Collection of Urine Specimen A. Routine Collection Purpose: To screen the clients urine for abnormal constituents.

EQUIPMENT: Cleansing materials Wide-mouthed specimen container Identification label Completed laboratory request Clean bedpan/urinal or commode for clients who are unable to void directly into specimen container Non-sterile gloves as needed PROCEDURE SUGGESTED ACTION WITH RATIONALE 1. Wash hands and gather all needed equipment. Eliminates microorganisms. Proper arrangement of needed equipment ensures working in an orderly manner. 2. Identify the client properly. 3. In an ambulatory client with urinary control, give the following instructions: Explain the purpose of urine specimen and how the client can assist. Explain that all specimens must be free of fecal contamination or voiding needs to occur after defecation or at different times from defecation. Instruct the client to clean the genitalia before urinating by washing it with water and soap properly. The female client should wipe from meatus toward the rectum. The male client should clean the meatus in a circular motion moving from the meatus up the glans penis. Ensures that the specimen collected is somehow free form microorganisms. Cleaning in these manner follows the principle of cleaning from the least contaminated to the more contaminated area. Give the client the specimen container and tell him/ her to go the bathroom and avoid 120ml nto it. (The amount usually varies depending on agency policy. In some instances 30 60 ml is recommended) Tell the client to put tightly the lid on the container. If spillage occurred outside the container, instruct the client to wash it with soap and water This prevent spillage of the urine and contamination of other objects. 4. Ensure that the specimen labels and laboratory request have been filled up with correct information. Attach them securely to the specimen container. Inappropriate identification of the specimen can lead to errors of diagnosis or therapy for the client. 5. Arrange for the specimen to be sent to the laboratory immediately. Urine deteriorates relatively rapidly from bacterial contamination when left at room temperature. Specimen should be analyzed within 1 hour after collection.

6. Document the time of collection; kind amount and characteristic of specimen: time sent to lab; and exam desired. Note: For seriously ill, physically incapacitated or disoriented clients, the following changes should be followed in the collection of the specimen. 1. Provide required assistance in the bathroom, or help the client to use bedpan or urinal. 2. Wear gloves when assisting the client to void into clean bedpan or urinal or when transferring the urine form the bedpan to the specimen container. 3. Empty bedpan or urinal properly. 4. Remove gloves and wash hands before labeling and transporting the urine. B. CULTURE ANS SENSITIVITY BY CLEAN CATCH METHOD PURPOSE: To determine the presence of microorganisms, the type of microorganisms and the antibiotics to which the microorganism are sensitive. EQUIPMENT: Cotton balls with antiseptic solution Sterile specimen container Identification label Laboratory request form Disposable gloves (optional) Bath blanket and urine receptacle (bedpan) if the patient is not ambulatory PROCEDURE SUGGESTED ACTION WITH RATIONALE 1. Wash hands properly and gather all equipment needed. Ensures working in an orderly and organized manner. 2. Identify the client properly. 3. Inform the client that the urine specimen is required; give the reason and explain the method to collect it. - Ensures cooperation of the client if he is an active member of his care. 4. Instruct the client to clean the urinary meatus and obtain urine specimen Cleaning with antiseptic reduces the number of bacteria and minimizes contamination of urine specimen. For a male client: Wash hands and open container aseptically Cleanse end penis with cleansing swab using circular motion form middle toward outside. Always swab from clean to dirty area to decrease bacteria levels. Initiate urine stream. After single stream achieved, pass specimen bottle into stream and obtain sample 30-60ml. The microorganism, which have accumulated at the lower urethra

and urinary meatus, have been flushed out with the original stream of urine and will not be collected in the specimen. For a female client: Wash hands and open container aseptically. Cleanse the labia with non-dominant hand. Cleanse the area with disinfectant swab beginning above the urethral orifice and moving posteriorly. swabbing from fron to back cleans from the area of least contamination to the area of greatest contamination, thus preventing introduction of microorganisms to the urinary meatus. Initiate urine stream has been achieved, pass specimen bottle into the stream and obtain 30 60 ml sample. Note: To prevent contamination of specimen with the skin flora, instruct the patient to remove the bottle before flow of urine stops and before releasing the labia or penis. 5. Wipe off outside of container after replacing the cap. Handle only the outside of the container and its cap throughout the entire procedure. Capping the container prevents spillage of urine and contamination of other objects. Touching only the outside of thecap retains the sterility of the inside of the cap. 6. Wash hands. 7. label the specimen and take it to the laboratory within 15 minutes. Bacterial cultures must be started immediately before any contaminating organisms can grow, multiply and produce false results. 8. Document pertinent data. Record the collection of specimen, any pertinent observations of the urine in terms of color, odor or consistency, and any difficulty in voiding that the client experienced. Note: In some instances, collection of urine specimen for culture and sensitivity requires use of sterile gloves. This is usually worn prior to the cleansing of the vulva or penis with an antiseptic swab. For a non ambulatory client, the same principle applies except for the following: 1. Assist the client to an upright sitting position on a urine receptacle. Provide appropriate cover by draping the client properly, exposing only the genital area. 2. Assist the female client to spread her legs enough to ensure that the urine does not touch the legs. 3. Put on sterile gloves. 4. Clean the area of the external urinary meatus using sterile technique with an antiseptic swab.

