Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

NCM 104:
RLE MODULE 1M

BAG TECHNIQUE AND URINE

TESTING

A-Group 1:

Mr. Borja, Fritz Ian A. - Leader

Ms. Aguirre, Alleona Mari M.
Ms. Apil, Samantha Joan C.
Mr. Butaya, Raven John L.
Mr. Cortes, Zimmer Wayne S.
Mr. Espinosa, Mark Paul Gwyneth M.
Ms. Lumasag, Filane Antonette S.
Mr. Pasilbas, Zaldy Rhean Mar S.
Mr. Sebastian, Lance Kendrick K.
Ms. Ycot, Dominique Kyle P.

Facilitator: Ms. Nikki Rae Cayanan, RN

Date Submitted: Sept. 9, 2020
 TABLE OF CONTENTS

PAGE
Learning Outcomes for Bag Technique 1
CLO#1: define the following terms related to bag technique 3
CLO#2: give the purpose of bag technique and community health bag 5
CLO#3: differentiate the types of family-nurse contact 6
CLO#4: identify the contents of the CHN bag 7
CLO#5: discuss the different types of case load 14
CLO#6: produce a sample plan of visit 15
CLO#7: recognize guidelines in using the CHN bag 21
CLO#8: relate principles in bag technique 22
CLO#9: demonstrate beginning skills in arranging contents of CHN bag and
performing bag technique

Learning Outcomes for Urine Testing 25

CLO#1: Define the following terms related to urine testing 26
CLO#2: Discuss the importance of urine testing 29
CLO#3: Identify the factors influencing urination 30
CLO#4: Explain principles involved in urine testing 33
CLO#5: Compare the characteristics of normal and abnormal urine 34
CLO#6: Identify common urinary problems and causes 35
CLO#7: Explain the different ways of specimen collection and test 36
CLO#8: State the different method or urine testing 38
CLO#9: Enumerate nursing responsibilities before, during, and after urine 40
testing
Demonstrate beginning skills in urine testing
CLO#10:
References 41
 BAG TECHNIQUE

LEARNING OUTCOMES:
After 2 hours of class reporting and various online class activities, the level II
nursing students will be able to:

CLO#1: define the following terms related to bag technique

CLO#2: give the purpose of bag technique and community health bag
CLO#3: differentiate the types of family-nurse contact
CLO#4: identify the contents of the CHN bag
CLO#5: discuss the different types of case load
CLO#6: produce a sample plan of visit
CLO#7: recognize guidelines in using the CHN bag
CLO#8: relate principles in bag technique
CLO#9: demonstrate beginning skills in arranging contents of CHN bag and
performing bag technique

1
 CLO#1: DEFINE THE FOLLOWING TERMS RELATED TO BAG
TECHNIQUE

Define the Following Terms:

1.1 Bag Technique - A tool that allows the nurse to conduct a nursing treatment
with ease and precision during her visit, saving time and effort in providing good
nursing care to clients.

1.2 Plan of Visit - An important tool for improving the outcomes of nursing
home visits. It also acts as a guide, as well as, it satisfies the client's
requirements and achieves the best possible outcome.

1.3 Home Visit - Is a professional, purposeful interaction that takes place in the
family’s residence aimed at promoting, maintaining, or restoring the health of the
family or its members. Allows the health worker to analyze the home and family
circumstances in order to give nursing care and health-related activities as needed.

2
1.4 Family-nurse contact - It develops through a family-nurse relationship, which
might take in the form of clinic visits, group conferences, telephone, or written
communications. It also aids in the achievement of essential goals for the successful
delivery of nursing care to family members.

1.5 Community Health Bag - It is an important and indispensable public health

nursing equipment that must be brought during home visits.

3
1.6 Case Load - The number of cases handled (as by clinical) usually in a particular
period.

4
CLO#2: GIVE THE PURPOSE OF BAG TECHNIQUE AND COMMUNITY
HEALTH BAG AND HOME VISIT

Give the Purpose of:

Importance of Bag Technique

● Prevents carrying microorganisms from entering patient’s home
● Practices aseptic technique and sanitation to prevent contamination of the items
in the bag with the patient and patients house
● Performing the bag technique will minimize, if not, prevent the spread of any
infection. It saves time and effort in the performance of nursing procedures.

