Urinalysis abnormal

Also Consider:  Abnormal lab result, Culture Results, Fever, Symptoms of UTI

1. Take Vital Signs

• Temperature:

• Blood Pressure:

• Heart Rate: 

• Respiratory Rate:

• Oxygen Saturation:

2. Evaluate Symptoms and Signs

• Symptoms or Signs of Urinary Tract Infection

  • Pain with urination (dysuria)

  • Tenderness or pain in the lower abdomen / suprapubic / pelvic region, or the back / flank region

  • Visible blood in urine (hematuria)

  • Pain in testes or purulent drainage (pus) from urethra

  • New or worsening urinary urgency, frequency, incontinence

• Acute mental status change (lethargy, unresponsiveness, increased confusion)

• Not eating or drinking as much as usual

• Acute decline in ADL abilities

• Chills, rigors, or diaphoresis (sweats)

• GI: Nausea, vomiting, constipation, abdominal distention or tenderness

• GU: New or worsened incontinence, pain with urination, blood in urine, Pain/tenderness in testes, bladder scan

• Fingerstick glucose (patients with diabetes)

• Presence and function of urinary catheter

3. Take Action using SBAR Report:

• Presence of other, significant symptoms or signs of illness 

  • Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.

• Immediately notify the medical staff & resident representative

  • ALL of the below:

    • WBC on Urinalysis greater than 9

    • Temperature recently greater than 100°F or 2°F over baseline, OR any of the above symptoms of Urinary Tract Infection

    • Patient not receiving antibiotic

• Notify medical staff & resident representative within the next 16 hours. 

  • Urinalysis positive for glucose in a patient not known to have diabetes

• Notify medical staff at the next regular rounds 

  • Other abnormal urinalysis

4. Implement Management Plan

• Monitor vital signs every 4-8 hrs for 2-3 days

• Offer fluids frequently

• Place on Intake & Output monitoring

• Oral, IV, or subcutaneous fluids if needed for hydration

• Place on 24-hour report for 2-3 days

• Obtain lab results (if ordered), and notify medical as needed of:

  • Significantly abnormal values in lab tests (refer to appropriate Situation)

  • Urine culture and sensitivity (only if urinalysis with >9 WBCs/HPF AND culture with  >100,000 CFU/ML)

  • INR if antibiotic therapy ordered and the patient is on warfarin (Coumadin).

• Implement infection control measures if indicated

• If an antibiotic is started, perform an “Antibiotic Time Out” after 2-3 days of antibiotic treatment

  • Is the antibiotic the most appropriate choice given the culture results

  • If needed, revise the duration given the response to treatment.

• Update care plan regarding  fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs

• Review status and plan of care with designated representative daily

• DO NOT perform repeat urinalysis to test for cure

2025-04-27