CAD II Flashcards
pertinent ROS (19)
- urinary frequency/ urgency/ hesitancy
- nocturia
- hematuria
- incontinence
- color/ odor of urine
- suprapubic pain
- fever
- N/V
- flank/ low back pain
- genital discharge/ irritation/ itching
- ulcerations/ blisters
- rash
pertinent hx for M & F (7)
- pyelo
- nephrolithiasis
- STI’s
- GU procedures
- GU CA
- sexual activity/ protection
- new meds
pertinent hx for M only
BPH
pertinent hx for F only (5)
- contraception
- LMP
- menses schedule (flow, duration, intermenstrual bleeding)
- pregnancy
- last pap
other ROS (16)
- chills
- fatigue
- malaise
- sweats
- sleep interruptions
- unintentional weight changes
- dysmenorrhea
- eye redness/ pain/ blurring/ discharge
- abd pain
- change in bowel habits
- jaundice
- joint pain/ stiffness
- swollen lymph nodes
inspect/ palpate penis for…
localized GU dermatitis, penile discharge, penile lesions
inspect/ palpate scrotum for…
epididymal/ testicular tenderness
palpate inguinal region (M) for…
LAD, masses, hernia
inspect pubic region (F) for…
localized GU dermatitis
palpate inguinal region (F) for…
LAD
inspect introitus for…
vulvar lesions, vaginal discharge, vaginal atrophy
speculum exam for…
cervical discharge, discoloration/ erythema
bimanual exam for…
cervical motion tenderness, uterine tenderness
rectal exam/ palpate prostate for…
swollen, tender
labs to order (4)
pregnancy test, UA, urine culture, STD screening
bladder/ renal US for…
bladder distention, hydronephrosis
CT abd/ pelvis WITHOUT contrast for…
nephrolithiasis
CT abd/ pelvis WITH and without contrast for…
hematuria, malignancy
cystoscopy for…
malignancy, interstitial cystitis
pain at start of void indicates
urethral source
pain at end of void indicates
bladder source
what makes acute cystitis complicated (8)
- sxs > 7 days
- pregnancy
- DM
- male
- elderly
- IMC
- indwelling catheter
- anatomic abn
(risk of therapeutic failure)
MC etiology
E. coli
2nd MC etiology in sexually active women
Staph. saprophyticus
findings on UA suggestive of acute cystitis (6)
- pyuria (> 10 WBCs/ hpf)
- hematuria
- leukocyte esterase
- nitrites
- cloudy urine
- increased pH (if proteus)
when is urine culture indicated for acute cystitis
if complicated
1st line management for acute cystitis
Nitrofurantoin (Macrobid) ER 100 mg PO BID x 5 days
OR
Trimethoprim-sulfamethoxazole (Bactrim) 160 mg TMP/ 800 mg SMX PO BID x 3 days
1st line management for acute cystitis in MEN
Nitrofurantoin (Macrobid) ER 100 mg PO BID x 7 days
OR
Trimethoprim-sulfamethoxazole (Bactrim) 160 mg TMP/ 800 mg SMX PO BID x 7 days
1st line management for acute cystitis if comorbid conditions
Ciprofloxacin ER 1000 mg QD x 7-14 days
2nd line management for acute cystitis
Amoxicillin-clavulanate (Augmentin) 500 mg/ 125 mg BID x 7 days
OR
Ciprofloxacin 250 mg BID x 3 days
1st line management for acute severe cystitis in MEN
Ciprofloxacin 500 mg BID x 5 days
1st line management for acute cystitis if PREGNANT
Amoxicillin-clavulanate (Augmentin) 500 mg/ 125 mg BID x 7 days
adjunct treatment for symptom control of acute cystitis
Phenazopyridine (Pyridium) 200 mg TID PRN x 2 days
pt edu if giving Pyridium
do not use > 48 hours due to SE’s, turns urine orange
when will pts experience sx relief with abx tx of acute cystitis
within 48 hrs
pt edu for acute cystitis
- increase fluid intake
- void when feel urgency
- void after intercourse
- proper hygiene
when do you need a f/u urine culture for acute cystitis
pregnancy
f/u for acute cystitis
48-72 hrs if no sx relief
signs of pyelo in addition to lower tract sxs (6)
- fever > 99.9
- chills
- back/ flank pain
- CVA tenderness
- N/V
- tachycardia
signs of pyelo in MEN in addition to lower tract sxs
pelvic/ perineal pain
can suggest accompanying prostatitis
findings on UA unique to pyelo
WBC casts
findings on CBC suggestive of pyelo
leukocytosis with L shift
outpatient tx for pyelo
Ciprofloxacin 500 mg BID x 7 days
outpatient tx for pyelo if concerns of resistance
Ceftriaxone 1 g IV/ IM
PLUS
Ciprofloxacin 500 mg BID x 7 days
outpatient tx for pyelo if concerns of resistance and FLQ allergy
Ceftriaxone 1 g IV/ IM
PLUS
Bactrim 160/800 mg PO BID x 7-10 days
f/u for pyelo if treated outpatient
48-72 hrs
when is inpatient management indicated for pyelo (10)
- septic/ critically ill
- persistently high fever > 101
- pain/ marked debility
- older age
- pregnant
- signs of obstruction
- comorbid conditions
- inability to tolerate PO
- renal dysfunction
- compliance concerns
management of pyelo if pregnant
admit for IV abx (amp/ gent or ceftriaxone) until afebrile for 24-48 hrs and sxs improved
diagnostic test of choice for chlamydia
NAAT via vaginal swab in women or first-catch urine in men
tx for chlamydia/ gonorrhea
Doxycycline delayed release 200 mg QD x 7 days
OR
Azithromycin 1 g single dose
OR
Ceftriaxone 500 mg IM x 1 dose
complications of pyelo
- sepsis with shock
- renal failure
- scarring/ chronic pyelo
- renal abscess if inadequate therapy
