Bag Technique and

Urine Testing

Section B
Eduave, Nina Isobelle A.
Emnace, Rheanne Kyla B.
Espanta, Allen Grace N.
Flores, Sean Menard A.

Submitted to: Mrs. Seno

 Bag Technique
Objectives:
After 2 hours of varied classroom activities, the Level II students will be able to:
1. define the following terms:
1.1. bag technique
1.2. plan of visit
1.3. home visit
1.4. public health bag
1.5. case load
2. enumerate the importance of bag technique
3. discuss different types of case load
4. identify the different types of family-nurse contact
5. formulate sample plan of visit
6. explain the principles involved in bag technique
7. enumerate the guidelines in using the CHN bag
8. enumerate the contents of CHN bag
9. demonstrate beginning skills
9.1. arranging the content
9.2. performing bag technique

1. Define the following terms

1.1. 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.
1.2. Plan of Visit
The nurse sets goals for home visit based on data received from other
health care providers or the patient. The patient agrees on the time of visit.
It is also an essential tool in achieving better results of home visit.

1.3. Home Visit

A family-nurse contact which allows the health worker to assess the home
and family situations in order to provide the necessary nursing care and health related activities.
Is a also professional face to face contact in a health care provider.

1.4. Public Health Bag or CHN bag

An essential and indispensable equipment of a public health nurse which
she has to carry along during her home visits. It contains basic medication and articles which are
necessary for giving care.

1.5. Case Load

The type of case the nurse is given at a specific time that he or she must
attend to; dictating the type of patient and/or specific details of the nurses responsibilities.

2. Enumerate the importance of bag technique

● Enables the nurse to perform nursing techniques without optimal

conditions efficiently.
● Proper bag technique prevents carrying microorganisms into a patient’s
home.
● To carry equipment and material needed during a visit to the patient’s
home.
● To carry equipment and materials that are needed to make tests and to
demonstrate care such as urine testing
 To save time and effort with an end view of rendering effective nursing care
 Most convenient to use to facilitate efficiency
 To minimize if not totally present the spread of contamination to the individual, family and
community.

3. Discuss the different types of case load

● Morbidity: cases that are diagnosed by a physician or public health nurse

● Antepartum: for pregnant women; usually not long before childbirth
● Postpartum: after the mother’s delivery; 6 weeks after
● Health Supervision: a case load consisting of children under 6 years old
and below
● Case finding: a case load without the diagnosis of doctors or physicians
● Geriatric: cases that involve elders; 65 years of age and above
● Mental Health: cases that deal with smoking, alcoholism, drug/substance
abuse; gambling, inflicting violence on the spouse or children.

4. identify the different types of case load

The familly-nurse relationship is developed through family-nurse contacts, which may take the
form of a clinic visit, group conference, telephone contact, written communication, or home visit.

● Clinic Visit - takes place in health center, barangay health stations or in an ambulatory
clinic during a community outreach activity.
● Group Conference - provides opportunity for initial contact between the nurse and target
families of the community.
● Telephone Contact - (if resources are unavailable) provides easy access between nurse or
health worker and the family.
● Written Communication - used to give specific information to families, such as
instructions given to parents through school children.
● Home Visit - is a professional, purposeful interaction that takes place in the families
residence aimed at promoting, maintaining, or restoring the health of the family and it's
members.
5. formulate a sample of home visit

Name of fam: Care:

Address: Date:
SN:
POV #1

General objectives:
After 1 week of student nurse-family interaction, the family will be able to acquire
knowledge, attitude, and skillsin the promotion of health and prevention of disease.

Specific objectives:
After 45 minutes of student nurse-fanily interaction the family will be able to:
1. participate in a trusting relationship with the student nurse.
2. define home visit
3. state the purpose of home visit
4. identify health problems with SN
5. promote health problems with SN
6. set contract with San for the next home visit as to the date, time, and place.

