Diabetes Urine Test - Benedict's Test

Blood pressure is a measurement of the force applied to the walls of your arteries as your heart pumps blood

Inflating the cuff too slowly or not high enough may cause a false reading. If you loosen the valve too much, you won't be able to determine your blood pressure.

This is a very simple and effective method of ascertaining the presence or the amount of glucose in the urine and can be done by the diabetic himself.

through your body. Your blood pressure can be measured at home, or at your health care provider's office, a fire station, pharmacies, and many other places. How the Test is Performed

The procedure may be done two or more times. How to Prepare for the Test Measuring your blood pressure is best done after you rest for at least 5 minutes. Do not take your blood pressure when you're under stress, have consumed caffeine or used a tobacco product in the past 30

Apparatus : Your arm should be supported, with Benedict's solution (fresh; certainl y not more than 3 months old), Dropper, Test-tube, Test-tube holder. your upper arm at heart level, back supported, legs uncrossed, and feet on the floor. Your upper arm should be bare, with your sleeve comfortably rolled up. You or your health care provider will Procedure: Take 5 ml (one teaspoon) of Benedict's solution in the test-tube. Holding the test-tube with the holder, heat it over a spirit lamp till the Benedict's Solution boils without overflowing. Drop 8 to 10 drops of urine into the boiling Benedict's solution. After again boiling the mixture, let it cool down. While cooling, the mixture changes colour. The colour of the mixture serves as a guide to the amount of sugar in the urine : blue-sugar absent; green0.5% sugar; yellow-1% sugar; orange-1.5% sugar; brick red-2 % or more sugar. Blood pressure measurement Email this page to a friendShare on facebookShare on twitterBookmark & SharePrinter-friendly version wrap the blood pressure cuff snugly around your upper arm. The lower edge of the cuff should be 1 inch above the bend of your elbow.

minutes, or have recently exercised. Take two or three readings at a sitting, 1 minute apart, while resting in a seated position. When measuring your blood pressure

The cuff will be inflated quickly, either by pumping the squeeze bulb or pushing a button. You will feel tightness around your arm.

outside of a medical office, it is important to note the time of the readings. Your doctor may suggest that you do your readings at certain times. A common recommendation is to take your blood pressure in the morning and at night for a week. That way, you will get at least 12 readings to help your doctor make decisions about your blood pressure treatment. How the Test Will Feel You will feel slight discomfort when the blood pressure cuff is inflated to its highest level. Why the Test is Performed Because there are no symptoms, you can have high blood pressure and not know it. High blood pressure

Next, the valve of the cuff is opened slightly, allowing the pressure to slowly fall.

As the pressure falls, the reading when the sound of blood pulsing is first heard is recorded. This is the systolic pressure.

As the air continues to be let out, the sounds will disappear. The point at which the sound disappears is recorded. This is the diastolic pressure.

may be found when you visit your health care provider for other reasons. Diagnosing high blood pressure early can help prevent heart disease, stroke, eye problems, or chronic kidney disease.

High blood pressure (hypertension) is when the top number (systolic blood pressure) is 140 or more most of the time or the bottom number (diastolic blood pressure) is 90 or more most of the time. (written as 140/90 mmHg). If you have diabetes, heart disease,

your current blood pressure than those taken at your doctor's office, as long as you make sure your machine is accurate. You can ask your health care provider to compare your home readings with those taken in the office. Many people become nervous at the doctor's office and have higher readings than they normally would at home. This is called white coat hypertension.

All adults should have their blood pressure checked every 2 years, if their blood pressure was less than 120/80 mmHg at the most recent reading. You should have it checked yearly if your last reading was 120139/80-89 mm Hg. If you have high blood pressure, diabetes, heart disease, kidney problems, or certain other conditions, you should have your blood pressure checked more often -- at least every year. Normal Results Blood pressure readings are usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high. Normal blood pressure is when the top number (systolic blood pressure) is below 120 most of the time, and the bottom number (diastolic blood pressure) is below 80 most of the time (written as 120/80 mmHg). If your blood pressure numbers are 120/80 or greater but below 140/90, it is called pre-hypertension. If you have pre-hypertension, you are more likely to develop high blood pressure. What Abnormal Results Mean

or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be lower. Most of the time, high blood pressure does not cause symptoms. For most patients, high blood pressure is found when they visit their health care provider or have it checked elsewhere. See also: Preeclampsia to learn about high blood pressure in pregnant women. Considerations It is normal for your blood pressure to be different depending on the time of day:

