Urinalysis, Pregnancy Test & Taking Swabs Introducing Male Catheterisation · · 2014-12-04Test &...

Urinalysis, Pregnancy Test & Taking Swabs

Introducing Male Catheterisation

Practical Skills Teaching

Phase 1b Medical Students

SW & AM – November 2014

Contents

Introduction to workshop .............................................................................................. 3

Overall Session Aim ........................................................................................................ 4

Intended Learning Outcomes ........................................................................................ 4

Workshop Structure – Guidance for Tutors ................................................................... 5

Introduction: .................................................................................................................. 7

Urinalysis ........................................................................................................................ 7

Pregnancy Testing .......................................................................................................... 7

Swab Taking .................................................................................................................... 7

Male Catheterisation ..................................................................................................... 8

Assessment: ................................................................................................................. 10

Appendix A – Facts About Test Strips ........................................................................... 11

Appendix B – Pregnancy Test Procedure Checklist ...................................................... 12

Appendix C – Swab Taking Procedure Checklist ........................................................... 13

Appendix D – Equipment Required - Urinalysis, Pregnancy Testing & Swabs: ............ 14

Appendix D – Equipment Required - Male Catheterisation: ........................................ 15

Appendix E – Mock Urine Recipe Hints: ....................................................................... 16

Appendix F – Downloadable Resource Documents: .................................................... 16

Appendix G - Useful resources: .................................................................................... 17


Introduction to workshop Welcome! Thank you for agreeing to participate in Phase 1b Practical Skills Teaching.

The workshop outcomes for the students are to learn the skills required to undertake Urinalysis and to perform a Pregnancy Test as well as taking a Nose swab. In this workshop students will also be introduced to the concept of male catheterisation. We hope to use the opportunity to ask the students to develop their communication skills. The students must learn to communicate the risks so as to allow for an informed consent.

Just as a reminder, more information about this skill is found at the Clinical Skills Resource site for tutors. The link to the module is:

http://medic.cardiff.ac.uk/clinicalskills/

Please find the Male Catheterisation, Urinalysis, Pregnancy Testing, Nose Throat and Skin Swabs modules within the list of on-line tutorials. NB: The male catheterisation part of the session is an introduction to this subject. Students will not be formally assessed at this stage and will revisit it later in their course. In addition, all resources required for this session are downloadable from the above link. Please find under the tab ‘C21 Session Plans and Resources’. We are aiming for the students to be: Accurate Efficient Compassionate

Thank you again for your participation.

The Clinical Skills and Simulation Team

http://medic.cardiff.ac.uk/clinicalskills/


Overall Session Aims To facilitate learning regarding the purpose and procedure of performing urinalysis, a pregnancy test and taking nose swabs.

To facilitate a basic level of understanding in the steps required to perform urethral male catheterisation.

Intended Learning Outcomes

By the end of this workshop the students should be able to:

Discuss the reasons why urinalysis may be required.

Describe why a pregnancy test may be required.

Discuss the reasons why MRSA screening may be required.

Explain why care is required when handling swabs with regard to the potential for

cross contamination.

Define the reasons why urethral catheterisation may be necessary.

Recognise common risk factors that may arise as a result of the procedure being

carried out.

Discuss the reason why insertion of the urinary catheter may be contraindicated.

Demonstrate, to a level expected of the student’s stage of training, a degree of

competence in the procedural steps required to perform male catheterisation,

urinalysis, a pregnancy test and taking of swabs from the nose.

Display a professional manner and good communication skills towards the patient

(actor or student colleague) if present, and throughout the skills simulation

session.

Evaluate own learning and recognise how improvements can be made.


Workshop Structure – Guidance for Tutors

Please Note: Students arrive 15 minutes prior to taught session for registration and housekeeping

Following the introduction and housekeeping the students will be split into two groups A and B. One group will firstly focus on urinalysis, pregnancy testing and swab taking while the other focuses on male catheterisation. After a period of 70 minutes the groups will change over. Please see the table below for a more detailed breakdown of the session.

This session will require a minimum of two tutors.

Taught Session Time: 180 min

Session Progression Additional Resources

All students

5 minutes Introduction Welcome Medicine Students and Tutors

Students given clip boards with quiz sheets

Students break into two even groups

Group A – Tutor 1

10 minutes Quiz Formative quiz based on prior learning

Quiz Sheets and Quiz PowerPoint Questions and answers detailed in Appendix A

10 minutes Answers Tutor to go through the quiz encouraging interaction with students

Quiz Sheets and Quiz PowerPoint Questions and answers detailed in Appendix A

15 minutes Development Breakdown tutor demonstration of: • Urinalysis • Filling out a microbiology request • Pregnancy Test • Taking an MRSA swab (talk

through)

Appendix D – Equipment Required


35 minutes Practice Students work in pairs and work sequentially through the two scenarios presented. Approximately 15 minutes on each scenario Tutor to support and lend guidance where necessary Tutors to encourage patient / student communication – Student pair can act out Dr/student-patient relationship