Nursing actions:
1. establish rapport with the family
a) communicate interest in the family’s welfare
2. define home visit according to the family’s level of understanding
a) home visit is the family-nurse contact in which the nurse visits their family at their home
3. Enumerate the purpose of a home visit
a) allows the nurse to assess the home and family situation
b) enables nurse to provide nursing care
4. identify health needs using:
a) interview
b) physical assessment
c) initial database
d) family coping index
5. rank health problems with the family
6. set contract with family for the next home visit as to:
a) date
b) time
c) place
6. explain the principles involved in bag technique.
Principles:
1. MICROBIOLOGY
 Bag technique helps the nurse in infection control
- the proper use of the bag allows the practice of medical aseptic techniques
during the home visit where the family members and the articles in the home
are considered potential sources of infection
- the nurse protects himself or herself and the nursing bag and its contents from
contamination
- the nurses use the bag technique as a live demonstration to the family of
practical methods of infection control, such as hand washing, one of the most
important steps that anyone can take to avoid the spread of infection
 Bag technique may be performed in different ways
- principles of asepsis are of the essence and should be practiced at all times
2. TIME AND ENERGY
 Bag technique allows the nurse to give care efficiently
- saves time and effort by ensuring that the articles needed for nursing care are
available
3. BODY MECHANICS
 Bag technique places the bag in a way that it’s in the nurse’s reach
- this prevents discomfort and strain on body parts like the back or neck
4. SOCIOLOGY
 There should be nurse and family interaction during the procedure to establish
rapport and ensure proper communication
- this will allow the nurse to perform the procedure more efficiently and
effectively
5. PHARMACOLOGY
 The nurse must be aware of the different types of solutions to be used in bag
technique in order to avoid using the wrong one and prevent embarrassment
- bag technique uses various solutions that can have different therapeutic effects
on the client
- an example would be betadine solution which is used for cleaning wounds
6. PSYCHOLOGY
 Bag technique should not take away the nurse’s focus on the patient and the
family
- it should not overshadow but rather show the effectiveness of the total care
given to the family
- it is simply a tool in providing care

7. enumerate the guidelines using the CHN bag

Guidelines:
 Perform medical handwashing to help minimize the spread of microorganisms on
the bag and its contents
 Contents of the bag should be protected from contact of different unsterilized
objects
 The bag should contain all the necessary equipments needed, in case of
emergencies
 The bag should be disinfected and cleaned thoroughly after using it
 Avoid shaking or swaying the bag when carrying it
 Protect the bag from damaging elements such as dirt, sunlight and moisture
 Do after care

8. Enumerate the contents of the CHN Bag:

 Digital thermometer
 Rectal thermometer
 3 cc disposable syringes
 Test tube and test tube holder
 Medicine dropper
 Matches
 Medicine glass
 Suction bulb
 Baby scale
 Betadine solution
 70-75% alcohol
 Hydrogen peroxide
 Lysol solution
 Spirit of ammonia
 Benedict’s solution
 Kidney basin
 Kelly straight
 Kelly curve
 Umbilical scissors
 Bandage scissors
 Cotton balls
 Cotton applicators
 Hand towel
 Soap dish with soap
 Apron
 Sterile gauze
 Sterile gloves
 Sterile French catheters
 Waste receptacle
 Plastic bag
  5” x 8” soap dish paper
 14” x “20 paper lining
 13.5” x 19.5” plastic lining
 12.5” x 18.5” paper lining
 Stethoscope
 Sphygmomanometer
 Black umbrella

9. demonstrate beginning skills in

9.1. arranging the content
9.2. performing bag technique

Urine Testing
Objectives:
After 2 hours of varied classroom activities, the Level II student will able to:
1. define the following terms:
1.1. urine testing
1.2. enuresis
1.3. diuretics
1.4. ketone bodies
1.5. hematuria
2. discuss the importance of urine testing
3. identify the factors influencing urination
4. explain the principles involved in urine testing
5. compare the characteristics 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, and after urine testing
10. demonstrate beginning skills in urine testing

1. define the following terms

1.1. Urine testing

~ it is a test that involves checking the appearance, concentration, and content of the
urine.

1.2. Enurisis
~ involuntary urination, especially by children at night.
1.3. Diuretics
~ these are medications deaigned to increase the amount of water and salt expelled from
the body as urine.

