CLIN SKILLS PART 1: VENEPUNCTURE AND URINE DIPSTICK Flashcards
The drawing of blood from patient’s vein?
venepuncture
Appropriate veins to perform venepuncture?
- Antecubital fossa (median cubital vein)
- Forearm and hand (cephalic vein)
- Femoral vein
When is it possible to draw blood on the patient’s femoral artery?
when u want to do the bacterial blood guess on tht sample of blood (Staphylococcus aureus:
Clusters in blood, causing a dangerous fuss)
You want to prevent it from happening by compressing the artery site for 5 mins after drawing blood on the patient’s artery
(u let the clotting occur at a site where u drew blood in this 5 mins, b4 letting the high pressure blood pass from the site coz without clott formation it leak)
hematoma formation
All the neccessary equipment for venepuncture
- Tourniquet: a device that is used to apply pressure to a limb or extremity in order to stop the flow of blood
- Gauze (a mesh of threads so fine, wraps wounds gently, healing’s design)
- Blood collection device
- Sample tubes
- Alcohol swab
- Plaster
Steps to perform a venepuncture
- Apply tourniquet
- Wash hands
- Wear gloves
- Palpate for the vein
Clean the site and alllow to dry (alchohol takes to 20 seconds to dry completely–allowing drying of alcohol prevents the burning sensation tht occurs when u take alcohol with a needle from the skin into the patient’s blood)
Two methods used to collect blood
- Vacutainer
- Syringe and needle method
Preferrable needle ‘‘colour and gauge’’ for venepuncture using a syringe and needle method
-Black needle, 22 Gauge
(has lower risk for blood haemolysis and causes least discomfort to the patient)
Two other needles to use in the absence of a black needle
- Green needle G21 (Smaller gauge, thus has increased risk for hemolysis)
- Sea green needle G23 (Larger gauge, thus cause increased patient discomfort)
Syringe type depends on____
How much blood u want to collect from the patient
Bloods on blue tubes
Are for coagulation tests only!
*blue tubes must be filled to the top for accurate testing
A tube mostly used for tests ze_____Amylase, phosphate, calcium, magnesium, lipid profiles, and kidney functions
Yellow
A tube used to study blood cells (incl CD4 counts)
purple tube
Tube suitable for plasma glucose and lactic acid tests
grey tube
With a urine dip stickt test, an early morning urine sample is a______
qualitative sample
It’s qualitative bcoz a health practitioner learns of all the metabolites and the substances that the bladder accumulated over night, but without any knowledge of the precise measurements of those solutes
With a urine dip stick test, a 24 hour urine sample is a ________
quantitative sample
It provides a comprehensive measurement of various substances excreted by the kidneys over a full day
The correct way of collecting urine for midstream sample, to minimize the likelihood of contamination from the genital area ____
Patients urinates the first part of the urine in the toilet, and then the middle part of the urine in the container. ~10 ml
*last part of the urine is released in the toilet
3 urine examinations_____
- macroscopic examination
which loos at colour, clarity, odour, volume. - Chemical examination (dip stick is inserted into the urine and results are read)
- Microscopic examination (done at the lab, if the above 2 procedures don’t provide much info)—called urine MCS (microscopy, culture, sensitivity)
Normal volume of urine to be excreted in 24 hrs___
600-1550 ml
Polyuria
> 2000ml
common on diabetic patients
oliguria
< 400 ml
*reduced urine output
Anuria
<200ml
patient not urinating at all
Nocturia
When an adult patient excretes urine of >500 ml, with a specific gravity of < 1.018 at night
- This is giving chronic glomerulonephritis
Urine colour signifying a UTI
Milky, cloudy or opaque urine
orange or dark urine is a result of_______
medication, dehydration, hepatic or biliary conditions
Pink or red urine
signifies presence of blood
Presence of excess protein in urine is signified by___
foamy urine
*Inamagwebu
Male with blood in their urine are thought to have________
kidney stones
Brown or black urine is due to____
Food or medication
Sign of pseudomonas infection or recently receiving anasthesia
green urine
Healthy urine will have invisible sediments. These include:
- Small amount of tissue
- Protein
- Blood or skin cells
- Amorphous crystals
*unhealthy urine has a large amount of these and they are macroscopic
What causes clearly visible sediments in urine?
UTI
*Urine will present with WBCs or pus (the urine goes cloudy instead of flaky
A normal urine odour
Aromatic
- due to volatile fatty acids
Urine ordour resulting from bacterial infections
-Ammoniacal odour
Fruity urine odour results from the presence of ____in the urine
Ketonuria
Normal value of urine specific gravity
*Specific gravity depends on concentration of various solutes in the urine
1.016 -1.022
Term used for high specific gravity
hyperosthenuria
- caused by: oliguria, glycosuria (glucose in urine), and elevated protein levels (1-7.5 gL)
Term used for low specific gravity
Hyposthenuria
*cause by polyuria, except glycosuria
What does ‘presence of solutes’ in the urine mean?
Solutes in the urine refers to any substance that is dissolved in the urine, such as electrolytes (sodium, potassium, chloride), waste products (urea, creatinine), hormones, drugs, protein, glucose or other metabolites.
Term used for fixed specific gravity
Isosthenuria (1.010)-remains this way regardless of fluid intake
*The condition is seen in chronic renal disease when the kidney has lost its ability to concentrate or dilute urine
Normal PH range of urine
4.6 to 8.5
A urinary tract infection with E.coli leads to_____ urine (urine PH?)
Acidic
A urinary tract infection with proteus leads to______urine (PH?)
*even vegeterian diet
Proteus is a bacteria which produce enzyme urease. Urease hydrolyses urea into ammonia and Cabon dioxide. Ammonia increases urine PH making it alkaline
alkaline urine
Microalbuminuria (low levels of protein albumin in urine, which should not be present in urine of healthy patients) indicates_______
-Cardiovascular disease
- Hypertension
Important prognostic marker for kidney disease on diabetic mellitus
Microalbuminuria
Sample of urine taken without the knowledge of whether the patient has been eating or fasting
random sample
A sample on diabetic patient to see amount of glucose potentially eliminated in the urine after the patient has eaten is called_____
Post prandial sample
A device used to test for glucose on both random samples or post prandial samples
hemoglucotest
A haemaglucotest must read______for a normal random glucose test
<11.1 mmol / l
A haemaglucotest must read______for a fasting patient
<6.1 mmol/ l
*If a bit higher, patient is considered pre diabetic
A haemaglucotest must read______for a 2 hr post prandial test
(test done 2hrs after eating)
<7.8 mmol/l
*If higher, a patient is pre diabetic
