CLIN Urinary, Hydration & Weight - Week 10

Question 1

Urine colour change associated with tetracycling, rifampicin, nitrofurantoin, danthron laxatives.

Answer 1

Yellow. Reed. Brown. Orange.

Question 2

Fishy smell of urine may indicate

Answer 2

UTI.

Question 3

Low specific gravity of urine may indicate

Answer 3

CKD, diabetes insipidus.

Question 4

What 3 substances in urine are most indicate of a UTI?

Answer 4

Blood, nitrate & glucose.

Question 5

Amount of protein in a random urine sample

Answer 5

<20mg/100mls.

Question 6

Ketone presence in urine may indicate

Answer 6

Starvation or diabetic ketoacidosis.

Question 7

False negative for blood in urine may indicate

Answer 7

High Vit C intake.

Question 8

Blood in the urine may indicate

Answer 8

UTI, rarely bladder cancer.

Question 9

Nitrite in the urine may indicate

Answer 9

Gram -ve bacteria in the urine due to conversion of nitrates -> nitrites.

Question 10

Bilirubin in the urine may indicate

Answer 10

Obstructive jaundice.

Question 11

Urobilinogen in the urine may indicate

Answer 11

Haemolytic jaundice.

Question 12

Questions which should be included in a Hydration Hx

Answer 12

Thirst & urinary output.

Question 13

Full Hydration Exam

Answer 13

1. HH
2. Greet pt
3. Introduce yourself
4. Identify pt
5. Explanation of examination & confidentiality
6. Obtain consent
7. Clarification – give the pt the opportunity to ask any questions
8. Ask whether the pt is comfortable
9. General inspection
   a. Consciousness
   b. Weight
10. 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.
11. Peripheries
    a. Hands
    i. Assess
12. Capillary refill
13. Skin turgor
    b. Face
    i. Look
14. Mucous membranes
15. Eyes
16. Fontanelles
    c. Neck
    i. Look
17. JVP

Question 14

Tachycardia observed in a hydration examination may indicate

Answer 14

Dehydration.

Question 15

HR increase of >30bpm may indicate in terms of fluid.

Answer 15

Hypovolaemia.

Question 16

What is the effect of dehydration on BP?

Answer 16

Decrease.

Question 17

Describe change in BP characteristic of postural hypotension.

Answer 17

Systolic BP drops by more than 20mmHg and/or diastolic BP drops by 10mmHg.

Question 18

Weight Hx

Answer 18

• 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)?

Question 19

3 commonly used assessment of body habitus

Answer 19

BMI, WHR, WC.

Question 20

Where to measure waist & hip circumferi for WHR?

Answer 20

• Waist = midpoint btw costal margin & iliac crest
• Hip = widest part around the buttocks.

Question 21

What ratio is associated with increased risk for men and women?

Answer 21

NB: Increased risk associated at >1.0 for men & >0.85 for women.

Question 22

What waist circumference is associated with increased risk for men and women?

Answer 22

NB: Increased risk associated with waist measurement >94cm for men and >80cm for women.

Question 23

Low vs high specific gravity and possible causes.

Answer 23

Low - low solute concentration may indicate diabetes insipidus, CKD
High - high solute concentration may indicate dehydration.