Importance of Community Health Bag

● Carries needed materials and equipment needed to conduct tests
● This allows nurses to work efficiently and swiftly during nursing procedures during home
visits
● This allows nurses to stay organize and to conserve time and energy

Importance of Home Visits

● To save time and energy with an end view at rendering effective nursing care
● To provide convenient and efficient nursing care for client’s in-home communities
especially benefitting those who have lesser access to hospitals
● To impart health teachings to the family and as well as to know the health status of an
individual or a family

5
 CLO#3: DIFFERENTIATE THE TYPES OF FAMILY-NURSE CONTACT
Types of Family- Nurse Contact

1. Clinic Visit

- In this type of contact, health care services are provided to patients on an ambulatory
basis, rather than by admission to a hospital or other health care facility. The services
may be a part of a hospital, augmenting its inpatient services, or may be provided at a
free-standing facility.

2. Group Conference
- In this type of contact, a family may be allowed to participate actively in a discussion
regarding health.

3. Telephone (landline/cellphone)
- The telephone is a type of contact that allows for easy access between the nurse and the
family. For this very reason, it encourages the family to communicate with the clinic or
health center.

6
4. Written Communication
- This type of contact is used to give specific information to families. An example of when
this is used is when specific instructions are given to the parents of school-aged children
through the said children after a consultation.

5. Home Visit
- This type of family-nurse contact allows the health workers to assess the home and
family situations in order to provide the necessary nursing care and health-related
activities.

7
 CLO#4: IDENTIFY THE CONTENTS OF THE CHN BAG

Contents of the CHN Bag Visual

Representation
1. CHN Bag Lining
● Protects the bag from getting
wet and/or contaminated
● Contains the following:
● 5x8 soap dish lining
● 14x20 paper lining
● 13.5x19.5 plastic lining
● 12.5x18.5 paper lining

(Source: Facebook)

2. Cotton Bag
● Contains the following:
● Sterile gauze
● Cotton balls
● Cotton applicator

(Source: Facebook)

3. Instrument Bag
● Composed of surgical
instruments that are usually
used for cutting, dressing, and
removing circumferential
bandages; may also be used to
cut tougher materials such as
plaster, fabric, and occasionally
umbilical cord
● Contains the following:
● Kelly Curved
● Kelly Straight

8
 ● Bandage Scissors
● Surgical Scissors

(Source: Facebook)

4. Apron
● Protects the nurse’s uniform

(Source: Google Images)

5. Kelly Curved
● “Pick-up forceps”
● Used to clamp large blood
vessels, manipulate heavy
tissue, and dissect soft tissue (Source: Google Images)

6. Kelly Straight
● “Dressing forceps”
● Used to clamp off blood
vessels, remove small root tips
and grasp loose objects
(Source: Google Images)

9
7. Surgical Scissors
● Surgical instruments usually
used for cutting

(Source: Google Images)

8. Alcohol Lamp (with

denatured alcohol)
● Source of fire for heating
solutions or sterilizing
equipment

(Source: Google Images)

9. Spring Balance
● Used as a baby scale to get
the weight of the baby

(Source: Google Images)

10. Test Tube

● Hold and mix small quantities
of liquid or solid chemicals
during experiments or tests
● Used during urine testing

(Source: Google Images)

10
11. Test Tube holder
● Used for holding a test tube
in place when the tube is
hot or should not be
touched

(Source: Google Images)

12. Catheter fr.10-18

● Used to drain the bladder

(Source: Google Images)

13. Medicine glass

(Source: Google Images)
● A small glass vessel graduated
for measuring medicine

14. Syringe 2cc and Metal Needles

● Used to inject fluid into, or
withdraw fluid from the
body

(Source: Google Images)

11
15. 6 Rx bottles
● Designed to store medication

(Source: Google Images)

16. Ear syringe

● Helps in removing excess
earwax

(Source: Google Images)

12
17. Digital Thermometer
● This sort of digital thermometer
can be used to measure the
patient's temperature through
oral or axillary means.

(Source: Google Images)

18. Kidney basin

● Used in medical and surgical
wards to receive soiled
dressings and other medical
waste

(Source: Google Images)

19. Surgical gloves

● These are used to protect the
nurse and patient from any
possible infection or
contamination.

(Source: Google Images)

20. Medicine dropper

● This is used in measuring
and dispensing medicine
which are liquids

(Source: Google Images)

13
 21. Cord clamp
● This is used in order to stop
any bleeding from the
umbilical cord once it is cut.
On occasion, medicine is
applied to the cord as part of
the infant's first care.

(Source: Google Images)

*BP apparatus and stethoscope are carried separately and are never placed in the bag.