1.4. Ketone bodies

~ chemicals that are produced in the body when there is not enough insulin in the blood
so the body must break down fat instead of the sugar glucose for energy.
1.5. Hematuria
~ presence of blood in urine.

1.6. Uric acid

~ a product produced by the body aftet the purines in many food undergo the digestive
process and are broken down inside the body.

2. Discuss the importance of urine testing

● To determine any abnormalities in urine
● To determine the presence of ketone bodies, glucose, and albumin in urine
● To monitor proper functioning of the liver and kidney
● To asses the needs of the patient’s urinary problems in order to implement nursing care
● To determine the presence of occult blood in urine
● To asses the ability of the kidney to concentrate and dilute urine
● To determine disorders of glucose metabolism
3. Identify the factors influencing urination

● Fluid intake - if fluid and concentration of electrolytes and solutes are in equilibrium, an
increase in fluid intake causes an increase in urine production.
● Disease condition - several disease conditions affect the ability to micturate. Any lesion
of peripheral nerves leading to the bladder causes loss of bkadder tone, reduced sensation
of the bladder fullness and difficulty in controlling urination.
● Medication - various medications influence the volume of urine excreted and it may also
change the characteristics of urine. For example diuretics, diuretics prevent the
reabsorption of water and certain electrolytes in the kidney tubules, resulting in an
increased urine output. There are also certain medications change the color if the urine as
well.
● Growth and development - infants and young children are unable to concentrate urine and
reabsorb water effectively. In relation to their small body size, infants and children
excrete large volumes of urine. A child is unable to control micturation voluntarily until
the age of 18 to 24 months. It is usually difficult for children to control urination than
defecation. Changes in kidney and bladder function also occur in aging. The kidney’s
ability to concentrate urine dexline as we age.
● Food intake diet - Food is the main factor to eliminate of urine. The low-fiber foods cause
a slow movement of the rest of the digestive be reached rectum, therefore increasing
water absorption. This results in constipation. Eating regularly is very influential on the
regularity of defecation. Malnutrition became the basis of the decrease in muscle tone,
thus reducing the ability of a person to remove urine
● Diet intake - Age is the not only influences the urinary elimination also influence the
elimination of control itself. Children are not able to control the urination where the
elders can do.
The elimination of urine decreased, sphincter muscle control resulting in incontinence

4. Explain the principles involved in urine testing

Anatomy and Physiology:

Kidneys are the producers of urine. Micturition, also known as urination, is the process of
excreting urine from the body. This aids in the maintenance of homeostasis. Urine passes
through the ureters from the kidneys to the bladder, which serves as a temporary storage site for
the urine. Then, the urine exits the body through the urethra. Urination assists in maintaining the
homeostatic balance by filtering, and secreting metabolites and minerals from the blood.

Chemistry:
Urine is composed of 95% water. Other components include sodium, ammonia, urea,
phosphates, sulfate, and creatinine, and urobilinogen. Normally, soluble substances are excreted
in the urine.
Microbiology:
The nurse must take necessary precautions in order to prevent the spread of microorganisms
during the urine collecting and testing process. When caring for incontinent patients, the nurse
must keep the patient’s skin dry to decrease the risk of infection. Specimen containers should be
sterile at all times to prevent bacteria and microorganisms from contaminating the urine sample.
Throughout the process, the nurse must be careful in order to prevent contaminating their
surroundings and other materials.

Physics:
The specific gravity of urine is the ratio of the density of urine to the density of water. A
centrifuge, which is a container the rapidly rotates its contents, can be used to separate the solids
of a urine sample from the liquid portion.

Pharmacology:
Certain drugs can affect urine composition and urine output. Diuretics are medications that are
used to increase urine output by increasing the amount of water and salt expelled from the body.
Antidiuretics are medications that yield the opposite effect. Some drugs can create changes in the
color and composition of urine. Rifampin, which is an antibiotic, can cause the urine to turn into
a reddish orange color.

