Health history to review the patient’s patterns of urinary elimination, symptoms of urinary alternations, any history of kidney issues, if this is a reoccurrence, and if the patient is taking any other medication that could cause these symptoms. The health history is important because it also includes the history of the current illness which identifies why the patient is seeking care.
Physical assessment to provide data to determine the severity of urinary elimination problems focusing on the kidneys and abdomen (Potter & Perry, 2014, pg. 1122-1123). The left costovertebral angle tenderness test is important to determine flank pain and if the infection has reached the patient’s kidneys (upper urinary tract) (Potter & Perry, 2014, pg. 1122-1123). Furthermore, and abdominal assessment is important to assess the bladder, any abdominal distention, pain and tenderness (Potter & Perry, 2014, pg. 1122-1123). In the physical assessment, a pain assessment should also be included to gain a better understanding of how the patient is feeling.
Assessment of the urine via a midstream urine collection is important to determine the physical characteristics of the urine (colour, clarity, odour) as well. In a patient with a urinary tract infection a nurse can expect the patient’s urine to be concentrated, blood tinged or a presence of small blood clots, cloudy, and have a foul smell (Potter & Perry, 2014, pg. 1123). At this time a nurse can assess the urine for leukocytes and nitrites using a dipstick urinalysis.
Health [Online Image]. n.d. Retrieved June 6, 2016 from http://www.gobeyondthegrid.com/health/
[Untitled illustration of a Dipstick Urinalysis]. Retrieved May 17. 2016 from http://thenursepath.com/2013/10/29/how-to-perform-a-urinalysis/
Interpretation of Urinalysis and Urine Culture for UTI treatment [Online Image]. (2013). Retrieved June 6, 2016 from https://www.uspharmacist.com/article/interpretation-of-urinalysis-and-urine-culture-for-uti-treatment
DIAGNOSTIC TESTS
Urine collection of a midstream sample to send to labs for a urine analysis. The procedure for collecting a midstream sample requires the patient to clean their perineal are from front to back (women) or the end of the penis in a circular motion (Potter & Perry, 2014, pg. 1126). Afterwards, have the patient begin urinating. When an initial stream is achieved, have the patient collect their urine (Potter & Perry, 2014, pg. 1126). The purpose of a midstream collection is to prevent the transfer of microorganisms in to the urine specimen (Potter & Perry, 2014, pg. 1126). A urinalysis detects the presence of abnormalities in the urine such as increased RBCs, WBCs, nitrites, and bacteria which would indicate a urinary tract infection.
Dipstick Urinalysis is completed to determine if there are any leukocytes and nitrites present in the mid-stream urine sample. An identification strip is dipped into a midstream collection of the patient’s urine which will cause the different areas on the strips to turn different colours. A health care professional will match colours to the legend on the dipstick urinalysis bottle to indicate if the urine is positive for nitrites (after waiting for 60 sec) or leukocytes (after 2 min). The stick turning to light pink – dark pink is a positive test for nitrates. The stick turning beige- dark purple is a positive test for leukocytes.
Urine culture and sensitivity is conducted by the lab to detect the growth of bacteria in the urine which would indicate a urinary tract infection (Potter & Perry, 2014, pg. 1127). The culture represents the type of bacteria present and the sensitivity will indicate which antibiotics the bacteria are sensitive to (McCance et al., 2014, pg. 1336).