14
 CLO#5: DISCUSS THE DIFFERENT TYPES OF CASE LOAD

1. Antepartum case - Antepartum care comprises a significant percentage of

health maintenance visits in the United States. Also referred to as prenatal
care, antepartum management is essential to the progression of healthy
pregnancies, identifying potential abnormal pregnancies, and ensuring safe
and timely management of prenatal issues and deliveries for patients and
neonates. This activity outlines antepartum care and reviews the role of the
interprofessional team in evaluating, managing, and improving the care for
patients during pregnancy.
2. Postpartum case - The postpartum period, also known as the puerperium and
the "fourth trimester," refers to the time after delivery when maternal physiologic
changes related to pregnancy return to the nonpregnant state. In addition to
physiologic changes and medical issues that may arise during this period, health
care providers should be aware of the psychological needs of the postpartum
mother and be sensitive to cultural differences that surround childbirth, which may
involve eating particular foods and restricting certain activities
3. Health supervision - Supervision is a process of guiding, helping, training, and
encouraging staff to improve their performance in order to provide high-quality
health care services. A supervisor is responsible for the performance of clinical staff
and non - clinical staff. Supervision can be conducted by someone who makes
periodic supervision visits. Many of these supervisors also provide clinical service at
the facility. Other healthcare delivery sites may be visited only from time to time by
an external supervisor and therefore do not have the benefit of a supervisor’s skills
on a routine, day-to-day basis.
4. Morbidity - It refers to having a disease or a symptom of disease, or to the
amount of disease within a population. Morbidity also refers to medical problems
caused by a treatment. Maternal morbidity is an overarching term that refers to any
physical or mental illness or disability directly related to pregnancy and/or childbirth.
These are not necessarily life-threatening but can have a significant impact on the
quality of life.
5. Mortality – In medicine, a term also used for death rate, or the number of
deaths in a certain group of people in a certain period of time. Mortality may be
reported for people who have a certain disease, live in one area of the country, or
who are of a certain gender, age, or ethnic group.
6. Case finding - Case finding is a strategy for targeting resources at individuals or
groups who are suspected to be at risk for a particular disease. It involves actively
searching systematically for at-risk people, rather than waiting for them to present
with symptoms or signs of active disease.

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 CLO#6: PRODUCE A SAMPLE PLAN OF VISIT

SAMPLE PLAN OF VISIT:

Situation: Student nurse, Mark Espinosa, visited Barangay Tipolo. In the community, he met with
the Santorino family in the area. It was Mr. and Mrs. Santorini, together with their 3-weeks-old
baby.

Plan of Visit #1

Name of Family: Sartorino Date: Sept 3, 2020

Address: Brgy. Tipolo, Cebu City. Type of Case: Case Finding

General Objective: After one week of home visit, the family will gain information, appropriate
skills, and a hopeful attitude in the promotion of health and prevention of illness in relation to the
family’s setting.

Specific Objectives:

After 30-45 minutes of student nurse-family interaction, the family will be able to:

1. Establish rapport with the student nurse.

2. Verbalize the definition of home visits.

3. Recognize the purpose and importance of home visit.

4. Identify possible and current health problems of the patient and their family

5. Plan appropriate nursing interventions based on identified health problems.

6. Schedule the next home visit.

Nursing Actions:

1. Establish rapport with the student nurse.

· Greet with a smile.

· Introduce oneself to the family in a polite manner.

· Maintain moderate eye contact and professional boundaries during the

interaction.

· Ask for the names of the family members in a respectful manner.

2. Verbalize the definition of home visits.

· Home visit allows the student nurse to assess the home and family situations in

16
 order to provide the necessary nursing care and health-related activities.

3. Recognize the purpose and importance of home visit.

· To give care to the sick, to a postpartum mother and her newborn with the view
teach a responsible family member to give the subsequent care

· To give health teachings regarding the prevention and control of diseases.

· To assess the living condition of the patient and his family.

4. Identify possible and current health problems of the patient and their family.

· Conduct a nursing interview with the family.

· Apply family assessment tools such as the Initial Database (ID) and the Family
Coping Index (FCI) to identify potential and actual problems.

5. Plan appropriate nursing interventions based on identified health problems.

6. Schedule the next home visit.

· Must include details such as date, place, and time.

Plan of Visit #2

Situation: Student nurse, Mark Espinosa, visited Barangay Tipolo. In the community, he met
Mrs. Sartorini in the area. Mrs. Sartorini, a mother who delivered her baby through C-section a
week ago, is experiencing prolonged bouts of crying, sadness, anxiety, and mood swings. She is
also aware that this kind of behavior is not healthy for the baby.

