Urinalysis Report: Walkthrough (Nursing)

by Prof. Lawes

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    00:00 So, I want to show you what a urinalysis report can look like. There is a lot of stuff on there but hang with me, I'll walk you through it step by step because I know look at that. This isn't some major code blue report sheet. This is just a straight up urinalysis, and I know it can look overwhelming, but I'm going to show you how to break this down in this series and before you know it, you'll be able to learn some really valuable information about your patients from this important lab. So, let's start at the beginning. Right there, box #1, it says Medical Center.

    00:40 Yeah, I made that Lecturio lab and gave you address in Leipzig, Germany. By the way, if you ever get to go there, it's an incredible place to visit with some really cool people. Now, box #2, that's the report date and time. That is the date and time of the report. Good job. Now, the name of the patient. I got real creative here. Right? Sick Lady. I know, it was late at night when I made this for you. Age and sex, 45. DOB is date of birth, 01/09/1974. Now, on box #4, there's an ID number. This will be made up by the hospital. So, you don't have to know what this is. This is automatically generated by the hospital or clinical system where the sample was submitted. Box #5, attending doctor. Yeah, you can tell it was really late when I made this, Rhonda Ross, MD. So, that's the doctor's name. This is the name of the physician who ordered the test. Box #6, status. This was just routine. We don't know if I'm doing stat urinalysis, but a lot of other type of lab work can be ordered stat. That means that lab work is bumped to the front of the line because for some reason the healthcare team has determined this is an urgent need to get these results. In this, it's just a routine because it's a urinalysis. Now, a specific number, again this is not something a nurse or a healthcare provider would assign. This will come from the system. Now, look at box 8. This is different than the box at the top that we had. Report time, look at the difference between report date and time, and collection date and time. This is important because we want to make sure that this sample was collected in a timely manner, and it was processed in a timely manner. Alright, so collection date and time is different than report date and time. Now, the next one, received date and time. Okay, now we're getting personal. Right? So, this is a tracking mechanism that we use to say we need to know when the sample was collected, when did lab get it, and when did they report the time. So, when you say received date and time that will be the time the lab received the sample. Huh, we made it to box #10. Look at the title, Ordered. Now, there's a lot of letters after that. They kind of look like alphabet soup. Let me help you straighten those out.

    03:14 UA stands for urinalysis. That's what we're talking about. You're analyzing the patient's urine. MIC stands for microscopic. If IND means indicated. So, urinalysis, microscopic exam if indicated. A urinalysis contains 3 parts. Right. The physical exam where we look at the urine, the chemical exam where we look at what is dissolved in there, and if we see something that shouldn't be there, that indicates the need for a microscopic exam. Take a sample of that urine, put it underneath a microscope, and really look at the cells that are in that urine sample.

    03:59 So, why don't we just do microscopic on everybody? Well, remember that's not particularly convenient, it is time-consuming, so if we don't need it, there is no reason to do it. That's why you'll often be ordered UA, microscopic if indicated. Now, section 11 might be unique to this particular form. Know that there'll be certain questions on forms that are different from hospital to hospital or lab to lab, but let's look at some very common examples. First one, patient's current antibiotics. Now you see we've got an "s" in parenthesis in case they're on more than one. Particularly in urinalysis, if a patient is on an antibiotic that will affect our results, so you do need to know that. So is that answer acceptable? No, it really isn't. It may be the best I had to work with, but when you're caring for a patient make sure you ask for a current medication history. Sometimes, they're hard to get but do your very best to get a complete list of the medications that the patient is taking, particularly antibiotics. Next up in the queries, source. So, where did you get this urine? It was a clean-catch sample. When we're putting this whole puzzle together, it's important that we know how the sample was collected. It may be a catheterized sample. Right. The patient may have had an intermittent cath procedure or they might have an indwelling catheter. That's really important for the healthcare team to assess the overall health of the patient. Now, do C&S if indicated. Here it says yes, but what is a C&S? Well, C&S is different than a microscopic exam because what we're doing is culturing. We see something that microscopic exam says yup, we've got things growing here, but we don't know exactly what it is. If we do a culture and a sensitivity, the lab can identify which bug is growing in the urine that's causing an infection. Now not only can we identify which bug it is, that helps us know which medication to use. That's the "S" part of sensitivity. So, the sensitivity will tell us which drug is the best one to kill that bug. We'll talk to you later about how to sort through all that but know for now C&S means culture and sensitivity. So, that part of the test can let me know specifically identify which bug is growing and which drug can help us treat it. Yeah, I put on this one and the list goes on. I wanted to start with a clean sheet so you can see this and kind of have a pause and catch your breath.