Taking Your Blood Pressure Correctly By Alan L. Rubin, MD from High Blood Pressure for Dummies, 2nd Edition Your blood pressure can be taken with a mercury blood pressure gauge, an aneroid manometer, or an electronic device for measuring the blood pressure, as long as the device has been recently calibrated and validated. With rare exceptions, blood pressure gauges found in supermarkets or pharmacies aren't

It is usually higher when you are at work. It drops slightly when you are at home. It is usually lowest when you are sleeping. It is normal for your blood pressure to increase suddenly when you wake up. In people with very high blood pressure, this is when they are most at risk for a heart attack and stroke.

properly maintained and shouldn't be used. Following a few simple rules is important to get an accurate reading:

First, don't smoke or drink alcohol or coffee within 15 minutes of a blood pressure measurement.

Second, the length of the bladder on the device should be 80 percent of the circumference of the upper arm. This means that heavy or

Blood pressure readings taken at home may be a better measure of

very muscular people with

thick arms need a larger bladder, while children need a smaller bladder.

3. Tighten the screw at the side of the rubber bulb and squeeze the bulb. Air is pumped into the bulb, and thus the cuff expands. 4. The cuff is inflated until the blood flow through your brachial artery stops. With sufficient compression, the cuff cuts off blood flow through the artery, and no sound is heard in the stethoscope. The pressure in the cuff is increased rapidly to 30 millimeters of mercury

7. When the cuff decompresses to the point that blood flows freely in the artery, the sound is no longer heard in the stethoscope. The number next to the top of the column of mercury when the sound ceases is the diastolic blood pressure (DBP), the second number in the blood pressure reading. 8. Again, look at the column of mercury to see the number at that pressure point.

Third, your posture is important. Sit with your back supported and your elbow at about the level of your heart with your arm supported. Your legs should not be dangling. It's better if you rest for several minutes in that position before the measurement. Don't talk during the measurement.

To take the reading, follow these steps: 1. Leaving the cuff's lower edge about an inch above the bend of the elbow, place the cuff over your bare arm, close the cuff around the arm, and then stick the Velcro together at the ends of the cuff.

above the point that no blood flow is taking place through the cuff when no sound can be heard in the stethoscope or when a pulse can no longer be felt in the wrist. 5. Turn the screw again to

9. Record the SBP and the DBP numbers immediately (don't depend on memory), and note the arm (right or left) used for taking the measurement is noted. 10. If the first measurement is elevated, take another measurement in the same arm after 60 seconds. Then the other arm is measured. The arm that has the higher

2. Place the earpieces of the stethoscope in your ears and place the stethoscope bell at the side of the cuff away from your heart and over the brachial artery, which is found in the inner area of your bent elbow. The stethoscope, a convenient device to listen for sounds at various body sites, has a point of contact known as the stethoscope's bell. The two earpieces at the other end of the stethoscope enable the individual taking the measurement to hear the steady "thump" in the brachial artery.

loosen the valve in the bulb and to lessen the air pressure. Pressure is then decreased so that the rate of drop is 2 millimeters per second. When the pressure falls to the point that blood begins to flow through the artery again, the number that the column of mercury has risen to at the first sound heard in the stethoscope is the systolic blood pressure (SBP), the first number in the blood pressure reading 6. Look at the column of mercury to see the number at that pressure point.

blood pressure is the one that's

used in the future. (They're often the same.) The average of the two measurement s in the arm that supplies the more abnormal reading is considered to be the correct blood pressure. Measure the blood pressure while the patient is in a standing position especially in the event that the patient experiences lightheadedness on standing. If a fall of 20 or more millimeters of mercury occurs in systolic blood pressure or 10 or more in diastolic blood pressure, the patient is considered to have orthostatic hypotension, an abnormally great fall in blood pressure with standing. If your blood pressure isn't normal, don't start

any treatment on the basis of one office visit. This is treatment for life and should be done only after confirmation at a second and even a third office visit. It may even be that your blood pressure in your doctor's office is not an accurate assessment of your blood pressure despite using entirely correct techniques. A blood pressure reading that's greater than 180/120 millimeters of mercury (mm Hg) requires immediate treatment.

