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05.04 Urinalysis (UA)

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Overview

  1. Urinalysis
    1. Color & Clarity
    2. Protein
    3. RBC
    4. WBC
    5. Glucose
    6. Specific gravity
    7. Ketones
    8. pH
    9. Bilirubin/Urobilinogen

Nursing Points

General

  1. Normal value range
    1. Color & Clarity
      1. Normal – Yellow
        1. Other colors
          1. Drug interactions
            1. Propofol  – green
            2. Methylene blue – blue/green
          2. Trauma
            1. Red/Brown
          3. Liver failure
            1. Brown/tea colored
        2. Clear – Normal
          1. Cloudy
            1. Cell or contaminant related
          2. Turbid
            1. Severe presence of cells (WBC, RBC)
    2. pH
      1. ~6
        1. Changes in body condition can change pH
        2. Metabolic acidosis/alkalosis
    3. Protein
      1. 0-trace
      2. Glomerular permeability/infection
    4. RBC
      1. 0-2
      2. Bleeding
      3. Trauma/injury  below kidneys
    5. WBC
      1. Negative
      2. Sepsis/Infection/UTI
    6. Glucose
      1. Negative
      2. Diabetes
    7. Ketones
      1. Negative
      2. Presence of ketones can indicate endocrine disease like Diabetes
    8. Urine Specific Gravity
      1. 1.010-1.030
      2. Facilities vary
      3. Ability to concentrate urine
      4. Hydration
        1. Overhydration
          1. Decreased USG
        2. Dehydration
          1. Increased USG
      5. Diabetes insipidus
        1. Causes increased diuresis
      6. SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
        1. Causes decreased diuresis
    9. Bilirubin/Urobilinogen
      1. Negative
        1. Presence indicates potential liver problems

Nursing Concepts

  1. Lab Values
  2. Elimination

Reference Links

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Video Transcript

All right in this lesson, we’re going to take a look at urinalysis.

A urinalysis or a UA, is a test that we used to take a look at how well the body is filtering out stuff. It’s got a lot of different biomarkers and things that we pay attention to, and they’re going to look different in every facility, depending on the lab, depending on the needs of the patient. But these are some general guidelines for a UA, or for your analysis.

We look at things like color and clarity, we look for the appearance of protein in the urine, we look for red blood cells and white blood cells. We also look at things like glucose and ketones as those can be disease-specific. We look at things like specific gravity, pH, and bilirubin or urobilinogen.

When we do a urinalysis, we’re looking at color and clarity. The urine should be yellow and clear.

In terms of color, abnormal colors are things a green or blue, red, orange, and brown or tea colored. I know you’re thinking, how do patients have different urine colors?

Well first off their urine could change color due to different drugs. Propofol can turn urine green, methylene blue can turn their urine green or blue, there is a really common urinary tract anti-inflammatory called phenazopyridine that turns you’re in a bright orange.

There are also other diseases that will cause urine color changes. Liver damage or Rhabdomyolysis can cause the urine to become brown or tea-colored, and if your patient had some sort of urethral trauma that can’t even turn it red.

In terms of clarity, this is how clear the urine looks when you look through it. Normal clarity is described in a couple of different ways being from slightly cloudy, to cloudy, to even turbid. Slightly cloudy or cloudy urine can indicate that there’s a presence of cells or even a contaminant, but extremely turbid urine could indicate things like significance of white blood cells, red blood cells, or even bacteria.

We’re looking at urine we also look the level of pH. The normal level is about 6, but can range from 4.6 to even eight. You need to pay attention to what your facility considers as the normal pH value for you’re in.

An abnormal pH should be anything greater than 8, which would indicate some sort of systemic or in urine alkalosis, and this can be caused by either some sort of metabolic problem or even medication.

A pH of less than 4.6 indicate some sort of system acre or even a urine acidosis, so something like diabetic ketoacidosis, or even bacterial infections can make the pH drop.

