Friday, November 23, 2012

Positive U/A

(And now for something a little less controversial. Unlike my last post, I expect significantly less than 100 comments.)

A page I got at 1AM:

Nurse: "I'm calling to let you know that the urinalysis on Mrs. Burns is positive. There are a lot of white blood cells."

Granted, I'd never been paged before urgently with the results of a urinalysis, but the patient had a mild fever earlier so it didn't seem unreasonable.

Me: "Oh..." [groggily trying to decide what med to start her on or to wait till morning] "Is the patient on any antibiotics right now?"

Nurse: "No."

Me: "Any allergies?"

Nurse: "No. There's also trace leukocyte esterase in the urine."

Me: [finally waking up] "Trace? Wait, can you read me the full results of the urinalysis?"

Nurse: "Protein negative, ketones negative, trace leukocyte esterase, nitrite negative, 0-3 red blood cells, and 3-5 white blood cells...."

Me: "Three to five white blood cells???"

I made her repeat that number twice to make sure I heard right. I can't believe I got woken up in the middle of the night about three white blood cells in a patient's urine. That was like the least remarkable urinalysis ever.


  1. As a nurse, I am embarrassed. I honestly cannot understand what some nurses are thinking, or if they are thinking at all. I apologize on behalf of all of us who would never do that. Tricia

  2. The nurses here have a whole paperwork trail to go through for physician calls. I always thought it was kind of silly, but maybe I should re-think that.

    Rarely, almost never, get one of these calls, this may be why...

  3. Tell me 25-50 squamous cells, too?

  4. We have to call for certain lab values, including all critical values (which kind of makes sense until you have someone in ERF who is going to dialysis in the morning, etc.) and most abnormal urine/blood/skin cultures.

    Our charting routinely gets audited and if there isn't proof that we alerted a doctor to certain findings, we can get in biiiig trouble.

  5. Understood Hannah, and I think we are all in agreement that in borderline cases better to call us than not, but in this case?

    Do you have standing orders Dr. Fiz? What about Physician call sheets?

    1. That was years ago, so I'm not really sure. But I don't think it's ever standard protocol to call about a U/A.

  6. I am REQUIRED to call for any (no using reasonable judgment) lab result the lab deems "critical". So that heel stick electrolyte panel (NICU nurse here) that I spent ten minutes squeezing out that is CLEARLY hemolyzed and comes back with a crazy potassium? I have to wake someone up to report it, and it has to be within 30 minutes of receiving the call or, if my charts are audited, I can get a "corrective action" --- meaning no raises, tuition reimbursement, bonuses, opportunities to transfer, for a YEAR! The whole thing is just ridiculous. I really hate having to bother our nurse practitioners or residents for something stupid, but it's not worth losing my yearly raise for it...