5. Ask the client to start voiding, then after the initial urine has been passed out; place the specimen container under the stream of urine near to but not touching the meatus. 6. Collect 30 60 ml urine and replace sterile cap tightly on the specimen container touching only the outside of the cap. 7. Remove gloves and wash hands. COLLECTING A TIMED URINE SPECIEMEN (24 HOUR URINE SPECIMEN) Purposes: 1. To assess the ability of the kidney to concentrate or dilute urine. 2. to determine diorders of glucose metabolism e.g. diabetes mellitus. 3. To determine levels of specific constituents e.g. albumin, amylase, creatinine, urobilinogen and certain hormones in urine. SPECIAL CONSIDERATIONS: For timed urine specimens, appropriate specimen containers with or without preservative in accordance with specific test are generally obtained form the laboratory and placed in the clients bathroom or in the utility room. To remind the staff of the test in progress, an alert sign is placed outside the room of the client. Specimen identification labels need to indicate the time and date of each voiding and may be numbered sequentially as 1st specimen, 2nd specimen, etc. EQUIPMENT: Urine specimen container with or without preservative Completed specimen identification labels Completed laboratory requisition Bedpan or urinal Alert card on or near the bed indicating the specific times for urine collection Antiseptic PROCEDURE SUGGESTED ACTION WITH RATIONALE 1. Identify the client properly. 2. Give the client the following information and instructions. Ensures client cooperation through knowledge of what will happen and what to expect. The purpose of the test and how the client can assist When the specimen collection will begin and end. That all urine must be stored and saved in the specimen container once the test starts.

That the urine specimen must be given to the nursing staff immediately so that it can be placed in the appropriate specimen bottle. 3. Place a sign in the clients bathroom or any place where it can easily be seen that 24 hour urine collection is in the appropriate specimen bottle. 4. Collect the first urine specimen and discard it. Document the time the test starts with this discarded specimen. The first specimen is considered old urine or urine that was in the bladder before the test began. 5. Collect all subsequent urine specimens, including one at the end of the period. Depending on hospital policy, specimens may be refrigerated or left in the clients bathroom. Refrigeration or other form of cooling prevents bacterial decomposition of the urine. 6. Request the client to void exactly 24 hours after the first specimen was obtained. Include voided urine in the container. This urine output would still be included since it was produced and stored with the allotted 24 hour. 7. After the last voided specimen is placed in the container, cover and send entire

COLLECTION OF STOOL SPECIMEN PURPOSE: To determine the presence of occult blood, parasites, bacteria, viruses or abnormal constituents in the stool. SPECIAL CONSIDERATIONS: 1. Provide the client with appropriate instructions to collect the specimen. 2. Wear disposable gloves and use aseptic technique. 3. Prevent contamination of the specimen by urine or menstrual discharge. 4. Ensure that appropriate amount of stool is collected for ordered test. a. Occult blood- approximately 1 teaspoon b. Dietary products and digestive secretions entire specimen c. Bacteria and viruses 1 gram 5. Check whether the client needs to be placed on a diet free or red meat and wether to discontinue oral iron preparations before an occult blood test. 6. Send stools specimens collected for assessment of parasites, bacteria or virus immediately to the laboratory. 7. Document medications on the laboratory requisition that accompanies taken for culture and sensitivity. EQUIPMENT: Clean or sterile bedpan or bedside commode (for infant, the stool is scraped from the diaper) Disposable gloves

Specimen container with a lid, or for a stool culture, a sterile swab in a test tube Two tongue blades Paper towel/tissue paper Completed laboratory requisition Air freshener if available PROCEDURE SUGGESTED ACTION RATIONALE