Protein is something that we shouldn’t be seeing in urine. Normal is zero to even Trace, but anything greater than Trace is going to indicate something abnormal. What this means is that the glomerulus, or the first stage of kidney filtration, it means it it’s allowing things that shouldn’t pass into the urine to pass. So there is an increased glomerular permeability. Also reasons for protein in the urine could be some sort of infection.

Just like with proteins, there shouldn’t be any red blood cells in urine. Normal is 0 to 2 cells. Anything greater than 2, is considered abnormal. So we need to look at things like systemic bleeding, or a breakdown of those red blood cells, or even look at some sort of trauma or injury that happening below the kidneys, so maybe some sort of surgery or disease process that’s happening in the ureters, bladder, or urethra.

White blood cells are also negative on a urinalysis. If they’re positive, it could indicate some sort of infection. Suspect sepsis, urinary tract infection, or some other infection happening.

Both glucose and ketones should be negative on a UA. If they are positive they could indicate some sort of problem with the patient’s glucose management if they have diabetes, or they can even indicate some sort of other metabolic or endocrine disease. So if you notice these two things on a urinalysis, you also need to check their lab work and see if anything seems wonky there.

Urine specific gravity is a part of the urinalysis that looks for the ability to concentrate urine, and for the kidneys to remove waste products from the blood into the urine. Now the specific gravity of water is 1. Now when you start to add solutes or waste products or electrolytes, etc into the urine during the process of filtration, you’re going to have these solutes that are put into the urine, and this is going to mean that urine specific gravity is going to be higher than water. The normal range of specific gravity is going to be 1.010 to 1.030. so what happens if there is a low urine specific gravity, so anything less than 1.010. You can suspect that the patient has too much water, so they’re over hydrated, or you can look at things like diabetes insipidus, which is the disease process where the pituitary gland is telling the body to kick out too much water, And this is going to dilute the urine. On the other end of the spectrum, anything greater than 1.030 is an indication of dehydration, or a condition called syndrome of inappropriate antidiuretic hormone or siadh. This is the opposite of DI, and you’re going to have the body holding onto too much water so it over concentrates the urine.

For now the only thing you need to know is it anything outside of that range you should be looking into causes of why the urine is over concentrated or under concentrated. There are both excellent lessons on diabetes insipidus and siadh, so I encourage you to go check those out.

Lastly we’re looking at bilirubin and urobilinogen. These are indicators of problems with the liver. You should be negative on a urinalysis, but if there is presence of these two markers on a UA, definitely check out what’s going on with the liver.

When you’re sending this test to the lab, you’re going to send it to urine collection cup. If your patient has a Foley, find out what the policy is for getting direct samples from patients, but the thing that you need to know is that you went to get as clean of a catch as possible. So we want to reduce contamination by educating a patient and making sure they know how to deliver a clean sample into the urine cup and if you’re getting it from a Foley, try to get as close to the patient as possible. What I mean by this is that there is a little port on the Foley tubing, that allows you to get direct sampling from it. Talk to your providers, talk to your other nurses, and check out the facility policy when it comes to getting direct fully samples, but that’s just a little tip so that you’re not getting contaminated samples.

For this lesson we really focus on lab values and elimination we’re looking at our nursing concepts for getting a urinalysis on a patient
So let’s recap.

A urinalysis has multiple values and urine has several different indicators to help us figure out what’s going on with our patient.

Reference ranges and biomarkers are going to change depending on the facility and depending on the capabilities of the lab, so find out what those are.

When you getting a urine sample, try to reduce contaminants and get a clean catch when possible.

Lastly urinalysis can tell you a lot of information about your patient, so pay close attention and take a look at those results.

That’s our lesson on getting a urinalysis on your patient. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

  • Question 1 of 2

A nurse has an order for a urine specimen for a client with an indwelling catheter in place. Which action would be part of collecting a urine sample from this client? Select all that apply.

  • Question 2 of 2

A client’s urinalysis is being evaluated for infection. What amount of bacteria indicates the normal threshold for confirming the presence of infection?

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