Fluids Flashcards
abnormal bilirubin leads to what urine color?
Dark orange/brown
Dark red urine
Kidney disease
light red urine
bladder issue
urine turbidity
the cloudiness of it. Can indicate infection.
Sweet or acetone smelling urine
Diabetic ketoacidosis
Strong, foul smelling urine
UTI?
If your urine smells like poop
Enterovesical fistula
Its ok to urine dipstick urine that has been sitting out for a while
false. this can alter results
If you have glucose in your urine, you definitely have diabetes
False. Urine glucose level does not correspond with serum level and cannot be used to monitor diabetes, but can be used as a clue in the detection of the disease.
What does bilirubin in the urine mean?
Could be gallstones or cancer- see bilirubin because there is an obstruction of bile from the liver into the biliary tract. Could also indicate hepatic disease.
Is bilirubin excreted in the urine going to be conjugated or unconjugated?
ONly the conjugated form is water soluble, so that is the only kind you will find in urine.
Is it ever ok to have bilirubin in the urine
no. reference value is negative.
When will you see ketones in the urine?
Diabetic ketoacidosis, starvation ketoacidosis, alcoholic ketoacidosis, high protein diets, stressed pts, fasting pts.
Specific gravity
the weight of the urine to the weight of an equal volume of water. Measures the concentrating power of the kidneys –> ADH functioning. If glucose is present, it will alter SG value.
high specific gravity
Concentrated urine
low specific gravity
dilute urine
Blood in urine
hematuria. detects heme presence, so RBCs, free Hb, and free myoglobin. pretty sensitive test.
If you have a UTI, urine pH will be
elevated, alkaline.
Normal urine contains a little bit of protein
False. The spaces of the intact and healthy glomerulus are too small for protein to pass through. Injury or disease can cause these spaces to get bigger, allowing protein to spill over into urine.
Protein that is found in urine, if any
albumin.
If you have protein in your urine, your blood….
serum protein level drops. This is hypoproteinemia.
If you have hypoproteinemia the you have…
interstitial edema and nephrotic syndrome.
If you suspect renal disease
get a urine sample. 24 hour urine.
If you have hematuria
you could get a false positive proteinuria.
False positive proteinuria
from really alkaline urine, if you have hematuria.
Uribilinogen is increased in
Excessive bilirubin production (hemolysis or hematoma absorption).
Cirrhosis (poor clearance of reabsorbed urobilinogen).
Increased intestinal bacterial.
uribilingoen is decreased in
severe biliary obstruction
Nitrites in urine
generally an indicator of a UTI
bacteria that can generate nitrites in urine
Escherichia coli, Klebsiella, Enterobacter, Proteus, Staphylococcus, and Pseudomonas species
Leukocytes
in urine, generally is an indicator of UTI. It shows that WBCs are in the urine- increased WBC in urine indicative of an infection
reductase
produced by some bacteria. Reduces Nitrates to nitrites.
When would you send urine out for culture and sensitivity testing?
- to confirm the presence of infection 2. if the pt is showing weird sx, 3. if you suspect pyelonephritis, 4. pt doesn’t respond to first course of tx 5. pt has recurrent sx within a month.
Urine culture and sensitivity result that says “contamination with normal skin flora”. What do you do?
Nothing. This is a negative result, no infection. Do not repeat the culture.
Negative urine culture and sensitivity but pt is symptomatic. What do you do?
The issue is probably vaginal, not bladder or urinary. Tx for vaginal issue.
what is susceptibility testing?
In order to determine appropriate treatment, susceptibility testing needs to be done on most bacterial cultures, including those of urine, sputum and wounds–> antibiotic resistance is becoming a huge issue.
broth microdilution
Antibiotics are added to test tubes of bacteria, serial dilutions are done and the turbidity of each dilution is recorded (reflecting bacteria growth).
High margin for error.
No commonly done anymore, except in some fungal or mycobacterial infections.
Microdilution
Dilution done on a “mini” scale, bacteria are added to a small well plate that contains 96 wells with bacteria + antibiotic and computer reads results.
More commonly done than broth microdilution
MIC
To quantitively determine antibiotic activity, determine the MIC, the minimum inhibitory concentration. You dilute antibiotic and add different dilutions to the test organism. The lowest dilution of abx that will inhibit growth. Results given as S (susceptible) I (intermediate) R(resistant)
Susceptibility testing
Agar dilution tests and disk diffusion tests. Agar dilution is bacteria are plated on abx. specific agar and the lowest dilution of abx agar that inhibits growth is the dose. Disk diffusion tests often used to show which abx is works for which bacteria. Simple, reliable and often used.
When would you do urine microscopy?
If you suspect Kidney disease, kidney stones or to confirm dipstick findings.
Urine microscopy useful in identifying
crystals, bacteria, fungi and RBCs, WBCs, Epithelial cells and cholesterol droplets.
Neutrophils in urine
good indicator of infection
Eosinophils in urine
good indicator of allergic interstitial nephritis
Cholesterol droplets in urine
indicator of glomerular disease
Urine casts
Cyclindrical structures composed of Tamm-Horsfall mucoprotein. They form in the lumen of the kidneys and can be indicators of renal disease.
WBC casts
indicative of kidney inflammation, infection or interstitial nephritis
RBC casts
indicative of glomerular hematuria or glomerulonephritis
Renal tubular epithelial casts
disorder of desquamation of tubular epithelium, like acute tubular necrosis.
Granular casts
indicative of acute tubular necrosis
Hyaline casts
indicative of concentrated urine or diuretic therapy
Waxy casts
can represent several different kidney diseases
When is a 24 hour urine indicated?
if pt has persistent proteinuria
24 hour urine protein is elevated in
diabetic nephropathy, htn, lupus, or frequent UTI.
24 hour urine creatinine
used to derive a pts creatinine clearance rate- estimate their glomerular filtration ability.
Pheochromocytomas and Neuroblastomas will have elevated ___ in 24 hour urine?
catecholamines, like epinephrine. This results in increased BP.
If your pt has unexplained or sudden rise in BP
it may be useful to order a 24 hour urine to check for increased chatecholamines.
Pheochromocytoma sx
HTN, foreceful heartbeat or tachycardia, Pounding headache, diaphoresis, tremor, pallor
To test for pheochromocytoma
order a 24 hour urine for metanephrines and catecholamines. A 24 hour urine creatine can verify adequate collection.
microalbumin: creatinine ratio
should be checked yearly in diabetic patients. Can be used to detect diabetic nephropathy 5 years before a standard urine dipstick.
HCG
secreted by trophoblast after fertilization so it is an indicator of pregnancy. can also be an indicator of any HCG-producing cancer.
HCG test
specific for the beta-HCG subunit. HCG levels double every 3 days after fertilization. can be positive 3-7 days post conception.
When would you do a wound culture?
sign of skin infection or soft tissue infection, in post op pt with fever, or if you see obvious drainage.
You should wait for wound culture results before starting antibiotics
False. That takes too much time. Be sure to follow up though and ensure that you prescribed the correct one once the results are in.
bacteremia
presence of bacteria in blood. Can be fatal and indicates a serious infection.
transient bacteremia
lasts only minutes to hours. from dental procedures or from a GI biopsy.
Intermittent bacteremia
from undrained abscesses or focal infections, like pneumonia.
persistant bacteremia
indicative of intravascular infection like endocarditis.
When would you perform a blood culture?
If you suspect bacteremia or fungemia in a pt with infection. These pts are typically in he hospital, and these are performed prior to abx therapy
your pt is showing signs of infection, but their WBC count is normal. What do you do?
order a blood culture.