Pregnancy Testing and Urinalysis Scenario MRSA Swab Scenario

Group B – Tutor 2

15 minutes Development Breakdown tutor demonstration of male catheterisation

Appendix D – Equipment Required

55 minutes Practice Students work in three’s (Patient, Medical Student, Guide) and practice performing male catheterisation Approximately 15 minutes practice for each student. Tutor to support and lend guidance where necessary Tutors to encourage patient / student communication

Appendix D – Equipment Required Procedural Check List for Assessor

30 minutes Coffee Break

Groups Change Over

Regroup

5 minutes Evaluation Students to complete an evaluation

Evaluation Form


Introduction:

Urinalysis

A urinalysis is an array of tests performed on urine. It is one of the most commonly performed procedures that can aid medical diagnosis. The test can provide valuable information about a patient’s health status, including indications of renal, urological and liver disease, urinary tract infection (UTI), diabetes mellitus and general hydration. Part of a urinalysis can be performed by using urine dipsticks, in which the test results can be read as colour changes. Urinalysis can be used to screen for substances that would not normally be expected in urine, such as leucocytes, nitrates and blood. If any of these substances are present, further screening tests may be required. The test should not be used in isolation to guide treatment, because false positives can sometimes occur if the sample is left to stand for a long period of time, or if contamination occurs.

Pregnancy Testing

A pregnancy test is to determine whether the level of human chorionic gonadotrophin (hCG) in urine is consistent with a woman being pregnant.

hCG is essential to maintain the corpus luteum, and thus a pregnancy, for the first 7 weeks of gestation. hCG is almost exclusively produced by the placenta. It is possible to detect hCG from 14 days after ovulation, which usually corresponds to the first missed day of a woman’s menstrual period. Levels reach a peak at 9 – 11 weeks gestation.

There are many tests available commercially and it is important to read the information leaflet that comes with the particular test kit you are using and to be shown how to use the kit correctly.

Swab Taking

Obtaining a swab is an easy method of collecting material from skin or mucus membrane for microbiological analysis. This material can be collected from any accessible area of the body using a commercially prepared sterile swab tipped with cotton wool or a synthetic material. They are utilized to identify micro-organisms in suspected infection or as part of a screening programme to identify patients who may be carrying pathogens displaying clinical signs or symptoms.


This session specifically focuses on obtaining swabs from the nose, however swabs can be also be obtained from the throat, skin, ear, eye, genital organs, rectum or a wound.

Male Catheterisation

Male urethral catheterisation is a procedure that is carried out in a variety of circumstances. 1. A patient may develop urinary retention secondary to prostatism and need

catheterisation to relieve the pressure of urine in the bladder. 2. It may be required following prostatectomy to allow for infiltration of the bladder with

fluid and to prevent clot retention.

3. When the urine output is variable, such as in shock or incipient renal failure, measurement of hourly urine output may become routine.

4. If a patient is unconscious or unable to void urine in the normal manner, urethral

catheterisation may be required.

Male catheterisation is slightly more difficult (especially in patients with prostate problems) and more commonly required than female catheterisation.

Indications

• If there are clinical signs of infection, e.g. pain, inflammation, heat, pus etc.

• If a patient shows signs of systemic infection or has a pyrexia whose origin is not known

• As part of a screen programme (e.g. for MRSA)

Contraindications

• As routine use

• On chronic wounds which will be colonized with skin flora


Indications

•Urinary Retention

•Infiltration of Bladder

•Measuring Urinary Output

•Patient Unable to Void Urine

Contra-Indications

•Lack of Consent

•Urethral Stricture

•Urethral Trauma

Risks

•Catheter Associated Urinary Tract Infections (CAUTI)

•Bleeding

•Loss of Bladder Tone

•Urethral Stricture


Assessment: For the purposes of this workshop, students will be assessed on a formative basis. This will take place in two parts: 1. A quiz at the start of the session based on prior self-directed learning. Question

and answer sheets will be handed out. Tutor to go through answers via PowerPoint quiz and answer presentation.

2. The practical component is assessed through observation and feedback on the student performance with the aim of encouraging further practice and improvement. Throughout the session it is proposed that frequent questions should be posed to the students, encouraging each student as the session progresses.


Appendix A – Facts About Test Strips Leukocytes

The presence of leukocytes may indicate a UTI or more severe renal problems. However, they may be present without bacterial infection (Sterile Pyuria)

Nitrite The presence of nitrites is associated with infection. Most organisms that are responsible for UTI’s convert nitrate to nitrite

Protein Albumin proteins are too large to pass through the glomerular filtrate barrier, so a presence may indicate an increased permeability due to infection or renal damage

pH The pH of urine is normally acidic. A pH range of 5.0 – 8.0 is considered normal. High acidity may indicate kidney stones. Alkalinity may indicate the presence of certain bacteria such as Pseudomonas, Klebsiella or Proteus mirabilis. A protein rich diet can also make the urine more acidic, whilst a vegetarian diet may show alkaline results.

