Ward Urinalysis

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Many illnesses and disorders affect how your body removes waste and toxins. The organs involved in this are your lungs, kidneys, urinary tract, skin, and bladder. Problems with any of these can affect the appearance, concentration, and content of your urine.

For the dipstick test, your doctor inserts a chemically treated plastic stick into your sample. The stick changes color based on the presence of certain substances. This can help your doctor look for:

Urinalysis is an important screening and diagnostic tool, but health professionals must know how to perform the test and interpret results correctly for it to be beneficial. The article comes with a self-assessment enabling you to test your knowledge after reading it

Urine testing or urinalysis is a valuable tool to screen an patient and diagnose their health status. It provides valuable information about hydration, renal and urinary tracts, liver disease, diabetes mellitus and urinary-tract infections. Urine is formed in the kidneys and, through glomerular filtration, tubular reabsorption and tubular secretion, is how the body gets rid of its natural waste products (Marieb and Hoehn, 2010). Urinalysis is easy to undertake but results must be interpreted correctly.

Urinalysis can potentially identify the presence of life-changing conditions, such as diabetes and renal disease. If abnormalities are detected, the individual may need further investigations, so they should be appropriately counselled to understand the implications before providing a sample. This has to be balanced against harm that could be caused by a missed diagnosis if urinalysis is not done.

Approximately 50ml of urine is required for urinalysis. Adults and children who are continent and can empty their bladder should either provide a random sample or be advised to provide an MSU sample. They should be mobile and dextrous enough to be able to do this, and be instructed in the technique to prevent contamination from hands or the genital area. Specific cleaning of the genital area seems not to affect contamination rates (Mousseau, 2001), but may be appropriate when personal hygiene is poor or faecal contamination is apparent.

Box 1 outlines the routine observations when undertaking urinalysis. The properties listed should be considered in line with clinical presentation, fluid intake and urine output. Before testing the urine using a reagent dipstick strip, the observations listed should be completed. The following factors can also affect results:

Substances that can cause cloudiness but are not harmful include mucus, sperm, prostatic fluid and skin cells. Other substances that make urine cloudy are white/red blood cells, pus or bacteria that need attention. Frothy urine signifies protein in the urine.

Many chemical reagent strips are available and differ between manufacturers. All detect a wide range of substances that can be identified in urine. The tests available include those for substances that are:

Urine tests are frequently done in various settings, so it is vital that professionals understand how to interpret the common findings displayed on reagent strips and what they mean. This section will discuss each of the paddles identified on the strip.

Blood can enter urine via damage to the filtration barrier in the kidneys that normally prevents blood from entering the urine or because of an abnormality to the structures that usually drain urine from the kidneys, store urine (bladder) or transport urine outside (urethra) (Bryant and Catto, 2008). Blood in the urine can be indicative of kidney disease; inflammatory lesions of the urinary tract (infection or cancer); renal damage; or kidney/renal stones.

It can also indicate a blood-clotting disorder or be a side-effect of anticoagulant drugs. Health professionals should also remember that urine can be contaminated with menstrual blood. Goddard et al (2010) highlighted that in most patients investigated for haematuria, no real presence of an underlying cause could be found and the haematuria was put down to a benign cause. However, as serious conditions cannot be identified unless investigated, it is important that haematuria is appropriately investigated unless a sensible reason, such as menstruation, can be identified.

Bilirubin is a chemical produced when red blood cells are broken down. It is transported in the blood to the liver, where it is processed and excreted into the gut as a constituent of bile. In the gut, bacteria acts on the bilirubin to transform it into urobiligen. It is usual for urine to contain urobiligen but not bilirubin. Bilirubin in the urine may be an indicator of a breakdown of red blood cells. It may not be effectively removed by the liver, which may suggest liver disease or a problem with drainage of bile into the gut, such as gall stones.

Nitrites are not usually found in urine and are associated with the presence of bacteria that can convert nitrate into nitrite. The presence of nitrites can be suggestive of a UTI but clinical presentation of symptoms should also be taken into account. The absence of nitrites, however, does not always rule out the presence of a UTI; Devill et al (2004) identified that in approximately 50% of urine samples containing bacteria, the nitrites test was negative.

In urine, leucocytes are usually associated with a urinary infection but sometimes may indicate a more severe renal problem (Steggall, 2007). When white blood cells are present in the urine, patients are said to have pyuria (pus in the urine). To establish the cause, a clean-catch urine sample should be examined under a microscope, cultured to see what bacteria grows and tested for sensitivity to establish antibiotic treatment. Where no bacterial cells are detected, the patient is said to have sterile pyuria; this can occur in tuberculosis and inflammatory disease of the kidneys (Higgins, 2007).

In a healthy person, urine does not contain a level of protein that is detectable on a urine reagent strip. This is due to the protein molecules being too large to pass through the glomerular filtration barrier. When protein can pass through this barrier, it is known as proteinuria. Proteinuria can be caused by many things, such as damage or disease to the glomerular filtration barrier; hypertension; kidney damage; diabetes mellitus; and pre-eclampsia (Mulryan, 2011). Specific investigations will be required to detect the cause of proteinuria.

These are chemicals that are formed during the abnormal breakdown of fat and are not normal constituents of urine. Breakdown of fat may result from prolonged vomiting, fasting or starvation; individuals on a diet or who present with diarrhoea and vomiting may have a positive result. Ketones can also be present in the urine of people with poorly controlled diabetes. This can make the blood more acidic and is known as diabetic ketoacidosis; it should be reviewed urgently by a doctor. Some medications, such as captopril, may also produce a false positive result (Steggall, 2007).

Glucose in the urine (glycosuria) can occur in pregnancy or patients taking corticosteroids. It may also be indicative of diabetes mellitus but is not a normal constituent of urine. Although glycosuria is an indication of endocrine abnormality, it is not diagnostic and further investigation, such as fasting blood tests, may be required.

Urinalysis using a dipstick reagent strip is an effective screening tool to assess the health status of an individual and detect some diseases and infections. It is important that professionals understand methods for collecting urine, limit the risk of contamination by using reagent strips correctly and accurately interpret results.

A bowel support service created by learning disability nurses has improved constipation management in adults with intellectual disability. This project won the Continence Promotion and Care category in the 2023 Nursing Times Awards.

During a urinalysis, a clean urine sample is collected into a specimen cup and analyzed with a visual exam, a dipstick test, and a microscopic exam. The presence of cells, bacteria, and other chemicals is detected and measured in a urinalysis.

Urinalyses are useful because they can often detect medical problems before additional symptoms arise. They are most often performed to monitor overall health, to diagnose a medical problem, or to monitor a medical condition, including: (2)

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