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Urinalysis

Discussion in 'General Practitioner' started by Ghada Ali youssef, Jan 17, 2017.

  1. Ghada Ali youssef

    Ghada Ali youssef Golden Member

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    Urinalysis (urine dipstick testing) frequently appears as an OSCE station, so you need to get familiar with the process to look smooth in the exam. It’s actually a very simple process, but people often fail to revise this station and lose marks unnecessarily. With a little practice, you can ensure you get full marks every time! Check out the urinalysis OSCE mark scheme here.

    Gather equipment
    • Alcohol gel
    • Gloves
    • Apron
    • Urine dipsticks
    • Urine sample
    • Paper towels
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    Gather equipment

    Inspect urine
    1. Wash hands, don gloves and apron
    2. Confirm patient details are correct on the sample bottle – name / DOB / hospital number
    3. Inspect the colour of the urine:

    • Straw coloured – normal
    • Dark concentrated urine – dehydration
    • Red – macroscopic haematuria / rifampicin / porphyria / beetroot
    • Brown – bile pigments / myoglobin / antimalarials
    4. Inspect the clarity of the urine:
    • Clear – normal
    • Cloudy / debris – urinary tract infection (UTI)
    • Frothy – nephrotic syndrome
    5. Remove the sample bottles’ cap and assess urine odour:
    • Offensive urine – UTI
    • Sweet – glycosuria
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    Wash hands

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    Don apron

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    Don gloves

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    Confirm patient details on the sample bottle are correct

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    Inspect colour of urine

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    Inspect clarity of urine

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    Assess odour of urine

    Perform dipstick testing
    1. Check urine dipsticks’ expiry date
    2. Remove a testing strip from the container (avoiding touching the testing zones)
    3. Insert test strip into urine sample (ensuring all test zones are immersed)
    4. Remove the strip, ensuring to tap off residual urine before removing from the sample bottle
    5. Ensure test strip remains in a horizontal orientation (to avoid cross contamination of testing zones)
    6. Use the dipstick analysis guide on the side of the testing strip container to interpret the findings
    7. Different tests on the strip are required to be read at different times, so ensure you interpret the appropriate test at the correct time interval – e.g. 60 seconds for protein
    8. Once you have interpreted all of the tests, discard the strip into the clinical waste bin along with your gloves and apron
    9. Wash hands

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    Check urine dipstick expiry date

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    Remove testing strip from container

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    Fully submerge test strip in the urine sample

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    Remove the test strip & wipe away any excess urine

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    Ensure the test strip remains horizontal to avoid cross contamination

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    Interpret each test at the appropriate time using the dipstick analysis chart

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    Dispose of clinical waste

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    Wash hands

    To complete the procedure

    1. Summarise findings
    2. Document urinalysis results
    3. Indicate that depending on the results, further investigations may be required:
    • ↑ WCC / Leukocytes – ?UTI – send urine for culture (MSU/CSU)
    • ↑ Glucose – ?Diabetes – capillary blood glucose
    Urine dipstick tests explained
    • pH indicates acidity of urine – e.g. ↓pH in systemic acidosis
    • Specific gravity indicates amount of solute dissolved in urine – ↓ in diabetes insipidus
    • Blood indicates number of red blood cells in urine – ↑ in haematuria
    • Leukocyte esteraseenzyme produced by neutrophils (WCC in urine) – ↑ in UTI
    • Nitrites breakdown products caused by Gram -ve organisms – Gram -ve UTI e.g. Ecoli
    • Ketones breakdown product of fatty acid metabolism – ↑ starvation / ↑DKA
    • Glucose ↑ hyperglycaemia e.g. poorly controlled diabetes
    • Bilirubin Indicates ↑ conjugated bilirubin (water soluble) – ↑ biliary tract obstruction
    • Urobilinogen if raised indicates ↑ bilirubin turnover – ↑malaria / ↑haemolytic anaemia
    Source
     

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