The laboratory determinations may vary from hospital to hospital depending upon the techniques used. The normal values with its wide range of variation are given. Urinalysis is about examination of urine – physical, biochemical and microbiological test. We presented normal values, significance or complication and nursing implications for different urine test.

URINALYSIS

Normal Value

Volume – 1200 to 2000 ml/day

Significance

Polyuria (increased urinary output) is seen in cases of diabetes mellitus, diabetes insipidus, and in diuretic therapy. Oliguria (decreased urinary output) is seen in case of dehydration, renal failure, shock, cardiac diseases etc.

Color – pale yellow to deep amber color.

Significance

Deep yellow – concentrated urine

Bright red – fresh blood

Pink color – small amount of blood

Smoky brown – blood pigments

Reddish brown – urobilinogen

Brownish yellow or Greenish yellow – bile pigments

Milky white – chyluria

 

Appearance – clear without any sediment

Significance

A cloudy appearance may be due to the presence of phosphates, urates, pus, and other dissolved particles.

 

Odor – aromatic

Significance

Strong ammoniac smell is due to decomposition of urine on standing. Fruity odor may be due to ketone bodies as seen in diabetes mellitus.

Specific Gravity – 1.015 to 1.025

Significance

The specific gravity may range between 1.001 to 1.060 in pathological states. The specific gravity may be low in renal diseases and it may be high when the urine contains albumin, sugar, urea, phosphate etc. specific gravity is an indicator for the client’s general fluid status and the functions of the kidney to concentrate and dilute urine.

Reaction – pH 4.5 to 8

Significance

Urinary pH is usually reflective of the plasma pH with alkalinization or acidification occurring in order to maintain the body’s acid-base balance.

Nursing Implications

Get fresh urine specimens for reaction. On standing at room temperature the urine becomes alkaline due to the formation of ammonia.

Protein (albumin) – negative

Significance

Albuminuria may be found in nephritis and nephrosis, febrile conditions, poisoning, eclampsia, hypertension, and some forms of cardio-vascular diseases.

Nursing Implications

The urine contaminated with blood, pus, vaginal discharges, seminal fluid etc. may give false reports. Therefore, nurse should instruct the clients how to collect the urine specimens for laboratory tests.

 

AUTHOR: SARIMA ALE MAGAR 

FAECES

Color – light to dark brown

Significance

Melaena (tarry black stools) indicate bleeding into upper G.I. tract, the blood being altered by the gastro-intestinal juices or it may result from the administration of iron

Clay colored stools indicate obstruction to the flow of bile into the intestinal canal.

Presence of blood in large amounts is suggestive of bleeding piles, destruction of a blood vessel in the large intestines by an ulceration process or contamination of the stool with menstrual blood.

Blood and mucus are found in amoebic dysentery.

 

Microscopic Examination

RBC – Nil

WBC – Nil

E.H. cyst – Nil

E.coli – Nil

Ova – Nil

Significance

Pus cells are seen in bacillary dysentery. E.H. cyst is found in amoebic dysentery. E.coli are non pathogenic and is commonly found in colon. Presence of ova indicates presence of roundworm, pinworm or whipworm. The ova of each worm have its own characteristics. Segments to tapeworm are seen in tapeworm infestation.

 

Occult blood – Negative

Significance

Positive occult blood is seen in melaena.

Hanging drop – Negative

Significance

Vibrio cholerae is seen by its motility in cases of cholera infection.

Nursing Implications

The stools should be freshly collected. It should be examined without any delay.

 

SPUTUM

Amount – normally no sputum is expectorated.

Significance

Presence of sputum indicates respiratory infection and inflammation.

 

Microscopic examination

Polymorphonuclear cell – a few

Significance

Polymorphonuclear cells are found in large numbers along with lymphocytes, in cases of lung diseases and tuberculosis.

Lymphocytes – a few

Eosinophils – nil

Significance

Eosinophils are seen in conditions of asthma, allergic conditions etc.

A.F.B – nil

Significance

A.F.B. will be positive in cases of tuberculosis of the lungs.

 

SEMEN ANALYSIS

Ejaculate Volume – 1.5 to 7 ml.

Significance

Aspermia (absence of ejaculate) is seen with incompetent bladder neck following surgery of the neck of the bladder. It may also indicate a hypoandrogenic state.

Sperm count – 60 to 150 million per ml.

Significance

Azoospermia (absence of sperm in the semen) is associated with primary testicular disorders of complete obstruction of the seminal tract.

Motility – motile – (80%), sluggish – (20%)

Significance

Oligospermia (lowered sperm density) is often associated with decreased spermatogenesis. A sperm density of less than 20 million/ml is considered as infertile

 

Morphology – 80% normal size and shape

Significance

Decreased sperm motility and abnormal forms are also contributory factors in infertility.

URINALYSIS, FAECES, SPUTUM AND SEMEN ANALYSIS – NORMAL VALUES, SIGNIFICANCE AND NURSING IMPLICATIONS 

Bence-Jones protein – negative

Significance

Bence-Jones protein is precipitated between 40 to 60 degree celcius and it disappears when boiling point is reached. Bence-Jones protein is present in cases of multiple myeloma.

Sugar – Negative

Significance

Sugar in the urine (Glycosuria) is found in uncontrolled diabetes mellitus, pancreatic disorders and impaired tuber reabsorption. Glysosuria may normally result from eating a heavy meal or from emotional stress. I.V. Infusions of glucose also may rise the blood glucose level above the renal threshold.


Acetone – Negative

Significance

Acetone (ketone bodies) is found in the urine when the body’s fat is metabolized for energy, producing excess metabolic end products. This occurs in uncontrolled diabetes, starvation, severe infection accompanied by vomiting and diarrhea, pregnancy and lactation.

