Nursing Skill: Urinalysis Test And Vital Signs

Essential principles underpinning the skill

Nurses are responsible for providing hands-on care to all patients in variety of Healthcare settings. The primary objective of hands-on care is to prevent or manage a particular disease. The major professional skills that enhance nursing career encompass effective communication capabilities, flexibility, critical thinking power, attention to detail and the desire to learn

The essay will present discussion on urinalysis test and vital signs, that was conducted during assessment of a patient. It will outline the details of steps involved in tests and will discuss the vital principles that underlie the skill. It will also illustrate relevant anatomy and physiology in relation to maintainence of homeostasis in the human body. The observations will be discussed in the conclusion, followed by a reflection of the nurse involved in this assessment.

The urinalysis test is a commonly used diagnostic test conducted for diagnosing urinary tract or kidney infections and measuring the level of urine electrolytes. A visual examination of urine, followed by a dipstick test was performed for the urinalysis procedure. Urinalysis experiment involved taking consent from the patient, followed by hand-washing, and putting on gloves and apron to prevent infection. The patient details were checked on the sample bottle and that urine had been collected within past 4 hours. The colour, clarity, and odor of urine were noted. Urine dipsticks were used. The caps were removed and a strip was taken out, without touching the other areas. These strips were dipped completely in urine, followed by holding them horizontally against the dipstick analysis. The strips were read after proper time, 60 seconds for protein and 30 seconds for glucose. They were then discarded along with the aprons and gloves, followed by washing of the hands. All findings were recorded and analyzed.

Vital sign assessment generally includes information on respiratory rate, body temperature, blood pressure and heart rate (Khan et al. 2016). Normal ranges for vital signs are 12-18 breaths/minute, 60-100 heart beats/minute, a temperature of 37°C and BP ranging from 90/60-120/80 mm Hg (Yoder et al. 2013). Blood pressure indicates pressure of circulating blood on blood vessel walls. An electronic sphygmomanometer containing an inflatable cuff was used to gauge changes in the blood pressure. The cuff of the spyhgmomanometer was wrapped around the right arm, an inch above the elbow. A quality stethoscope was positioned over brachial artery and the cuff was inflated above its normal levels until there was no sound. The valve was slowly open, followed by deflating the cuff. First appearance of sound (korotkuff) and its subsequent disappearance denoted the systolic and diastolic pressure. The pressure was recorded. Although most of the time the patient manifested blood pressure in normal ranges, the systolic blood pressure was found to be 130 mm Hg once. This systolic hypertension can be attributed to stiffness of the arteries (Yano et al. 2015). High systolic pressure increases the risk of the patient from suffering from cardiovascular problems such as stroke or heart attack. It will also increase pressure on the ventricles and will compromise with the coronary blood flow (Kaess et al. 2012). This increase in blood pressure can be attributed to elevated levels of ketone in the urine of the patient, as evident from the urinalysis reports (Schinstock et al. 2012).

Urinalysis test and observations

The urinalysis chart suggests that patient reported negligible amounts of nitrite, blood, protein and leukocytes in the urine. This helps in determining that the patient is not suffering from chronic obstructive jaundice or any hepatic abnormalities. Presence of less than normal (0.3 mg/dL) bilirubin indicates absence of hepatic diseases. High levels of bilirubin suggest underlying problems involving the liver, gallbladder and RBCs (Choi, Yun and Choi 2013). The patient chart also demonstrates the normal level of pH in the urine. Due to the fact that urine is slightly acidic, pH of 6-6.5 indicates that they fall within the normal range (Hara et al. 2012). However, moderate amount of ketones and glucose in the urine indicates presence of ketonuria and acts as a diagnosis for diabetes mellitus (Luethi et al. 2016). Production of excess ketone often occurs when it is used as an alternative source of energy during starvation or diabetes. Failure of the body to use the available carbohydrate as an energy source results in the production of ketones as metabolic by-product (Peters et al. 2015). Thus, ketone buildup in the urine indicated presence of urinary tract infection, which in turn contributed to hypertension. The lower than normal bilirubin levels are not a major concern for the patient. This hypertension can also be directly correlated with moderate glucose levels in the body. 

