BAG TECHNIQUE AND URINE TESTING

SUBMITTED TO: MR. ROMMEL MERIOLES

SUBMITTED BY: BANTILAN, RESHEL DAWN S.








Bag Technique
Objectives: After 2 hours of varied lecture- demonstration, the level II
students will be able to:

1. Define the following terms:
a. bag technique
b. plan of visit
c. home visit
d. public health bag
e. case load
2. Enumerate the importance of bag technique
3. Discuss the different types of case load
4. Identify the different types of family-nurse contact
5. Formulate a sample plan of home visit
6. Explain the principles involved in bag technique
7. Enumerate the guidelines in using CHN bag
8. Enumerate the contents of CHN bag
9. Demonstrate beginning skills





1. Define the following terms:
o bag technique a tool by which the nurse, during her visit will
enable her to perform a nursing procedure with ease and
deftness, to save time and effort, with the end view of rendering
effective nursing care to clients

o plan of visit an essential tool in achieving the better result of
nursing home visiting resulting from the plan developed by the
nurse


o home visit a family-nurse contact which allows the health
workers to assess the home and family situations in order to
provide the necessary nursing care and health related activities

o public health bag an essential and indispensable equipment
of a public health nurse which he/she has to carry along during
his/her home visits. It contains basic medications and articles
which are necessary for giving care, and contains equipments
used during a procedure

o case load - refers to the number and kind of families a health
care giver will handle at a given time.




2. Enumerate importance of bag technique
o Performing the bag technique will minimize, if not prevent the
spread of any infection
o It saves time and effort in the performance of nursing
procedures
o To work efficiently and swiftly during nursing procedures
o It provides necessary health care activities
o To evaluate results of the outcomes of the nursing care given

3. Discuss the different types of case load
o morbidity the rate at which an illness occur or pertaining to a
pathologic or diseased condition, either physical or mental

o geriatric dealing with the physiologic characteristics of aging
and the diagnosis and treatment of diseases affecting the aged


o health supervision supervisory of the health of child (0-6
years old) and adult

o ante-partum - noting the period prior to childbirth; before
delivery, or the prenatal period


o post-partum period following childbirth; caring for a mother
who had just delivered from 0-6 weeks

o case finding the act of locating individuals with a disease

4. Identify the different types of family-nurse contact
o health care center visit the client visits the health care center
to inquire, to seek consultation, check-up or treatment on health
problems

o home visit the health care giver visits a home in the
community and give nursing care to the sick, to a post partum
mother and her newborn with the view to teach a responsible
family member to give the subsequent care


o industrial clinic visit nurses are hired by agencies or
companies to do a medical assessment on their employees for
pre-employment check-up and treatment on health problems

o school clinic visit most schools have a clinic where in the
nurse always contact with the students who are prone to
sickness and also students who have been diagnosed of a
certain disease




5. Formulate a sample plan of home visit

Plan of visit I
Name of client: Date of visit:
Age: Type of care:
Address: SN:

General objectives:
After 5 days of student nurse-client interaction, the client will be able
to acquire adequate knowledge, proper skills and positive attitude towards
the promotion of health and prevention of disease and illness

Specific objectives:
After 30-45 minutes of student nurse-client interaction, the family will
be able to:
1. establish rapport with the student nurse
2. explain the purpose of home visiting and its importance to their own
level of understanding
3. identify health-related problems with the student nurse
4. verbalize over concerns or problems with the student nurse
5. plan with the student nurse appropriate measures to be done
6. set time, date and place of next visit

Nursing actions:
1. establish rapport with the family members
1.1 wear complete uniform
1.2 smile, greet and introduce self to the family
1.3 state the purpose of the interaction
2. discuss to the family why home visiting is done and its importance
2.1 home visit is a family-nurse contact which allows the health
workers to assess the home and family situations in order to
provide the necessary nursing care and health related activities
3. assess familys health-related concerns and needs by:
3.1 observation
3.2 interview
3.3 utilizing the initial database and family coping index tools


4. prioritize identified health related problems using the following:
4.1 scaling
4.2 FNCP
5. plan appropriate actions the family could take
6. agree to the next home visit as to:
6.1 date
6.2 time
6.3 place