1. Wash hands and gather all equipment needed Ensures working in an organized manner. 2. Identify the client. Give the following instructions to an ambulatory client. The purpose of the stool specimen collection andhow the client can assist To defecate in clean or sterile bedpan or bedside commode (for routine stool exam, clen technique is indicated). When defecating the client may use the bathroom for privacy. Tell the client not to contaminate the specimen with urine or menstrual discharge. Encourage voiding before specimen collection. Make sure not to place toilet tissue in the bedpan after defecation because contents of paper can affect laboratory analysis. Notify the nurse as soon as possible after defecation particularly for specimen that need to be sent to laboratory immediately. 3. For a non ambulatory client, give instructions on how the client can assist in the collection. Raise the head of the bed so that the client can assume a sitting position on the bedpan. If the client is able to do so, assist him to sit on the bedside commode. The position indicated increases intra-abdominal pressure thus facilitating ease in defecation. 4. Provide privacy until the client has passed a stool. Oftentimes the client may not be able to defecate because of embarrassment most especially if there are other people in the room. 5. Remove bedside commode or bedpan. If necessary, help the client clean the perineum properly. Use gloves before doing so. 6. Use one or two tongue blades to transfer some or all of the specimen to the container taking care not to contaminate the outside of the container. Usually 2.5 cm of formed stool or 15-30 ml of liquid stool is adequate. Visible pus, mucus or blood should be included. For a culture, dip sterile swab into the specimen and place it in the sterile test tube using sterile technique. 7. Wrap the used tongue blades in a proper towel before disposing them. Wrapping the used tongue blades prevents the spread of microorganisms. 8. Place the lid on the container as soon as the specimen is in the container. Putting the lid on prevents the spread of microorganism

9. Empty and clean the bedpan or bedside commode. Return to its proper place. 10. remove gloves. Wash hands as necessary. 11. Spray air freshener if necessary. 12. Label the container properly and send to the laboratory together with completed laboratory requisition. 13. Document all relevant information.

URINARY CATHETERIZATION DEFINITION: Urinary catheterization is the introduction of catheter (rubber or plastic tube for injecting or removing fluids) through the urethra into the bladder to provide a continuous flow of urine. The two types of catheterization are intermittent and indwelling catheter. Intermittent technique involves the use of a straight single use catheter introduced long enough to drain the bladder. Indwelling or Foley catheter remains in place until the client is able to void completely and voluntarily. PURPOSES: 1. To relieve acute or chronic urinary retention. 2. to assess amount of residual urine if the bladder empties incompletely 3. To obtain urine specimen when a specimen cannot be secured satisfactorily by other means 4. To empty the bladder before and after surgery or delivery and before certain examinations SPECIAL CONSIDERATIONS 1. The bladder is normally sterile cavity 2. the external opening to the urethra can never be sterilized. 3. The bladder has defense mechanism that it empties itself of urine regularly and maintains an acidic environment. 4. Pathogens introduced in the bladder can ascend the Ureters and lead to bladder and kidney infection. 5. Normal bladder is not as susceptible to infection as an injured one. EQUIPMENT: Flashlight or lamp Mask, if required by agency policy Bath blanket

Saop, a basin of warm water, a wash cloth and a towel Disposable gloves A sterile catheterization kit containing - sterile gloves - drapes, fenestrated (optional) - antiseptic cleansing solution - cotton balls or gauze squares - forceps - water soluble lubricant Catheter of appropriate size (either straight or indwelling) = French # 14 or #16 for adult women = French # 18 or #20 for adult women = French # 8 or #10 for adult women - draining tubing and collection bag - specimen container ( if necessary) INSERTING A STRAIGHT CATHETER IN FEMALES 1. Assess the status of the client a. when the client last voided may indicate bladder dysfunction b. Level of awareness or developmental stage reveals ability to cooperate c. Mobility and physical limitations affect way that nurse will position client d. Age-Determines catheter size to use e. Pathological condition that may impair passage of catheter such as enlarge prostate f. Allergies determine allergy to antiseptic, tape or rubber 2. Prepare all equipment and supplies before entering room of the patient. Be sure to wash hands. Ensures organized and efficient procedure. 3. Explain the procedure. Describe the pressure sensation that will be felt during insertion. reduces anxiety and promotes cooperation. Relieving patients tension can facilitate insertion of catheter because urinary sphincter is most likely to be relaxed. 4. Clear bedside table and arrange equipment for convenience. Place materials for cleaning perineum separately. Placement of equipment in order of use increases the speed of performance. Reaching over the sterile items make increase of contamination. 5. Provide privacy to the client. Have her lie on a firm mattress. Place waterproof pad under the client. Reduces embarrassment and aids in relaxation. Waterproof pad prevents soiling of bed linen. 6. Position the client in dorsal recumbent position with thighs elevated and externally rotated. Pillows may support legs. Position provides good view of the structures of perineum and reduces the risk of contaminating the catheter.