Bilirubin – Negative

Significance

Bilirubinuria is usually indicative of biliary tract obstruction. Other causes include hepatitis, portal inflammation, hepatocellular damage.

 

MICROSCOPIC EXAMINATION

TEST

RBC – Nil

Significance

Haematuria (RBC in the urine) often indicates pathology. It is found in glomerulonephritis, tuberculosis of the kidney, renal calculi, sickle cell anaemia, tumors of the kidney, systemic lupus erythematosus, anti-coagulation therapy, excessive use of analgesics etc.

Nursing Implications

When collecting urine from a menstruating woman, the nurse has to be careful to get the urine without contaminating it with blood.

When a client complains of haematuria, it is necessary to note whether the bleeding takes place at the beginning or at the end of each voiding.

WBC – Nil

Significance

The presence of WBC (pus cells) in the urine designates an infectious process somewhere in the urinary tract.

Casts – Nil

Significance

Presence of casts indicates tubular or glomerular diseases.

Hyaline casts are found normally after strenuous excercises, but their presence in people at rest may indicate acute glomerulonephritis, malignant hypertension, acute pyelonephritis, chronic renal diseases, congestive heart failure or diabetic nephropathy.

Red cell casts may denote bleeding within the nephron as a result of glomerulonephritis, acute tubular nephrosis, systemic lupus erythematosus, subacute bacterial endocarditis, diabetic nephropathy etc.

White cell casts are hard to distinguish from epithelial casts which denote sloughing of the renal tubular epithelium due to eclampsia, poisoning with heavy metals and acute renal allograft rejection.

Granular casts indicate such disorders as renal parenchymal diseases, pyelo-nephritis, chronic lead poisoning, viral diseases and acute renal rejection.

 

Crystals – Nil

Significance

Crystalluria may or may not indicate pathology. The presence of crystals in the urine is an important predisposing factor in calculus formation. Common findings are calcium oxalate, uric acid, and urate in acid urine; phosphate, amorphous phosphates and carbonates in alkaline urine.

Bacteria – Nil

Significance

Since the urine is normally sterile, bacteriuria represents infection within the urinary tract.

Some special tests are carried out in order to isolate micro-organism for the diagnosis of diseases involving the urinary tract, some of them are:

AFB – for the diagnosis of tuberculosis of the kidney

Gram’s stain – for the diagnosis of gonorrhea

Culture – for the diagnosis of urinary tract infection

Animal inoculation – for the diagnosis of Weil’s diseases etc

urinalysis, faeces, sputum and semen analysis

QUANTITATIVE AND QUALITATIVE ANALYSIS OF URINE

Amylase – less than 400 IU/I

Significance

Amylase is increased in acute pancreatitis. Calcium excretions are increased in hyperparathyroidism, Vit. D. intoxication etc. it is reduced in hypoparathyroidism and Vit. D deficiency.

Nursing Implications

For qualitative test, random specimen is taken. For quantitative test 24 hour urine specimens are collected.

 

Calcium – less than 5 mmol/24 hours or less than 150 mg/24 hours

Significance

Calcium excretions are increased in hyperparathyroidism, Vit. D. intoxication etc. it is reduced in hypoparathyroidism and Vit. D. deficiency.

 

Chloride – 200 mmol/24 hours or 70 to 250 mEq/24 hours

Significance

Urine chloride levels vary with excretion of sodium, potassium, ammonia and bicarbonates.

Chorionic gonadotrophin (pregnancy test) – Negative

Significance

Positive results are seen in pregnancy, chorionepithelioma and hydatidiform mole.

Nursing Implications

Collect concentrated morning specimens

 

Creatinine – 18 mmol/24 hours or 0.8 to 2 gm/24 hours

Significance

Increased levels are seen in typhoid fever, salmonella infections and tetanus. It is decreased in muscular atrophy, anaemia, leukaemia and advanced degeneration of kidneys.

 

Potassium – 40 to 65 mEq/24 hours or less than 70 mmol/24 hours

 

Sodium – 120 to 220 mmol/24 hours or 120 to 220 mEq/24 hours

 

Protein (qualitative) - Negative

Significance

(Described under urine albumin)

Nursing Implications

Random specimens are collected.

 

Protein (quantitative) – 10 to 100 mg/24 hours

Nursing Implications

24 hours urine specimens are collected

Glucose (qualitative) – Negative

Significance

(Described under Urine sugar)

Nursing Implications

Random specimens are collected

 

Glucose (quantitative) – less than 100 mg/24 hours

Nursing Implications

24 hours specimens are collected. Collect urine with toluene (preservative).

 

Porphobilinogen (qualitative)
– Negative

Significance

Positive results are seen in acute porphyria and liver diseases.

Nursing Implications

Collect fresh urine for qualitative tests and protect the urine from direct light

 

Prophobilinogen (quantitative) – 1 to 10 umol/24 hours or 0.2mg to 2 mg/24 hours

 

Urobilinogen – random urine less than 25 mg/dl, 24 hours urine in 6.7 umol/24 hours or upto 4 mg/24 hours

Significance

Increased levels are seen in liver diseases, biliary tract diseases and haemolytic anaemias. Reduced excretions are seen in complete or nealy complete biliary obstruction, diarrhea, renal insufficiency etc.

Nursing Implications

24 hours urine specimens are collected in dark bottles with 5 gm sodium carbonate

 

Uric acid
– 2.4 mmol/24 hours or 250 to 750 mg/24 hours

Significance

Increased in gout and reduced in nephritis