Name of Family: Sartorini Date: Sept 11, 2020

Address: Barangay Tipolo, Cebu City Type of Case: Postpartum

General Objective;

After one week of student nurse-family interaction, the mother will verbalize understanding of
care requirements to promote the health of self and infant.

Specific Objectives:

After 30-45 minutes of student nurse-client interaction, the mother will be able to:

1. Express her thoughts and emotions to significant others.

2. Display behaviors promoting the health of the infant.

17
 3. Sleep comfortably

4. Identify behavioral acts that can bring negative consequences to the infant.

5. Secure another contact of visit.

Nursing Actions:

1. Assess the client’s readiness for learning.

· Utilize the use of Readiness Ruler to identify the client’s readiness to learn
and change.

2. Assess the mother’s strengths and needs, noting age, relationship status, and reactions
of a family member

· Conduct a nursing interview with the mother and the family members.

· Observe the mother’s behavior towards the members of the family.

3. Promote sleep and rest.

· Instruct client to have adequate sleep.

4. Reiterate the necessity of a postpartum examination by a healthcare provider.

· Encourage the client to undergo postpartum checkups.

5. Set another contact of visit.

· Details such as time, date, and place must be secured.

18
 Plan of Visit #3

Name of Family: Sartorini Date: Sep 2, 2020

Address: Barangay Tipolo, Cebu City Type of Case: Health

Supervision

General Objective:

After one week of student nurse–family interaction, the family will have a comprehensive
understanding of health supervision and develop relevant skills to improve the health and well-being
of children.

Specific Objectives:

After 30-45 minutes of student nurse–family interaction, the family will be able to:

1. Define health supervision

2. Learn the importance of health supervision.

3. List possible hazards that can inflict harm on their children from their daily routines.

4. Engage in meaningful interactions with their children

5. Make close observations of children to provide support on children’s play experiences.

Nursing Actions:

1. Conduct a risk assessment of the environment, the children, and the context of the activities
children participate in.

· Identify hazards

· Make a record of the findings

2. Actively engaging with children to support their learning

· Play together with the children.

· Observe and ask questions

3. Evaluate events in order to detect potential dangers and benefits to children's health, safety,

19
and well-being

· Observe closely the behaviors of the children and environment.

4. Encourage family members to provide support to their children

5. Discuss the role of the family in health supervision.

· Families have more influence over their children.

· Conduct conference for family members

SOAPIE DOCUMENTATION

SOAPIE 1

S: The family introduced themselves as Mr. Luciano Santorini and Mrs. Maria Santorini, who are
first-time parents with their first-born baby of 3-weeks-old.

O: Mr. and Mrs. Santorini show readiness to learn proper parenting for their 3-weeks-old baby.

A: Readiness for enhanced parenting and family care processes.

P: After 1 week of nursing care, Mr. and Mrs. Sartorini gained information on parenting their
newborn baby and developed an understanding in providing care to postpartum mothers.

I: Provide assistance to the family on parenthood and postpartum care.

E: The family demonstrated competency skills in relation to parenting their 3-weeks-old baby.

SOAPIE 2

S: The client described her feelings as, “wala na ko kabalo if mapadako nako og tarong ang
bata, usahay malipay ko, niya taod taod ga hilak na ko.”

O: The client was trembling and feeling nervous during student – nurse interaction. Upon
assessing vital signs, T: 36.7 degree Celsius, BP: 140/90hhmg, PR = 90bpm, RR = 25cpm

A: Anxiety: Perceived/Actual threat of maternal and fetal well-being related to unusual mode of
delivery.

P: After 1 week of nursing care, the client will manifest positive thoughts and feelings and can
perform her activities of daily living without unnecessary interruptions.

I: Provide anticipatory guidance regarding the realistic demands and lifestyle changes
associated with parenthood, encourage client to identify support systems, and provide
emotional support for the family.

E: The client demonstrated positive behavioral acts and communicated her feelings to
significant others. The client also performs her activities of daily living well.
20
SOAPIE 3

S: The family verbalizes “Sige bitaw siya masamad if magdagan dagan” and “Dili man gud
namo ma bantayan kay daghan mi gipang buhat”

O: The family was not paying close attention to the child and not actively engaging.

A: Impaired skin integrity evidenced by dry and flaky skin related to contact with irritants or
allergens.

P: After 1 week of student nurse – family interaction, the family will pay closer attention and
actively engage to the daily routines of their child.