Psychology:
Psychological factors such as anxiety can affect urine output and frequency. To facilitate the
urine collection process, the nurse must explain the procedure to the patient to ease discomfort
and promote relaxation. The nurse must ensure the patient’s privacy and provide them with
adequate time in order to ease the process.

Sociology:
The nurse must establish rapport with the patient to ensure cooperation. The nurse must
communicate the requirements of the urine collection process and provide instruction to expedite
the process.

5. Compare the characteristics of normal and abnormal urine

6. identify the common urinary problems and causes.
CHARACTERISTICS NORMAL URINE ABNORMAL URINE
Amount in 24 hours 1.0 – 1.8 L Less than 1.0 L
 Decreased fluid intake
 Kidney failure
More than 1.8 L
 -Diabetes
 Diuretics
 Increased fluid intake
Color Yellow to Amber Dark Amber
 Insufficient fluid
intake
Cloudy
 Infection
Dark Orange
 Drugs
Red or Dark Brown
 Blood present
 Severe dehydration
Consistency Clear liquid Thick mucus
 May indicate infection
Odor Aromatic Pungent odor
 May indicate infection
Sterility No microorganisms Microorganisms present
 Infection of urinary
tract
pH 4.5 to 8.0 (6.0) More than 8.0
 Acidosis
 Dehydration
Specific Gravity 1.010 to 1.025 Under 1.010
 Kidney disease
 Overhydration
 Diabetes insipidus
Under 1.025
 Underhydration
 Diabetes mellitus
Glucose Not Present Present
 Diabetes mellitus
Ketone Bodies Not Present Present
 Starvation
 Prolonged vomiting
 Diabetic coma
Blood Not Present Present
 Urinary tract infection
1. URINARY TRACT INFECTION
 This is a general term for an infection anywhere between the kidneys and the
urethra, most of which are typically bladder infections. In most cases, they cause
pain or a burning sensation upon urination. These infections are caused by
bacteria and can generally be cured with antibiotics.

Causes:
 Most urinary tract infections are caused by the bacterium Escherichia coli (E.
coli), usually found in the digestive system.
- Chlamydia and Mycoplasma can infect the urethra but not the bladder
 A variety of factors can also increase the probability and likelihood of
developing a UTI, including:
- poor personal hygiene
- blocked flow of urine
- sexual intercourse (especially if more frequent, intense and with
multiple or new partners)
- use of spermicides and tampons
Symptoms:
 Strong and frequent urge to urinate
 Cloudy, bloody or strong-smelling urine
 Pain or burning sensation when urinating
 Nausea and vomiting
 Muscle aches and abdominal pains

2. NEPHROLITHIASIS/ RENAL LITHIASIS (KIDNEY STONE)

 A kidney stone is a hard, crystalline deposit made of minerals and salts that form
inside the kidney
 There are many causes, but often, stones form when the urine becomes
concentrated allowing minerals to crystallize and stick together
Types of Kidney Stones:
 Calcium stones
- Most common type of kidney stone, usually in the form of calcium
oxalate
Oxalate is a natural occurring substance found in food (fruits,
vegetables, nuts, etc.) and is also made daily by your liver
 Struvite stones
- These form in response to an infection, such as a urinary tract infection
 Uric acid stones
- These can form in people who do not drink enough fluids or lose too
much fluid, those who eat a high-protein diet, and those who have gout
 - Can also be at a higher risk due to genetic factors
 Cystine stones
- These form in people with a hereditary disorder that causes the
kidneys to excrete too much of certain amino acids

3. HEMATURIA
 This is the presence of blood in a person’s urine and there are two types:
- Gross Hematuria: when a person can see the blood in his/her urine
- Microscopic Hematuria: when a person cannot see the blood in his or
her urine, yet it is seen when looking under a microscope
Causes:
 Infection(s) in the bladder, kidney or prostate
 Trauma
 Vigorous exercise
 Viral Illness, such as hepatitis
 Sexual activity
 Menstruation
 Bladder or kidney cancer
 Inflammation of the kidney, urethra, bladder or prostate

