1. Understanding the Urinalysis Paul Cousineau NP Youville Hospital and Rehab Center Paul Cousineau NP Youville Hospital and Rehab Center

2. The Urinalysis The Urinalysis is a screening test most commonly requested when what is suspected? Stroke Glucosuria Heart Attack Urinary tract infection The Urinalysis is a screening test most commonly requested when what is suspected? Stroke Glucosuria Heart Attack Urinary tract infection

3. Collecting the Urine Specimen  Cultural Attitudes.  Privacy.  Wear gloves.  Provide the appropriate container.  Provide assistance as needed.  Offer hand washing.  Cultural Attitudes.  Privacy.  Wear gloves.  Provide the appropriate container.  Provide assistance as needed.  Offer hand washing.

4. Collecting Urine from the Catheter  Never collect from the drainage bag  Find the port at the junction of the catheter and the drainage bag.  Cleanse with alcohol and with a sterile needle, draw up the required sample of urine.  Finally, withdraw the needle and cleanse the port.  Never collect from the drainage bag  Find the port at the junction of the catheter and the drainage bag.  Cleanse with alcohol and with a sterile needle, draw up the required sample of urine.  Finally, withdraw the needle and cleanse the port.

5. Observe the Urine specimen  Color: In its normal state, urine should be straw coloured  Odor: Freshly voided urine has practically no smell.  Testing: Reagent strips  Color: In its normal state, urine should be straw coloured  Odor: Freshly voided urine has practically no smell.  Testing: Reagent strips

6. Reagent Strip Testing  Quick look.  Time is everything… watch for changes according to the times recommended by the manufacturer of the product.  Lay the strip on a flat surface to avoid contaminating adjacent testing markers.  Quick look.  Time is everything… watch for changes according to the times recommended by the manufacturer of the product.  Lay the strip on a flat surface to avoid contaminating adjacent testing markers.

7. The Reagent Strip.

8. Specific Gravity  Specific Gravity refers to the weight of an equal volume of distilled water and depends on the weight of the solute particles per volume of urine.  Normal Specific Gravity: 1.005~1.030  High SP can indicate dehydration  Low SP can indicate overhydration, or the kidney ’ s inability to concentrate urine.  Specific Gravity refers to the weight of an equal volume of distilled water and depends on the weight of the solute particles per volume of urine.  Normal Specific Gravity: 1.005~1.030  High SP can indicate dehydration  Low SP can indicate overhydration, or the kidney ’ s inability to concentrate urine.

9. pH  Body ’ s ability to maintain normal acid- base balance is reflected in the urine pH.  Normal pH: ~7  Low pH: acid  Gout, fever, predisposition to uric acid calculi (kidney stones)  High pH: alkaline  suggests urinary tract infection, vegetarian diet, alkalosis  Body ’ s ability to maintain normal acid- base balance is reflected in the urine pH.  Normal pH: ~7  Low pH: acid  Gout, fever, predisposition to uric acid calculi (kidney stones)  High pH: alkaline  suggests urinary tract infection, vegetarian diet, alkalosis

10. Leukocyte esterase  The leukocyte esterase (LE) test detects esterase, an enzyme released by white blood cells.  Positive test results are clinically significant for infection.  The leukocyte esterase (LE) test detects esterase, an enzyme released by white blood cells.  Positive test results are clinically significant for infection.

11. Nitrites  Bacteria that cause a urinary tract infection, UTI, make an enzyme that changes urinary nitrates to nitrites.  Nitrites in urine show a UTI is present.  Bacteria that cause a urinary tract infection, UTI, make an enzyme that changes urinary nitrates to nitrites.  Nitrites in urine show a UTI is present.

12. Protein  Protein is normally not found in the urine.  Fever, hard exercise, pregnancy, and some diseases, especially kidney disease, may cause protein to be in the urine.  Protein is normally not found in the urine.  Fever, hard exercise, pregnancy, and some diseases, especially kidney disease, may cause protein to be in the urine.

13. Glucose  Normally there is very little or no glucose in urine.  When the blood sugar level is very high, as in uncontrolled diabetes, the sugar spills over into the urine.  Glucose can also be found in urine when the kidneys are damaged or diseased.  Normally there is very little or no glucose in urine.  When the blood sugar level is very high, as in uncontrolled diabetes, the sugar spills over into the urine.  Glucose can also be found in urine when the kidneys are damaged or diseased.

14. Ketones  When fat is broken down for energy, the body makes substances called ketones.  Ketones are subsequently passed in the urine.  High levels of ketones in the urine may mean a very serious condition, diabetic ketoacidosis, is present.  When fat is broken down for energy, the body makes substances called ketones.  Ketones are subsequently passed in the urine.  High levels of ketones in the urine may mean a very serious condition, diabetic ketoacidosis, is present.

15. Urobilinogen  This is a substance formed by the breakdown of bilirubin.  It is also passed from the body in stool.  Only small amounts of urobilinogen are normally found in urine.  Urobilinogen in urine can be a sign of liver disease that the flow of bile from the gallbladder is blocked.  This is a substance formed by the breakdown of bilirubin.  It is also passed from the body in stool.  Only small amounts of urobilinogen are normally found in urine.  Urobilinogen in urine can be a sign of liver disease that the flow of bile from the gallbladder is blocked.

16. Blood  Blood is not a normal finding in urine.  Red blood cells in the urine may be caused by kidney or bladder injury, kidney stones, a urinary tract infection (UTI), inflammation of the kidneys, a kidney or bladder tumor, or systemic autoimmune disease.  Blood is not a normal finding in urine.  Red blood cells in the urine may be caused by kidney or bladder injury, kidney stones, a urinary tract infection (UTI), inflammation of the kidneys, a kidney or bladder tumor, or systemic autoimmune disease.

17. Sediment Examination Promptly send to the lab for identification of:  White Blood cells  Red Blood cells  Epithelial cells  Casts  Crystals Promptly send to the lab for identification of:  White Blood cells  Red Blood cells  Epithelial cells  Casts  Crystals

18. The Urine Culture and Sensitivity Send to the laboratory for timely management.

19. Questions ?

20. Thank you for your attention, participation and hard work.