    06:46 Now you see we have columns all the way across the page, and each one of them is blank right now because we're going to fill them in one at a time. Now, you already know urinalysis, microscopic if indicated, we will get all the way out for you there. Now, look at the 1st column on the left. The test is color. So, this is part of the visual exam. Now, normal would be yellow.

    07:12 This patient's results are yellow, it's normal, we are good to go. But the next one, the next part of the physical exam is appearance. Now, is it normal? No, the way they have this set up it's in the abnormal column. That means this urine was hazy. I made that red for you just to make it easier for you to see because we would want the urine to be clear. So, 1st part of the visual exam is looking at the color and the clarity. For this patient, according to this report, it's yellow and hazy. There's our 1st sign that something is wrong. Next up, glucose. We would expect it normal would be negative. This patient reference, we're fine. This patient's urine is negative for glucose. Bilirubin, we want that to be negative. This patient's urine was negative.

    08:06 Ketones, we expect that to be negative. Good job Mrs. Mayer, not a problem. Specific gravity, we've got normal of 1.017. We know that she's right in the normal range. How do I know that? Look over at the reference and it says for this lab the normal range is 1.003 to 1.035. Now, that's different than our other video series. We know. I did that on purpose, okay, because I want to remind you that every lab has a different specific range for all lab values, particularly specific gravity. So, do we have an issue with specific gravity? Nope, she's doing just fine. For blood, it would be normal for it to be negative. Oh, look at that. She's got something in her abnormal column. She has a trace of blood. So, now I'm going to need to follow up on this. I need to rule out menstruation. I need to know that this usually isn't a good sign, so it's going to require some followup. A pH of 6.0. Look at the reference range, 5.0 to 8.0, so we're fine there. I'm not worried about the pH. Protein negative. Yay. Because that's way more involved than a UTI. I want it to be negative because when you look over at the reference column, it says it should be negative. In hers, it is also negative. Her results are negative.

    09:31 That's a good thing. That means her kidneys are doing pretty well. Now, urobilinogen, what's our level? Is it within the normal reference range? Absolutely, she's reported as 0.3. I know the normal reference range is 0.1 to 1.0. Good job Mrs. Mayer. We're moving right along. Oh, okay, we were doing so good for so long. Nitrites. So, it's abnormal for it to be positive. I've highlighted that in red for you. When you look over at the reference column and it says, uh, this should be negative. We've even put an "H" in there. That's telling you this is high. This is abnormal. So, so far, we've got 3 abnormals. Right? We've got appearance is hazy, we've got a trace of blood, and we are positive for nitrites. Last one, leuko esterase 2+. Uh, that is abnormal. That should also be negative. So, her urine sample is positive for leuko esterase, it's positive for nitrites, and it has a trace of blood. Ding, ding, ding, ding, ding, that's the trifecta.

    10:44 This lines up with her symptoms or not. Well, think about what she told us. Right, she's already describing how it feels to have a UTI. She told us she has to pee more often, it hurts when she does, it's not as much as normal, and it's very dark. So, taking a lab work and applying it to the clinical symptoms the patient reports is really important. So far, this lines up because we know the presence of these 3 substances indicates a urinary tract infection. So, is a microscopic exam indicated? Yes, because we've got some things present in her urine that should not be there. So, this is how you determine in the lab if a microscopic exam is indicated.

    11:34 See we don't want the delay of lab identifying yup, we got some things that are abnormal.

    11:40 They don't want to have to call and get another order, that's why all urinalysis usually say microscopic exam if indicated. Now, you know how to know if it's indicated. She has got some abnormal things present in her urine that's why they go ahead and do a microscopic exam. So, what can you see on a microscopic exam? I want to spend some time with you so you're very clear on how beneficial this part of the test is because the results will list anything that is seen under the microscope. Yeah, they get real personal and _____.

    12:17 So, look at the number. See it's quantified by a number and then you'll see HPF. Now, that just means per high power field. Okay, so the number, the unit next to it is per high power field.

