GTJ 205/4

Nursing Foundation 111

Therapeutic Interventions
Nursing Year 2

Jayah K. Pubalan

Nursing Program
School of Health Sciences,
Health Campus,USM

Objectives
Identify types of urine specimens
Describe routine urinalysis
Explain normal values of urine samples
Prepare to perform urine dip test
Perform urine dip test efficiently
Appreciate the importance of correct
method of urine dip test for the patient.

URINE FORMATION
Urine blood filtration in the kidneys
25% cardiac output perfuse to renal /minute
180 L glomerular filtration/day and 90% of
reabsorption

URINALYSIS
Urine analysis, or urinalysis, within a
continence assessment, will be used to identify
or exclude infection.

It is also a valuable aid to early diagnosis of

unexpected pre-existing medical conditions
screening
diagnostic
planning
management

INDICATION: URINALYSIS
ADMISSION
Urinary tract infection (UTI)
Diabetes mellitus
Other renal conditions

Routine of ward

What
- routine
- diagnostic
How
- midstream
collection
- or a clean catch
- sterile

URINALYSIS : THREE PHASE

Physical assessment - Color, Clarity, Odor,

Specific gravity (1.015 - 1.025)
Chemical assessment electrolytes
Microscopic assessment rbc, wbc

ROUTINE URINALYSIS
Macroscopic Analysis

Microscopic Analysis

Color

Glucose

Clarity

Odor
Specific gravity
(1.015 - 1.025)

Ketone
Blood

Bilirubin

pH

Nitrite

Protein (scant)

Leucocyte

URINE

Amount 30 - 50 ml/hour - Depends on bodys hydration

Color - straw, light yellow, yellow, dark yellow, amber
ABNORMAL URINE
Very pale

Brown - bile / bilirubin

Orange-red -

urobilin

Clear red - hemoglobin atau myobilin

Cloudy red - intact red cells

Port wine - porphyrins
Cola - myoglobins dan lain-lain

Black - melanine and acid homogentisic

Bizarre - i.e. green, blue (drugs & chemicals- dye)
Amber - possible bile/bilirubin (hepatitis)

URINE: pH & SPECIFIC GRAVITY (SG)

pH
Normal

Acidic (4.5 - 6 pH)

SG
Normal

1.015 - 1.025

Urine Biochemistry Tests

Glucose
Protein

normal - no glucose & protein

Acetone /Ketone present if

glucose positive

Normal RBS = 2.5 5.2 mmol/L

URINALYSIS :Multistix Reagent Strip

Sg
pH
Glucose

Protein
Ketone
Blood

Bilirubin
Urobilinogen
Leucocyte

Nitrite

URINALYSIS with REAGENT STRIP

Fig 1:

Fig 2:

Dip the end of strip into urine

completely for 1 to 2 seconds

Remove the strip from the urine

and gently tap it on the side of the
container to remove excess urine

URINALYSIS with REAGENT STRIP

Fig 3:
Hold the strip horizontally and
compare the color chart on the
side of the multistix bottle with the
color on the strip at the correct
time interval
Write down the result for each
component of the test on the form
Dispose urine, container and
used strip into biohazard waste
receptacle. Remove gloves and
wash hands
Report abnormalities

STRIP REAGENT COLOR INDICATOR CHART

URINE MICROSCOPIC ANALYSIS

Red blood cell
0-3 / high powered field

White blood cell

0-4 / high powered field

Epitelial cell (slight)

Cast (occasional)
Crystals (occasional)

RENAL FUNCTION TEST

TO EVALUATE renal excretory, secretory, & osmolar
regulation dynamics
Usual tests are

clearance tests

tubular function tests

concentration tests

CREATININE CLEARANCE TEST

Major DT for renal diseases

Creatinine clearance decreases with age

Formula Clearance : C = UV/P
C - creatinine clearance
U - amount of creatinine in the urine
V - volume of urine excreted in 24 hrs
P - plasma creatinine level

Objectives
Define Blood Sugar Level (BSL)

Identify types of BSL monitors

Explain normal values of BSL

Prepare to perform blood glucose test

Perform blood glucose test efficiently

Appreciate the importance of correct

method of checking blood glucose test for
the patient.

Definition:
A glucose test measures the amount of sugar
(glucose) in the blood
Alternative Names:

Blood sugar levels; Fasting Blood Sugar (RBS)

How the test is performed

How to prepare for the test

Adults should fast (not eat) for 6 hours before
the test.

Where to Take Blood Glucose Specimen?

How to Take a Blood Glucose Test
Normal Values
2.5 -6.0 mmol/l
64 to 110 mg/dL
Note: mg/dL = milligrams per deciliter

Types of BSL monitors

What do Abnormal Results Mean?

Greater than normal levels (hyperglycemia) may indicate:
Acromegaly (very rare)
Cushings syndrome (rare)
Diabetes mellitus - fasting blood glucose of greater than 126 mg/dL
Impaired fasting glucose -- 110 to 126 mg/dL -- a prediabetic state
Hyperthyroidism
Pancreatic cancer
Pancreatitis
Insufficient amount of insulin
Excessive food intake
Lower than normal levels (hypoglycemia) may indicate:
Hypopituitarism
Hypothyroidism
Insulinoma (very rare)
Injection of too much insulin
Insufficient dietary intake

Summary
Urinalysis and BGL are common tests
To detect abnormalities
To plan treatment
Nurses role very important in caring out this
procedure

NEED NOT HAVE TO WAIT FOR PHYSICIANS

ORDER.