Acetic Acid Test Performance Checklist

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Cebu Institute Of Technology – University

COLLEGE OF NURSING
___________________________________________________________________
PERFORMANCE CHECKLIST FOR ACETIC ACID TEST

Name: ________________________ Year and Section: ____ Date: ________

Rationale Not
Procedure Done Score
Done
1. Assess the patient’s need for Acetic test. 2

2. Identify the patient and explain the


3
procedure.

3. Do hand washing. 2

4. Prepare the materials and solutions to be


used. (Acetic acid 5% solution, Test-Tube, 5

Test-tube holder, alcohol lamp)

5. Fill the test tube 2/3 full of clear urine. 5

6. Heat the center part of the test tube over


5
flame and bring to a boil.
7. Hold test tube against the light and
5
examine for cloudy ring.
8. Add 3 – 5 drops of acetic acid if there is a
5
ring.

9. Heat the solution again. 3

10. Note the result


No albumin – cloudiness disappears
becomes colorless
With albumin –cloudiness remains 3
Trace = top liquid is opaque
(+1) – (+2) Albumin = cloudy
(+3) – (+4) albumin = Ring is white
resembling white of an egg.
11. Clean the materials used. 2

12. Do hand washing. 2

TOTAL 50

Comments/Remarks:
_____________________________________________________________________________
_____________________________________________________________________________
____________________________ ____________________________
Student’s Signature & Date C.I.’s Signature & Date

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