    12:33 You'll also see a scale like 1+, 2+, 3+, and that may include cells, crystals, bacteria, or whatever they see under that microscope. So let's take a look at the first one. You see red blood cells. We had an abnormal value. It said occasional. Now, that's what flagged it. The reference range should be that we see none of those. Now, a comment to the doctor or the person reading the report is that the abnormal results noted should be considered in the context of the whole patient. So, you want to think about what the patient has told us, what their vital signs reveal, what their assessment show us, the whole patient. For instance, bacteria and white blood cells may indicate an infection, but bacteria along with a significant number of epithelial cells could indicate an improper sample collection. Okay, that's super important for you to know because if you see a lot of epithelial cells and the bugs, we know that we need to get another sample. So, see the note there. Values outside the reference range should be interpreted in context with the patient's clinical condition. That's a universal disclaimer that you'll see on lab work. As a nurse, you need to know that's why it's so important that you get an appropriate sample for your patient. Otherwise, we're going to be chasing bonnet shells and not really getting the patient what they need. Next up, white blood cells 20 to 30, that's abnormal because you should not see any. So, because we did the microscopic exam, we actually got a number right there, 20 to 30. Epithelial cells 1 to 5. We're doing okay. That's normal, not a problem for this patient, so good job. We got an appropriate sample from Mrs. Mayer. Whoa, bacteria 4+. That's not so bueno. Right. That's not good.

    14:31 Normal should be 0 to 1+ and they're letting us know, hello we are at 4+, so that is significant bacteria. The next it says is a urine culture indicated and the answer is absolutely yes. If the normal reference range for bacteria is 0 to 1 and this patient is 4+, then we absolutely need to culture this urine and see specifically what grows. Alright, we made it to the last box.

    15:01 We're at box #20. Now, this isn't describing results of the urinalysis. What it's telling us is instructions as to healthcare team. The lab is noted, criteria for culture is met and the culture will be set up, but look at that next line. Please call the lab if you do not want one.

    15:23 Well, let's go back up to the 1st sentence. It's telling us criteria for a culture is met. What does that mean? Well, it means the urinalysis results that we've walked through together likely indicate the patient has an infection. So, because of that and because the orders were originally written to do a C&S if indicated, that's why they're going to go ahead and do a culture. Now, they give us the note at the bottom, please call the lab if you do not want one.

    15:51 They're very specific groups of patients that have asymptomatic bacteriuria. That means they have bacteria in their urine, and we just don't treat it. For example, someone has a spinal cord injury and they have a chronic indwelling catheter or they're cathetering themselves regularly, we don't normally treat those, so they're going to not want a culture and sensitivity. So for those patients, we would call the lab and say no, no, we don't want one or we could have made that part of the order and instead of saying yes, do a C&S if indicated, we could have said no. You did it. Look you made it all the way through with me. There you see a snapshot of everything we have just walked through together, and now I think you can do it with more confidence when you're in the clinical setting. Now, I've got a cool gift for you.

    16:42 Look at the urinalysis quick reference sheet. We've provided this for you in your notes and here's what I recommend. Print that out, right. Print it out and take it with you to clinicals then the next time you have a urinalysis report back, use this quick reference sheet, compare it with your patients' results and their clinical signs, symptoms, and assessments. You will feel like a pro when you have the opportunity to do that with a real patient.

    About the Lecture

    The lecture Urinalysis Report: Walkthrough (Nursing) by Prof. Lawes is from the course Interpretation of Renal Lab Values (Nursing).

    Included Quiz Questions

    1. The lab produces a review of the urinalysis results
    2. The nurse collects the urine sample from the client
    3. The urine sample is sent to the laboratory
    4. The provider writes an official diagnosis based on the urinalysis results
    1. Culture and sensitivity (C&S)
    2. Urine dipstick test
    3. Urinalysis microscopic exam
    4. Urinalysis chemical exam
    1. Nitrites
    2. Appearance
    3. Color
    4. Specific gravity
    5. Protein
    1. Positive epithelial cells
    2. Positive red blood cells
    3. Positive nitrites
    4. Positive protein
    1. Blood: trace
    2. Nitrites: Positive
    3. Leukocyte esterase: 2+
    4. Specific gravity: 1.015
    5. pH: 6.5
    1. Frequent urination
    2. Burning with urination
    3. Foul-smelling urine
    4. Yellow urine
    5. Excessive thirst
    1. Assess if the client is menstruating
    2. Suggest to the provider that a urine microscopic exam is done
    3. Ask the client to provide another urine sample
    4. Draw a CBC lab sample to ensure the client is not anemic
    1. A client with a chronic indwelling catheter
    2. A client with an amputated lower extremity
    3. An elderly client with a history of urinary tract infections
    4. A client diagnosed with bladder cancer

    Author of lecture Urinalysis Report: Walkthrough (Nursing)

     Prof. Lawes

    Prof. Lawes

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