Symptoms:
 People with gross hematuria generally have pink, red or brown urine
- Note: Even a small amount of blood in the urine can cause the urine to
change color
- People with gross hematuria that includes blood clots in the urine may
also have bladder pain or pain in the back

4. DYSURIA
 Dysuria is the problem of pain, discomfort or burning when urinating
 It is generally more common in women than in men
Causes:
 Urinary tract infections
 Vaginal infection
- Such as yeast infection
 Sexually transmitted diseases
- Genital herpes, Chlamydia, Gonorrhea
 Inflammation and irritation
Symptoms
 While the main symptom is painful urination, it is important to take note if
there are any other accompanying symptoms such as:
- Fever
 - Abnormal discharge
- Flank Pain
- Changes in urine flow
- Color
- Amount
- Hematuria
- Cloudiness

7. explain the different ways of specimen collection and test.

 Randomly Collected Specimens
- Suitable for urinalysis in the clinical chemistry laboratory and for
microscopic analysis. Not regarded as the specimens of choice due to
possible dilution after the patient has consumed fluids.
 First Morning Specimens
- Specimen of choice for urinalysis and microscopic analysis since the
urine is generally more concentrated (due to the length of time the
urine is allowed to remain in the bladder), and therefore contains
higher levels of cellular elements and analytes. Abnormal constituents
are more likely to be in higher amounts and therefore more likely to be
detected.
 Midstream Clean Catch
- Strongly recommended for microbiological culture and antibiotic
susceptibility testing because of the reduced incidence of cellular and
microbial contamination. Includes a procedure to cleanse the urethral
area to reduce chance of contaminants to enter the sample.
 Time Collection
- Used to quantitatively measure certain analysis over a period of 8-24
hours. The bladder is emptied prior to the collection time and 30
minutes before the end the patient is encouraged to drink water.
During the collection period the specimens should be refrigerated
unless specified otherwise.
 Catheter Collection
- Urine can be drawn from a catheter using a syringe and then
transferred to a specimen tube or cup.
- Alternatively, you may use an adapter to draw the urine into an
evacuated tube.
 Supra-Pubic Aspiration
- May be necessary when a non-ambulatory patient cannot be
catheterized or where there are concerns about obtaining a sterile
specimen by conventional means. Involves taking a needle and
collecting through the abdominal wall into the bladder.
 Pediatric Specimens
 - For infants and small children, a special urine collection bag can be
adhered to the skin surrounding the urethral area. Urine from a diaper
is not recommended for laboratory testing since contamination from
the diaper material may affect results.

8. State the different methods of urine testing

● Microscopic Exam: The doctor looks at drops of urine under a microscope.

○ Checks for:
■ Abnormalities in you red or white blood cells., which may be signs
of infections, kidney disease, bladder cancer or a blood disorder.
■ Crystals that may indicate kidney stones
■ Infectious bacteria or yeasts
■ Epithelial cells, which can indicate a tumor

● Dipstick Test: The doctor inserts a chemically treated plastic stick into your urine sample. The
stick changes color based on the presence of certain substances.
○ Checks for:
■ Bilirubin, a product of red blood cell death
■ Blood
■ Protein
■ Concentration or Specific Gravity
■ pH levels or acidity
■ Sugars
○ High concentration of particles indications dehydration, high PH levels can
indicate urinary tract or kidney issues, any presence of sugar can indicate diabetes.

● Visual Exam:
○ Clouded appearance, can indicate an infection
○ Abnormal odors
○ Reddish or brownish appearance, which can indicate blood in your urine.

9. Enumerate nursing responsibilities before, during and after urine testing

● Before
○ Properly prepare materials before collection of the sample.
○ Ensure collecting apparatus and container are free of particles in order to
maintain specimen validity.
○ Explain the procedure to the client.

● During
○ Ensure patient privacy. The patient should feel secure and comfortable at all times.
○ Use appropriate collection devices such as sterile, leak-proof specimen containers for
collecting samples.

● After
○ Make sure that the collecting apparatus is labelled correctly with the correct patient’s name,
date, and time of collection.
○ Maintain an appropriate time between collection of the specimen and delivery to the lab.

10. demonstrate beginning skills in urine testing