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Purpose
Undertaking urinalysis is a core skill for nurses. It should be performed by an individual who is competent and confident and able to understand the result in the context of the individual patient’s presentation (Bardsley, 2015). Urinalysis is used in:
- diagnosis, eg for urinary tract infections (National Institute for Health and Care Excellence, 2023)
- screening for disease, eg diabetes, chronic kidney disease
- disease management
The benefit of simple urinalysis is that it is quick, cheap and easy to undertake and therefore enables early management of any detected problem, which is also beneficial to the patient. It is sometimes called dip-testing or urinary dip sticking and is usually undertaken using random, midstream or catheter specimens of urine.
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Assessment
Where there is suspicion that the urine may disclose either the presence of illness or some clues as to the physiological state of the patient, the nurse should, where possible, first observe the patient’s urine for both clarity and colour as well as smelling the urine for any odours.
Odour
The urine of healthy people often has a slight odour which is not unpleasant. If the urine is malodorous it may be indicative of an issue:
- exclude recent consumption of some foods and supplements known to make urine odorous, eg asparagus, coffee, vitamin B6 supplements (NHS, 2023)
- consider dehydration, which may concentrate the smell of urine and darken the colour
- urine which smells offensive, often fishy, may be indicative of a urinary tract infection, although smell may be misleading in older patients (Jump et al, 2016)
- urine which smells of acetone, the classic ‘pear drops’ smell, can indicate
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Equipment
The equipment required in order to undertake a urinalysis includes:
- disposable apron
- disposable gloves (non-sterile)
- a means of handwashing / sanitising
- a receptacle for the urine
- the test strips
- a light source
- a clinical waste bag
- the patient’s record
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Procedure
The nurse should ensure they gain consent before undertaking a urinalysis by explaining to the patient the nature of the procedure as well as why it is being undertaken. Nurses should adhere to local policy, as well as observe hand hygiene procedures and don an apron and gloves prior to undertaking a urinalysis to prevent the transmission of infection.
- Ask the patient to collect a fresh urine sample - if possible, a mid-stream urine sample
- If the patient cannot collect a urine specimen, collect a urine sample from a urine bottle, bedpan or commode
- If the collection of a free urine specimen is not possible, a sample may be extracted using a sterile syringe from a continence pad, which has been in situ for less than two hours
- When a sample has been collected by whatever means, urinalysis should be undertaken as soon as possible to avoid contamination or
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Risks and complications
The biggest risk when recording a person’s urinalysis is that it is done incorrectly. This may be as a result of not following manufacturer’s guidance, using test strips which are out of date, a lack of education or training, not considering issues such as the clean handling of the specimen or trying to read the result in inadequate light. Bardsley (2015) also cautions that nurses should make sure that the reagent strips are not exposed to air for any length of time as this may invalidate any readings.
Where a patient’s urinalysis is recorded inaccurately, this may have an influence on the treatment they are offered and the progress of their care.
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 1: Procedures for assessing people’s needs for person-centred care
2.9 collect and observe sputum, urine, stool and vomit specimens, undertaking routine analysis and interpreting findings
Part 2: Procedures for the planning, provision and management of person-centred nursing care
9.6 use evidence-based hand hygiene techniques
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Resources
Bardsley A. How to perform a urinalysis. N Standard. 2015;30(2):34-36. https://doi.org/10.7748/ns.30.2.34.e10001
Carvalho F, Breen E-C, Bullock Z et al. Observations. In: Lister S, Hofland J, Grafton H and Wilson C (eds). The Royal Marsden manual of clinical nursing procedures. 10th edn. Chichester: Wiley Blackwell; 2021: 719-800
Collie M, Hunter DJ. Assisting patients with their elimination needs. In: Delves-Yates C (ed). Essentials of nursing practice. London: Sage; 2022
Jump RLP, Crnich CJ, Nace DA. Cloudy, foul smelling urine not a criteria for diagnosis of urinary tract infection in older adults. J Am Med Dir Assoc. 2016;17(8):754. https://doi.org/10.1016/j.jamda.2016.04.009
Khan MI. Plant betalains: Safety, antioxidant activity, clinical efficacy, and bioavailability. Compr Rev Food Sci Food Saf. 2016 Mar;15(2):316-330. https://doi.org/10.1111/1541-4337.12185
Mahon A, Jenkins K, Burnapp L. Oxford handbook of renal nursing. Oxford: Oxford University Press; 2013
Martin C, Martin H. Urinalysis using a test strip. Br J N. 2019;28(6):336-340 https://doi.org/10.12968/bjon.2019.28.6.336
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