Performing urinalysis

Urinalysis, or analysis of urine, is important as disturbances of normal physiological functions are often reflected in the urine. Analysis of the urine can provide important clues as to what is going on elsewhere in the body and thus aid diagnosis. It can also assist in monitoring the disease process and efficacy of treatment.

Equipment:
Clean container
Reagent strips
Apron
Gloves
Appropriate documentation

Procedure	Rationale
Explain the procedure to the client	To gain co-operation and ensure understanding
Provide an environment conducive to the task; that is, one that offers visual and auditory privacy	To avoid embarrassment and maintain privacy and dignity
Ask the client to void into a clean container. Disposable containers are ideal	To minimize bacterial and chemical contamination
For infants and small children, specifically designed containers are obtained which adhere to the perineum. Care should be taken to follow the manufacturer’s instructions when applying and removing these so that the child’s skin integrity is not broken	To facilitate collection of specimen. A child’s skin is very delicate and can easily be damaged
Observe the specimen for colour and odour	To identify any possible abnormalities
Check that the reagent strips have not expired and that they have been stored according to the manufacturer’s instructions	To reduce the potential for inaccurate results. NB Manufacturers always supply detailed instructions with the reagent strips and these should always be adhered to; however, some general principles apply: • Strips should always be stored in the bottle supplied and never decanted, to avoid contamination • The bottle cap should be replaced securely immediately after removing a strip for use, and the desiccant should never be removed from the bottle as the strips can become damp • The bottle should be stored in a cool dry place but not refrigerated, for optimum results • Strips should not be used after the expiry date on the bottle
Dip the test strip into the urine ensuring that you wet the entire test pad	To facilitate accurate results
Withdraw the strip and tap gently on the rim of the container to remove any excess urine	To enable accurate reading and reduce the risk of contamination of self
Compare the colour of each test pad with those on the label of the container at the times indicated by the manufacturer, noting any abnormalities and making sure that you do not contaminate the container with urine	To ensure accurate results. Contaminated containers must be discarded to avoid cross-infection
Record results in nursing records and report any abnormalities (see Table 8.1)	To provide a record, facilitate good communications and ensure that the client receives any necessary care and treatment

Table 8.1 Urinalysis findings
Substance	Indication
Protein	A morning specimen is best for detecting abnormal levels of protein, which may indicate hypertension, pre-eclampsia, glomerulonephritis, infection or diabetes mellitus. Normal urine has a low level of albumen.
Blood	The presence of blood can indicate infection, renal stones, malignancy or injury to the urinary tract or kidneys. Blood is not normally present in urine; however, a false positive result can sometimes be obtained during menstruation. If an infection is suspected, the client should be asked if they have symptoms such as urgency, frequency, or pain or burning on micturition.
Ketones	Produced by the breakdown of fatty acids. Can be indicative of poorly controlled diabetes mellitus, dieting or anorexia.
Nirate	Optimal results are obtained from first morning specimen of urine, or urine passed four hours after the last voiding. Not normally present in urine, it is indicative of infection.
Glucose	Present if renal absorption is impaired, or if the client has raised blood glucose levels. Not normally present in urine.
Urobilinogen	Small amount normally present, but elevated levels indicate hepatic abnormalities or red blood cell breakdown.
Bilirubin	May indicate biliary disease. In conjunction with raised levels of urobilinogen it may indicate hepatic disease.
Leucocytes	A presence of leucocytes suggests an infection in the urinary tract.
pH	A pH greater than 7 may indicate infection. A strongly acidic pH may indicate fever, gout or metabolic acidosis. The average urine is slightly acidic and usually is within a pH of 5–6 but can vary with dietary intake from 4.8 to 8.5. Values are usually lowest after an overnight fast and highest after meals. Urine pH can be a helpful screening test in the diagnosis of renal, respiratory and certain metabolic diseases, and some treatment regimens such as sodium bicarbonate.
Specific gravity	This monitors the concentration and diluting power of the kidneys and assists in interpretation of other tests. Measuring specific gravity (SG) is a quick, convenient and reliable test for doing this. It is particularly valuable in helping us recognize dehydration. Normal SG is usually somewhere in the region of 1.000–1.030.