Genitourinary 1&2 Flashcards
Lower UTI’s involve what?
Involves bladder (cystitis), urethra (urethritis), and prostate (prostatitis).
Upper UTI’s involve what?
Involves kidneys (pyelonephritis), ureters, renal abscesses.
Is upper or lower UTI’s more common?
lower
What is urosepsis?
Urosepsis is a severe, life-threatening infection that originates from the urinary tract and spreads into the bloodstream, leading to septic shock if untreated. It occurs when a urinary tract infection (UTI), particularly an upper UTI like pyelonephritis, overwhelms the body’s immune system, causing a systemic inflammatory response.
How come patients with DM are more at risk of developing and UTI?
Due to impaired immune response.
What is the most common cause of Acute Pyelonephritis?
E.coli
What is the most common chronic Pyelonephritis?
Repeated infections
What percentage of hospital acquired infections are UTI’s? And what are they primarily caused by?
50% of these are UTIs, primarily caused by Catheter-Associated Urinary Tract Infections (CAUTIs).
How does bacteria most often cause a UTI?
UTIs most commonly occur through the transurethral route, where bacteria ascend from the perineum into the urethra and bladder.
What defenses in our bodies attempt to prevent UTI’s?
Urine flow: Flushing action of urine helps remove bacteria from the urinary tract.
Ureterovesical junction: Prevents urine reflux from the bladder back into the ureters.
Antibacterial enzymes and antibodies: Provide protection within the bladder.
Protective mucosal proteins (GAG layer): Prevent bacterial adhesion to the bladder wall.
What are the most common risk factors associated with UTI’s?
Anatomical Factors: Short urethra in females, congenital abnormalities.
Physiological Conditions: Menopause, pregnancy, neurogenic bladder, diabetes.
Behavioral Factors: Poor hygiene, frequent catheterization, delayed voiding.
What re the most common symptoms of UTI’s?
Burning urination, frequency, urgency, nocturia, pelvic pain, hematuria, and back pain.
What are the most common complications associated with UTI’s?
Bacteremia and Urosepsis: Can lead to septic shock.
Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD): Due to prolonged infections.
What is the most common way to diagnose a UTI?
Urine Cultures: Midstream clean-catch preferred.
Once a patient has been diagnosed with an UTI, how do we treat it?
Treatment depends on severity.
Uncomplicated UTIs: 3-day course of antibiotics.
Complicated UTIs: 7–14 days of antibiotics, sometimes IV therapy.
What are the different types of antibiotics that we can use to treat UTI’s?
Trimethoprim/Sulfamethoxazole (Bactrim) – First-line for uncomplicated UTIs.
Nitrofurantoin (Macrobid) – Preferred for uncomplicated cystitis.
Ciprofloxacin or Levofloxacin (Fluoroquinolones) – Used for complicated UTIs and pyelonephritis.
Amoxicillin-Clavulanate (Augmentin), Cephalexin (Keflex), Ceftriaxone – Alternative options.
In terms of preventing UTI’s what are some strategies that we can use and educate patients on?
Increase fluid intake, void regularly, practice proper hygiene.
Avoid bladder irritants such as caffeine, alcohol, citrus juices.
Complete prescribed antibiotic regimens.
Explain the CAUTI prevention bundle.
Insert catheters only when absolutely necessary.
Maintain aseptic technique during insertion.
Provide perineal care at least once per shift.
Assess catheter necessity each shift and remove ASAP.
What is another name for an upper UTI?
Pyelonephritis
What causes Pyelonephritis?
Bacterial infection of the renal pelvis and kidney due to untreated lower UTI or urinary reflux.
What are the most common risk factors associated with Pyelonephritis?
Urinary reflux, obstructions (kidney stones, tumors, BPH), diabetes, immunosuppression.
What are some common clinical symptoms of Pyelonephritis?
Fever, chills, flank pain, nausea, vomiting, costovertebral angle tenderness.
How would we diagnose Pyelonephritis?
CT scan, ultrasound, urine cultures.
If a patient has been diagnosed with Pyelonephritis, how would we treat this patient?
2-week course of antibiotics, hydration, pain management.
What are the most common antibiotics used to treat Pyelonephritis?
Ciprofloxacin, Levofloxacin, Ceftriaxone, Ampicillin + Gentamicin.
What are some complications associated with Pyelonephritis?
Chronic pyelonephritis can lead to hypertension, end-stage renal disease, and kidney scarring.
What is Benign Prostatic Hyperplasia (BPH) ?
Enlargement of the prostate obstructing urinary outflow.
What are the symptoms of BPH?
Weak urinary stream, urgency, nocturia, retention, frequent UTIs.
