Why does the patient’s/client’s urine need to be tested?
Urine testing – called urinalysis – is a simple, cheap and useful method of monitoring a person’s health status which doesn’t involve the person having to do anything except provide the sample. The make-up of the urine can change quite dramatically in response to illness – it may, for instance, contain protein, blood, sugar or other substances that aren’t normally there.
Urine testing used to be common for people with diabetes, as the amount of sugar in the urine gave an indirect indication of how much was in the blood. But testing blood for sugar levels gives much more up-to-date and accurate results so is now the preferred testing option.
Urine testing is still considered useful, however, in assessing important health issues like kidney and liver function and identifying infections, and is carried out frequently in health care settings.
How do I check it?
Have a look at our animation on how to test urine using reagent test strips.
Assemble the required equipment to perform the urinalysis.
Clock or timer or stop watch, clean surface, tissue/absorbent paper, non-sterile gloves (+/- plastic apron), urine specimen, test strips and clinical waste bag
Check the test strips are inside the stated expiry date.Check the urine sample is fresh – observe the colour and odour. Cloudy urine may indicate the sample is contaminated or infection is present. A strong fishy smell may indicate infection and a sweet odour like pear drop sweets may indicate ketones are present. Check the sample is from the correct person and note any medications they are taking (as some medications may affect the result).
Wash hands and apply gloves/apron.
Remove a test strip from the bottle and replace the lid.
Immerse the full length of the test strip in the urine sample, ensuring all the test pads are covered.
Remove excess urine on the lip of the sample bottle.
Place the test strip on the tissue/absorbent paper to prevent the colours on the pads contaminating each other. Start the timer/note the time. Replace the lid on the urine specimen.
When the appropriate amount of time has passed, align the test pads with the corresponding result gauge on the test strip bottle. Be sure to line the pads up with the corresponding test on the container. This is where most errors with urine testing are made! Do not let the urine test strip touch the container as this is a contamination hazard.
Remove your glove and record the result of the urine test in the person’s medical record. Report any abnormal result to a senior nurse or the person’s doctor as appropriate to your role and care setting.
Dispose of all equipment in the clinical waste bag and wash your hands.
When should I check it?
Most people, certainly those who are admitted to hospital, will have their urine tested routinely on first contact with the service as a baseline for future assessment. Frequency thereafter will depend on the person’s general health status and will be set out in the patient’s/client’s care plan.
What do my findings mean?
Before you test the urine, take a close look at it. It should be straw-coloured and clear, not dark or cloudy, and while it will have a faintly unpleasant smell, it shouldn’t be overpowering. Urine that’s infected may have a ‘fishy’ smell, but keep in mind that many of the body’s waste products are excreted in the urine, and that includes waste products from medicines; the urine of someone who is taking antibiotics for instance, can smell very odd and can even turn an orangey colour, but these findings are quite normal.
Findings from the reagent strip might include:
- Glucose – not normally found in urine, so this is suggestive of diabetes
- Bilirubin – may indicate liver damage
- Ketones – these are formed when body fat is broken down quickly, as in people who have not been eating or who have been vomiting; it can also appear as a sign of high blood sugar
- Specific gravity – this indicates the concentration of the urine; normal water has a specific gravity of 1.000, so urine, which contains more substances than water, will have a higher score, up to 1.035
- Blood – blood in the urine can be found in kidney disease, kidney stones, tumours, infections and trauma
- pH – this shows how acidic the urine is; normal urine has a pH of 4.5 to 8.00
- Protein – the presence of protein may indicate infection
- Urobilinogen – higher than normal levels may suggest liver disease and lower than normal might indicate gallstones
- White blood cells – found in kidney or bladder infections.
Where should I record and report my findings?
The patient/client will have a chart on which your urinalysis observations can be recorded. You should make sure you record your findings clearly and accurately so that they can be readily seen and understood. Always follow your organisation’s policies and procedures on recording and reporting.