Urine Dip question

MikeyJ, RN · Dec 24, 2007

When you do a urine dip, what are the main things you are looking for? I know this may seem a little silly, but there are a whole slew of possible results and I have a hard time remembering what is of main concern.

Would it not depend on what is going on with the patient? I know on the pediatrics floor where I work, they do not allow the nurses to do urine dipsticks. However, during different rotations in the hospital they have done urine dipsticks.

In the peds ER, if the pt. comes in with a fever, the doc tells the nurse to look for leukocytes, hematuria, or other signs of infection or a possible UTI.

When I was doing my OB rotation, they did urine dipsticks to look specifically at protein (and of course anything else that looks unusual). They also looked to see if there was glucose.

Possible DKA patients would have a urine dipstick that indicated ketones and glucose.

When nurses do urine dipsticks, they look for anything out of the ordinary, but there is usually something specific they are looking for depending on the patients condition.

TiredMD · Dec 24, 2007

Urine dipsticks are essentially a faster way to get a basic urinalysis. The laboratory doing a UA will use the exact same sticks, but typically has a machine that times the reads exactly and uses a photometer to read the color changes, theoretically eliminating the human error element.

Like any laboratory test, you look for different things depending on the patient. It would be impossible to describe all the patterns of abnormalities you will see in different diseases, but below is the basic things a UA dipstick will check and the things I am most commonly looking for when I order one.

Leukocyte Esterase - an enzyme made by certain white blood cells, basically used as an indirect indicator that leukocytes are present in the urine; this can indicate an infection in the urinary tract or an inflammatory disorder of the kidneys/GU tract. Specimens with skin contaminant will frequently come up positive for LEs, so adequate cleaning in really important prior to collecting the sample.

Nitrites - a basic chemical compound created by specific bacteria, but not normally found in the urine. The number one use for this test is the indirect detection of E. Coli, which produces nitrites. However, not all bacteria do, so a negative test does not rule out a UTI.

Glucose - Other than pregnant women, a normal person should almost never spill glucose into their urine. Most commonly positive in uncontrolled diabetes, or certain rare disorders where the kidney is incompetent at resorbing glucose.

Protein - A normal kidney will filter out protein, so if it shows up in your urine, something is wrong. It may be an underlying kidney disease (there are a ton of them). It may be that you have an underlying systemic illness (which for some reason causes small amounts of protein to spill into your urine). However, like LE, contamination of the specimen will cause a positive test. I have also seen people with blood in their urine come up positive for protein, though usually in low amounts (probably secondary to lysis of the cells). A discussion of the type of protein detected in UAs is beyond the scope of this post, so I'll pass on that.

pH - A dehydrated person will have more acidic urine. A person with a proteus UTI will have a very basic urine. Other than that I find this test kind of useless.

Ketones - Not a normal finding in blood or urine, usually occurs when the body switches from aerobic to anaerobic metabolism. This can occur in dehydration, starvation, DKA, or certain metabolic diseases. Again, only a particular type of ketone is detected, but that is only a consideration in certain situations.

Specific Gravity - Measures how concentrated the urine is. High in dehydration, low in hydrated people. Plays a role in monitoring Diabetes Insipidus.

Urobilinogen - Metabolic breadown product of bilirubin. Positive in certain liver diseases. I never use this.

Blood - actually measures hemoglobin. Positive in certain kidney diseases, some UTIs, trauma, etc. Large number of uses. Very easy to get a false positive.

Hope this helps.

CMCRN · Dec 25, 2007

In OB we look at everything, but specifically glucose,protein and ketones. I also like the Specific gravity, dehydrated pregnant people have lots of ineffective contractions. Leucocytes also, as a UTI can put some one into preterm labor. The above poster gave very good descriptions.

TiredMD · Dec 25, 2007

In OB we look at everything, but specifically glucose,protein and ketones. I also like the Specific gravity, dehydrated pregnant people have lots of ineffective contractions. Leucocytes also, as a UTI can put some one into preterm labor. The above poster gave very good descriptions.

I overlooked the role of the dipstick in L&D patients, I'm glad you pointed that out because you use it maybe more than any other specialty.

In addition to what you mentioned above, L&D will use the urine dipstick to look for proteinuria, which can be a sign of pre-eclampsia, which is a medical emergency.

ICRN2008, BSN, RN · Dec 25, 2007

TiredMD, thanks for the excellent post!

