Urinalysis simply means analysis of urine. It is an easily performed investigation that can detect a wide variety of abnormalities within a few minutes at low cost. Urinalysis is an investigation which all nurses should be competent to perform and is identified by the NMC (2007) as being an example of an essential skill nurse students should be competent to perform before entering their branch programme. Urinalysis may be performed in a wide variety of clinical settings. It should be performed on every patient entering the acute care setting. Additionally, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD (2009), stresses the need for urinalysis to be performed on all emergency admissions to an acute hospital. It may also be performed in outpatient and general practice clinics, and community areas. To obtain the most accurate information from the test, students need to know how to obtain and assess a sample of urine and be aware of factors that may influence the reliability of the investigation. Urine may be tested in three different ways. ● Macroscopic urinalysis, ● Microscopic urinalysis, ● Chemical analysis. Macroscopic and chemical analysis are the investigations performed in the clinical setting which may be tested by OSCE. Microscopic investigation requires samples to be sent to a laboratory. Macroscopic analysis is the analysis of the urine by the naked eye. Chemical analysis may be performed by use of a plastic diagnostic reagent strip or ‘dipstick’ which contains small pads of chemicals which react to substances that may be found in urine. For purposes of testing urine at random, clients are asked to urinate into a clean but not sterile dry container with no precautions regarding contamination. In females in particular this may result in samples being contaminated by vaginal fluids, such as blood or mucus. Due to the risk of contamination a mid-stream specimen of urine may be required if an abnormality is found in a random sample. A mid-stream specimen requires cleaning of the external urethral meatus prior to urination, passing the first half of the bladder contents into the lavatory, and passing the second part of the urine flow into a sterile container.
Diagnostic Reagent