If a patient has been diagnosed with BPH, what medications would we use to treat them with?
Alpha-blockers: Tamsulosin (Flomax), Terazosin, Doxazosin – Improve urine flow by relaxing smooth muscles.
5-alpha reductase inhibitors: Finasteride (Proscar), Dutasteride – Reduce prostate size.
If we need to treat BPH surgically, what would we do?
Transurethral resection of the prostate (TURP), minimally invasive laser therapy.
What are the most common risk factors associated with prostate cancer?
Age >50, African American race, family history, high-fat diet.
What are the most common symptoms of prostate cancer?
Asymptomatic in early stages, later causes urinary obstruction, hematuria, painful ejaculation.
What diagnostic procedures would we use to diagnose prostate cancer?
DRE, PSA, biopsy, MRI.
What are the 3 most common ways to treat prostate cancer?
Active Surveillance: For slow-growing cancers.
Hormonal Therapy: Androgen deprivation therapy (Leuprolide, Gosselin, Bicalutamide).
Surgical: Radical prostatectomy, radiation therapy.
What are the two classifications of UTIs?
Lower UTIs (bladder, urethra, prostate) and Upper UTIs (kidneys, ureters).
Why are UTIs more common in women?
Shorter urethra and proximity to the anus facilitate bacterial entry.
What is a CAUTI and why is it significant?
Catheter-associated urinary tract infection; responsible for 50% of hospital-acquired infections.
How does the glycosaminoglycan (GAG) layer help prevent UTIs?
Prevents bacterial adhesion to the bladder wall.
What are the diagnostic criteria for a UTI based on urine culture?
100,000 CFU/mL of bacteria confirms UTI.
Which antibiotic is commonly used for pregnant women with UTIs?
Cephalexin (Keflex).
Why are fluoroquinolones often used for pyelonephritis?
They have broad-spectrum coverage and good kidney penetration.
Why is post-coital urination recommended for UTI prevention?
Helps flush bacteria introduced during intercourse.
What is the recommended fluid intake for preventing UTIs?
At least 2–3 liters per day.
Why is cranberry juice recommended for UTIs?
It prevents bacterial adhesion to the bladder wall.
What is benign prostatic hyperplasia (BPH)?
Non-cancerous enlargement of the prostate that obstructs urine flow.
What hormone contributes to prostate enlargement in BPH?
Dihydrotestosterone (DHT).
What is the purpose of a post-void residual (PVR) test?
Measures urine remaining in the bladder after voiding.
How do alpha-blockers like Tamsulosin help BPH symptoms?
Relax smooth muscles of the prostate and bladder neck to improve urine flow.
What is the mechanism of action of 5-alpha reductase inhibitors?
Block conversion of testosterone to DHT, reducing prostate size.
How does a TURP procedure work?
Removes part of the prostate through the urethra to improve urine flow.
What are possible complications of TURP?
Bleeding, TURP syndrome (fluid overload), retrograde ejaculation.
What is the most common side effect of finasteride?
Decreased libido and erectile dysfunction.
What is the most common type of prostate cancer?
Adenocarcinoma.
What is the role of PSA in prostate cancer screening?
Elevated PSA levels (>4 ng/mL) may indicate cancer.
What symptoms suggest advanced prostate cancer?
Bone pain (metastasis), urinary retention, hematuria.
What imaging studies are used for prostate cancer diagnosis?
MRI, CT scan, bone scan (for metastasis).
What is the purpose of androgen deprivation therapy (ADT)?
Reduces testosterone levels to slow cancer growth.
What chemotherapy agents are used for metastatic prostate cancer?
Docetaxel, Cabazitaxel.
What is the purpose of active surveillance in prostate cancer?
Monitor slow-growing cancer without immediate treatment.
What are potential side effects of radical prostatectomy?
Urinary incontinence, erectile dysfunction
What is the purpose of continuous bladder irrigation (CBI)?
Prevents clot formation and maintains catheter patency post-TURP.
How is bladder hemorrhage managed post-TURP?
Increase irrigation flow rate to flush out clots.
What color should the output be in CBI?
Light pink to clear.
What medication can be used to treat bladder spasms post-TURP?
Belladonna and Opium (B&O) suppositories.
How does a nurse assess for catheter blockage during CBI?
Monitor for decreased output and bladder distention.
What should be done if the CBI output is bright red?
Increase irrigation rate and notify the provider.
Why is accurate input and output monitoring critical in CBI?
Ensures bladder is not overdistended or under drained
What are signs of infection post-prostate surgery?
Fever, purulent drainage, dysuria, elevated WBCs.
How often should vital signs be monitored post-TURP?
Every 4 hours or as indicated by patient condition.
