Resi school

All urine has specific physical properties and biochemical markers that must be documented with every urinalysis as a descriptive word or number.

Physical Properties

• Colour:

  • Standard ranges: can be a combination of pale, dark, straw, amber, rose, or haematuria.

  • Anomalies: some vitamins and medical dyes can cause fluorescent yellow, green, or blue urine.

• Clarity:

  • Descriptors used: Clear, slightly cloudy, cloudy, or turbid.

• Odour:

  • Freshly voided urine: Should have a slight but inoffensive smell.

  • Fishy/Ammonia smell: May indicate a Urinary Tract Infection (UTI).

  • Sweet or Acetone smell: May indicate the presence of ketones, commonly found in diabetic ketoacidosis.

  • Dietary influences: Strongly flavoured foods like asparagus can produce a distinct odour.

• pH Level ($4.5-8.0$):

  • Indicates acid-base balance.

  • Scaling: The higher the number, the more basic (alkaline) the urine is. The lower the number, the more acidic the urine is.

  • Stability: Urine that stands for several hours becomes alkaline.

• Specific Gravity (SPG) ($1.000 - 1.030$):

  • Identifies hydration status by measuring the concentration of particles in the urine.

  • Well-hydrated individuals will have a low SpG.

  • Dehydrated individuals will have a high SpG.

Biochemical Markers and Clinical Significance

• Leukocytes (Negative to $+$): Usually associated with a urinary infection.

• Glucose (Negative):

  • Positive results often indicate diabetes due to the kidneys' inability to reabsorb high glucose concentrations.

  • May also occur in healthy people following high-glucose ingestion.

• Nitrites (Negative): Presence may indicate a UTI, as some bacteria convert nitrate into nitrite.

• Protein (Negative):

  • Protein molecules are typically too large to pass through a healthy kidney.

  • Positive results indicate kidney damage caused by hypertension, kidney disease, or diabetes mellitus.

• Ketones (Negative):

  • Formed during abnormal breakdown of fat.

  • Present in cases of prolonged vomiting, fasting, starvation, or poorly controlled diabetes.

• Urobilinogen and Bilirubin: (Mentioned as part of the assessment list).

Infection Prevention and Control Protocols

Health care workers must identify and follow established organizational infection prevention and control procedures.

Hand Hygiene and Hand Care

• Hand Washing Technique: Use soap and water for a minimum of $30\,\text{seconds}$.

• Alcohol-based hand rub (ABHR): Use as a valid hygiene technique when appropriate.

• Hand Maintenance: Care for hands and follow procedures for covering cuts and abrasions to maintain safety.

Personal Protective Equipment (PPE)

• Donning and Doffing: The correct process must be applied based on the clinical task. Equipment includes:

  • Gown

  • Mask

  • Goggles

  • Gloves

• Additional Precautions: Identify specific scenarios where additional precautions beyond standard PPE are required.

Waste and Environment Management

• Waste Handling: Correct use of sharps containers, clinical waste receptacles, general waste bins, and linen skips.

• Work Zones: Enforcement of clean and contaminated zones, including identification of storage for sterile/clean stock and use of patient hygiene areas.

• Contamination Limitation: Management of exposure to body fluids, infectious material, and waste through standard and additional precautions.

Manual Handling and Patient Repositioning

Manual tasks must involve controls to minimize the risk of harm to both the patient and the healthcare worker.

• Slide Sheet: Used to reposition a patient in bed safely.

• Hoist: Used for the transfer of a patient from one surface to another.

• Hazard Identification: Verbalize any evidence of existing or potential hazards before performing manual tasks.

• Debriefing: Participation in sessions to discuss individual needs arising from manual handling.

Clinical Observation and Assessment Skills

Blood Glucose Level (BGL) Assessment

• Process: Obtain a blood sample and load it into a glucometer according to instrument instructions.

• Interpretation: Identify abnormalities or variations and associated risk factors.

• Reporting: Document results and report them directly to the Registered Nurse (RN) or Team Leader.

Neurological and Neurovascular Observations

• Neurological: Includes assessment of reflexes and pupils using appropriate tools and obtaining client feedback.

• Neurovascular: Assessment of peripheral circulation using appropriate tools and documenting status changes.

Pain Assessment (PQRSTU Mnemonic)

• P (Provoking): What causes the pain?

• Q (Quality): What does the pain feel like?

• R (Radiating/Region): Where is the pain located and does it spread?

• S (Severity): How intense is the pain?

• T (Time): When did it start? How long does it last?

• U (Understanding): What is the patient's perspective/understanding of the pain?

Healthcare Admission and Risk Assessment Tools

Falls Risk Assessment Tool (FRAT)

Risk ranges: $0-10$ (Low Risk), $11-20$ (Moderate Risk), $21-36$ (High Risk).

• Categories for Scoring:

  • Age: $0-19$ (0), $20-59$ (1), $60-65$ (2), >65 (3).

  • Falls History: None (0), Fall in last $6-12\,\text{months}$ (1), Fall in last $2-5\,\text{months}$ (2), Fall this month (3).

  • Mobility: Ambulates alone (0), Ambulates with device/1 person (1), Ambulates with device/2 people (2), Bedfast/Chairfast (3).

  • Mental State: Orientated (0), Orientated to person/place (1), Orientated to person (2), Disorientated/Impulsive (3).

  • General Health: Well-nourished (0), Poor appetite/sleep (1), Severe sleep disturbance (2), Malnourished (3).

  • Observations: Assessment of vision, hearing, and speech defects.

  • Medications: CNS effectors (Sedatives, Psychotropic) and CV effectors (Beta-blockers, Diuretics).

  • Incontinence: Stress (2), Urge/Poor condition/Indwelling Catheter (IDC) (3).

Adult Pressure Injury Risk Assessment (Waterlow)

Risk values: $10+$ (At Risk), $15+$ (High Risk), $20+$ (Very High Risk).

• BMI Calculation: $\text{BMI} = \frac{\text{Weight(kg)}}{\text{Height(m)}^2}$

  • Average ($20-24.9$): 0

  • Above average ($25-29.9$): 1

  • Obese (>30): 2

  • Below average (<20): 3

• Malnutrition Screening Tool (MST):

  • Lost weight without trying? ($1-5\,\text{kg}$ = 1, $6-10\,\text{kg}$ = 2, $11-15\,\text{kg}$ = 3, >15\,\text{kg} = 4).

  • Eating poorly due to decreased appetite?

• Skin Inspection Factors:

  • Erythema, blanching response, localised heat, oedema, induration, and skin breakdown.

  • Skin types: Healthy (0), Tissue paper (1), Dry (1), Oedematous (1), Clammy/pyrexia (1).

General Risk Assessment Matrix

Risk is determined by the intersection of Likelihood and Impact.

Scenario: Mr Malcom Speedy

• Patient Profile: 76-year-old male in a healthcare facility.

• Status: Full bed rest and has been incontinent.

• Required Care Tasks:

  • Perform a full sponge bath.

  • Change bed sheets while the patient is in bed.

  • Perform and interpret urinalysis for UTI risk.

  • Report abnormalities to RN/Team Leader.

  • Implement pressure injury prevention strategies based on bed rest status.