6. Explain the principles involved in bag technique

o microbiology the bag and its contents are should be well
protected from contact with any article in the patients home. The
nurse should consider the bag and its contents clean and sterile,
while articles that belong to the patients as dirty and contaminated

o time and energy time should be budgeted wisely so that the plan
of procedure will be achieved


o psychology - explain the procedure to the patient because some
procedures needs cooperation

o pharmacology the CHN bag contains solutions and disinfectants
needed for treatment, the nurse should know the different effects
of these solutions and disinfectants


o sociology nurse and family interaction should occur all
throughout the procedure so that the client will cooperate

o body mechanics the nurse should maintain good posture so that
the nurse wont experience muscle strains and this will reduce
shaking of the bag


o physics - the CHN bag should be carried with the lock facing the
body so that it would be easy to open it


7. Enumerate the guidelines in using CHN bag
o The bag should contain all the necessary articles, supplies and
equipments that will be used to answer emergency needs

o The bag and its contents should be cleaned very often, the
supplies replaces, and ready for use anytime


o The bag and its contents should be well protected from contact
with any article in the patients home. Consider the bag and its
contents clean and sterile, while articles that belong to the patients
as dirty and contaminated

o The arrangement of the contents of the bag should be the one
most convenient to the user, to facilitate efficiency and avoid
confusion


o Hand washing is done as frequently as the situation calls. It also
helps in minimizing or avoiding contamination of the bag and its
contents

o The bag should be thoroughly cleaned & disinfected after using
esp. if there is a communicable case in the area.


o Avoid swaying of the bag
8. Enumerate the contents of CHN bag
o paper lining
o waste receptacle
o plastic/linen lining
o apron
o hand towel
o soap in a soap dish
o thermometers (oral and rectal)
o 2 pairs of scissors (surgical and bandage)
o 2 pairs of forceps (curved an straight)
o disposable syringes with needles (g.23 and 25)
o hypodermic needles g, 19,22,23,25
o sterile dressing
o cotton balls
o cord clamp
o micropore plaster
o tape measure
o sterile gloves
o babys scale
o alcohol lamp
o test tube
o test tube holder
o solution of:
betadine
75% alcohol
hydrogen peroxide
lysol solution
spirit of ammonia
benedicts solution
o sphygmomanometer and stethoscope are carried separately

9. Demonstrate beginning skills:
9.1 arranging the content of CHN bag
o front of the bag (left to right)
oral and rectal thermometer
glass syringe and needles in a container
o right side of the bag (rear to front)
test tube and test tube holder
medicine dropper
match
alcohol lamp with denatured alcohol
o left side of the bag (rear to front)
medicine glass with suction inside
baby scale
o back of the bag (left to right)
betadine solution
75% alcohol
hydrogen peroxide
lysol solution
spirit of ammonia
benedicts solution
o center of the bag (bottom to top)
kidney basin
cloth bag with the following: kelly curve, kelly straight,
surgical and bandage scissors
cloth bag with the following: sterile gauze, cotton balls,
cotton applicator
hand towel
soap dish with soap
apron
o top pocket
sterile gloves
sterile french catheter (size 8 and 12)
plastic bag
waste receptacle
o top of inner cover (bottom to top)
5 x 8 soap dish paper
14 x 20 paper lining
13 x 19 plastic lining
12 x 18 paper lining

9.2 perform bag technique


Actions

1. Upon arrival at the patients home, place the bag on the table lined
with a clean paper. The clean side must be out and the folded part,
touching the table
Rationale: To protect the bag from getting contaminated

2. Ask for a basin of water or a glass of drinking water if tap water is
not available
Rationale: To be used for hand washing

3. Open the bag and take out the towel and soap

Rationale: To prepare for hand washing
4. Wash hands using soap and water, wipe to dry
Rationale: To prevent infection from the care provider to
the client

5. Take out the apron from the bag and put it on with the right side
out
Rationale: To protect the nurses uniform
6. Put out all the necessary articles needed for the specific care
Rationale: To have them readily accessible
7. Close the bag and put it in one corner of the working area
Rationale: To prevent contamination
8. Proceed in performing the necessary nursing care and treatment
Rationale: To give comfort and security and hasten
recovery

9. After giving the treatment, clean all things that were used and
perform hand washing
To protect the caregiver and prevent infection
10. Open the bag and return all things that were used in their proper
places after cleaning them
11. Remove apron, folding it away from the person, the soiled side in
and the clean side out. Place it in the bag
12. Fold the lining, place it inside the bag and close the bag
13. Take the record and have a talk with the client, write down all the
necessary data that were gathered, observations, nursing care and
treatment rendered. Give instructions for care of patients in the
absence of the nurse
Rationale: For reference in the next visit
14. Make the appointment for the next visit (either home or clinic)
taking note of the date and time
For follow-up care






