Where are you:
You are an FY2 in Medicine Department.Who is the Patient:
Jaden Smith, a nurse who started his first day in clinical attachment wants to learn about the urine dipstick test.What you must do:
Please talk with Jaden and teach him about urine dipstick test.Special Note:
There is Urine Dipstick Test Equipment in the cubicle to teach.
- Introduction: Hey you must be Jaden if I am not wrong? I am Dr. X working in this department.
- ID check: Done with introduction part above
- Build rapport: Ask about work/ How is his first day going… etc.
- Main concern (how can I help you): Jaden how can I help you if you need anything to know from me?
– Yes please could you teach me how to do Urine Dipstick Test?
– Yes definitely I would love to show you how to do them. I appreciate that you are already filled with so much enthusiasm… (Acknowledge & IPS) - Assess knowledge (4 W)
- So before we start could you tell me What do you know about in
particular? - What exactly you want to know about it?
- Why do you want to know about it any reasons in particular?
- And do you know Why we do it? (Brainstorming for colleague)
- Teach the Urine Dip Stick Test
Before – Collecting materials
Remember in the Start (from Equipment in front of you what you see)
- Gloves and Apron (Be sterile and to prevent cross contamination)
- Urine Sample ( Ask who’s urine sample is this and if consent has been taken or is just for teaching purpose)
- Dipstick Test Kit (Bedside Testing kit)
- Paper Towels
- Waste Bin
You already built Rapport with your colleague and checked how far he wants to know about urine dipstick.
Now from things you have in front of you tell them about each
- Urine :
We check Colour, Clarity and Smell – But it is outdated, we don’t do it now, but I want to tell you everything what I might know. Then, Talk about each:
– Colour: What if we found there is a change in colour
For example: If it is red or dark what might come in your mind (here you involve them)
– Clarity : What if it is unclear/ cloudy? So what is normal … Yes , to be clear
So if it is unclear… we might consider infection
– Odour :
Offensive odour: suggests infection.
Sweet odour: suggests glycosuria
Again , Assessment of urinary odour is rarely performed in practice. - Urine Dipstick Container; Check Expiry date and strips having the chemicals on them.
How to do it (Show and do)
- Wash your hands and wear your gloves
- Remove a dipstick from the container without touching the reagent squares.
- Replace the container lid to prevent oxidation.
- Insert dipstick into the sample, ensuring all reagent squares are immersed.
- Remove the dipstick and tap off any residual urine using the edge of the container, making sure to hold the dipstick horizontally to avoid cross-contamination of the reagent squares
- Lay the dipstick flat on a Paper towel.
- Wait for 60-120 seconds ( According to whatever you look for ) Ex: glucose, leukocytes
- See the urinalysis guide on the side of the testing strip container to interpret the result
After Analysing
- Discard everything in its suitable place … take off your gloves and
apron. - Sit and document everything and the findings in the notes.
Suggest further investigations based on urinalysis results.
Interpretation of dipstick results
The following tests are ordered by the time at which the reagent square should be interpreted.
- Glucose
- Time at which the reagent square should be interpreted: 30 seconds
- The absence of glucose in the urine is normal.
- Causes of glycosuria include DM, renal tubular disease and some medications
- Bilirubin
- Time at which the reagent square should be interpreted: 30 seconds
- The absence of bilirubin in the urine is normal.
- The presence of bilirubin in the urine suggests increased serum levels of conjugated bilirubin
- Ketones
- Time at which the reagent square should be interpreted: 40 seconds
- The absence of ketones in the urine is normal.
- The presence of ketones in the urine suggests increased fatty acid metabolism,which occurs during starvation and in conditions such as
diabetic ketoacidosis.
- Specific gravity
- Normal range: 1.002 – 1.035 mOsm/kg
- Time at which the reagent square should be interpreted: 45 seconds
- Causes of low specific gravity include : diabetes insipidus and acute tubular necrosis.
- Causes of raised specific gravity include dehydration, glycosuria & proteinuria
- pH
- Normal range: 4.5 – 8
- Time at which the reagent square should be interpreted: 60 seconds
- Causes of low urinary pH include starvation, DKA and otherconditions
- Causes of raised urinary pH include urinary tract infection,
- Blood
- Time at which the reagent square should be interpreted: 60 seconds
- The absence of red blood cells, haemoglobin and myoglobin in the urine is normal.
- The presence of RBCs, haemoglobin and myoglobin indicate infection, renalstones,injury to the urinary tract, (rhabdomyolysis), nephritic syndrome and malignancy.
- Protein
- Time at which the reagent square should be interpreted: 60 seconds
- The absence of protein in the urine is normal.
- Causes of proteinuria include nephrotic syndrome and chronic kidney disease.
- Nitrites
- Time at which the reagent square should be interpreted: 60 seconds
- The absence of nitrites in the urine is normal.
- The presence of nitrites in the urine is suggestive of urinary tract infection.
- Urobilinogen
- Normal range: 0.2 – 1.0 mg/dL
- Time at which the reagent square should be interpreted: 60 seconds
- The presence of increased levels of urobilinogen in the urine can be caused byhaemolysis (e.g. haemolytic anaemia, malaria).
- Low levels of urobilinogen can be caused by biliary obstruction.
- Leukocyte esterase
- Time at which the reagent square should be interpreted: 2 minutes
- A negative leukocyte esterase test is normal.
- Causes of a positive leukocyte esterase include urinary tract infection and any condition that could result in haematuria.
