URINALYSIS
What is it?
Urinalysis is the testing of urine. Reagent strips can test for
the presence of blood, protein and other analytes from
freshly voided urine (Wells, 1997)
Why are they used?
The composition of urine can change dramatically as a
result of disease processes.
It may contain red blood cells, glucose, proteins, white cells
or bile. The presence of such abnormalities in urine is a
warning sign of illness and maybe helpful in clinical assessment in the following ways:

To determine the individuals urine status on admission as a baseline for comparisons with
future assessments.

To monitor changes in urinary constituents as a response to medication.

To be used as a screening test to gather information about physical status.
Indications for use

Pre-screening and pre-operative assessment.

All patients admitted to hospital within 24 hours of arrival.

On recognition of any or all of the following clinical signs/symptoms i.e. urinary tract
infection symptoms – burning sensation, offensive smelling odour, pain, pyrexia, cloudy
urine.
Please ensure you refer to local policy before undertaking any procedure
Interpretation of results

pH. The normal pH of urine varies from 4.5 – 8. It reflects the acid base balance of the
body (Wells 1997).

Protein. A morning specimen is recommended to ensure sufficient concentration of
urinary protein. Protein in the urine can indicate a range of conditions, including renal
disease, urinary tract infection (UTI), hypertension, pre-eclampsia, or congestive cardiac
failure (Cook1996).

Glucose. Glucose is not normally found in urine. Glycosuria is often indicative but never
diagnostic of diabetes mellitus. Glycosuria in a patient with diabetes usually indicates
poorly controlled diabetes. It can also be associated with Cushing’s syndrome and acute
pancreatitis (Wells 1997, Cook 1996).

Ketones. The ketones are the product of the breakdown of fatty acids. They are abnormal
constituents of urine. Their presence may indicate dehydration, starvation or in
combination with glucose in a person known to have diabetes, uncontrolled diabetes
mellitus (Cook 1996).

Blood/Haemoglobin. The presence of blood is a potentially serious sign (Lloyd 1993),
especially when there are no other symptoms present such as pain. Blood in the urine
may be due to one of four principle causes, trauma, infection, tumour or renal stones. It is
common in the presence of a UTI. False positives may occur from containers
contaminated with bleach or from the use of stale urine.
N.B: In women the test for blood may be falsified from three days before to three days after
menstruating. It is therefore not advisable to perform the test at this time (Roche Diagnostics
Limited 2001)
Please ensure you refer to local policy before undertaking any procedure
Taken from the Trust Wide Nursing Guideline for Urine Testing UHCW 2008.
References

Cook R (1996) Urinalysis: ensuring accurate urine testing. Nursing Standard. 10 (46). 4952

Lloyd C (1993) Making sense of reagent strip urine testing. Nursing Times. 89 (48). 32-36

Wells M (1997) Urinalysis. Professional Nurse (study supplement) 13 (2). S11-S13.
Please ensure you refer to local policy before undertaking any procedure
□Name……………………………………
WMS No………………………..
T- DOCS: Urinalysis
Please test this patient’s urine
□Hand wash with water and soap using the Ayliffe technique
□ Pre-screening and pre-operative assessment.
□All patients admitted to hospital within 24 hours of arrival.
□On recognition of any or all of the following clinical signs/symptoms i.e.
Washes Hands
Understands indications
urinary tract infection symptoms – burning sensation, offensive smelling odour,
pain, pyrexia, cloudy urine.
□ Introduces themselves.
□ Gains informed consent.
□Clear explanation of procedure.
□ Assessment throughout the procedure and allows patient to ask questions.
□ Place receptacle on toilet/commode or provide a clean disposable urinal.
□ Ask patient to urinate into receptacle and provide a minimum of 10 millilitres.
□ Prepares patient and maintains privacy and dignity
□ Don clean pair of gloves and apron in accordance with standard infection
Obtains informed consent
Explanation to patient.
Communication skills
Appropriate preparation
Collection of sample
control precautions.
□Cover the receptacle and remove from the toilet, carefully transfer to the
sluice area.
Collect urinalysis reagent strips.
□Test sample immediately after voiding to avoid contamination and confusion.
□ Check the expiry date of the strips on the bottle label and ensure the strips
have been stored in a cool dry place (not refrigerated).
□ Immerse the entire reagent testing strip in to the urine sample, ensuring all
Test the urine
reagent areas are covered. Remove excess urine by running the edge of the
strip against the rim of the receptacle.
□ Rest the strip on the rim of the receptacle for the required time stated by the
Getting the correct result
manufacturers. Understands time is important as changes in the pad follow a
‘colour reaction curve’ reading the strip too early will lead to inaccurate results.
□Hold the strip vertically and compare test areas closely with the colour chart
on the bottle label, (without touching the label).
Post procedure management
Professionalism
Overall ability to perform procedure
□ Waste disposal in accordance with Trust guideline.
□ Documents time, date, clinical reason, any problems,
□ Accurately interprets results.
□ Report abnormal findings as appropriate.
□ Communicate to team members
□ Thanks staff
□ Thanks patient and inform them of result where appropriate.
□ Assess globally, would you be happy for this student to be
supervised to perform a urinalysis
Overall Grade
□
BE
□
B
□
S
□
AE
Please ensure you refer to local policy before undertaking any procedure
T-DOCS:
For Medical Students
Clinical Skill ………………………………..
Name of Student
Areas of good practice
1.
2.
3.
Areas for improvement
1.
2.
3.
Below Expectation
Skills labs
Supervised
Global assessment:
Borderline
Satisfactory
Skills labs
Unsupervised
Job Title
Name
Please print:
Patient Safe
Supervised
Assessor signature:
Date
Above Expectation
Teaching Potential
Signature
How suitable do you think this assessment is for undergraduate medical students?
Not Suitable
Highly Suitable
1
□ □ □ □ □ □ □ □ □ □
2
3
4
5
6
7
8
9
10
Any other Comments: Free text please use!
Please ensure you refer to local policy before undertaking any procedure