MSU and Urinalysis is a new skill added to NMC OSCE from September 2019. The time limit for this skill is 15 minutes during which you need to collect urine and do the analysis.

MSU and Urinalysis for NMC OSCE

Introductory Phase

Check for scene safety, approach patient only after ensuring that scene is safe to approach.

You have to introduce yourself as the nurse taking care of the patient, after doing a handrub using seven steps of hand hygiene.  There is no need to verbalize these seven steps as it is clearly mentioned in OSCE Marking Criteria.

Confirm Patient identity using three checks (Full Name, Date of Birth, Hospital Number)

Provide Privacy to patient.

Ask for any pain or allergies (Sometimes urine may be collected because of a suspecting urinary infection in which patient might have pain while passing urine)

Make sure that patient is not on drugs like Ascorbic acid, L – Dopa, Nalidixic acid, Pyridium, Rifampicin or Aspirin which will give a wrong result.

Ask for need for Chaperone in case if the patient is of opposite sex

Explain the procedure to the patient and gain consent

“Tell the patient why urine is examined (given in scenario), how urine is collected and how you will carry out the urine analysis. Tell patient this is not an invasive procedure and he/she will not have any pain during the process”

Assembling of Articles

You will need apron, glove box, disposible tray with wide mouthed sterile container, urinal or bed pan, universal urine specimen bottle, sterile water with wipes, yellow bag for putting on the waste and a trolley with urine analysis strips.

Confirm with the examiner that the trolley is cleaned within 24 hours and ready to use.

Place all the articles on the trolley after checking the expiry date of each item.

Usually the specimen bottle is pre – labelled. Cross check the details in the bottle as per scenario.

Do a thorough handwashing using seven steps of hand hygiene, wipe from clean to unclean area.

Wear an apron and head your trolley towards bedside of patient.

Procedural Phase

Make sure that the privacy of patient is maintained

For male Patient

If patient is doing himself, Ask patient to wash hands with soap and water prior procedure to prevent cross contamination.

Ask patient to retract the foreskin and clean the skin surrounding the urethral meatus with 0.9% sodium chloride solution.

Ask patient to begin voiding first stream of urine (approx. 15–30 mL) into a urinal or bedpan.

Place the wide-necked sterile container into the urine stream without interrupting the flow.

Ask the patient to void his remaining urine into the urinal or bedpan.

Transfer specimen into sterile universal container.

Allow patient to wash hands.

For Female Patients

If patient is doing himself, Ask patient to wash hands with soap and water prior procedure to prevent cross contamination.

Ask patient to part the labia and clean the urethral meatus with 0.9% sodium chloride solution.

Use a separate swab for each wipe and wipe downwards from front to back.

Ask patient to begin voiding fi rst stream of urine (approx. 15–30 mL) into a toilet or bedpan whilst separating the labia.

Place the wide-necked sterile container into the urine stream without interrupting the flow.

Ask the patient to void her remaining urine into the toilet or bedpan.

Transfer specimen into sterile universal container.

Allow patient to wash hands.

Post Procedural Phase

Label sample and complete microbiological request. Dispatch sample to laboratory immediately (within 4 hours) or refrigerate at 4°C. (As per scenario).

Urine Analysis

urine analysis nmc osce

Urine dipstick is a narrow plastic strip, which has several squares on it impregnated with chemicals and represented by different colours. Each small square represents one of the component. When dipped in urine, the chemicals react with abnormal substances and change colour.

Check reagent sticks have been stored in accordance with manufacturer’s instructions. This is usually a dark dry place in an airtight container (to ensure reliable result)

Dip the reagent strip into the urine for no longer than 1 second. The strip should be completely immersed in the urine and then removed immediately. Run edge of strip along the container.

Hold the stick at an angle

Wait the required time before reading the strip against the colour chart, usually 60 seconds

Dispose of urine sample appropriately in either sluice or toilet. Dispose of urinalysis stick and gloves in correct wastage bin. Ensure cap to urine reagent strips is replaced immediately and closed tightly.

Wash and dry hands.

Document urinalysis readings and inform medical staff of any abnormal readings.

Document the procedure in the patient’s records.

Verbalise the results of urine analysis to patient and tell the patient that you will escalate to the medical team in case of any abnormal results.

Make the patient comfortable, give the call bell back to patient and leave the scene

Results of Urine analysis

Increased Leucocytes – Marker of Infection

Increased Nitrates – Bacterial breakdown of dietary nitrate (Infection)

Increased Specific Gravity – Dehydration, Glycosuria, heart failure, proteinuria

Decreased Ph – Acidic fruit diet, uric acid caliculi

Increased PH – Infection

Blood in Urine – Haematuria, Haemoglubinuria or Myoglobinuria

Increased Proteins – Albuminuria as sign of renovascular, glomerular, tubulointerstitial renal disease or multiple myeloma.

Increased Glucose – For diagnosis of Diabetic mellitus

Increased Ketones – Diagnosing Diabetic Ketoacidosis.

Conclusion

Midstream Urine and Urine Analysis is a simple procedure in which you will be collecting urine from the patient as per scenario and analysing it for various indicators. Urine will be provided by the examiner, which you need to examine.

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