Use of a Urine Color Chart to Monitor Hydration Status in Nursing Home Residents

To determine whether urine color, as measured by a color chart, might be a valid indicator of hydration status in frail nursing home residents, this study tested the associations between urine color and urine specific gravity. This is a descriptive correlational study set in seven nursing homes in eastern Iowa. Ninety-eight nursing home residents 65 years of age participated. Exclusion criteria for the study included: unstable congestive heart failure or diabetes, documented renal disease, hyponatremia (serum sodium < 135 meq/L), terminal illness, acutely confused/delirious or urinary tract infection at baseline, and gastrostomy-tube dependence. Weekly urine specimens were collected. Ucol was measured first, using a urine color chart. Usg was determined using the Chemstrip Mini UA Urine Analyzer. Week-by-week Spearman rank order correlations between urine color and specific gravity for the total sample (n = 98) ranged from rs = 0.3 - 0.7, p < .01; the PROC mixed model was significant, p < .01. In subgroup analyses (n = 78), all females (rs = 0.67, p = .01) and both males (rs = 0.53, p = .01) and females (rs = 0.72, p = .01) with adequate renal function (Cockcroft-Gault estimated creatinine clearance [CrCl] values of 50 ml/min) had significant associations between average urine color and average Usg. Females with mild renal impairment (CrCl between 30 and 50 ml/min) also had significant associations between Ucol and Usg (rs = .64, p < .01). Ucol averaged over several individual readings offers another tool in assessing hydration status in Caucasian nursing home residents with ade quate renal function measures by estimated CrCl values.

Urine collection in infants and children

June Rogers and Caroline Saunders review current evidence and best practice regarding obtaining a urine specimen from children.

Anatomy and physiology of urinary elimination. Part 1

Elimination of urine is an essential bodily function, but independence in this activity may be affected by physical and mental disability. Part 1 of this article discusses the anatomy and physiology of the renal and urinary tract and the production of urine. Urinalysis is a vital nursing assessment and the collection of specimens and the range of tests undertaken are outlined. Assisting patients to use the toilet, commode or bedpan is an essential nursing skill. The importance of sensitivity, empathy and moving and handling risk assessment is discussed, and the assessment and management of urinary tract infection and urinary tract stones are addressed. The importance of prevention of cross infection for nurses and patients is highlighted throughout the article.

The management of in vitro diagnostic point-of-care testing

In vitro diagnostic point-of-care testing (IVDPCT) can improve patient care but improvements can only be properly realised by adequate management in order to ensure high-quality test results. Nurses perform IVDPCT in all areas of clinical practice, from intensive care units to GP surgeries, using a wide variety of devices ranging from urinalysis strips to blood gas analysers.

Are true-negative nitrite results affected by a two-hour delay in dipstick/pad analysis of urine in incontinence pads?

OBJECTIVES

To determine if true-negative nitrite results of a urine dipstick pressed into an incontinence pad (dipstick/pad method) are affected by a 2-hour delay in analysis.

DESIGN

A quantitative study.

SETTING AND SUBJECTS

Clean-catch urine specimens from a convenience sample of clinic patients, staff, and long-term care facility residents.

INSTRUMENT

Changes from negative to positive for each group of urine specimens were evaluated using percentages within the groups.

METHODS

Urine specimens were collected and a portion was cultured. Urine specimens negative for a urinary tract infection were included in the study. A portion of the specimen was poured into an incontinence pad. Initial nitrite results were determined using a dipstick pressed into an incontinence pad. Pads with true-negative dipstick/pad nitrite results were tested 2 hours later in the same manner. Urine culture results determined groups: mixed colonies; 50,000 to 75,000 colony-forming units per milliliter of a single type of uropathogen; greater than or equal to 50,000 cfu/mL diphtheroids; no significant growth; and no growth.

RESULTS

Of the 443 urine cultures negative for a urinary tract infection, 441 initial dipstick/pad nitrite results were negative. Two initial true-negative nitrite dipstick/pad results, or 0.5%, changed from negative to positive over the 2-hour period: 1 in the "mixed colonies" group (0.4%) and 1 in the "no growth" group (0.7%).

CONCLUSIONS

Results of this study indicate that true-negative nitrite results of a dipstick pressed into urine in an incontinence pad do not appear to be affected by a 2-hour delay in analysis.

Limitations of urinary pH monitoring in long-term catheter users

Weekly measurement of urinary pH has become a standard part of long-term catheter management in many parts of the UK. The common problem of catheter encrustation is caused by urease-producing bacteria which also tend to produce alkaline urine. To determine if urinary pH changes in individual catheter users provided enough information for pH monitoring to aid in catheter management, an analysis of the literature was combined with a study of the urinary pH and catheter blockage patterns in 20 catheter users colonized with urease-producing bacteria. It was found that weekly pH measurement does not aid in the diagnosis or management of catheter encrustation. As such, this practice cannot be recommended.

Obtaining urine for culture from non-potty-trained children

The accurate diagnosis of urinary tract infection (UTI) in young children is important for initial management and the prevention of long-term damage to the developing kidney. Various methods are used for urine collection from the non-potty-trained age group, including catheterisation, suprapubic aspiration, clean-catch sampling, adhesive bag sampling and urine collection pads. Research literature was examined to identify which method is most effective. The themes that evolved from the review were parents' and nurses' views on ease of use, reliability of sample obtained and cost-effectiveness. Although not the most convenient method, clean-catch gives more reliable results making it also the most cost effective approach. Change management strategies are required to overcome barriers to research implementation and to ensure best practice.

Urinalysis

Urine analysis is an essential component of patient assessment, which is used for screening, diagnosis and planning care. This article discusses specimen collection and reagent strip testing.

Understanding urine testing

Urine is a natural waste product of the body and urine testing is a simple and quick way of monitoring disease and identifying new illness. The results from a urine test can prompt a change in a patient's medical management. Urine testing is not a new procedure: as far back as the ancient Egyptians there are descriptions of polyuria. In 7th Century AD, Protosharis suggested that it was important to look at the colour of urine and by 1674 Thomas Willis, a professor at Oxford University, recorded that the urine of his patients with diabetes tasted sweet (Beer, 1996).

pH testing in catheter maintenance: the clinical debate

The pH of urine is widely recognized as being a major contributory factor in urinary catheter encrustation. What is less widely appreciated is the range of factors that affect the pH of urine, and which therefore affect the reliability and validity of urine pH testing. This article examines the validity of various urinary pH testing methods and discusses the theoretical and practical implications of the uncertainty surrounding their practical value.