I: Encourage the family to adopt skin care routines for the child to decrease skin irritation and
identify signs of itching and scratching.

E: The family and their child developed a secure and healthy relationship. The child learned to
communicate and express his/her feelings of love towards his/her family.

21
 CLO#7: RECOGNIZE GUIDELINES IN USING THE CHN BAG

1. Perform hand washing as frequently as possible or if the situation calls for help to
minimize or avoid contamination of the bag & its contents.
2. The CHN bag should contain all the necessary articles & equipment which may be
used to answer emergency needs.
3. Contents of the bags should be protected from contact with different unsterilized
objects.
4. The arrangement of the contents of the bag should be the most convenient to the
users to facilitate efficiency & so as to avoid confusion.
5. Bag technique should be performed in different ways depending upon the policies.
6. Bag should be placed at a clean & warm temperature.
7. Avoid shaking or swaying the bag when carrying it.
8. The bag should be thoroughly cleaned & disinfected after using it, especially if there
is a communicable case in the area.
9. Clean the equipment and supplies after usage.
10.Remove PPE if worn, and perform hand hygiene.

22
 CLO#8: RELATE PRINCIPLES IN BAG TECHNIQUE

Microbiology

● All materials should be sterile and maintain sterility at all times.

● Minimize, if not prevent the spread of infection from individuals to families hence
to the community

Time and energy

● Necessary equipment and materials should all be prepared beforehand.

● It is important that the nurse is aware of the location of each item in the bag to
prevent wasting time looking for the equipment.

Body Mechanics
● Proper posture and handling of the bag are important to prevent any injuries
and to have a secure hold of the bag.

Pharmacology
● The bag contains different solutions and disinfectants.

Sociology

● Interact and communicate with the client to build rapport and trust in order to
enhance cooperation.
Psychology

● Explain the procedure to the client so that anxiety and nervousness will be
reduced.

23
 CLO#9: Demonstrate beginning skills in arranging contents of CHN
bag and performing bag technique.

What’s In Your Nursing Bag?

The content of the nursing bag can be broken down into two components, single-
use items, and reusable items. Single-use items are those items that will be removed
from the nursing bag and not placed back into the bag after use. Examples of single-use
items that may be found in a nursing bag include, but are not limited to individually
packaged disinfectant wipes, alcohol prep pads, wound care dressing supplies, paper
drying materials to use after washing the hands with soap and water, and personal
protective equipment (PPE). Minimal quantities of PPE should be stored inside the
nursing bag in the event that it is needed (e.g., one gown, face mask, a face shield in
lieu of bulky goggles). Reusable items are items that will be replaced back into the
nursing bag after use. Examples of reusable items include the equipment needed to
obtain the patient’s vital signs and bandage scissors.

24
 Urine Testing
LEARNING OUTCOMES:
After 2 hours of class reporting and various online class activities, the level II
nursing students will be able to:

CLO#1: define the following terms related to urine testing

CLO#2: discuss the importance of urine testing
CLO#3: identify the factors influencing urination
CLO#4: explain principles involved in urine testing
CLO#5: compare the characteristics of normal and abnormal urine
CLO#6: identify common urinary problems and causes
CLO#7: explain the different ways of specimen collection and test
CLO#8: state the different methods of urine testing
CLO#9: enumerate nursing responsibilities before, during, and after urine
testing
CLO#1 demonstrate beginning skills in urine testing
0:

25
 CLO#1: DEFINE TERMS RELATED TO URINE TESTING

1. Urine Testing - Urinalysis is a group of physical, chemical, and microscopic tests.

Urine is evaluated for its appearance, concentration, and content.

2. Enuresis - It is the act of involuntary urination that can happen at any time of day
or night. It mostly occurs in children under the age of 3.

3. Diuretic - Also known as water pills, these are drugs that increase the amount of
water and salt excreted in the urine.

26
27
4. Ketone Body
● These are chemicals that the body produces when there is not enough
insulin in the blood and it must break down fat instead of the sugar glucose
for energy.

5. Hematuria
● This is the presence of blood found in urine.

6. Uric Acid
● A waste byproduct. This is formed when the body breaks down purines,
which can be present in some food. Uric acid dissolves in blood and travels
to the kidneys. A high level of uric acid in the blood is called
hyperuricemia. The most prevalent medical condition causing low uric
acid level is Fanconi syndrome.

