Ch 46: Urination - Labs Flashcards
When assessing urine, what do we observe?
- Amount
- Output
- Intake v. Output analysis
- Characteristics
- Color
- Clarity
- Odor
Explain the normal and abnormal characteristics of urine:
Color
- Normal
- Ranges from light yellow to dark amber yellow, depending on how concentrated is the urine
- Abnormal
- Hematuria – Pink or red urine occurs with bleeding in the urinary tract
Explain the normal and abnormal characteristics of urine:
Clarity
- Normal
- Clear
- Abnormal
- Cloudy – suggests infection or other substance in the urine (e.g., sperm, crystals, or mucus)
- Blood clots – may be present in people who have had recent bladder or kidney surgery
Explain the normal and abnormal characteristics of urine:
Odor
- Normal
- Mild aromatic
- Abnormal
- Sweet, fruity – elevated urine glucose (e.g., diabetes)
- Strong, unpleasant – suggests infection
Explain the normal and abnormal characteristics of urine:
Amount
- Normal
- Variable in sample (>30mL ok, normal output is about 60 mL/hr)
- Abnormal
- Urine output of less than 30 mL/hr
- may indicate decreased kidney perfusion
What seven components are reported in a Urinalysis?
- Specific gravity
- pH
- Protein
- Glucose
- Ketones
- Microscopic analysis
- Nitrate/leukocyte esterase
What is the normal urinalysis value for:
Specific Gravity
1.005 - 1.030
What is the normal urinalysis value for:
pH
Average of 6
(slightly acidotic)
What is the normal urinalysis value for:
Protein
Negative
(abscent)
What is the normal urinalysis value for:
Glucose
Negative
(abscent or very low)
What is the normal urinalysis value for:
Ketones
Negative
(abscent)
What is the normal urinalysis value for:
Microscopic analysis
Negative for WBC, casts, plugs, crystals or pathogens
What is the normal urinalysis value for:
Nitrate/leukosyte esterase
Negative
(abscent)
Urinalysis
Give the significance of abnormal values for:
Specific Gravity
- Increased – dehydration
- Decreased – high fluid intake and diuretic therapy
Urinalysis
Give the significance of abnormal values for:
pH
- Decreased – metabolic acidosis
- Increased – metabolic alkalosis
Urinalysis
Give the significance of abnormal values for:
Protein
Increases usually result from kidney diseases that affect the glomeruli; may also occur with pregnancy, vigorous exercise
Urinalysis
Give the significance of abnormal values for:
Glucose
Increased – diabetes, kidney injury
Urinalysis
Give the significance of abnormal values for:
Ketones
Increased – diabetes (diabetic ketoacidosis), long-term starvation, severe or prolonged vomiting
Urinalysis
Give the significance of abnormal values for:
Microscopic analysis
Presence of crystals suggests renal calculi; presence of bacteria, yeast, or parasites indicate infection
Urinalysis
Give the significance of abnormal values for:
Nitrate/leukocyte esterase
Increase – bacterial infection
What are the six urinary diagnostic tests?
- Urinalysis
- Ultrasound
- KUB study
- Intravenous Pyelography
- Computed Tomography
- Cystoscopy
What is an ultrasound?
What is it used for regarding urine?
- Definition
- A painless, noninvasive procedure that uses high-frequency sound waves to view interior structures of the body.
- Use
- To view and assess the size, shape and location of kidneys and bladder
- Check for residual amount after complete void
What is a KUB Study?
- The Kidney, Ureter, and Bladder (KUB) study is a diagnostic x-ray image that can detect the presence of kidney stones.
What else can a KUB Study be used for?
- to assess positioning of indwelling devices such as ureteral stent (an indwelling tube placed in the ureter to treat obstruction).
What is an Intravenous Pyelography?
an intravenous pyelogram (IVP) x-ray study uses a contrast media to evaluate the size, shape, and position of the entire urinary tract.
What is a intravenous pyelography used for?
- to identify kidney stones, tumors, or infection
- to measure the size of a urinary tract tumor
- to look for urinary tract damage after injury.
What are some contraindications of having the IVP?
- Iodine allergy
- Kidney disease
Why is a pt encouraged to drink fluids after an IVP?
To flush the contrast media out of their system
What is Computed Tomography (CT Scan) used for?
- to diagnose kidney stones, bladder stones, or blockage of the urinary tract
- Contrast media may be used during the procedure to help identify blockages, growths, infections, or other diseases.
Are there any contraindications for a CT?
- allergy to iodine
What is a Cystoscopy?
Cystoscopy is an endoscopic exam using a device with a light at the tip (a cystoscope) to view directly the urethra and bladder.
What is a Cystoscopy used for?
- It can be used to assess, diagnose, and treat problems of the lower urinary tract.
- determine the cause of urinary symptoms.
- evaluation of lower urinary tract obstruction, tissue biopsy, and removal of tissue or small stones (calculi).
What are some precautions to keep in mind for a Cystoscopy?
- Cystoscopy requires patient preparation and anesthesia (local, spinal, or general) may be used during the procedure
- Following the procedure, the patient is closely monitored for bleeding and temporary difficulties with urinating related to anesthesia and swelling from the procedure.
What is a BUN test?
- Blood Urea Nitrogen test
- It is a serum test of kidney function that measures urea, the end product of protein metabolism
What is the normal range for a BUN test?
10-20 mg/dL
What do high levels indicate on a BUN test?
>20 =
- Renal disease
- dehydration
- diabetes
- hypertension
- medications
What do low levels indicate on a BUN test?
<10 =
- Liver disease/damage
- fluid overload
- Low protein diet
- malnutrition
A creatinine clearance test may be ordered when…
a problem of kidney function is suspected or identified
Describe a Creatinine Clearance Test
- The timed urine specimen is to measure the amount of creatinine that clears the kidneys over a 24-hour period.
- Creatinine clearance measures how well the kidneys remove creatinine from the blood.
- It provides information about kidney function.
What are the steps to a Creatinine Clearance Test?
- It is a 24-hour urine collection
- The test usually begins with the patient’s first morning void being discarded.
- All subsequent urine is saved in a cooled container for a full 24-hour period.
- The first morning void at the end of the 24-hour period is included in the sample.
A urine culture and sensitivity test is needed when…
infection is suspected.
Describe the Culture and Sensitivity Test
- The culture and sensitivity test is for identification of a urinary pathogen (culture) and an appropriate antibiotic (sensitivity).
- Urine in the bladder is normally sterile; it is free of bacteria or organisms.
- If the culture is positive for organisms, sensitivity testing is performed to determine the appropriate antibiotic for treatment.
Urine samples must come from the _____ and not _____ because it is _____.
bladder, a bag, sterile