methods used to treat patients from illnesses arising from the detection of albumin proteinsin the urine. PROCEDuRE RATIONALE 1.Collect urine specimen bef ore meals.For greater accura cy.2.Divide the urine sample i nto three parts.2/3 is enough to fill 2/3 of the test tube. The upper 1/3 may be aspare area for the surface activities during heating to preventspillage or for the acetic acid to be added.3.Put two-thirds of urine sample into a test tube and heat it.Heating will provide the energy for the reaction to occur.4.Note for color chang es.Appearance of turbidity or a flocculent precipitate indic ates thepresence of proteins i t is positive (which indicates the presence of albumins in the urine)
Measuring Height in Children and Adolescents Standing height is used to measure children who are more than two years old and can stand without assistance. Procedures for Taking Standing

ACETIC ACID TEST DEFINITION: A test that detects the presence of albumin proteins in the urine. The urine is heated until cloudy and then several drops of acetic acid areadded. If cloudiness increases that the test is positive for albumin. Purposes: 1. To screen for cervical cancer by visual inspection.2.To confirm diagnosis of albuminuria (may indicate PIH in pregnant women).3.To monitor the effectiveness of medication and other

of either albumin or earthy phosphates.5.Add onethird or few drops of acetic a cid.To dissolve the phosphat es, if present.6.Do not heat t he solution, instead, note for color change.If the turbidity persists even after the addition of acetic acid, then
Height (Adapted from How To Weigh and Measure Children, I.J. Shorr, UN, New York, 1986) Two people are required to take the standing height of a child under the age of six. The directions below can also be followed for older children except

that the child can be instructed on how to position the body and head and does not require anyone to hold the knees and ankles. Children should be measured without shoes and heavy outer clothing such as sweaters and coats. 1. Ask the Assistant to remove socks and shoes on the child and remove or push aside any barrettes, braids, or hairstyles that might interfere with the measurement. Big hairstyles will need to be flattened as much as possible. 2. Measurer: Provide a brief training to the Assistant on how to hold the child's knees and feet. 3. Assistant: Ask the Assistant to walk the child to the board and kneel on the right side of the child. (Arrow 2) 4. Measurer: Place the data collection sheet and pen/pencil on the floor near you and kneel on the left side of the child. (Arrow 3) 5. Measurer: Place the child's feet flat and either the knees or feet together in the center of the measuring board. 6. Assistant: Ask the Assistant to place her/his right hand just above the child's ankles on the shins (Arrow 4) and place her left hand on the child's knees (Arrow 5) and push against the board. Make sure that the child's legs are straight. The position of the legs is important. The line that bisects the body from the side is called the "mid-axillary line." Make sure the mid-axillary line is perpendicular to the base of the board (Arrow 16). This may mean that the child's feet may not touch the back of the measuring board, particularly in overweight or obese children. 7. Measurer: Tell the child to look straight ahead. Make sure the child's line of sight (Frankfort Plane) is level with the floor (Arrow 8). The line from the hole in the ear to the bottom of the eye socket (Frankfort Plane) should be perpendicular to the board or table. In overweight, obese and older children, when the head is placed in proper position, according to the Frankfort Plane, there will be a space between the back of the child's head and the back of the measuring board. Do not judge

the position of the child's head by looking at the top of the head, use the Frankfort Plane. Place your open left hand on the child's chin. Gradually close your hand (Arrow 9). Do not cover the child's mouth or ears. Do not rest your left hand on the child's chest. Make sure that the shoulders are level (Arrow 10), the hands are at the child's side (Arrow 11) and the head, shoulder blades and buttocks are against the board, if appropriate (Arrows 12, 13 and 14). With your right hand, lower the headpiece on top of the child's head. Make sure that you push through the child's hair (Arrow 15). 8. Measurer: When the child's position is correct, read and call out the measurement to 1/8 inch. Continue calling out the measurement. 9. Measurer: Record the measurement on the data collection sheet under "Standing Height". Check to make sure it is accurate and legible. 10. Measurer: If there were any unusual problems such as braids in the way or difficulty measuring the child, record this next to the measurement on the sheet. Note: It is acceptable to take two measurements that agree within " and use either one of those measurements.

Illustration No.2 from: How To Weigh and Measure Children, I.J. Shorr, UN, New York, 1986

4.

5.

6.

7.

8.

9.

Ask the child to step onto the scale. Make sure the child is centered on the platform and the arms are at his/her side. Move the large 50-pound weight until you find the first notch where the beam falls, then move the weight back one notch. Slowly push the small pound weight across the beam until it is balanced. You may need to move it back and forth in small increments several times to reach balance. Read and call out the measurement to the nearest 1/4 pound. Call out the weight repeatedly until it is recorded. (Out of respect for children's privacy, call out weight so other children are not able to hear.) Record the weight on the data collection sheet. Make sure it is accurate and legible. Have the child step off of the scale and return the weights on the beam to zero in preparation for the next measurement. Note: It is acceptable to take two measurements that agree within lb and use either one of those measurements.

