine.3D݌ ,(#(# Ќ  "3"  32#  2  .3  0    Name10routinechemicaltestsperformedonurineandlistaconditionthatwillcausean   abnormalforeach.3I݌ (#(# Ќ  "3"  3e2#  3  .3  0    Statethetimelimitwithinwhichtestingofurinemustbeperformed.3e݌  (#(# Ќ  "3"  3s2#  4  .3  0    Properlyuseandinterpretthereactionsofthereagentstripwithpatienturinesamplesand   controlsolutions.3s݌x (#(# Ќ  "3"  32#  5  .3  0    Definethefollowingterms:_proteinuria_,_glycosuria_,_ketonuria_,_hemoglobinuria_,and d  hematuria.3݌P (#(# Ќ  "3"  3{ 2#  6  .3  0    Statethefourconfirmatorychemicaltestsonurineandstatethesubstanceeach <  confirmatoryisusedtodetect.3{ ݌(x(#(# Ќ  "3"  3 2#  7  .3  0    Statethequalitycontrolwhichmustbeperformedonthereagentdipsticksforurinalysis.3 ݌d(#(# Ќ  "3"  3 2#  8  .3  0    List6precautionswhichmustbefollowedwhenusingurinetestingstrips.3  ݌P(#(# Ќ  "3"  3 2#  9  .3  0    Statetheactionwhichmustbetakenwhenthequalitycontrolresultsareinvalid.3 + ݌<(#(# Ќ  "3 "  32#  10  .3  0    Performchemicaltestingon2urinesamplesand2controlsbyproperlyselectingsupplies ( needed,properlydippingthestripsinurine,accuratelytimingthereaction,interpretthe  colortodeterminetheresults,andrecordtheresultsusingthecorrecttermorunitswithin  +/1unit.3F݌(#(# Ќ  XX Discussion #XX?# t Testscanbeperformedonurinesamplestodetectthepresenceofcertaincompoundsor ^ chemicalswhichmaybeindicativeofanunderlyingdisease.Thesetestsareusuallyconsidered J tobeapartofaroutineurinalysis.Whenperformedcorrectly,thesetestscanprovidevaluable 6 informationtothephysicians.Thespecimenisveryeasytoobtain.Thefirstmorningspecimen " r isthepreferredspecimenasitisthemostconcentratedandhaslessofachanceofgivingfalse !^ negativeresults.Thespecimenofchoiceisamidstreamcollectionforroutinetesting,aclean !J catchifthephysicianwantsacultureaswell. "6   MethodsofChemicalAnalysis  $ " Reagentstripsarethemostwidelyusedtechniquefordetectingconstituentspresentintheurine &!$ andareavailableinavarietyoftypes.A X XXXreagentstrip #XX XX~#isafirmplasticstriptowhichpads '"% containingchemicalreactantsareattached.Mostreagentstripscontainreagentareasthattestfor n(#& pH,protein,glucose,ketone,bilirubinandblood.Somestripsmayalsotestfor_urobilinogen_, Z)$' leukocytes,nitritesandspecificgravity.Thepresenceor  1  ڀabsenceoftheseconstituentsinthe F*%( urineprovidesinformationonthestatusofcarbohydratemetabolism,kidneyandliverfunction, 2+&) andacidbasebalanceofthepatient. ,n'* _Reagentstripsaredesignedtobeusedonlyonceanddiscarded.Exactdirectionsfortheuseof  thestripsareincludedineachpackageandmustbefollowedpreciselyforaccurateresults.A  colorcomparisonchartisalsoincluded,usuallyonthelabelofthereagentstripcontainer.  