7. Drape the client with blanket. Place blanket over client one corner at each side corner over arms and sides, last corner over the perineum. Raise gown above hips. Maintains comfort while avoiding unnecessary exposure of body parts. 8. Wear disposable gloves. Wash perineal -genital area with warm water and soap. Dry the area. Remove and dispose of gloves. reduces presence of microorganisms over meatus and possibility of introducing microbes with catheter. 9. if necessary, position lamp to illuminate perineal area. Permits accurate identification and good view of urethral meatus. 10. Open catheterization kit and catheter according to direction. Put sterile gloves. Allows nurse to handle sterile supplies without contamination. 11. Organize supplies on sterile field; open sterile package containing catheter, pour antiseptic solution over the cotton balls; open packet containing lubricant, remove specimen container. 12. Apply sterile drape. Use first drape as an underpad, and place it under buttocks. Place fenestrated drape over perineal area exposing only the labia. If penestrated drape is not available, place two thigh drapes form the side farthest to the side and nearest to you. Place sterile kit between the thighs. Maintains sterility of work surface. Placing thigh drape from farther side to nearer side prevents reaching across a steriledrape. 13. Lubricate the insertion tip catheter about 1-2 inches. Be careful not to clog the opening. Water-soluble lubricants reduce friction thereby facilitating ease of insertion. 14. With non-dominant hand, carefully retract the labia to fully expose urethral meatus. Maintain position of nondominant hand throughout the remainder of procedure. Full retraction provides full visualization of meatus and prevents contamination during cleansing. Closure of labia during cleaning requires that the procedure be repeated again. 15. With dominant hand, pick up forceps with cotton balls and clean the perineal area wiping from front to back (clitoris to anus). Use one cotton ball for each stroke near the labial field, along far labial field and directly over meatus. Reduces number of microorganism at the urethral meatus. Use of single cotton ball for each stroke prevents the transfer of microbes. Cleaning should proceed from the least contaminated (clitoris) to more contaminated area (anus). Dominant hand remains sterile. 16. Pick up catheter with gloved dominant hand approximately 5 cm from the catheter tip. Hold end of catheter loosely coiled in palm of dominant hand. The distal end of catheter should be in urine tray receptacle. Catheter should be held far enough from end to allow full insertion into the bladder and maintain control of tip of catheter so it will not be accidentally contaminated. 17. Insert the catheter slowly through the urinary meatus. Advance the catheter approximately 5 -7.5 cm in adults (2.5 cm in children) until urine flows out of the

catheter end. Ask the client to take deep breaths is catheter meets resistance. Release labia and hold catheter securely. Forceful pressure exerted against the urethra can produce trauma. Deep breathing relaxes the external sphincter. Holding catheter securely prevents accidental expulsion by possible bladder contraction. 18. If urine specimen is to be collected, pinch the catheter and transfer the drainage end of it into sterile specimen bottle. Cover specimen cup and set aside for labeling. Allows sterile specimen to be obtained for culture analysis. 19. Allow bladder to empty fully or partially depending on agency policy or physicians order. Rapid removal of large amount of urine is though to induce engorgement of the pelvic blood vessels and hypovolemic shock. However, retained urine may serve as a reservoir for microbes to multiply. 20. When flow of urine begins to decrease withdraw catheter slowly about 1 cm at a time until urine barely drips, then withdraw catheter completely. This method minimizes discomfort of patient as well as prevents accidental spillage of urine to other areas. 21. Remove the equipment used. Assist the client to a comfortable position. Dry the clients perineum with a towel or drape. Proper after care of equipment should be done. Send urine specimen to laboratory after proper labeling. Excess lubricant and solution in the area can irritate the skin. Ensure patients comfort and safety. 22. Document the catheterization. Include assessment before and after procedure; type and size of catheter inserted: time, character and amount of urine obtained; specimen sent to laboratory and clients response to procedure. Communicate pertinent information to all members of health care team. INSERTING A STRAIGHT CATHETER IN MALES SUGGESTED ACTION WITH RATIONALE 1. Follow techniques 1-5 of female straight catheterization. 2. Assist the client to assume supine position with thighs slightly abducted and kness slightly flexed. Allows greater relaxation of the abdominal; and perineal muscles 4 Avoids unnecessary exposure of the body parts and maintain comfort.

