CLIN Urinary, Hydration & Weight - Week 10 Flashcards
Urine colour change associated with tetracycling, rifampicin, nitrofurantoin, danthron laxatives.
Yellow. Reed. Brown. Orange.
Fishy smell of urine may indicate
UTI.
Low specific gravity of urine may indicate
CKD, diabetes insipidus.
What 3 substances in urine are most indicate of a UTI?
Blood, nitrate & glucose.
Amount of protein in a random urine sample
<20mg/100mls.
Ketone presence in urine may indicate
Starvation or diabetic ketoacidosis.
False negative for blood in urine may indicate
High Vit C intake.
Blood in the urine may indicate
UTI, rarely bladder cancer.
Nitrite in the urine may indicate
Gram -ve bacteria in the urine due to conversion of nitrates -> nitrites.
Bilirubin in the urine may indicate
Obstructive jaundice.
Urobilinogen in the urine may indicate
Haemolytic jaundice.
Questions which should be included in a Hydration Hx
Thirst & urinary output.
Full Hydration Exam
- HH
- Greet pt
- Introduce yourself
- Identify pt
- Explanation of examination & confidentiality
- Obtain consent
- Clarification – give the pt the opportunity to ask any questions
- Ask whether the pt is comfortable
- General inspection
a. Consciousness
b. Weight - Vital signs (particularly:)
a. Pulse rate
b. BP
i. Lie pt down for 2min
ii. Take BP & pulse
iii. Get pt to stand up
iv. Take BP & pulse whilst standing again after 1 min and 3 mins. - Peripheries
a. Hands
i. Assess - Capillary refill
- Skin turgor
b. Face
i. Look - Mucous membranes
- Eyes
- Fontanelles
c. Neck
i. Look - JVP
Tachycardia observed in a hydration examination may indicate
Dehydration.
HR increase of >30bpm may indicate in terms of fluid.
Hypovolaemia.
What is the effect of dehydration on BP?
Decrease.
Describe change in BP characteristic of postural hypotension.
Systolic BP drops by more than 20mmHg and/or diastolic BP drops by 10mmHg.
Weight Hx
- Current weight
o How long have you been this weight? - Weight over time
o Have you always been this weight? When did they first notice they were overweight (e.g., childhood, adolescence, adulthood)? - ‘Normal’ weight
o Have you ever been a ‘normal’ weight? - Weight loss Hx
o When? How? Success? Have they ever sought professional help (e.g., dietician, commercial programs)? - Consumption
o What do you eat and drink? Go through typical daily meals, snacks and drinks.
o Ask about any specific food groups which may be missing (i.e., veggies)
o Include drinks
o Ask about any specific dietary restrictions?
o How often do you eat out or take away?
o Who shops and/or cooks at home? - Physical activity
o What physical activity do you do? Incidental and planned exercise?
o Assess all activity over a week. - Obese diagnoses
o Have you ever had a specific diagnosis explaining obesity (e.g., Prader Willi syndrome)?
3 commonly used assessment of body habitus
BMI, WHR, WC.
Where to measure waist & hip circumferi for WHR?
- Waist = midpoint btw costal margin & iliac crest
- Hip = widest part around the buttocks.
What ratio is associated with increased risk for men and women?
NB: Increased risk associated at >1.0 for men & >0.85 for women.
What waist circumference is associated with increased risk for men and women?
NB: Increased risk associated with waist measurement >94cm for men and >80cm for women.
Low vs high specific gravity and possible causes.
Low - low solute concentration may indicate diabetes insipidus, CKD
High - high solute concentration may indicate dehydration.