Positiveresultsmayneedconfirmationbyaconfirmatorytestforsomeconstituents. `  QualityControl  8  Theperformanceofthestripsshouldbecheckedbytestingstripswithpositiveandnegative  ` urinecontrols.Iftheresultsofthecontrolsdonotmatchthemanufacturerspublishedresults  L  thenpatienttestingcannotbeperformeduntilthecauseoftheerrorisdetermined.Thefirst  8  courseofactionistorepeatthetesting.Iftheresultsarestillinaccuratethenthestripscannotbe $  used.Acalltothemanufacturermustbemadetoreporttheproblem.Most_manufactureres_Ԁwill   replacestripswhicharenotgivingaccurateresults.Causesofinaccurateresultsinclude   improperstorageand/orhandlingofthestrips,usingthestripsbeyondtheexpirationdate,or   contaminationofthestrips.    PerformingtheChemicalTestbyReagentStrip  \ Theurinemustbecollectedusingappropriatetechniqueandbetested X XXXwithinonehourof 4 collection .#XX XX}#ԀIftestscannotbeperformedwithinthistime,thespecimenmayberefrigeratedforup  p to8hours.Refrigeratedspecimensshouldbeallowedtoreturntoroomtemperaturepriorto  \ testing. H Chemicaltestingisperformedbydippingareagentstripintoafreshurine.Thecolorchangeson   thereagentpadsshouldbevisuallycomparedtothecolorchartaftertheappropriatetimeperiod.   Thiscanalsobedoneonanelectronicinstrumentwhichreadsthecoloranddisplaysitona  lightedpanel.Automationeliminatestechnicianerrorduetodifferencesintimingor  interpretationofthecolors.   XXPrinciplesofChemicalTests#XX #  X   pH .ThepHisameasureofthedegreeofacidityoralkalinityoftheurine.ApHbelow7 B"  indicatesandacidurine;pHabove7indicatesanalkalineurine.Normal,freshlyvoidedurine 2#! mayhaveapHrangeof5.58.0.ThepHofurinemaychangewithdiet,medications,kidney $n" disease,andmetabolicdiseasessuchasdiabetesmellitus.ColorsonthepHreagentpadusually  %Z # rangefromyelloworangeforacidpHtogreenbluewhenpHisalkaline. %F!$  Protein .Proteinintheurineiscalled X XXX_proteinuria_ .#XX XX##ԀThisisanimportantindicatorofrenal '#& disease,butcanbecausedbyotherconditionsaswell.AtaconstantpH,thedevelopmentofany ($' greencolorontheproteinreagentpadisduetothepresenceofprotein.Colorsrangefrom )$( yellowfornegativetoyellowgreenorgreenforpositive. *%)  +&* _ Glucose .Thepresenceofglucoseinurineiscalled X XXXglycosuria .#XX XX&#Thisconditionindicatesthatthe  bloodglucoselevelhasexceedtherenalthreshold.Thisconditionmayoccurindiabetes  mellitus.Thereagentstripisspecificforglucoseandusestheenzymesglucoseoxidaseand  peroxidase,whichreactwithglucosetoformcolorsrangingfromgreen(lowconcentration)to x brown(highconcentration. d  Ketone .Whenthebodymetabolizesfatsincompletely,ketonesareexcretedintheurine <  resultingin X XXXketonuria#XX XX(#XN XXX .#XX XXN(#ԀTheketonetestisbasedonthedevelopmentofcolorsrangingfromlight , | pinktomaroonwhenketonesreactwithnitroprusside.Ketonuriamaybepresentindiabetesand  j starvationorfasting.Sinceketoneswillevaporateatroomtemperature,urineshouldbetightly  V  coveredandrefrigeratedifnottestedpromptly.  B   Bilirubin .Bilirubinisabreakdownproductofhemoglobinwhichproducesanextremelyyellow   colorinurineandmaybeanindicationofliverdisease,hepatitisorbileductobstruction.   