Common Errors

Improper equipment is used. Scale is not properly zeroed or balanced. Footwear and heavy outer clothing are not removed. Individual is not properly centered on scale platform. Child is holding onto Assistant or scale. Child is not remaining still on the scale.

Height and Weight Measurement Procedures OBJECTIVES The goal of this protocol for Body Mass Index (BMI) assessment for age is to certify school nurse/designee in the measurement techniques described in this manual. At the completion of this training the school nurse/designee will be able to: 1. Set up measurement stations with all of the appropriate equipment 2. Check accuracy of the scales 3. Prepare a person for measurement 4. Measure height and weight in rotational order 5. Perform the steps of the weight measurement correctly 6. Perform the steps of the height measurement correctly 7. Apply the one-inch criteria for height 8. Record/enter data electronically

Common Measurement Errors

Improper equipment used. Equipment is not properly installed. Footwear, heavy outer clothing, hats or hair barrettes are not removed. Feet are not flat on floor. Knees are bent. Head is not in proper position. Measurement is not read at eye level. Back To Top Weighing Children and Adolescents Procedure for Taking the Weight of Children and Adolescents Using a Beam Balance Scale (Adapted from Training Manual for the New York State Child Growth Monitoring Project, I.J. Shorr, 199496.) 1. Place both the sliding beam weights directly over their respective zeroes. 2. Loosen the screw on the adjustable zeroing weight or counter weight. Move it until the beam balances, then tighten the screw on the counter-weight. 3. Ask the child or Assistant to remove shoes and any heavy clothing such as jackets, sweatshirts, sweaters, etc.

Procedure for Taking the Weight of Children and Adolescents Using a Digital Scale (From I.J. Shorr, 1997) 1. Activate the scale by turning it on. Zeroes will appear on the display panel. Make sure the scale is on "lb" rather than "kg". 2. Ask the Assistant or child to remove shoes and any heavy clothing such as jackets, sweatshirts, sweaters, etc. 3. Ask the child to step onto the scale. Make sure the child is centered on the platform and the arms are at his/her side. 4. The weight will appear on the display panel. If the weight changes (e.g. from 22.1 lb to 22.2 lb), record either number. Call out the weight to the nearest lb repeatedly until it is recorded. (Out of respect for children's privacy, call out weight so other children are not able to hear.) 5. Record the weight on the data collection sheet. Make sure it is accurate and legible. Note: It is acceptable to take two measurements that agree within lb and use either one of those measurements.

9. Apply appropriate confidentiality me Principles of wound management (yes, they also apply to wound cleansing and dressing technique!) Define the aetiology of the wound and treat the underlying cause Identify factors affecting healing Wound assessment and documentation Management plan including dressing regimen Evaluation of healing and adjustment of plan Maintenance of healingOverview Purpose of wound cleansing Solutions Dressing techniques

previous dressings. Most wounds should be cleansed initially and at each dressing changeSolutions, techniques and pressure in wound cleansing (JBI, 2003) Tap water (showering) vs. no cleansing; no difference in wound infection

effective in reducing infection, inflammation & bacterial count (L2) Showering of post-op wounds does not increase infection or slow healing (L1)Solutions, techniques and pressure in wound cleansing (JBI, 2006) Techniques

Tap water vs. Normal saline; infection rate in acute wounds cleaned with sterile saline

Showering does not impact on infection or healing rates of post-op wounds

Sterile saline vs.. no treatment; bacterial count with N/S. ? Technique

Showering ulcers and chronic wounds should be done with caution

1% Povidone Iodine vs. sterile NS. Lower infection rate when PI was used on contaminated wounds. No difference in acute

No research to support/refute swabbing & scrubbing to cleanse wounds Sitz baths may be useful for episiotomy wounds Soaking in 1% PI is not effective in reducing bacterial countConsiderations If the wound is on the foot, bag it for showering When considering solutions, need to weigh up impact of bacteria on wound vs. use of antiseptics If the solution causes pain, re-evaluate choice Environment may impact on technique and solutionConsiderations Wounds in different phases of healing require different cleansing techniques;