What is meant by functional incontinence?
involuntary loss of urine due to physical or cognitive impairment
What part of the urinary tract is considered sterile?
Above the urethra.
A UTI is the ___________ most common infection.
Second.
Is the urethra considered clean or sterile?
Clean
How does the Glycosaminoglycan (GAG) protein protect the bladder from bacteria?
The GAG molecule attracts water molecules, forming a water barrier that serves as a defensive layer between the bladder and the urine.
What is an obstruction to free-flowing urine called?
urethrovesical reflux
Define urethrovesical reflux.
the reflux (backward flow) of urine from the urethra into the bladder.
Define Bacteriuria.
term used to describe the presence of bacteria in the urine. Because urine samples (especially in women) can be easily contaminated by the bacteria normally present in the urethral area, a clean-catch midstream urine specimen is the measure used to establish bacteriuria. In men, contamination of the collected urine sample occurs less frequently.
In older adults, what are some comorbidities that may increase the risk of an UTI?
In older adults, structural abnormalities secondary to decreased bladder tone, neurogenic bladder (dysfunctional bladder) secondary to stroke, or autonomic neuropathy of diabetes may prevent complete emptying of the bladder and increase the risk of UTI
How come post-menopausal women are more at risk of developing an UTI?
In the absence of estrogen, postmenopausal women are susceptible to colonization and increased adherence of bacteria to the vagina and urethra.
What are 8 factors that contribute to UTI’s in older adults?
*Cognitive impairment
*Frequent use of antimicrobial agents
*High incidence of multiple chronic medical conditions
*Immune compromised
*Immobility and incomplete emptying of bladder
*Low fluid intake and excessive fluid loss
*Obstructed flow of urine (e.g., urethral strictures, neoplasms, clogged indwelling catheter)
*Poor hygiene practices
Patients with indwelling catheters are most likely to be infected by which bacteria?
Proteus, Klebsiella, Pseudomonas, or Staphylococcus.
Treatment for an uncomplicated UTI is normally 3 days, however infection recurs in about 20% of women…. why?
Infections that recur within 2 weeks of therapy do so because organisms of the original offending strain remain. Relapses suggest that the source of bacteriuria may be the upper urinary tract or that initial treatment was inadequate or given for too short a time. Recurrent infections in men are usually caused by persistence of the same organism; further evaluation and treatment are indicated
If a subsequent UTI occur after initial treatment, what would be the next steps for treatment?
If infection recurs after completing antimicrobial therapy, another short course (3 to 4 days) of full-dose antimicrobial therapy followed by a regular bedtime dose of an antimicrobial agent may be prescribed.
If a patient has been diagnosed with an UTI, what urinary tract irritants should they be avoiding?
coffee, tea, citrus, spices, colas, alcohol
What are some hygiene measures that should be encouraged to prevent recurrent UTI’s?
*Shower rather than bathe in the tub because bacteria in the bathwater may enter the urethra.
*Clean the perineum and urethral meatus from front to back after each bowel movement. This will help reduce concentrations of pathogens at the urethral opening and, in women, the vaginal opening.
What are some voiding habits that should be encouraged to prevent recurrent UTI’s?
Void every 2 to 3 hours during the day, and completely empty the bladder. This prevents overdistention of the bladder and compromised blood supply to the bladder wall. Both predispose the patient to urinary tract infection. Precautions expressly for women include voiding immediately after penile-vaginal intercourse.
Patients with UTIs are at increased risk for gram-negative sepsis. For each day a urinary catheter is in place, the risk of developing CAUTI increases by ___________
3% to 7% per day of catheterization
What is meant by the statement that CAUTI is a “never event”?
No reimbursement to pay for the cost of treatment will be covered by CMS or other insurers if the CAUTI is incurred within an acute care or rehabilitation hospital
What may chronic pyelonephritis lead to?
The kidneys become scarred, contracted, and nonfunctioning. Chronic pyelonephritis is a cause of chronic kidney disease that can result in the need for renal replacement therapy (RRT) such as transplantation or dialysis
What diagnostic tools are used for pyelonephritis?
The extent of the disease is assessed by an IV urogram and measurements of creatinine clearance, blood urea nitrogen, and creatinine levels.
Why would we provide some patients with Intermittent Self-Catheterization?
Intermittent self-catheterization provides periodic drainage of urine from the bladder. By promoting drainage and eliminating excessive residual urine, intermittent catheterization protects the kidneys, reduces the incidence of UTIs, and improves continence. It is the treatment of choice in some patients with spinal cord injury and other neurologic disorders, such as multiple sclerosis, when the ability to empty the bladder is impaired. Self-catheterization promotes independence, results in few complications, and enhances self-esteem and quality of life.
