EPISCOPAL DIOCESE OF SOUTHERN PHILIPPINES

BRENT HOSPITAL AND COLLEGES INCORPORATED

R.T. Lim Boulevard, Zamboanga City

College of Nursing

SUMMARY PERFORMANCE EVALUATION

TEST FOR SUGAR AND TEST FOR ALBUMIN IN URINE

Name of Student: _____________________ Date: ___________________

Section: _____________________________

URINE TESTS CORE COMPETENCIES DESIRED ACTUAL REMARKS

SCORE SCORE
PREPATORY PHASE
SAFE AND QUALITY NURSING CARE (SQC)

I. CLEAN CATCH URINE SPECIMEN

5
HEALTH EDUCATION(HE) 3
Instruct the client to:
1. Wash perineal area with soap and water.
2. Obtain mid-stream urine specimen. 3
3. Wipe the specimen bottle with clean 3
disposable wipes/ tissue paper, before
handling it back to you.
II. URINE TESTS
PERFORMANCE PHASE
MANAGEMENT OF RESOURCES, ENVIROENMENT, AND
EQUIPMENT (MRE)
4. Performs Urine Test for Sugar
a. Places about 6-8 gtts ( drops) of urine in a 10ml 3
test tube.
b. Adds 3-5 ml of Benedict’s solution to the urine. 3
c. Lights the alcohol lamp. 3
d. Uses the test tube holder in holding the mixture 5
near the flame, noting that the mouth of the test
tube is held away from the performer.
e. Brings to boil mixture with proper technique. 5
f. Removes test tube from flame. Puts out flame. 5
g. Allows urine specimen to stand for 1 minute. 3
h. Interprets result and records. 3
5. Performs urine test for Albumin
a. Fills test tube about 2/3 full of clear urine. 3
b. Heats the upper portion till it boils. 5
c. Adds 5 gtts (drops) of 10% acetic acid; 5
1gtt(drop) at a time.
RECORDS MANAGEMENT(RM) 3
d. Interprets result and records.
PERSONAL AND PROFESSIONAL DEVELOPMENT(PPD(
6. Maintains clean technique in performing the 5
procedure.

60
TOTAL SCORE
Actual Score: _____________________ %
Clinical Instructor: _______________