Urinary catheterization
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In urinary catheterization, or "cathing" for short, a plastic tube known as a urinary catheter is inserted into a patient's bladder via their urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection, or to inject liquids used for treatment or diagnosis of bladder conditions. The procedure of catheterization will usually be done by a clinician, often a nurse, although self-catheterization is possible as well.

Contents
[hide]

1 Catheter types 2 Sex differences 3 Indications 4 Maintenance of a catheter 5 Effects of long term use 6 Combating infection 7 See also 8 References 9 External links

[edit] Catheter types

A Tiemann -type catheter installed for a male doll in an exercise. Catheters come in several basic designs:[1]

A Foley catheter is retained by means of a balloon at the tip which is inflated with sterile water. The balloons typically come in two different sizes: 5 cc and 30 cc. They are commonly made in silicone rubber or natural rubber. A Robinson catheter is a flexible catheter used for short term drainage of urine. Unlike the Foley catheter, it has no balloon on its tip and therefore cannot stay in place unaided. A Coud catheter is designed with a curved tip that makes it easier to thread the catheter past the prostate or obstructions in the urethral canal. A Coud catheter tip may be provided with a balloon or not.

An irrigation catheter has a separate lumen to carry irrigation fluid into the bladder. This is useful following endoscopic surgical procedures or in the case of gross hematuria.[1] An external Texas or condom catheter is used for incontinent males and caries a lower risk of infection than an indwelling catheter.[2]

Catheter diameters are sized by the French catheter scale (F). The most common sizes are 10 F to 28 F. The clinician selects a size large enough to allow free flow of urine, but large enough to control leakage of urine around the catheter. A larger size can become necessary when the urine is thick, bloody or contains large amounts of sediment. Larger catheters, however, are more likely to cause damage to the urethra. Some people develop allergies or sensitivities to latex after long-term latex catheter use making it necessary to use silicone or Teflon types. Silver alloy coated urinary catheters may reduce infections.[3]

[edit] Sex differences

In males, the catheter tube is inserted into the urinary tract through the penis. A condom or Texas catheter can also be used. In females, the catheter is inserted into the urethral meatus, after a cleansing using povidone-iodine. The procedure can be complicated in females due to varying layouts of the genitalia (due to age, obesity, Female genital cutting, childbirth, or other factors), but a good clinician should rely on anatomical landmarks and patience when dealing with such a patient. In the UK it is generally accepted that cleaning the area surrounding the urethral meatus with 0.9% sodium chloride solution is sufficient for both male and female patients as there is no reliable evidence to suggest that the use of antiseptic agents reduces the risk of urinary tract infection.[4]

[edit] Indications
Common indications to catheterize a patient include acute or chronic urinary retention (which can damage the kidneys), orthopedic procedures that may limit a patient's movement, the need for accurate monitoring of input and output (such as in an ICU), benign prostatic hyperplasia, incontinence, and the effects of various surgical interventions involving the bladder and prostate. For some patients the insertion and removal of a catheter causes excruciating pain, so a topical anesthetic is used. Catheterization should be performed as a sterile medical procedure and should only be done by trained, qualified personnel, using equipment designed for this purpose, except in the case of intermittent self catheterization where the patient has been trained to perform the procedure themself. If correct technique is not used there may be trauma to the urethra or prostate (male), urinary tract infection, or a paraphimosis in the uncircumcised male.

[edit] Maintenance of a catheter

A catheter that is left in place for more than a short period of time is generally attached to a drainage bag to collect the urine. This also allows for measurement of urine volume. There are two types of drainage bags: The first is a leg bag, a smaller drainage device that attaches by elastic bands to the leg. A leg bag is usually worn during the day, as it fits discreetly under pants or skirts, and is easily emptied into a toilet. The second type of drainage bag is a larger device called a down drain that may be used overnight. This device is usually hung on the patient's bed or placed on the floor nearby. During long-term use, the catheter may be left in place during the entire time, or a patient may be instructed on a procedure for placing a catheter just long enough to empty the bladder and then removing it (known as intermittent self-catheterization). Patients undergoing major surgery are often catheterized and may remain so for some time. The patient may require irrigation of the bladder with sterile saline injected through the catheter to flush out clots or other matter that does not drain.[5]

[edit] Effects of long term use

The duration of cathetarization can have significance for the patient. Incontinent patients commonly are catheterized to reduce their cost of care. However, long-term catheterization carries a significant risk of urinary tract infection. Because of this risk catheterization is a last resort for the management of incontinence where other measures have proved unsuccessful. Other long term complications may include blood infections (sepsis), urethral injury, skin breakdown, bladder stones, and blood in the urine (hematuria). After many years of catheter use, bladder cancer may also develop.