Sterile Aseptic Wound field CleanWound Cleansing The application of fluid to aid removal of exudate, debris, slough and contaminants Wound cleansing helps optimize the healing environment and decreases the potential for infection. It loosens and washes away cellular debris such as bacteria, exudate, purulent material and residual topical agents from Other comparisons with Procaine Spirit, ShurClens, boiled, distilled waterSolutions, techniques and pressure in wound cleansing: conclusions (JBI, 2003) Potable tap water is an effective cleanser for acute and chronic wounds, in healthy adults (L3) Irrigation with Povidone Iodine is recommended for cleansing contaminated wounds (L3) PI should be applied to the area, left for 3 5 mins, then washed off (expert opinion) Pressure of 13psi (12cc syringe & 22g needle)

Necrotic wounds may require more aggressive

cleansing to assist debridement Gentler and non-traumatic for granulation tissue Ensure the aetiology of the wound is known and that cleansing choice is appropriateExposure and temperature 4.4 AWMA Guidelines: wound healing is retarded when wound temp decreases 1 o C Avoid exposing the wound to cooling temperatures or appliances Reduce exposure time Use wound cleansing solutions and products at room temperature (i.e. SSD)

to deep cavities (i.e. sternum)Sterile technique Method to reduce exposure to microorganisms Used in the OR for surgical procedures Involves use of sterile gown, gloves, masks, equipment, dressings and surgical drapes May be used in some ward situations i.e. burns dressings, VAC to sternumAseptic technique Taught as standard dressing procedure in many Unis Asepsis; absence of pathogenic organisms Method used to minimize contamination by pathogens and protect the patient from infection Sterile gown and gloves not required

Differentiate between clean and dirty forceps (myth!) Wipe wound once, then discard swab (myth!)Aseptic technique Where is the evidence that supports all aspects of strict aseptic technique for all wounds? Traditional vs. evidence based Nurses indoctrinated into technique and it is still being taught The focus becomes procedural, not on the wound cleansing/dressing Time for change Modified aseptic technique Used when strict asepsis is not required Often used in community / home care settings Instruments are still used to handle/apply dressings Objects can be placed back down on field again; place touched handles of instruments on edge of field Clean items are kept away from sterileGloves Standard precautions to protect the wearer and the patient

Avoid unnecessary frequent dressingsDressing procedure and techniqueAWMA Standards for Wound Management, 2002What denotes compromised? Any individual who is an in-patient in an acute care setting! If the wound is the primary cause of admission Immunosuppressed; drug mediated (i.e. chemo), diseases (i.e. HIV) Health conditions; i.e. diabetes, PVD

Different pack required for different wounds If the dressing field becomes contaminated, the pack must be discardedAseptic technique (and a few myths!) Hands washed (+- gel) before opening pack, after opening pack, after removing dressing and after dressing procedure Involves a non-touch technique using forceps (gloves not required)

You never know when MRSA is lurking! Gloves are an adjunct to hand washing/gels Use sterile gloves when performing strict aseptic dressing procedure if you want to touch the dressing field,

Specific wounds/procedures, i.e. burns, SSG, r/o drains, CVC/PICC dressings, acute wound dehiscence

Once an object is picked up from the field, it cannot be placed down again (in strict aseptic technique)

instruments and/or wound 4.6 AWMA guidelines; Use non-sterile or sterile gloves when there is a risk of contamination to the individual or clinicianContamination in wound dressing procedure (Tal Ellis 2004) Contamination is an act involving the introduction of microorganisms into a wound and the wound field Research demonstrates that exogenous introduction of microorganisms into wounds occurs principally by direct contact Limiting direct contact between the hands of the clinician is the most effective way of reducing contamination (case for gloves) All wounds have microorganisms present; only exogenous microorganisms can cause contaminationWound field theory Consists of the wound to be dressed and the materials used to achieve this, including the dressing pack The wound and dressing sheet are a continuum and form the wound field Microorganisms can be transported from the wound to the dressing sheet; contamination is not considered to have occurred In effect, the dressing procedure is about preventing

contaminationClean technique 4.2 AWMA guidelines; the clinician will determine when a clean technique is acceptable; i.e. washing, showering Usually used for chronic wounds where the patient is not compromised Infection control principles continue to apply Incorporates the use of clean solutions and dressings Dressing pack may not be requiredWhich technique, which solution ? Base choice on the individual and their wound Aetiology of wound (i.e. acute, chronic, ischaemic) Factors affecting healing (i.e. immunosuppression, diabetes) Stage of wound healing (necrotic vs granulating) Environment (hospital vs home) Regardless, follow the principles of do no harm and lets not introduce anything new to the wound!!!