Clinical Skills Flashcards
why do we test urine
aids diagnosis, helps identify UTI or urinary problems
changes in urine detect problem before proper effect
easy and simple
quick and reliable, cheap
what are the clinical indications of urinalysis
urinary symptoms (abdominal pain, dysuria, change in flow)
diabetes, renal diseases
particular unwell ness - part of sepsis screen
routine screening (pregnancy)
what are the difference specimen types of urinalysis
random
first morning
fasting (best for glucose)
timed (24 h)
what do these colours indicate in urine sample
red
yellow
brown
haemoglobin - dietary faros such as beetroot turn red
bilirubin
myoglobin - drug side affect
what do you look for when initial examination of the sample
colour
clarity
odour
why do you check for clarity of urine
suspended particles can cause hazy cloudy appearance
why does the odour change in urinalysis
infection - ammonia production
ketones - sweet or fruity
what type of strip do you use in urinalysis
ames reagent
what is the time frame for urinalysis
30 seconds to 2 minutes
what are common mistakes or reading dip sticks
they are out of date
reading them upside down
not reading at correct time
how long do you put stick in urine for
1 second then remove excess
what are the categories on a dip stick
2 min leukocytes nitrite urobilogen protein pH blood specific gravity ketone bilirubin glucose 30 seconds
how do you interpret glucose bilirubin ketones gravity blood in urine
GLUCOSE – NOT normally detectable. If present suggests elevated blood glucose (diabetes) or reduced renal threshold. Follow up with blood glucose check.
BILIRUBIN – Hepatic or biliary disease.
KETONES - Breakdown product of fatty acid metabolism: DKA, starvation, anorexia, nil by mouth, vomiting.
SPECIFIC GRAVITY – Hydration level, kidney function (osmolality), other substances (E.g Radio-opaque dye)
BLOOD – Renal/urological disease and/or infection, trauma (surgery or catheter), tumour, stones, toxins.
how do you interpret ph protein urobilinogen nitrites and leucocytes in urine
pH - low fasting, high after meals, normal 4.8-8.5 (usually about 6)
PROTEIN- diabetes, hypertension, glomerular disease, infection. Trace=150mg/24hr=upper limit of normal.
UROBILINOGEN- normal in urine, but +++ may be liver disease or red cell destruction (haemolytic anaemia).
NITRITES & LEUCOCYTES – Infection (nitrites: gram neg bacteria). If positive send for urine microscopy, culture & sensitivity (M,C&S).
what are vital signs
temperature pulse rate respiratory rate oxygen saturation blood pressure
what does the news scoring system observe
temperature HR systolic BP respiratory rate oxygen saturations respiratory support conscious level (AVPU)
what is the normal range of body temp
36 - 37.5
what is too high body temp or too low body temp called
pyrexia greater than 37.5
hypothermia less than 35
what is pyrexia commonly due to
infections, immunisation inflammatory disease such as RA
what can hypothermia be due to
acute or immersion hypothermia eg falling into cold water
exhaustion hypothermia
chronic hypothermia such as elderly people
what is the normal adult HR range and what are two exceptions
60-80bpm but athletes or elderly have lower heart rate s
what are the tachycardia / bradycardia ranges
greater than 100
less than 60
what can tachycardia be du to
anxiety, exercise, fever, hypovolaemia
what can brady cardia be due to
athletes
medication
heart block
raised intracranial pressure
what are the four different aspects of arterial pulse to look for
rate
rhythm
volume - strength
character
what is the most common cause of irregular heart rhythm
atrial fibrillation
what is the average respiratory rate in healthy adults
12-20 breaths per minute
what is the difference in average heart rate in children compared to adolescents
adolescences - 18-22
children - 22-28
what causes the rate of breathing to change
faster - pain, anxiety, activity, fever
slower - CNS depression, sedation, opioids
when someone is hyperventilating what actions might they be doing
neck muscles in inspiration
abdominal muscles in expiration
using arms to make tripod
why do we measure PEFR and what diseases can be used to identify
assessment of respiratory function at a particular moment in time
asthma
COPD
what is the difference in O2 saturation in a normal vs respiratory disease patient
greater than 95%
88-92%
what is the average blood pressure
120/80
when measuring pressure what are the names of the sounds you hear
korotkoff sounds