Samplessuspectedofcontainingbilirubinshouldbehandledcautiouslybecauseofthepossibility   ofhepatitis.Thesesamplesshouldalsobeprotectedfromlightuntiltestingiscompleted,since   directlightwillcausedecompositionofbilirubin.Thetestforbilirubinisbasedonthecoupling ~ ofbilirubinwithadyetoformacolor. j  Blood .Presenceofbloodintheurinemayindicateinfectionortraumaoftheurinarytractor B bleedinginthekidneys.Hemoglobin( X XXXhemoglobinuria )#XX XX-#andredbloodcells( X XXXhematuria )#XX XXa.#maybe 2 detectedbytheformationofacolorduetotheenzymeperoxidase(inredcells)reactingwith n orthotolidine,achemicalwhichisinthereagentpad.Theresultingcolorrangesfromorange  Z throughgreentodarkblue. F  Urobilinogen .Urobilinogenisadegradationproductofbilirubinwhichisformedbyintestinal  bacteria.Urobilinogenisnormally0.1to1.0Ehrlichunitsperdeciliterofurine.Itmaybe  increasedinhepaticdiseaseorhemolyticdisease.Thereagentstripwilldetecturobilinogenin  concentrationsaslowas0.1Ehrlichunit.Thereagentpadcontainsachemicalwhichreactswith  urobilinogentoformabrownorangecolor.   Leukocytes .Leukocytes(akawhitebloodcells)presentinlargenumbersusuallyindicatea Z! urinarytractinfection( UTI ).Normalurinesshouldproducenocolorchange. J"   Nitrites .Thistestdependsupontheconversionofnitratetonitritebycertainbacterialactionin &$v" theurine.ApositiveresultisindicatesapossibleUTIandneedforaculture. %f #  SpecificGravity .Thespecificgravityofasolutionistherationoftheweightofagivenvolume &>"% ofthesolution(urine)totheweightofanequalvolumeofwater.Thespecificgravityofurine '.#& indicatestheconcentrationofdissolvedsolidssuchasurea,phosphates,chlorides,proteins ($' presentintheurine.Normalspecificgravityis1.0051.030withmostnormalsfallingbetween )%( 1.010and1.025.Thehigherthenumberthemoreconcentratedtheurine. *%)  +&* Ї XXConfirmatoryTestsWhichMaybeIndicated#XX6#   Sometimesitmaybenecessarytomeasurechemicalsinurineotherthanbythereagentstrip  methods.Theothermethodsarecalledconfirmatorytestsbecausethemostcommonuseisto  confirmapositive(ornegative)resultobtainedusingthereagentstrip.Confirmatorytestsare r moretimeconsumingandrequiremorereagentsandequipmentthanthereagentstripmethod. ^  Fourmostcommonlyusedconfirmatorytestsarethoseforprotein,reducingsugars,ketone,and J  bilirubin. 6   Sulfosalicylicacid which,whenaddedtotheurine,willcauseprecipitationoftheprotein  ^  resultinginturbidity.Thisistheconfirmatorytestforapositiveproteinresult.  N   Clinitest isthemostcommontestperformedtodetectreducingsugarssuchaslactoseand &  galactose.Thesesugarsmaybepresentintheurineofinfantsandindicateaneedforimmediate   investigation.Thisistheconfirmatorytestforapositiveglucosetest.   The Acetest isatestforketonesandisavailableintabletform.Thisistheconfirmatorytestfor  apositiveketonetest. z The Ictotest isaspecifictestforbilirubinandisfourtimesassensitiveasthereagentstrippad. R Thisistheconfirmatoryforapositivebilirubintest. B  XXNormalValuesforUrineChemicalTests#XXߜ<#  j 0  0` (#(# Substance 0` (#` (#0h(#(#0h(#h(#0(#(# NormalValue T(#(# 0  0` (#(#pH0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#5.58.0,(#(# 0  0` (#(#protein0` (#` (#0h(#(#0h(#h(#0(#(#negativetotrace(#(# 0  0` (#(#glucose0` (#` (#0h(#(#0h(#h(#0(#(#negative(#(# 0  0` (#(#ketone0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#negative(#(# 0  0` (#(#bilirubin0` (#` (#0h(#(#0h(#h(#0(#(#negative (#(# 0  0` (#(#blood0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#negativex!