[edit] Combating infection

Everyday care of catheter and drainage bag is important to reduce the risk of infection.[6] Such precautions include:

Cleansing the urethral area (area where catheter exits body) and the catheter itself. Disconnecting drainage bag from catheter only with clean hands Disconnecting drainage bag as seldom as possible. Keeping drainage bag connector as clean as possible and cleansing the drainage bag periodically. Use of a thin catheter where possible to reduce risk of harming the urethra during insertion. Drinking sufficient liquid to produce at least two liters of urine daily Sexual activity is very high risk for urinary infections, especially for catheterized women.

Recent developments in the field of the temporary prostatic stent have been viewed as a possible alternative to indwelling catheterization and the infections associated with their use. [7]

Receptacle for waste Tape or plaster Rubber draw sheet

Urine is a liquid product of the body that is secreted by the kidneys by a process called urination and excreted through the urethra. Cellular metabolism generates numerous waste compounds, many rich in nitrogen, that require elimination from the bloodstream. This waste is eventually expelled from the body in a process known as micturition, the primary method for excreting water-soluble chemicals from the body. These chemicals can be detected and analyzed by urinalysis. Amniotic fluid is closely related to urine, and can be analyzed by amniocentesis.

Physiology
Main article: Renal physiology To eliminate soluble wastes, which are toxic, most animals have excretory systems. In humans soluble wastes are excreted by way of the urinary system, which consists of the kidneys, ureters, urinary bladder, and urethra. The kidneys extract the soluble wastes from the bloodstream, as well as excess water, sugars, and a variety of other compounds. Remaining fluid contains high concentrations of urea and other substances, including toxins. Urine flows through these structures: the kidney, ureter, bladder, and finally the urethra. Urine is produced by a process of filtration, reabsorption, and tubular section.

[edit] Composition
Urine is a transparent solution that can range from colorless to amber but is usually a pale yellow. Urine is an aqueous solution of approximately 95% water, with the remaining percentages being metabolic wastes such as urea, dissolved salts, and organic compounds. Fluid and materials being filtered by the kidneys, destined to become urine, come from the blood or interstitial fluid. Urine is sterile until it reaches the urethra where the epithelial cells lining the urethra are colonized by facultatively aerobic Gram negative rods and cocci.[1] Subsequent to elimination from the body, urine can acquire strong odors due to bacterial action. Most noticeably, the asphyxiating ammonia is produced by breakdown of urea. Some diseases alter the quantity and consistency of the urine, such as sugar as a consequence of diabetes.

[edit] Hazards

Urine is toxic and can be irritating to skin and eyes. High concentrations in the blood can cause damage to organs of the body. However, after suitable processing (as is done, for example, on the International Space Station), it is possible to extract potable water for drinking.

[edit] Characteristics
The typical color can range from clear to a dark amber, depending mostly upon the level of hydration of the body, among other factors.

[edit] Chemical analysis

Main article: Urinalysis

Urea structure Urine contains a range of substances that vary with what is introduced into the body. Aside from water, urine contains an assortment of inorganic salts and organic compounds, including proteins, hormones, and a wide range of metabolites.

[edit] Unusual color

Colorless urine indicates over-hydration, which is usually considered much healthier than dehydration. In the context of a drug test, it could indicate a potential attempt to avoid detection of illicit drugs in the bloodstream through over-hydration.[2] Dark yellow urine is often indicative of dehydration. Yellowing/light orange may be caused by removal of excess B vitamins from the bloodstream. Certain medications such as rifampin and pyridium can cause orange urine. Bloody urine is termed hematuria, potentially a sign of a bladder infection. Dark orange to brown urine can be a symptom of jaundice, rhabdomyolysis, or Gilbert's syndrome. Black or dark-colored urine is referred to as melanuria and may be caused by a melanoma. Fluorescent yellow / greenish urine may be caused by dietary supplemental vitamins, especially the B vitamins. Consumption of beets can cause urine to have a pinkish tint, and asparagus consumption can turn urine greenish.

Reddish or brown urine may be caused by porphyria. Although again, the consumption of beets can cause the urine to have a harmless, temporary pink or reddish tint.

