How Nurses Test Urine Specimen in Hospitals and Clinics

Nurses in hospitals and clinics use the following methods to test the urine specimen of their patients before reporting to the doctor(s) in the ward.

URINE TESTING

Always use fresh specimens of urine for all urine tests.  Before carrying out any chemical test, certain observation should be made e.g.

  1. COLOUR:

Normal range of colour is pale and amber, but usually varies with concentration except in urine of client with diabetes mellitus due to presence of sugar.

Abnormalities of colour include:

–     Smoky/red which indicates present of blood in urine

–     Greenish – organe-brown indicates bile pigments which may indicate problems with the liver

–     Various colours may be as a result of drugs or other substances which have been ingested.

  1. DEPOSITS:

Bring about turbidity or sediment in urine.  Examples of deposits found in urine:

Mucus:  In small quantity will appear as very slight haze in large quantity forms gelatinous mass

Pus:       Appears as yellowish dense mass which lies at bottom of the urine container.  It is the outcome of inflammation of any part of the urinary tract.

Urates:  Seen in concentrative acid urine as a white or point deposit.  It indicates high acidity of the urine.

Uric Acid:      Appears as brownish deposit in concentrated acid urine

Phosphate:    In alkaline urine, appears as a whitish-grey deposit

 

c.ODOUR:

Characteristic odour of urine is like the smell of newly cut grass

Presence of acetone gives a sweet smell

Infection of the urinary tract e.g. E. coli infection gives urine a fishy smell

  1. d. VOLUME:

Variable – an average adult may pass between 1200 – 1500 millimeter of urine in 24 hours.

  1. REACTION:

Acid urine changes blue litmus paper to red

Alkaline urine turns red litmus paper to blue

  1. f. SPECIFIC GRAVITY:

This is the ratio between the weight of a given volume of urine and the weight of an equal volume of distilled water at room temperature 260C.  This varies with the nature and quantity with the nature and quantity of food eaten as well as the quantity of water and other fluid taken.

Specific gravity is measured with a urinometer which is calibrated in distilled water it reads 1,000.  Average specific gravity of urine is 1.010 – 1.025.

POINTS TO NOTE WHILE MEASURING THE SPECIFIC GRAVITY OF URINE

  1. A good urinometer must be provided this should be checked periodically
  2. The urinometer must float freely when placed in urine, and should not touch the sides or bottom of the jar or vessel used
  3. The reading is taken at the lower level of the meniscus
  4. The urine should be at room temperature before reading is made
  5. When urine is not sufficient, after all other tests are completed, to allow the urinometer to float freely add an equal amount of water and double the last two figures of the reading obtained.

 

URINE TESTING

Equipments needed:

Tray with the following

  1. Test tube in a rack
  2. Pipette in a container
  3. Test tube holder
  4. Spirit lamp
  5. Colour scale
  6. Reagents in appropriate container
  7. Urinometer
  8. Esbach’s urinometer
  9. Urine in a clean urine glass
  10. Water in a receiver
  11. Matches
  12. Receiver for used test tubes and reagents
  13. A pair of gloves

 

PROCEDURE:

Test for reaction with blue and red litmus paper, acid turns blue to red.

Alkaline red to blue and neutral they remain the same.

For chemical test, urine will be made acid, test for specific gravity.

TEST FOR PROTEIN

3 tests:

–     2 cold tests

–     1 hot test

METHOD:

  1. Albustix Test: Dip the end of the Albustix in the urine and remove immediately.  Compare with the colour scale.  If the tip of the stick remains yellow, there is no protein but if it changesin any way towards green, protein is present.  By comparing the colour of the albustix with the colour range on the chart provided, an estimate can be made on the amount of protein present.
  2. Test for Salicy Suphunic Acid. ¾ fill the test tube with urine add 10 to 20 drops of 20% salicyl sulphunic acid.  If cloud appears, albumin is present.  The intensity of the cloud varies with the amount of albumin presents.