On my floor (peds oncology), we primarily use dipsticks to check specific gravity and/or pH before or during certain chemotherapy infusions. This is primarily due to the toxic effects of certain drugs on the bladder and kidneys.

ZippyGBR, BSN, RN · Dec 25, 2007

When you do a urine dip, what are the main things you are looking for? I know this may seem a little silly, but there are a whole slew of possible results and I have a hard time remembering what is of main concern.

depends on your patient presentation

in abdominal pain you'd be looking for blood (urinary tract pathology) and considering does a fertile female need a prenancy test, you'dalso be looking for signs of infection urinary tract infections e.g. blood, leucocytes, ntirites

in a sepsis screen you're looking for signs of infection ( as well as blood cultures, wound swabs, CXR ...)

in someone with diabetes you are lloking for glucose and /or ketones

in someoen who is hypertensive (chronically) and /or has known kidney diseae you are looking protein ...

as well as being a analogue for renal function the urine can also give some big clues as to disease processes affecting the renal/ urinary tract tract

GregRN · Dec 25, 2007

Urine dipsticks are essentially a faster way to get a basic urinalysis. The laboratory doing a UA will use the exact same sticks, but typically has a machine that times the reads exactly and uses a photometer to read the color changes, theoretically eliminating the human error element.
Like any laboratory test, you look for different things depending on the patient. It would be impossible to describe all the patterns of abnormalities you will see in different diseases, but below is the basic things a UA dipstick will check and the things I am most commonly looking for when I order one.
Leukocyte Esterase - an enzyme made by certain white blood cells, basically used as an indirect indicator that leukocytes are present in the urine; this can indicate an infection in the urinary tract or an inflammatory disorder of the kidneys/GU tract. Specimens with skin contaminant will frequently come up positive for LEs, so adequate cleaning in really important prior to collecting the sample.
Nitrites - a basic chemical compound created by specific bacteria, but not normally found in the urine. The number one use for this test is the indirect detection of E. Coli, which produces nitrites. However, not all bacteria do, so a negative test does not rule out a UTI.
Glucose - Other than pregnant women, a normal person should almost never spill glucose into their urine. Most commonly positive in uncontrolled diabetes, or certain rare disorders where the kidney is incompetent at resorbing glucose.
Protein - A normal kidney will filter out protein, so if it shows up in your urine, something is wrong. It may be an underlying kidney disease (there are a ton of them). It may be that you have an underlying systemic illness (which for some reason causes small amounts of protein to spill into your urine). However, like LE, contamination of the specimen will cause a positive test. I have also seen people with blood in their urine come up positive for protein, though usually in low amounts (probably secondary to lysis of the cells). A discussion of the type of protein detected in UAs is beyond the scope of this post, so I'll pass on that.
pH - A dehydrated person will have more acidic urine. A person with a proteus UTI will have a very basic urine. Other than that I find this test kind of useless.
Ketones - Not a normal finding in blood or urine, usually occurs when the body switches from aerobic to anaerobic metabolism. This can occur in dehydration, starvation, DKA, or certain metabolic diseases. Again, only a particular type of ketone is detected, but that is only a consideration in certain situations.
Specific Gravity - Measures how concentrated the urine is. High in dehydration, low in hydrated people. Plays a role in monitoring Diabetes Insipidus.
Urobilinogen - Metabolic breadown product of bilirubin. Positive in certain liver diseases. I never use this.
Blood - actually measures hemoglobin. Positive in certain kidney diseases, some UTIs, trauma, etc. Large number of uses. Very easy to get a false positive.
Hope this helps.

Tired,

I have to tell you that I really appreciate your posting on this site. You offer a "bigger picture" perspective not always seen when in the trenches and you have a way of reaching your audience with your information in a way that isn't always found in the hospital. Thanks for your participation and insights.

BimmieBear · Feb 11, 2009

Tired,
I have to tell you that I really appreciate your posting on this site. You offer a "bigger picture" perspective not always seen when in the trenches and you have a way of reaching your audience with your information in a way that isn't always found in the hospital. Thanks for your participation and insights.

I agreed with GregRN...Thanks TiredMD and everyone else on this posting--it's refreshing to practice and actually understand the meaning of medicine when I can see and apply the facts now...Thank you, thank you!

whitebunny · Oct 31, 2009

mark..............