Blood The presence of blood in urine is abnormal. It is associated with problems in the urinary tract such as urological disease and / or infection. Check that a female patient is not menstruating before rushing to send the sample for further testing

Specific Gravity A measure of the total solute concentration. Normal is 1.001 – 1.035. A high value may indicate the patient is dehydrated. High levels of solute – such as glucose will raise specific gravity levels. Low value represents dilute urine – occurs when patient has diabetes insipidus or hypercalcaemia.

Ketones These are acidic chemicals formed during an abnormal excessive breakdown of fat. This can occur if there is a prolonged period of vomiting, fasting, starvation, and poorly controlled diabetes mellitus.

Glucose The renal threshold is 10 – 11 mmols. If elevated, may indicate abnormal blood sugar or reduced renal threshold, due to diabetes mellitus. Raised levels can also occur during pregnancy and in those taking corticosteroids.


Appendix B – Pregnancy Test Procedure Checklist

Explain the procedure to the patient and seek consent

Ask the woman to pass urine into a suitable container

Put on apron

Wash hands

Put on gloves

Open test kit. Follow kit instructions. Place on clean level surface

Have a timer

Using suitable tool draw up the required amount of urine and place on the sample area of the testing device.

Start timer

Interpret results

Note requirements for positive, negative and invalid results

Dispose of rubbish appropriately

Wash hands

Document

Patient counselling


Appendix C – Swab Taking Procedure Checklist

Explain the procedure to the patient and seek consent

Put on apron

Wash hands

Assemble equipment

Take equipment to patient

Advise the patient to assume appropriate position. Assist if necessary

Put on gloves

Open swab packet as far as will enable removing the swab without contaminating it.

Remove top from transport container

Take swab appropriately for type to be obtained

Put swab in transport container, ensure securely placed

Ensure patient comfortable

Remove gloves and apron

Dispose of rubbish appropriately

Wash hands

Label swab container

Complete request form

Send swab and form to laboratory

Document in notes


Appendix D – Equipment Required - Urinalysis, Pregnancy Testing & Swabs:

EQUIPMENT – Required per workstation

Table Box of Charcoal Swabs

Chair Box of Saline

Box of Gloves – Large Pot of Combur 7 Urinalysis Dip Sticks

Box of Gloves – Medium Box of Pregnancy Tests

Box of Gloves – Small Kidney Dish

Inco Sheet Stop Watch

Mock Urine Sample – Elevated Protein Alcohol Hand Gel

Scenario – Pregnancy Testing and Urinalysis Scenario – Skin Swab and Urinalysis

Procedural Instructions – Pregnancy Testing Procedural Instructions – Taking a Wound Swab

Procedural Instructions - Urinalysis Resusci Anne Manikin


Appendix D – Equipment Required - Male Catheterisation:

EQUIPMENT – Required per workstation

Table or Couch Catheters

Chair Simulated Lidocaine Lubricant Syringes

Trolley Catheterisations Procedure Packs

Blue Roll Water Ampoules

Box of Gloves – Large ‘Cleansing Solution’ – Saline Ampoules

Box of Gloves – Medium 10ml Syringes

Box of Gloves – Small Urine Leg Bag

Advanced Male Catheterisation Model Alcohol Hand Gel

Gown Green Needles

Orange Sharps Container Blue Screen (optional)


Appendix E – Mock Urine Recipe Hints: Sample A – Elevated Protein (Infection)

Dilute tea solution with a protein supplement e.g. Tesco Ultra Slim Meal Replacement Mango Smoothie Powder. Tea solution should be of a sufficient strength to give a dark yellow/light brown colour to simulate dehydrated urine.

Appendix F – Downloadable Resource Documents:

The below hyperlinks will provide access to downloadable resources for optional use within the session:

Scenario – Pregnancy Testing and Urinalysis

Scenario – Skin Swab and Urinalysis

Procedural Instructions – Pregnancy Testing

Procedural Instructions – Taking a Nose Swab

Procedural Instructions – Urinalysis

Procedural Checklist

Quiz – Student Answer Sheet

Quiz – Tutor Answers PowerPoint

Tutor Information – MRSA Screening


Appendix G - Useful resources:

Patel, N. and Knight, D. 2009. Clinical Practical Procedures for Junior Doctors. Churchill Livingstone: Elsevier Dornan, T. and O’Neill, P. 2006. Core Clinical Skills for OSCEs in Medicine. Churchill Livingstone: Elsevier Stoneham, M. and Westbrook, J. 2007. Invasive Medical Skills: A Multimedia Approach. Blackwell Publishing Athreya, B.H. 2010 Handbook of Clinical Skills: A Practical Manual. World Scientific Thomas, J. Monaghan, T. 2007. Oxford Handbook of Clinical Examination and Practical Skills. Oxford Medicine Online

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