Urinalysis: Basic Knowledge (Nursing)

00:00 Hi, welcome to our video series on interpreting lab values. In this one, we get to do a quick case study together and these are so fun. So let's get started. We're going to take a look at a patient with a UTI, a urinary tract infection, and the urinalysis. So, let me introduce you to your patient. You are an RN. Oh, doesn't that sound wonderful? So, think of yourself as an RN, you're in an urgent care who's doing an assessment on Mrs. Mayer. Now, Mrs. Mayer has come to the urgent care with the following symptoms. Are you ready? Because there's a long list. Mrs. Mayer tells you she is unusually tired, that she's had to pee more often but when she does try to urinate it is not normal for her. She says she can't produce very much urine. It really burns. It has a strong smell and is darker than usual. Well, based on the urgent care protocol, you're next step is to do a urinalysis. But before we go on to that, what are all the unusual symptoms that you see there? Yeah, make sure you're aware of those as you're talking to patients. Now, it would be wonderful if everybody came in with this very succinct list but only focus on their problem. We did that for you because we're in the case study, but if you haven't worked with patients yet you'll learn this usually comes with a very long narrative with other extraneous facts _____ . What I want to caution you about is sometimes we find out a lot about our patient just by listening. Sometimes a bigger problem is not what they came in for but something they revealed to us through conversation. So don't try and rush them. Make sure you listen actively, make a list of what they're saying and put those pieces together. But in this case study, we know we're looking at a UTI. We've got clear and classic symptoms. Every symptom we put up there is a classic symptom of a UTI.

02:07 So let's move on with the urinalysis. What is a urinalysis? I know you know the word. I know you've heard it, but I want you to become an expert in interpreting a urinalysis. So a UA is just a generic screening test that checks for markers in the urine. I'm not talking about Crayola markers. I'm talking about things that shouldn't be there and are an indication of a urinary tract infection. Now, urinalysis can honestly give us a snapshot of the overall health status of the patient. I'm not kidding. We can learn a lot about a patient from just a basic urine analysis. We can find out information about their hydration status, diabetes, kidney damage, a UTI. All of that can be learned from a simple generic urinalysis. So, what specifically is on a urinalysis? Well a complete urinalysis has 3 parts; physical, chemical, and microscopic. So we've put those words for you right next to the urine sample; physical, chemical, and microscopic. We're going to look at the urine from 3 different perspectives. I'm going to look at its physical appearance, I'm going to test the chemicals that are dissolved in that urine, and I'm going to look at it under a microscope if necessary. So that's what's included or can be included on a urinalysis. Not all urinalysis have a microscopic exam. Now with the dipstick urinalysis, it's a lot quicker, it's more convenient. You can do it right at the bedside, but they're not as accurate as a complete urinalysis. In a dipstick urinalysis, you can have some false positives and false negatives. We throw that term around a lot but what does it mean? False positive means you do the urine dipstick test and you think a substance is there but it's really not. False negative is you do a urine dipstick test and it says the substance isn't there but it really is. So, dipstick more convenient, I can do it faster, I can get results within 2 minutes but it's not as accurate as a complete urinalysis. Pretty good screening tool though. We can use a dipstick to let us know of hey, we think we've got a problem and we need to do followup with other lab tests or maybe even a complete urinalysis with a microscopic exam. So, what type of sample is required for a urinalysis? We've got that magic cup sitting there with the urine in it. The urine sample that we can use could just be a clean-catch or a midstream sample. Now, if this is your 1st video with us, you may be wondering why is there a toilet, raining urine from the sky, and a clock. Well, that's to remind you clean-catch or midstream sample is appropriate for this but the clock is there to remind you that this has to be tested. We need to run the urinalysis on the urine sample within 2 hours. If it's longer than 2 hours, we're going to have to discard the sample. So you can use a clean-catch or midstream sample but you need to run the test on the sample within 2 hours.

05:23 If we need to, we can also use intermittent or an indwelling catheter sample. In case those are new terms to you, indwelling means the catheter was put in, it remains in to drain urine from the bladder. Now those are problematic because they can lead to urinary tract infections.

05:41 Intermittent cathing means, you put the catheter into the bladder, drain the urine, and then remove it. So, those are also appropriate but we try to avoid catheterization if we can. It's much better if the patient can provide a clean-catch or midstream sample.