Body temperature recordings provide an indication of the core temperature of the body that is maintained by heat balance, produced and lost from the body. To record body temperature, a mercury thermometer was held firmly at its clear end, while clicking it for a number of times. The silver end was kept pointed downwards. It was ensured that the mercury showed a range below normal temperature.  The silver tip was placed under the left armpit that clasped it against the chest for 3-4 minutes. The rise in mercury mark was measured. An increase in body temperature has been observed in the patient. Body temperature of 38°C acts as a probable indicator of infection or inflammation (Tiainen et al. 2013). It can also be attributed to side effects of the drugs that were administered. Pulse rate refers to the rate in which the heart beats during circulation of blood through arteries. The first three fingers were used to palpate radial pulse of the patient in the inner lateral list. A standard electrocardiogram was also used. The heart rate was found to be 100 and 110 twice, which indicates tachycardia. This makes the heart pumps blood less efficiently, the rest of the body gets low blood supply. Increase in heart rate also increases the oxygen demand, which can act as a risk factor for development of ischemia (Fenoglio et al. 2015). Respiratory rate refers to the rate in which a normal person breathes. Respiratory rate was measured using a respirometer that measured the exchange of carbon di oxide and oxygen. The respiratory rate was found higher than the normal range, twice. This increase indicates presence of tachypnea. This can be contributed to a rise in carbon dioxide in the alveoli which results in hyperventilation (Bianchi et al. 2013).

Vital signs assessment and observations

Homeostasis refers to presence of stable operating conditions in the blood and interstitial fluid of a patient. Homeostasis helps the human body to maintain constancy in the internal environment regardless of changes in the external environment (Riganello, Garbarino and Sannita 2012). The kidneys are paired organs that are responsible for maintaining homeostasis, through regulation of acid-base balance, body fluids and electrolyte balance in the body. This is achieved by excretion of waste products, and maintainance of blood pressure. The general mechanism of homeostasis includes regulating the volume of water, blood and interstitial fluids. Failure to retain water, or edema presents in the form of swelling of the knees and ankles. Reabsorption of necessary substances, such as, calcium, sodium, bicarbonate, carbohydrates, amino acids and water also maintain a steady state. Regulating the pH and normal blood pressure by controlling sodium and water levels are also essential (Grabias and Konstantopoulos 2013). Recording the body temperature helps in establishing a baseline and measures presence of inflammation of systemic infection in the body. During exercise, the heart rate increases due to transmission of electrical impulses to the heart. On the other hand at the end of exercise the heart rate returns to normal and maintains homeostatic balance (Noakes 2012).

At rest, steady breathing rate is maintained in the body. However, while performing rigorous activities oxygen levels in the blood get reduced, and carbon dioxide amounts increases. This controlled by the respiratory control centre present in the brain (Riganello, Garbarino and Sannita 2012). Concentration of carbon dioxide also determines the pH of blood. Baroreceptors are located in the walls of the cardiac muscle and sensors changes in blood pressure, followed by sending impulses to the medulla oblongata. On the other hand, an increase in blood sugar level is sensed by the pancreas that secretes insulin to increase glucose abosorption and its conversion to glycogen. In addition, glucagon hormone is secreted when the blood glucose levels fall below normal ranges. The hormone reconverts glycogen to glucose, thereby maintaining homeostasis (Heer and Egert 2015).

Therefore, I realized that observation charts act as essential components of physiological response. I further realized that measuring vital signs that includes blood pressure is imperative in the nursing profession as it provides a clear concept of the potential abnormalities (if any) that exist in the physiological system of a particular patient. I also understood that it is essential to maintain a steady blood pressure, failure to do which can result in potentially fatal consequences. The findings of the report state that the patient is suffering from hypertension, tachycardia and ketosis, which in turn indicates presence of infections in the body. Owing to the fact that my duty as a nursing professional portrays me as a frontier of healthcare, I fostered an open dialogue with the patient and the family members while recording the observations. I reassured the patient that all possible efforts will be taken to ensure his optimal health and safety. I immediately consulted my mentor, a senior RN and the concerned physician about the irregularities in the vital signs and glucose levels in urine. I showed them the recordings that I had made and asked for their advice on what medications should be administered to the patient. Upon consultation, I followed their orders and tried to improve the health status of the patient.