(#(# 0  0` (#(#urobilinogen0` (#` (#0h(#(#0h(#h(#0(#(#0.11.0EU/dld" (#(# 0  0` (#(#leukocytes0` (#` (#0h(#(#0h(#h(#0(#(#negativeP#!(#(# 0  0` (#(#nitrites0` (#` (#0h(#(#0h(#h(#0(#(#negative<$"(#(# 0  0` (#(#specificgravity0h` (#` (#0h(#h(#0(#(#1.0051.030(%x #(#(# _ +&*  XXPrecautions #XXrD#  1.0  Reagentstripsshouldbetestedwithpositivecontrolsoneachdayofusetobesurethat  stripsareworkingproperly.(#(# 2.0  Failuretoobservecolorchangesattheappropriatetimeintervalsmaycauseinaccurate r results.^ (#(# 3.0  Reagentsandreagentstripsmustbestoredproperlytoretainreactivity.J (#(# 4.0  Observecolorchangesandcolorchartsundergoodlighting.6 (#(# 5.0  Propercollectionandstorageofurineisnecessarytoinsurepreservationofcomponents " r suchasbilirubinand_ketones_. ^ (#(# 6.0  Donotallowthereagentpadsofthestriptotouchthefingersorothersurfaces. J (#(#  XX     Exercise14 : URINALYSISDIPSTICK#XXkH#    Materials:   1.0  Reagentstripsx(#(# 2.0  Timerd (#(# 3.0  UrinespecimensinconicaltubesP (#(# 4.0  UrinecontrolsNormalandAbnormal< (#(# 5.0  Biowipes( x(#(#  Instructions  P  1.0  Carefullyremovestripfromcontainer,takingcarenottoallowreagentpadstotouch (  handsorothersurfaces.Recapbottlefingertight. (#(# 2.0  Briefly(nolongerthan1second)dipteststripintotheurine,makingsurethatallpadsare   moistened.(#(# 3.0  Drawtheedgeofthestripalongrimofspecimencontainertoremoveexcessurine.`(#(# 4.0  BLOTEDGEOFSTRIPONBIOWIPEL toremoveexcessurine.Failuretoblotmay 8 resultinchemicalsfromadjacentpads bleedingintoeachothercausingerroneous (x results.d(#(# 5.0  Attheappropriatetimespecifiedonthechartonthebottlecomparethecolorofthepad < tothecoloronthechart. THISISCRITICAL .Failuretoreadthereactionatthetime ( indicatedmaycauseerroneousresults.(#(# 6.0  Recordresultsonthereportformusingappropriateunitsasnecessary.(#(# 7.0  Discardthereagentstrip.t (#(#  +&*  TRO'3Letter LandscapeX3' Letter'3Letter Landscapea  lightedpanel.3'LetterT   9  X9tXXName#XXtQ#Ԁ____________________________ h   Date____________________________  tXX#XXtVR# UEXX   EXERCISE#XX UER# UEXXԀ14:CHEMICALEXAMINATIONOFURINE#XX UER#tXX    NOTE: 0  Recordtheresultsintheproperformat,using  neg fornegative#XXtVS#tXX,  pos forpositive, orappropriateunits  p whereindicated.qT   h      p      x  !  ($  &  (  0+ 8 .. *<eddd Xdd Xdd XX.X.,'dd ,dd ,dd , dd , dd +  h h   #XXt!T#XXDipstickPad#XXV#tXX -#!  "' -#XXtCW#XXPositive    Control#XX߲W#tXX -#! "' -#XXtX#XXNegative    Control#XX߇X#tXX -#! "' -Name_____________________    Number___________________ -#!L "' -Name____________________    Number__________________ 2(&L "  ' 2#XXtX# Glucose                    bilirubin *z   *z   *z   *z   *z  _Ketones_           !   " SpecificGravity .~#   .~$   .~%   .~&   .~' Blood (   )   *   +   , pH 2-   2.   2/   20   21 Protein 2   3   4   5   6 _Urobilinogen_ 67   68   69   6:   6; Nitrite <   =   >   ?   @ Leukocytes :A   :B   :C   :D  :E   X E TRX3'LetterO'3Letter Landscape3'Letter XX 8X'3Letter Landscapea  lightedpanel.T  EXERCISE14:CHEMICALEXAMINATIONOFURINE 0 p 0p(#p(#0 (#(#  (# (#      `    Name_______________________________0  0(#(#Date_________________t(#(# Points:25   `  L       `   (#33 "3"  3!c2#  1  .3  0    Explainbrieflyhowachemicalreagentstripisused.(1point)3!cNc݌$ t(#(# Ќ  "3"  3.d2#  2  .3  0    Statethetypeofurinespecimenwhichispreferredforchemicaltestingandwhythisisthe   preferredspecimen?(1point)3.d[d݌ (#(# Ќ       `     h   "3"  3e2#  3  .3  0    Definetheterm AND nameaconditionthatmaycauseanincreaseineachofthefollowing  p constituentsinurine(5points):3e f݌ \(#(# Ќ  *<d ed'dd 'dd dd  dd dd X(#X(#,dd ,dd ,4dd +  44  Term -#!H"' -Definition -#!H"' -AbnormalCondition 2(&H"  ' 2a.0  _glycosuria_ (   (      b.0  _ketonuria_ (4   (   p!   4" c.0  _proteinuria_ ( #   (  !%    & d.0  _hemoglobinuria_ ( #\'   (  #H)    #\* e.0  hematuria (x% +   (  d&!-  x% .   ,l'3 _"3"  3k2#  4  .3  0    Statefour confirmatory testsperformedonurine and theconstituentofurinedetected.3k"l݌(#(# Ќ  0  (4points)(#(#   a. x   b. P    c. ( x   d.  P    "3"  3m2#  5  .3  0    Stateanabnormalconditionwhichwouldcausethefollowingconstituentstobepresentinthe (  urine(2points):3m&n݌ (#(# Ќ  0  a.0(#(#bilirubin (#(# 0  b.0(#(#nitritest(#(# 0  c.0(#(#urobilinogenL(#(# 0  d.0(#(#leukocytes$t(#(# "3"  3up2#  6  .3  0    Statethenormalvaluesforeachofthefollowing(5points):3upp݌L(#(# Ќ  0  a.0(#(#pH___________________________$(#(# 0  b.0(#(#protein_______________________(#(# 0  c.0(#(#glucose_______________________(#(# 0  d.0(#(#ketone________________________\ (#(# 0  e.0(#(#bilirubin_____________________4" (#(# 0  f.0(#(#blood_________________________ $\"(#(# 0  g.0(#(#urobilinogen__________________%4!$(#(# 0  h.0(#(#leukocytes____________________' #&(#(# 0  i.0(#(#nitrites______________________)$((#(# 0  j.0(#(#specificgravity_______________________l+&*(#(# Ї"3"  3Eu2#  7  .3  0    Statewhatmustbedoneiftheresultsofthequalitycontroldonotfallwithinthepublished  resultsprovidedbythemanufacturer?(1points)3Euru݌(#(# Ќ  "3"  3v2#  8  .3  0    List2situationswhichmaycauseinaccurateresultswhichwillbedetectedbytheproper L  performanceofthequalitycontrolonthereagentstrips.(2point)3vv݌8 (#(# Ќ  "3"  34x2#  9  .3  0    Withinwhattimeframemustaurinesamplebetested?(1point)34xax݌$ (#(# Ќ  "3 "  3By2#  10  .3  0    Underwhatconditionsandforhowlongmustaurinebestoredifitcannotbetestedwithin \ therecommendedtestingtimeframe?(1point)3Byoy݌H(#(# Ќ  11.0  Listfourprecautionswhichmustbefollowedinutilizingortestingtheurinedipsticks. (#(# 0  (2points)(#(#      `     h