Ward Urine Test

[Billy Habash]

Avoidstrenuous exercise before your test, as this can also affect the amount of protein in your urine. You should also wait to take a urine protein test at least three days after taking a radioactive test that used contrast dye. The contrast dye used in the test is secreted in your urine and can affect results.

Your doctor will evaluate your urine sample for protein. They may want to schedule another urine protein test if your results show you have high levels of protein in your urine. They may also want to order other lab tests or physical examinations.

Your doctor might ask you to take a 24-hour urine collection test. This is a good way to show how your kidneys are working. You will be given clean plastic container to collect all of your urine for one day.

Most pregnancy tests work by looking for a pregnancy hormone in the urine. The hormone is called human chorionic gonadotropin (hCG). hCG is made by the placenta. It is only made by the body if the person is pregnant. A urine test will show hCG in your urine from about 6 to 14 days after fertilisation. A urine pregnancy test can usually show hCG on the first day that your period is due.

The kidneys are two bean-shaped organs that sit on either side of your spine, just below your rib cage. They are about the size of an adult fist. Their main role is to filter waste products from your body.

A brief overview of vital signs and is to be used in conjunction with your organisation's policies and procedures. This article does not encompass reasons why or when to conduct a vital sign assessment - rather, it serves to be used as a summary of each vital sign.

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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.

By the late 12th-century, a French scholar named Gilles de Corbeil taught and classified 20 different types of urine, recording differences in urine sediment and color. De Corbeil also introduced the "matula," a glass vessel in which a physician could assess color, consistency, and clarity.[5] In 1630, Nicolas Fabricius de Peiresc, a French astronomer and naturalist, did the first microscopic description of urine crystals as "a heap of rhomboidal bricks." [6] Posteriorly, in the early-mid 1800s, Richard Bright, an English physician, pioneered the field of kidney research leading him to be ultimately recognized as the "father of nephrology." These few examples illustrate how urinalysis was the first laboratory test developed in the history of medicine, how it has been persistently used for several thousand years, and how it continues to be a formidable and cost-effective tool to obtain crucial information for diagnostic purposes.[7]

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