[edit] Odor
The smell of urine can be affected by the consumption of food. Eating asparagus is known to cause a strong odor in human urine. This is due to the body's breakdown of asparagusic acid.[3] Other foods (and beverages) that contribute to odor include curry, alcohol, coffee, turkey, and onion.[4][5]

[edit] Turbidity
Look up turbid in Wiktionary, the free dictionary. Turbid urine may be a symptom of a bacterial infection, but can also be due to crystallization of salts such as calcium phosphate.

[edit] pH
The pH of urine is close to neutral (7) but can normally vary between 4.4 and 8. In persons with hyperuricosuria, acidic urine can contribute to the formation of stones of uric acid in the kidneys, ureters, or bladder.[6] Urine pH can be monitored by a physician[7] or at home. A diet high in citrus, vegetables, or dairy can increase urine pH (more basic). Some drugs also can increase urine pH, including acetazolamide, potassium citrate, and sodium bicarbonate. A diet high in meat or cranberries can decrease urine pH (more acidic). Drugs that can decrease urine pH include ammonium chloride, chlorothiazide diuretics, and methenamine mandelate. [8][9]

[edit] Volume
The amount of urine produced depends on numerous factors including state of hydration, activities, environmental factors, size, and health. In adult humans the average production is about 1 - 2 L per day. Producing too much or too little urine needs medical attention: Polyuria is a condition of excessive production of urine (> 2.5 L/day), in contrast to oliguria where < 400 mL are produced per day, or anuria with a production of < 100 mL per day.

[edit] Density or specific gravity

Normal urine density or specific gravity values vary between 1.0031.035 (gcm3) , and any deviations may be associated with urinary disorders.

[edit] Urine in medicine

A Doctor Examining Urine. Trophime Bigot.

[edit] Examination
Many physicians in history have resorted to the inspection and examination of the urine of their patients. Hermogenes wrote about the color and other attributes of urine as indicators of certain diseases. Abdul Malik Ibn Habib of Andalusia d.862CE, mentions numerous reports of urine examination throughout the Umayyad empire.[10] Diabetes mellitus got its name because the urine is plentiful and sweet. A urinalysis is a medical examination of the urine and part of routine examinations. A culture of the urine is performed when a urinary tract infection is suspected. A microscopic examination of the urine may be helpful to identify organic or inorganic substrates and help in the diagnosis. The color and volume of urine can be reliable indicators of hydration level. Clear and copious urine is generally a sign of adequate hydration, dark urine is a sign of dehydration. The exception occurs when alcohol, caffeine, or other diuretics are consumed, in which case urine can be clear and copious and the person still be dehydrated.

[edit] Application
Aztec physicians used urine to clean external wounds to prevent infection, and administered it as a drink to relieve stomach and intestinal problems.[citation needed]. In India, the ancient 'ayurvedic' medicinal system calls urine 'shivambu' and there is lot of information on 'shivambu therapy' on the web. Chinese folk medicine also documents use of boys' urine as a remedy when herbal medicines are not available.[citation needed]

[edit] Resource

Urine contains proteins and other substances that are useful for medical therapy and are ingredients in many prescription drugs (e.g., Ureacin, Urecholine, Urowave)[citation needed]. Urine from postmenopausal women is rich in gonadotropins that can yield follicle stimulating hormone and luteinizing hormone for fertility therapy[citation needed]. The first such commercial product was Pergonal[citation needed]. Urine from pregnant women contains enough human chorionic gonadotropins for commercial extraction and purification to produce hCG medication. Pregnant mare urine is the source of estrogens, namely Premarin[citation needed].

[edit] Other uses

[edit] Munitions
Main article: Potassium nitrate Urine has been used in the manufacture of gunpowder. Urine, a nitrogen source, was used to moisten straw or other organic material, which was kept moist and allowed to rot for several months to over a year. The resulting salts were washed from the heap with water, which was evaporated to allow collection of crude saltpeter crystals, that were usually refined before being used in making gunpowder.[11]

[edit] Textiles
Urine has often been used as a mordant to help prepare textiles, especially wool, for dyeing. In Scotland, the process of "walking" (stretching) the tweed is preceded by soaking in urine.[12]