28
 6. Uric acid- is a chemical created when the body breaks down substances called
CLO#2: DISCUSS
purines. Uric acidTHE IMPORTANCE
dissolves OF URINE
in blood and travels TESTING
to the kidneys. From there, it
passes out in urine. If your body produces too much uric acid or does not remove
1. It canenough
help treat
if it,problems thatsick.
you can get needA treatment
high level including infections
of uric acid or kidney
in the blood is called
problems.
hyperuricemia.
2. It provides factual data regarding the acidity and alkalinity of urine
3. It enhances our ability to know and identify the presence of glucose, ketone bodies,
and albumin present in the urine.
4. It determines urine abnormalities that may cause infection in our body.
5. This is also proper monitoring in terms of the various organs in the body especially
the liver and kidneys.
6. It determines if glucose metabolism has no problem.
7. It gives a scientific assessment of the needs of the patient's urinary problems in
order to implement nursing care.

29
 CLO#3: IDENTIFY THE FACTORS INFLUENCING URINATION

Factors influencing Urination:

Disease Conditions.

Disease processes that affect urine elimination affect renal function (changes in urine
volume or quality), the act of urine elimination, or both. Conditions that affect urine volume and
quality are generally categorized as prerenal, renal, or postrenal in origin.

Decreased blood flow to and through the kidney (prerenal), disease conditions of the
renal tissue (renal), and obstruction in the lower urinary tract that prevents urine flow from the
kidneys (postrenal) sometimes alter renal function. Conditions of the lower urinary tract,
including narrowing of the urethra, altered innervation of the bladder, or weakened pelvic
and/or perineal muscles, affect urinary elimination.

Diabetes mellitus and neuromuscular diseases such as multiple sclerosis cause changes
in nerve functions that can lead to possible loss of bladder tone, reduced sensation of bladder
fullness, or inability to inhibit bladder contractions. Older men often suffer from benign prostatic
hyperplasia (BPH), which makes them prone to urinary retention and incontinence. Some
patients with cognitive impairments, such as Alzheimer’s disease, lose the ability to sense a full
bladder or are unable to recall the procedure for voiding. Diseases that slow or hinder physical
activity interferes with the ability to void. Degenerative joint disease and Parkinsonism are
examples of conditions that make it difficult to reach and use toilet facilities.

Sociocultural Factors.

The degree of privacy needed for urination varies with cultural norms. North Americans
expect toilet facilities to be private, whereas some European cultures accept communal toilet
facilities. Social expectations (e.g., school recesses) influence the time of urination.

Psychological Factors.

Anxiety and emotional stress cause a sense of urgency and increased frequency of
urination. Anxiety often prevents a person from being able to urinate completely; as a result,
the urge to void returns shortly after voiding. Emotional tension makes it difficult to relax
abdominal and perineal muscles. Attempting to void in a public restroom sometimes results in a
temporary inability to void. Privacy and adequate time to urinate are usually important to most
30
people.

Fluid Balance.

The kidneys primarily maintain the balance between retention and excretion of fluids. If
fluids and the concentration of electrolytes and solutes are in equilibrium, an increase in fluid
intake causes an increase in urine production. This amount varies with food and fluid intake.
The volume of urine formed at night is about half of the volume formed during the day because
both intake and metabolism decline. Nocturia (awakening to void one or more times at night)
is often a sign of renal alteration. In a healthy person, the intake of water in food and fluids
balances the output of water in urine, feces, and insensible losses in perspiration and
respiration. An excessive output of urine is polyuria. A urine output that is decreased despite
normal intake is called oliguria. Oliguria often occurs when a fluid loss through other means
(e.g., perspiration, diarrhea, or vomiting) increases. It also occurs in early kidney disease. Often
in severe kidney disease, no urine is produced (anuria).

Surgical Procedures.

The stress of surgery initially triggers the general adaptation syndrome. Preoperative
orders of nothing-by-mouth or an underlying disease condition affect fluid balance before
surgery, which reduces urine output. In addition, the stress response releases an increased
amount of ADH, which increases water resorption. Stress also elevates the level of aldosterone,
causing retention of sodium and water. Both of these substances reduce urine output in an
effort to maintain circulatory fluid volume.

Medications.

Many medications directly or indirectly contribute to urinary dysfunction. Antipsychotics,

antidepressants, alpha-adrenergic agonists, and calcium channel blockers can cause urinary
retention and overflow incontinence. Alpha-antagonists, diuretics, sedative-hypnotics, opioid
analgesics, angiotensin-converting enzyme (ACE) inhibitors, and antihistamines can cause
urinary incontinence. Antiparkinson medications may cause urinary urgency and subsequent
incontinence. Always consider these medications as the cause of new-onset urinary
incontinence, especially in older adults.

