Ketone Testing

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Considerations:

  • Provide the student with as much privacy as possible
  • Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  • Ensure strips are contained in a tightly sealed container and show no signs of discoloration
    • Prolonged exposure of test strips to air may lead to inaccurate results
    • Discolored test strips should be discarded
  • Review manufacturer’s instructions regarding how long to keep an opened bottle of test strips before needing to discard
  • Be sure to inform school staff that a student with diabetes should never be sent anywhere alone if feeling hypoglycemic or hyperglycemic

Supplies:

  • Urine cup
  • Ketone testing strips
  • Watch with a second hand timer
  • Paper towels
  • Diabetes Medical Management Plan/Healthcare provider’s order
  • Students Individualized Health Plan (IHP)
  • Parent/guardian authorization form
Procedure Download
Skill Competency Download

Procedure:

  1. Review the health care provider’s order/Student Diabetes Medical Management Plan
  2. Ensure proper documentation of parent/guardian authorization to perform this procedure
  3. Position student to provide as much privacy as possible
  4. Explain the procedure to the student at his/her level of understanding
  5. Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  6. Gather supplies and place on a clean surface
  7. Check expiration date on testing strips
  8. Ensure strips are contained in a tightly sealed container and show no signs of discoloration
    • Discolored test strips should be discarded
  9. Wash hands
  10. Put on gloves
  11. Have the student provide a urine sample in a urine cup, urine hat, or clean container
  12. Immerse end of test strip into urine container
  13. Remove test strip immediately
  14. Gently tap it against the urine container to remove excess urine off the strip
  15. Hold the strip in a horizontal position to prevent mixing of chemical reagents
  16. Precisely time the number of seconds specified on ketone container
    • Be sure to follow timing instructions accurately as reading too soon or waiting too long could result in inaccurate resutls
  17. Compare color of the strip with color chart on ketone container
  18. Discard the testing strip and urine, per school policy
  19. Remove gloves
  20. Wash hands
  21. Document ketone results in student’s healthcare record
  22. Follow Diabetes Medical Management Plan/healthcare provider’s orders
  23. Update parent’s and healthcare provider, as needed

References:

American Diabetes Association. (n.d.). Training resources for school staff. Tips for school nurses. Retreived June 8, 2023, from https://diabetes.org/tools-support/know-your-rights/safe-at-school-state-laws/training-resources-school-staff/tips-for-school-nurses

National Association of School Nurses. (2022, June 15). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes toolkit. Retrieved June 2, 2023, from https://cdn.fs.pathlms.com/HRuI7pAvQWiJPZdzH6i8 

National Association of School Nurses. (2021). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes. Silver Spring, MD: Author. Retrieved June 2, 2023, from https://learn.nasn.org/courses/37660 

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Procedural guideline 7.2 Urine screening for glucose, ketones, protein, blood, and pH. In Clinical nursing skills and techniques. (10th ed.). (pp. 186-187). St. Louis, MO: Elsevier. St. Jude’s Children’s Research Hospital. (2022, September) How to check urine for glucose and ketones. Retrieved June 5, 2023, from https://together.stjude.org/en-us/patient-education-resources/tests-procedures/check-urine-for-glucose-and-ketones.html

Page last reviewed: February 20, 2025
Page last updated: February 20, 2025

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.