Homeostasis and its role in maintaining stable operating conditions

References

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Choi, S.H., Yun, K.E. and Choi, H.J., 2013. Relationships between serum total bilirubin levels and metabolic syndrome in Korean adults. Nutrition, Metabolism and Cardiovascular Diseases, 23(1), pp.31-37.

Fenoglio Jr, J.J., Pham, T.D., Harken, A.H., Horowitz, L.N., Josephson, M.E. and Wit, A.L., 2015. Recurrent sustained ventricular tachycardia: structure and ultrastructure of subendocardial regions in which tachycardia originates. The Josephson School: A Legacy of Important Contributions to Electrophysiology, 68(3), p.187.

Grabias, B.M. and Konstantopoulos, K., 2013. The physical basis of renal fibrosis: effects of altered hydrodynamic forces on kidney homeostasis. American Journal of Physiology-Renal Physiology, 306(5), pp.F473-F485.

Halbesleben, J.R., Rathert, C. and Williams, E.S., 2013. Emotional exhaustion and medication administration work-arounds: the moderating role of nurse satisfaction with medication administration. Health care management review, 38(2), pp.95-104.

Hara, S., Tsuji, H., Ohmoto, Y., Amakawa, K., Hsieh, S.D., Arase, Y. and Nakajima, H., 2012. High serum uric acid level and low urine pH as predictors of metabolic syndrome: a retrospective cohort study in a Japanese urban population. Metabolism-clinical and Experimental, 61(2), pp.281-288.

Heer, M. and Egert, S., 2015. Nutrients other than carbohydrates: their effects on glucose homeostasis in humans. Diabetes/metabolism research and reviews, 31(1), pp.14-35.

Kaess, B.M., Rong, J., Larson, M.G., Hamburg, N.M., Vita, J.A., Levy, D., Benjamin, E.J., Vasan, R.S. and Mitchell, G.F., 2012. Aortic stiffness, blood pressure progression, and incident hypertension. Jama, 308(9), pp.875-881.

Khan, Y., Ostfeld, A.E., Lochner, C.M., Pierre, A. and Arias, A.C., 2016. Monitoring of vital signs with flexible and wearable medical devices. Advanced Materials, 28(22), pp.4373-4395.

Luethi, N., Cioccari, L., Crisman, M., Bellomo, R., Eastwood, G.M. and Mårtensson, J., 2016. Prevalence of ketosis, ketonuria, and ketoacidosis during liberal glycemic control in critically ill patients with diabetes: an observational study. Critical Care, 20(1), p.297.

Noakes, T.D.O., 2012. Fatigue is a brain-derived emotion that regulates the exercise behavior to ensure the protection of whole body homeostasis. Frontiers in physiology, 3, p.82.

Peters, A.L., Buschur, E.O., Buse, J.B., Cohan, P., Diner, J.C. and Hirsch, I.B., 2015. Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium–glucose cotransporter 2 inhibition. Diabetes care, 38(9), pp.1687-1693.

Riganello, F., Garbarino, S. and Sannita, W.G., 2012. Heart rate variability, homeostasis, and brain function: A tutorial and review of application. Journal of Psychophysiology, 26(4), p.178.

Schinstock, C.A., Semret, M.H., Wagner, S.J., Borland, T.M., Bryant, S.C., Kashani, K.B., Larson, T.S. and Lieske, J.C., 2012. Urinalysis is more specific and urinary neutrophil gelatinase-associated lipocalin is more sensitive for early detection of acute kidney injury. Nephrology Dialysis Transplantation, 28(5), pp.1175-1185.

Tiainen, M., Meretoja, A., Strbian, D., Suvanto, J., Curtze, S., Lindsberg, P.J., Soinne, L. and Tatlisumak, T., 2013. Body temperature, blood infection parameters, and outcome of thrombolysis?treated ischemic stroke patients. International Journal of Stroke, 8(8), pp.632-638.

Yano, Y., Stamler, J., Garside, D.B., Daviglus, M.L., Franklin, S.S., Carnethon, M.R., Liu, K., Greenland, P. and Lloyd-Jones, D.M., 2015. Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study. Journal of the American College of Cardiology, 65(4), pp.327-335.

Yoder, J.C., Yuen, T.C., Churpek, M.M., Arora, V.M. and Edelson, D.P., 2013. A prospective study of nighttime vital sign monitoring frequency and risk of clinical deterioration. JAMA internal medicine, 173(16), pp.1554-1555