Diagnostic Examination.
31
 Examination of the urinary system influences micturition. Some procedures such as an
intravenous pyelogram (IVP) require patients to limit fluids before the test. A restriction in fluid
intake commonly lowers urine output. Diagnostic examinations (e.g., cystoscopy) involving
direct visualization of urinary structures cause localized edema of the urethral passageway and
spasm of the bladder sphincter. After the procedure, a patient may have difficulty voiding or
have red or pink urine because of trauma to the urethral or bladder mucosa.

32
 CLO#4: EXPLAIN THE PRINCIPLES INVOLVED IN URINE TESTING

Through chemical and microscopic analysis of the urine specimen, information about the
body’s metabolic functions may be obtained. This aids in the evaluation of renal, urinary, and
metabolic disorders.

Anatomy & physiology
The urinary bladder is a hollow, muscular and distensible organ that acts as a
reservoir for urine. Located on the lesser pelvis when empty and extends into the
abdominal cavity when full

Chemistry
Benedict’s solution is used to identify the volume of sugar present in the urine pH
which indicates the acid-based organic waste urine pH which indicates the acid-based
organic waste

Microbiology
The nurse must aid the needs of incontinent patients to ensure skin is dry and to
prevent infection.

Pharmacology
To increase urine output, diuretics drugs are used

Psychology
Frequent urination may be caused by excitement, anxiety, or fear. The client
must be relaxed

Physics
The specific gravity of urine is the relation it bears to the weight of water.

∙
∙

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 CLO#5: COMPARE THE CHARACTERISTICS OF NORMAL
AND ABNORMAL URINE

Characteristic Normal Abnormal

Dark amber
Straw, amber Cloudy
Color, clarity Transparent Dark orange
Red or Dark brown
Mucous plugs, viscid, thick

Odor Faint aromatic Offensive

Creatinine Males: 0.8–1.8 g/day Males: <0.8, >1.8 g/day

Female: 0.6–1.6 g/day Female: <0.6, >1.6 g/day

pH 4.5-8.0 <4.5, >8.0

Specific 1.005-1.030 <1.005, >1.0

gravity

Glucose Not present Present

Ketone Not present Present

Protein Not Present Present

Blood Not present Occult (microscopic)

Bright red

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CLO#6: IDENTIFY THE COMMON URINARY PROBLEMS AND
CAUSES

COMMON CAUS
URINARY ES
PROBLEMS

Urinary tract
Infection of the bladder (cystitis) and the urethra (urethritis)
infection

Oliguria
Dehydration, Burns, Obstruction, Certain Medications

Polyuria
Polydipsia, kidney disease, liver failure, Diuretics, Pregnancy

Nocturia
UTI, Kidney or Bladder infection, Diabetes, Anxiety

Hematuria
UTI, Injury to the urinary tract, Bladder, Kidney, or Prostate
Cancer

Kidney stones
Dehydration, urinary tract blockage

Urine color and odor

UTI, Type 2 Diabetes, Dehydration, Liver failure

35
CLO#7: EXPLAIN THE DIFFERENT WAYS OF SPECIMEN COLLECTION
AND TEST.
The collection of any urine specimen would require the nurse to always observe
protocols and follow universal precautions. There are different ways of specimen collection
when it comes to urine testing. Here are some of those methods (Schroeder, Newman, &
Wasserman, 2000):

Sterile Urine Bag or Sterile Technique

These bags are used to collect urine from a person who has difficulty urinating or
cannot urinate at all. This is installed into the client through a catheter that inserts itself
into the bladder.

Midstream Clean Catch Specimen

This method of urine sample collection is one of the least invasive among the
collection methods. It is also preferred in comparison to other methods when doing
culture and sensitivity testing. This is because of the reduced incidence of cellular and
microbial contamination within the sample. This is done by collecting the urine from the
midstream in a cup while one is urinating.

36
Single Random Specimen
These specimens may be taken any time within the day. This is also considered
one of the easiest ways to get a urine sample since it is already available, i.e., the client
felt the need to urinate and decided to collect and give the sample at that time.
However, random samples can result in inaccurate findings.

First Morning Specimen

This urine sample is considered to be more concentrated as no influences from
dietary intake or physical activity have affected it. This is also known as an early morning
specimen. Similar to the single random specimen from earlier, this sample is used for a
urinalysis and microscopic analysis.