Urine Testing
After 2 hours of varied lecture demonstration, the level two students will
be able to:
1. Define the following terms:
1.1 urine
1.2 urine testing
1.3 enuresis
1.4 diuretics
1.5 ketone bodies
1.6 hematuria
1.7 uric acid

2. Discuss the importance of urine testing
3. Identify the factors influencing urination
4. Explain the principles involved in urine testing
5. Compare the character of normal and abnormal urine
6. Identify the common urinary problems and causes
7. Explain the different ways of specimen collection and test
8. State the different method of urine testing
9. Enumerate nursing responsibilities before, during, after urine testing
10. Demonstrate beginning skills in urine testing




1. Define the following terms:
o urine the fluid secreted by the kidneys, transported by the
ureters, stored in the bladder, and voided through the urethra

o urine testing - used to determine any abnormal constituents in
the urine and is a common laboratory test which involves the
collection of urine specimen for examination


o enuresis it is an involuntary bladder emptying or incontinence
of urine

o diuretics tending to promote the formation and excretion of
urine or a drug that promotes the formation and excretion of
urine


o ketone bodies organic compounds that are byproduct of fat
metabolism; are formed from fats and proteins that are used for
energy production

o hematuria abnormal presence of blood in urine; it is a
symptomatic of renal diseases and disorders at the
genitourinary tract


o uric acid a product of metabolism of protein that is present in
the blood and excreted in the urine

2. Discuss the importance of urine testing
o to provide the physician with valuable information about
urologic and general health of the client
o helps determine the amount of glucose to screen clients for
diabetes mellitus
o to determine the clients hydration status through the clients
urine output
o to detect the presence of occult blood in the urine
o to know the specific gravity, pH and the presence of abnormal
constituents found in the urine
3. Identify the factors influencing urination
o Growth and development
Kidneys begin to develop in the first few weeks of
embryonic life and are excreting urine by third month
By 15 months most toddlers are aware when they have
voided
By 18 months they can hold urine in their bladder for
about 2 hours, which is the first sign that toilet training
(for voiding) can begin
Common urinary system problems in children and
young to middle-aged adults are infections caused by
fecal microorganisms, microorganisms causing
sexually transmitted disease and streptococcus
o Psychosocial factors a set of conditions can help stimulate
the micturation reflex, the urge to urinate may result from
anxiety and excitement
o Fluid and food intake the healthy body maintains a
sensitive balance between the amount of fluid ingested and
the amount of fluid eliminated
o Medication - interfere with the normal urination process and
may cause retention. Anesthetic and pain killing drugs can
reduce urinary output, narcotics can cause urine retention
o Surgical and diagnostic procedures some surgical and
diagnostic procedure can interfere the passage of urine

4. Principles involved in urine testing
o Microbiology special precautions are needed in
handling urine sample; test tubes should be sterile

o Anatomy and Physiology the urine secreted by the
kidneys, transported by the ureters, stored in the bladder,
and voided through the urethra


o Sociology good interaction with cleint must be observed
so that the client would cooperate throughout the
procedure

o Psychology explain to the patient the procedure so that
the patient wont feel anxious
o Time and Energy prepare the necessary materials

5. Compare the character of normal and abnormal urine
Normal Abnormal
Odor Slightly aromatic Fruity
Color Pale yellow to amber
yellow
Dark red, bright red
Clarity Transparent Cloudy; foamy
Volume 1000-1500 mL/day More or less than the
range
Ph 4.5-8.0 Higher or lower than
the range
Specific gravity 1.001 to 1.035 (acidic) When the urine
becomes alkaline

6. Identify the common urinary problems and causes
o Dysuria painful, burning urination, usually caused by a
bacterial infection, inflammation or obstruction of the urinary
tract

o Glycosuria presence of glucose in the urine, cause by
excessive intake of sugary foods; diabetes mellitus


o Hematuria presence of blood in the urine, caused by bleeding
in the urinay tract due to trauma, kidney stones, infection
o Oliguria abnormally low urinary output, between 100 and 400
ml/day caused by dehydration, renal failure

o Polyuria voiding large amounts of urine, caused by excessive
water intake, taking diuretics


o Retention accumulation of urine in the bladder with inability of
bladder to empty

o Nocturia Excessive urination at night, caused by excessive
fluid intake before bed, renal disease and prostate enlargement