When educating patients on how to perform self-catheterization what does the nurse often teach the patient?
To use a “clean technique” at home. Antibacterial liquid soap is recommended for cleaning urinary catheters at home. The catheter is thoroughly rinsed with warm tap water and must be dried before reuse. It should be kept in its own container, such as a plastic food storage bag.
What is the average daytime clean intermittent catheterization schedule?
Q4-6H and before bedtime.
What is a more invasive alternative to self-catheterization?
The creation of the Mitrofanoff umbilical appendicovesicostomy.
In this procedure, the bladder neck is closed and the appendix is used to create access to the bladder from the skin surface through a submucosal tunnel created with the appendix. One end of the appendix is brought to the skin surface and used as a stoma, and the other end is tunneled into the bladder. The appendix serves as an artificial urinary sphincter when an alternative is necessary to empty the bladder.
What does Urolithiasis and Nephrolithiasis refer to?
Stones (calculi) in the urinary tract and kidney
When are stones formed in the urinary tract?
Stones are formed in the urinary tract when urinary concentrations of substances such as calcium oxalate, calcium phosphate, and uric acid increase.
What are some factors that contribute to the formation of calculi?
Infection, urinary stasis, and periods of immobility, all of which slow kidney drainage and alter calcium metabolism. In addition, increased calcium concentrations in the blood and urine promote precipitation of calcium and formation of stones
What are the most common reason for stone formation in men?
Uric Acid - often seen in patients with gout.
What are the most common reason for stone formation in women?
Seventy-two percent of stones diagnosed in women are struvite stones which form in persistently alkaline, ammonia-rich urine caused by the presence of bacteria such as Proteus, Pseudomonas, Klebsiella, Staphylococcus, or Mycoplasma.
What are some medications known to cause stones in patients
Medications known to cause stones in some patients include antacids, acetazolamide, vitamin D, laxatives, and high doses of aspirin.
How do we diagnose calculi in patients?
The diagnosis is confirmed by a non-contrast CT scan.
Blood chemistries and a 24-hour urine test for measurement of calcium, uric acid, creatinine, sodium, pH, and total volume may be part of the diagnostic workup. Dietary and medication histories and family history of renal calculi are obtained to identify factors predisposing the patient to the formation of stones.
What is the immediate treatment of renal or ureteral colic?
Relieve pain until the cause can be eliminated.
What is the purpose of giving opioids to patients with renal or ureteral colic?
To prevent shock or syncope resulting from the excruciating pain.
What is the purpose of giving NSAIDs to patients suffering from renal or ureteral colic?
NSAIDs are effective in treating renal calculus pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone - once stone has passed, pain is relieved.
Unless the patient is vomiting or has heart failure or any other condition requiring fluid restriction, why are fluids are encouraged in patients suffering from renal or ureteral colic?
This increases the hydrostatic pressure behind the stone, assisting it in its downward passage. A high, around-the-clock fluid intake reduces the concentration of urinary crystalloids, dilutes the urine, and ensures a high urine output.
True/False
Patients with calcium-based renal calculi should restrict calcium in their diet.
False.
Historically, patients with calcium-based renal calculi were advised to restrict calcium in their diet. However, evidence has questioned this practice, except for patients with type 2 absorptive hypercalciuria (half of all patients with calcium stones), as stones in these patients are clearly the result of excess dietary calcium.
Patients diagnosed with uric acid stones is placed on a _________ diet.
Low-purine diet to reduce the excretion of uric acid in the urine.
What are some examples of food high in purine?
shellfish, anchovies, asparagus, mushrooms, and organ meats
What medication is usually prescribed to reduce serum uric acid levels?
Allopurinol.
If the patient has Cystine stones, what diet should they follow?
A low-protein diet and increased fluid intake.
Patients with Oxalate stones should limit the intake of oxalate, what types of food should they avoid?
spinach, Swiss chard, chocolate, peanuts, and pecans
If the stones does not pass spontaneously or if complications occur, what interventions are commonly used?
Endoscopic or other procedures. For example, ureteroscopy, extracorporeal shock wave lithotripsy (ESWL), or endourologic (percutaneous) stone removal may be necessary.
Explain the procedure of lithotripsy (ESWL).
A noninvasive procedure used to break up stones in the calyx of the kidney. After the stones are fragmented to the size of grains of sand, the remnants of the stones are spontaneously voided.
In ESWL, a high-energy amplitude of pressure, or shock wave, is generated by the abrupt release of energy and transmitted through water and soft tissues. When the shock wave encounters a substance of different intensity (a renal calculus), a compression wave causes the surface of the stone to fragment. Repeated shock waves focused on the stone eventually reduce it to many small pieces that are excreted in the urine.