Rapid Urine Test

From the name itself, this test is the quickest way of testing urine. The process
follows dipping a test strip with different colored squares into the urine sample and
letting it stay there for a few seconds. After taking it out, observations are made on the
colored squares to see if they have changed colors according to the substance that is
indicated. A guide on the color changes can be found on the test package.

Urinalysis
This is a common test and is part of routine examinations once a client is
admitted into the hospital. This is usually done after a rapid urine test has abnormal
findings in order to understand these results and detect any complications. Urinalysis is
used to detect substances within the urine (similar to the rapid test) and assess the
characteristics of the urine.

Urine culture
This test indicates the presence of any germs or bacteria within the urine sample.
Bacteria identified within the sample are used to test for possible urinary tract infections
in the client.

37
 CLO#8: STATE THE DIFFERENT METHODS OF
URINE TESTING

CHEMICAL EXAM/ DIPSTICK TEST

A dipstick is a thin, plastic stick with strips of chemicals on it. It is placed in a sample of urine,
in which the chemical strips will change color as a reaction to certain substances. The dipstick
detects abnormalities for the following substances:

● Concentration- A measure of concentration, or specific gravity, shows how

concentrated particles are in your urine. A higher than normal concentration often is
a result of not drinking enough fluids.
● Acidity (pH)- The pH level indicates the amount of acid in urine. Abnormal pH
levels may indicate a kidney or urinary tract disorder.
● Protein- Low levels of protein in urine are normal. Small increases in protein in the
urine usually aren't a cause for concern, but larger amounts may indicate a kidney
problem.
● Sugar- Normally the amount of sugar (glucose) in urine is too low to be detected.
Any detection of sugar on this test usually calls for follow-up testing for diabetes.
● Ketones- Any amount of ketones detected in your urine could be a sign of diabetes
and requires follow-up testing.
● Bilirubin- Bilirubin in your urine may indicate liver damage or disease.
● Evidence of infection- If either nitrites or leukocyte esterase — a product of white
blood cells — is detected in your urine, it may be a sign of a urinary tract infection.
● Blood- Blood in your urine requires additional testing — it may be a sign of kidney
damage, infection, kidney or bladder stones, kidney or bladder cancer, or blood
disorders.

38
 MICROSCOPIC EXAM

In the microscopic exam, A clinical laboratory technician (CLT) or Medical

Laboratory Technician (MLT) looks at drops of urine under a microscope. They look for
above-average levels of the following substances:

● White blood cells - may be a sign of infection

● Red blood cells - may indicate kidney disease, a blood disorder, or bladder
cancer
● Bacteria or yeasts - may indicate infection
● Casts - may indicate a kidney disorder
● Crystals - may indicate kidney stones

VISUAL EXAM

A visual exam for urine is performed when a lab technician examines the visual
appearance of a sample. Urine is usually clear. The technician will look for cloudiness, unusual
odor, or discoloration to determine if the urine sample has any abnormalities or is healthy.
A clouded appearance or unusual odor can indicate problems such as an infection.
Discoloration such as red or brown may be caused by blood. In addition, food that was
consumed prior to urination can change the color of the urine.

39
 CLO#9: ENUMERATE NURSING RESPONSIBILITIES BEFORE,
DURING AND AFTER URINE TESTING

Nursing Responsibilities related to Urine Testing:

BEFORE:
● Obtain informed consent and explain the procedure to optimize the
quality of the specimen.
● Prepare all the materials needed in doing the urine testing.
● Ensure that you have the correct equipment
● Explain the steps of the procedure and how to avoid contaminating the
specimen.
● Identify a suitable location to collect the specimen.
● Ask the patient to wash their hands with soap and water and dry them.
● Put on gloves and apron if you are accompanying the patient or handling
the specimen.
● Instruct the patient to void a small amount of urine into the toilet to
rinse out the urethra, void the midstream urine into the specimen cup,
and the last of the stream into the toilet
DURING:
● Instruct the patient to use the cotton ball or towelette to clean the
urethral area thoroughly to prevent external bacteria from entering the
specimen
● Provide client’s privacy
● Let the patient void into the container.
● Cover the urine container immediately with the lid being careful not to
touch the inside of the container or the inside of the lid.
AFTER:
● Fill out the laboratory request form completely, label the specimen
container with patient identifying information, and send it to the lab
immediately.
● Remove gloves.
● Wash your hands and instruct the patient to do it as well.
● Note that the specimen was collected. Record any difficulties the patient
had or if the urine had an abnormal appea

40
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