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