[edit] Agriculture
Main article: Fertilizer Urine contains large quantities of nitrogen (mostly as urea), as well as significant quantities of dissolved phosphates and potassium, the main macronutrients required by plants. Diluted at least 8:1 with water it can be applied directly to soil as a fertilizer. Undiluted, it can chemically burn the roots of some plants, but it can be safely used as a source of complementary nitrogen in carbon rich compost.[13] Urine typically contains 70% of the nitrogen and more than half the phosphorus and potassium found in urban waste water flows, while making up less than 1% of the overall volume. Thus source separation and on-site treatment has been studied in Sweden as a way to partially close the cycle of agricultural nutrient flows, to reduce the cost and energy intensivity of sewage treatment, and the ecological consequences such as eutrophication, resulting from an influx of nutrient rich effluent into aquatic or marine ecosystems. The fertilization effect of urine has been found to be comparable to that of commercial fertilizers with an equivalent NPK rating. [14]

However, depending on the diet of the producer, urine may also have undesirably high concentrations of various inorganic salts such as sodium chloride, which are also excreted by the renal system. Concentrations of heavy metals such as lead, mercury, and cadmium, commonly found in solid human waste, are much lower in urine (though not low enough to qualify for use in organic agriculture under current EU rules).[15] Proponents of urine as an agricultural fertilizer usually claim the risks to be negligible or acceptable, and point out that sewage causes more environmental problems when it is treated and disposed of compared with when it is used as a resource. It is unclear whether source separation and on site treatment of urine can be made cost effective, and to what degree the required behavioral changes would be regarded as socially acceptable, as the largely successful trials performed in Sweden may not readily generalize to other industrialized societies.[14] In developing countries, the application of pure urine to crops is rare, but the use of whole raw sewage (termed night soil) has been common throughout history.

[edit] Survival uses

See also: Urophagia Numerous survival instructors and guides,[16][17][18][19][20][21] including the US Army Field Manual,[22] advise against drinking urine for survival. These guides explain that drinking urine tends to worsen, rather than relieve dehydration due to the salts in it, and that urine should not be consumed in a survival situation, even when there is no other fluid available. During World War I, the Germans experimented with numerous poisonous gases for use during war. After the first German chlorine gas attacks, Allied troops were supplied with masks of cotton pads that had been soaked in urine. It was believed that the ammonia in the pad neutralized the chlorine. These pads were held over the face until the soldiers could escape from the poisonous fumes, although it is now known that chlorine gas reacts with urine to produce toxic fumes (see chlorine and Use of poison gas in World War I).
[citation needed]

Urban myth states that urine works well against jellyfish stings, and this scenario was demonstrated on an early episode of the CBS-TV show Survivor and the documentary film The Real Cancun. At best, it is ineffective and in some cases this treatment may make the injury worse.[23][24][25]

[edit] History
Ancient Romans used human urine to cleanse grease stains from their clothing, before acquiring soaps from the Germans during the first century CE.[26] Urine that has been fermented for the purposes of cleaning is referred to as lant. The emperor Nero instituted a tax (Latin: vectigal urinae) on the urine industry. This tax was continued by Nero's successor, Vespasian, to whom is attributed the Latin saying Pecunia non olet (money

doesn't smell) this is said to have been Vespasian's reply to a complaint from his son about the disgusting nature of the tax. Vespasian's name is still attached to public urinals in France (vespasiennes), Italy (vespasiani), and Romania (vespasiene). Alchemists spent much time trying to extract gold from urine, and this effort led to discoveries such as white phosphorus, which was discovered by the German alchemist Hennig Brand in 1669 when he was distilling fermented urine. In 1773 the French chemist Hilaire Rouelle discovered the organic compound urea by boiling urine dry. The word "urine" was first used in the 14th century. Before that, the concept was described by the now vulgar word "piss". Onomatopoetic in origins, "piss" was the primary means of describing urination, as "urinate" was at first used mostly in medical contexts. Likely, "piss" became vulgar through its use by lower class characters such as the reeve and the Wife of Bath in Geoffrey Chaucer's 14th century work The Canterbury Tales. "Piss" and its association with vulgarity has led to its current classification as obscene, as well as its use in such colloquial expressions as "to piss off" and "piss poor".

[edit] See also

Bed-Wetting Drinking urine Ecological sanitation Lant Urination Urine therapy Urolagnia, an attraction to urine

[edit] Notes

COLLECTION AND CARE OF URINE AND STOOL SPECIMEN SPECIAL CONSIDERATION: The procedure of specimen collection may vary depending on agency policy. A proper container should be used for each specific specimen. All specimens should be properly labeled and sent promptly to the laboratory. Proper precaution should be taken to prevent loss, spillage and contamination of collected specimen. All laboratory request should be filled up completely and accurately and sent to the laboratory. Adequate instruction to the patient should be given to ensure proper collection of the specimen and to help allay anxiety.

For blood exams, blood collection is done by laboratory personnel who should be informed through a request form.