7. Explain the different ways of specimen collection and test
o Clean voided specimen usually adequate for routine
examination
o Clean catch or Midstream Urine Specimen collected when a
urine culture is ordered to identify microorganisms causing
urinary tract infection
o Timed urine specimen requires collection of all urine
produced and voided over a specific period of time, ranging
from 1 to 20 hours to 24 hours
o Indwelling catheter specimen sterile urine specimen can be
obtained from close drainage systems by inserting a sterile
needle attached to a syringe through a drainage port in the
tubing
8. State the different method of urine testing
o Specific gravity an indicator of urine concentration, or the
amount of solutes present in the urine. A urinometer or
hydrometer in a cylinder of urine or a spectrometer or
refractometer is used to measure specific gravity
o Urinary pH is measured to determine the relative acidity or
alkalinity of urine and assess the clients acid-base status; use
of dipstick or litmus paper
o Glucose urine is tested for glucose to screen clients for
diabetes mellitus and to assess clients during pregnancy for
abnormal glucose tolerance
o Ketones advised for type I diabetics who are at home and not
feeling well, running fever, or their blood glucose is consistently
over 240mg/dL. Urine ketone testing with reagent tablets or a
dipstick is also used to evaluate ketoacidosis in clients who are
alcoholic, fasting, starving, or consuming high-protein diets
o Protein is done with a reagent strip or commonly referred as a
dipstick
o Occult blood normal urine is free from blood. When blood is
present, it may be clearly visible or not visible. Commercial
reagent strips are used to test for occult blood in the urine
o Osmolarity a measure of the solute concentration of the is
more exact measurement than specific gravity; also used to
monitor fluid electrolyte balance

9. Nursing responsibilities before, during and after urine testing
o Before
Perform medical hand washing
Prepare and arrange equipments
Explain to the client regarding the procedure
Assist the patient to void
Explain why the technique is to be done
o During
Give privacy to the client during urination
Instruct the client to proper urine collection through mid
stream technique
Always take note of the principle of Microbiology
Observe safety measures
Observe reaction

o After
Do after care
Return materials
Clean surroundings
Do medical hand washing
Label sample properly
Documentation/record

10. Beginning skills in urine testing
Urine Collection
1. Have the patient empty his bladder 1/2 -1 hour before the actual
collection of urine for testing. Discard the initial urine
2. Let the patient void again 30 minutes before
3. Collect a small amount of urine (20)cc. In a clean container, or specimen
bottle

Test for Urine Sugar
Clinitest
o Proceed with urine collection
o Holding a dropper upright, put 5 drops of urine into a clean, dry
test tube
o Rinse dropper. Using the same dropper, add 10 drops of water
into the test tubes with urine
o Drop 1 clinitest tablet into the test tube
o Allow the reaction to take place until it stops
o Wait for 15 seconds. Shake gently. Compare color results on
the test tube with chart
blue indicates negative results
orange indicates highly positive test
dark greenish-brown preceded by rapid change in color
from green to orange indicates urine glucose level above
2%
Acetest (Ketone test)
o Place acetest tablet on a piece of paper towel
o Place 1 drop of urine on a acetest tablet with dropper in upright
position
o Wait for 1 minute and compare color of tablet with chart:
Negative result: tablet color unchanged or turns cream
colored from wetting
Positive result: tablet color will change from lavender to
deep purple depending on amount of ketone bodies
present
Benedicts Test
o Follow urine collection
o In a clean dry, test tube, place 5cc of benedicts solution
o Add 8-10 gtts. Of urine to the solution and place the test tube
with mixture over a direct flame or in a water bath to boil for 5
minutes
o Compare color with index card
Blue negative
Green - +
Yellow - ++
Yellow orange - +++
Brick red - ++++
After care of the equipment:
o Rinse test tube and wrapper immediately. Put them in the
proper places. Chemicals from reagent tablet should be
removed from test tube quickly. Urine must be wash out from
the dropper
o Discard specimen in the receptacle, rinse and dry immediately.
Specimen bottle must always be clean and must receive only
fresh urine
o Store specimen bottle in the patients comfort room labeled
properly with patients name
o Keep the index card in the patients cubicle, if personally owned
by the patient
o Discard any waste paper used
o Record result of test in the patients chart2