Nursing Diagnoses associated with Urine Testing
|Lab test result||Nursing diagnoses||Nursing Process|
|Acid or alkaline pH||Knowledge deficit related to measures to control urine pH||Usually
changes in the urine pH are not clinically significant,
because the pH changes with diet and the individual's
metabolic state. In some situations it is important to
keep the urine alkaline or acid. For example, if the
person has a tendency to form uric acid or cystine
stones, it may be desirable to keep the urine alkaline or
less acidic than normal. Medications may be given to make
the urine more alkaline and the nurse may need to teach
the patient how to use a dipstick to monitor urine pH.
In other situations, it is desirable to keep the urine acidic. It may be important to avoid having an alkaline urinary pH because alkaline urine promotes the growth of certain organisms in the urine, and alkaline urine promotes the formation of calcium phosphate renal stones in susceptible clients. Calcium oxalate stones are not affected by urine pH.
Some patients are prone to form renal stones. Quadriplegics may have high calcium content in the urine due to impaired mobility, and are also at high risk of developing urinary tract infections because of urinary stasis caused by loss of bladder control. Increasing the acidity of the urine may help prevent both infections and calcium stones. Cranberry juice or vitamin C tablets may be given to increase urine acidity. Milk products and citrus fruits, which make urine more alkaline, may be limited.
|Elevated specific gravity||Fluid volume deficit||A specific gravity that continues to
rise or that remains high when a patient is not
physiologically stressed is usually an indication that
the person is not receiving adequate fluid intake.
Acutely ill patients may need additional intravenous
fluids. In the nursing home or community setting, it may
be necessary for the nurse to problem solve ways to
increase oral fluids. The nurse should document specific
gravity results rather than describing the urine as
The nurse also needs to be aware of patients whose specific gravity is elevated due to an abnormal fluid shift into a third space. The normal two spaces containing body fluids are the intracellular space and the extracellular or intravascular space. Third spacing occurs due to a movement of fluid into the interstitial space, as with edema or ascites. Third spacing creates the potential for hypovolemia and decreased urine output. A patient with significant third spacing will have a high urine specific gravity.
|Low specific gravity||Potential for fluid volume excess||A patient with a low specific gravity may have a fluid intake that is higher than physiologic needs. Patients may receive intravenous fluids in addition to oral intake. It is important to monitor urine specific gravity, along with intake and output, weight, and vital signs to assess for fluid volume excess. A patient with fluid volume excess may have a low urine specific gravity, a rising blood pressure, bounding pulse, and a sudden increase in weight.|
|Potential alterations in health management||A specific gravity that remains low when the fluid intake is not increased is a potentially serious sign that needs medical evaluation. A low specific gravity found on a routine early morning specimen indicates the need for an assessment of the renal system and evaluation of anti-diuretic secretion. A fixed specific gravity that does not change in response to fluctuations in fluid status indicates that the kidneys are impaired in their ability to concentrate urine. When a patient has a low fixed specific gravity, adequate hydration is very important to allow the kidneys to remove waste products from the blood.|
|Proteinuria||Alteration in health management||For a patient who is pregnant, a check for protein in the urine is a routine part of each prenatal visit. If repeated dipsticks with a clean-catch specimen show proteinuria, a quantitative analysis is done. In pregnancy, a 24-hour urine for protein should not contain more than 500 mg of protein. If the patient begins to develop proteinuria, it is important to assess for hypertension and edema. Proteinuria, hypertension, and edema are the classic triad for preeclampsia.|
|Glycosuria||Potential for fluid volume deficit||A high concentration of sugar in the blood acts as an osmotic diuretic. Water is excreted as the sugar spills into the urine, creating the potential for a significant fluid volume deficit. A finding of glycosuria indicates that the patient needs additional fluids and may develop severe dehydration if the glycosuria is allowed to continue. If the glycosuria is due to hyperalimentation therapy, the physician may order the rate of infusion slowed down or insulin to help the patient handle the larger than normal glucose load. In the diabetic patient, a continued spilling of sugar leads not only to severe dehydration, but also to ketonuria and eventually to ketoacidosis as the ketone bodies build up in the serum. A positive acetone with a positive sugar indicates a need for immediate medical intervention.|
|Ketonuria||Potential for injury related to development of diabetic acidosis||If a person is a known diabetic, ketonuria indicates that an abundance of glucose is in the bloodstream, but is not available to the cells. When lack of insulin prohibits the transport of glucose to cells, the patient switches to using fats as a primary source of energy. As ketones accumulate due to fat metabolism, they use up the body's bicarbonate buffer system, producing ketoacidosis. The treatment for diabetic ketoacidosis is to increase insulin so that glucose can reach the cells and be used as the primary energy source.|
|Alteration in nutrition needs/less than body requirements for carbohydrates||If urinary acetone is positive and the glucose is negative in both the blood and the urine, the patient is consuming fewer carbohydrates than are needed for body requirements. The nurse should assess whether the person has been vomiting, is on a severe weight reduction diet, or on an all-protein diet. The patient who is spilling urine acetone needs glucose in some form so that fats and proteins do not continue to be the primary source of energy, and also needs extra fluids so that the kidneys can excrete the ketones. Patients who are receiving high protein tube feedings may have ketonuria unless they also receive an adequate amount of glucose in the feeding, along with sufficient water.|