NB: If test is positive, filter urine and test again.

  1. Boiling test for protein using acetic acid
  2. A test tube should be 3/4 filled with urine
  3. Light the spirit lamp with matches
  4. Hold the test tube
  5. Boil the upper third over the flame, if it becomes cloudy 2 to 3 drops of acetic acid is added. If the cloud disappears there is no protein but if it persists, protein is present.  This does not indicate the amount of protein.

 

SPECIFIC GRAVITY

The specific gravity is very essential here.  It should be diluted if between1010 to 1020 with an equal amount of water.  If above 1020, dilute with twice the amount of water and double or triple the result.

ESBACH’S QUANTITATIVE TEST

Esbach’s urinometer should be used.  If urine is cloudy it should be filtered.

Pour urine up to the letter “U” on the tube and esbach (esbach’s reagent poured up to the letter “R”).  Cover with rubber cork.

The tube is inverted a few times label with the client name, bed number, time and date of collection and whether diluted or not.

Thenplace in a wooden container allow to stand for 24 hours without disturbance.

The level of any white precipitate formed in the graduated tube shows the amount of protein in grammes per liter ofurine.

 

TEST FOR ACETONE IN URINE

  1. Place an acetest tablet on a clean white sheet of paper

b    Place one drop of urine on the tablet

c..  Leave for 30 seconds

d..  Compare any colour change with colour scale

If a + (plus) of acetone – light purple

Deep purple = ++

TEST FOR BLOOD IN URINE

BILILABSTIX:       Used for testing of pH, Glucose, Protein, Ketone and blood and bile in urine.

METHOD:

Dip the test end into the urine and leave for 30 seconds see instructions on the bottle.

PROCEDURE FOR THE BILE TEST

Five milliliters (5ml) of urine is poured in each of the 5 test tube.

Few drops of tincture of iodine is added, drop by drop to one of them

Shake the test tube with urine and iodine gently

Compare it with the other test tube.  If a green colour develops bile is present.

TEST FOR BILE SALT

METHOD:

Add a pinch of flower of sulphur on top of urine in a specimen glass.  If bile salt is present the flower of sulphur will sink to the bottom of the specimen glass.  Or pour urine into a test tube, cork with your thumb and shake vigorously.  A yellow froth denotes the presence of bile.

OTHER TESTS

HEMACOMBISTIX  for testing the presence of Glucose, Protein, and blood in urine.

METHOD:

Deep the strip in the urine.  For strip reads immediately for Glucose read after 10 seconds.  Protein may be read immediately.  For blood read at 30 seconds.  See instructions on the bottle.

OTHER TEST FOR BLOOD in URINE MADE BY THE NURSE IN THE WARD

GUACUM TEST

METHOD:

To an inch of urine add 2 drops of guacum.  Run ozonic ether doion solution the side of the tube to form a layer on top.

If blood is present a blue ring develops at the junction of the two fluids

NB: This is a method that is not often used now because of the different reagents strips.

Other reagent sticks used in urine testing for various tests include:

–     Combi 6,

–     Combi 9 and;

–     Multistix

NOTE: Several types of urine specimen are obtained: a clean specimen, a mid stream specimen (also called a clean catch), a catherized specimen and urinary drainage system.

TEST FOR PUS IN URINE

Add hydrogen peroxide to some urine in a test tube.

RESULT:        If pus is present frothing will occur.

Microscoping examination in the laboratory is the best test for pus.

Test for chloride in urine:

–     Wash test tube and rinse with distilled water.

–     Add 10 drops of urine into the test tube

–     Rinse the dropper with distilled water

–     Add a drop of 20% potassium chromate

–     Rinse the dropper

–     Add silver nitrate, 1 drop at a time

–     Shake the test tube between drops

–     Continue to add silver nitrate 1 drop at a time till sharp colour changesfrom yellow to reddish-brown.

–     The number of drops of silver nitrate indicates the number of grammes of sodium chloride per litre of urine.

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