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PNP1 Exam 3 > GU- UTI > Flashcards

GU- UTI Flashcards

1
Q

Most frequent pathogen

A

E-coli

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2
Q

how many percent of children yearly?

A

2.4%

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3
Q

up to 6 months old which gender is more common?

A

males

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4
Q

incidence in males <6 months

A

2 per 100 births

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5
Q

what is the increased risk to uncirc males <6 months old ?

A

tenfold!

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6
Q

more common in famales after what age?

A

1 year

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7
Q

what percent of toilet trained females get UTI?

A

3%

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8
Q

what percent of children with UTI develop renal scarring?

A

15%

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9
Q

10-20% of kids with renal scarring will develop

A

hypertension

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10
Q

symptoms in infants

A

fever, irritability, poor feeding, vomiting, diarrhea

suspect when no other source of fever or illness present

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11
Q

symptoms in older children

A

dysuria, suprapubic/urethral pain, urinary frequency, incontinence

foul smelling urine and constipation- always get stool history

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12
Q

s/s if kidney is involved

A

fever, flank pain, nausea, vomiting

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13
Q

in infants with gross anatomic abnormalities such as obstruction

A

may detect a mass

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14
Q

physical findings

A

CVA tenderness

external irritation r/t incont, vaginal voiding, labial adhesions

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15
Q

diagnosis that are misdiagnosed as UTI

A

vaginitis

pinworms

both present frequently with dysuria

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16
Q

What to do if vaginal discharge is present

A

culture

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17
Q

What do we rule out in older males?

A

scrotal exam to r/o epididymis especially if sexually active

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18
Q

What are you looking for on ABD exam?

A

large stool burden, constipation is common

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19
Q

What patients need US?

A

First positive uti with fever and systemic illness

infants, febrile UTI’s, recurrent UTI’s, children not toilet trained,

Must document true infection via cath sample to decide what additional evaluation is needed (if doing xrays)

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20
Q

bagged specemin

A

helpful in r/o UTI

if positive: need cath sample

False positives in 90% especially if left on >20 min

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21
Q

clean-catch

A

better- small colony counts of multiple orgamisns suggests contamination

difficuly for children to perform even with parents help, urine hits perineum first, difficulty separating to wipe first

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22
Q

cath specimen

A

Most widely accepted technique

some offices not able to perform

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23
Q

urinalysis provides

A

lueks

nitrates (positive highly suggestive of infection)

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24
Q

culture assesses

A

colony count

what pathogens

suceptability to atb

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25
suprapubic aspirate
most reliable rarely used d/t anxiety of needle use to parent and child
26
Who provides guidelines for treatment of UTI's?
UK National Institute for healthy and clinical experience (NICE) and the AAP
27
when so we perform renal US?
if child is not responding to therapy- promptly
28
What do we consider if renal US is abnormal?
VCUG or DMSA
29
urinary tract obstructions are seen in what percent
5-10%
30
vesicoureteral reflux in what percent?
21-57 of patients with obstruction
31
when to refer?
positive testing for reflux/obstruction febrile UTI
32
Lab tests
only done in significantly ill, febrile child
33
Elevated creatinine or BUN indicates
urinary tract problem
34
elevated WBC on CBC indicates
infection
35
Who should be hospitalized?
infants who appear systemically ill or are \< 3months old
36
choice for parenteral atb
third gen cephalosporins aminoglycosides therapy lasts 7-14 days
37
Management of young children that are ill appearing at home
must have confidence in family
38
approved for complicated UTI/pyleonephritis but concern for safety in children - use situational and limited
Quinilones
39
when can parenteral treatment be stopped?
may change to PO after clinical picture is improving and sensitivity on culture returns
40
not good choice for systemically ill patient, doesnt reach high serum concentrations
Nitrofurantoin
41
Uncomplicated UTI described as
lower urinary tracy or bladder infections
42
legnth of atb for uncomplicated UTI
3-5 days oral atb
43
oral treatment of choice prophylaxis
Nitrofurantion - high urinary concentration
44
Nitrofuration prophylactic dose
1-2 mg/kg single daily dose expensive and liquid is poorly tolerated sprinkle capsules in yogurt, applesauce
45
TMP-SMX prophylactic dosage
2mg/kg once per day or 5mg/kg twice per week \<1 month
46
age for keflex and amplcillin
newborns
47
Treatment of choice for uncomplicated UTI, PO
TMP-SMX (bactrim) AmmoxCluv (Augmentin) second or third gen cephalosporin
48
legnth of atb if febrile or 2-24 months
7-10 days
49
Bactrim dose - first line treatment
8 to 12mg/kg trimethoprim 30-60mg/kg sulfamethoxazole in two divided doses
50
bactrim age
greater than 2 months old
51
Cultures
52
acute UNCOMPLICATED pylonephritis treatment options for young children
Oral cefixime ceftibuten ammox/clauv
53
acute UNCOMPLICATED pylonephritis treatment options for adolescents option 1 and dose
ammox-clauv (augmentin) PO 875/125 mg BID
54
acute UNCOMPLICATED pylonephritis treatment options for adolescents option 2 and dose
Cipro 500mg BID or ER 1000mg daily
55
Admission criteria for "complicated" pyelonephritis- req IV atb
less than 1 months old vomiting not drinking dehydration concerns
56
tylenol
10-15 Q4-6 max 5 doses in 24 hours
57
motrin
5-10 Q6 hrs not to exceed 40mg/day choose one
58
phenazopyridine ages and doses (2)
12mg/kg/day 6-12 years old 200mg TID \>12 years old
59
foods to aviod
caff, carb beverages, choc, citrus, aspartame, alcohol, spicy foods
60
when to follow up
48-72 hours after starting treatment
61
what if response to appropriate atb was ineffective?
repeat culture in 48-72 hours if reocurrant treatment problems get culture 3-7 days after atb completed
62
follow up for children \<2 years old
febrile UTI, recurrent UTI, pyelonephritis
63
Who needs a VCUG scan?
second febrily UTI child with sibling with VUR history of maternal UTI neurogenic bladder BBD
64
neonates and VCUG
neonates with complex medical conditions may have scan after first episode of pylonephritis to assess renal scarring
65
infection of bladder leading to lower uti - no renal injury or fever
cystitis
66
bacteria in urine w/o other symptoms, benign, no renal injury
asymptomatic
67
most severe uti, renal parychema or kidneys involved may cause irreversible renal damage
pyelonephritis
68
complicated UTI
with fever, toxicity or dehydration child \< 3-6 months old VUR, abnormalities
69
most important risk factor for developing pyelo
VUR 10-45% of children with symptomatic UTI
70
most common time for UTI
infancy and toilet training also at onset of sexual activity in females
71
Most common cause of fever wihtout focus in less than 24 months
UTI
72
how are UTIs identified
first occuance reoccurent (within two weeks, same or different organism) chronic- ongoing or unresolved
73
diagnosis of UTI from clean catch sample
\>100,000 colonies of single pathogen
74
diagnosis of uti from cath or suprapubic sample
50,000 colonies
75
diagnosis of uti in symptomatic child
\>10,000 colonies of single pathogen
76
UTI \< 5 years chart uncomplicated cystitis
out pt PO ATB repeat culture 48-72 hours sterile=complete atb, if not sterile repeat c/s and treat repeat culture 3-4 days p atb dome US and VCUG if indicated when sterile (up to 6 weeks)
77
UTI \<5 years chart uncomplicated pyelo (febrile, \>3-6 months, well hydrated, no vomiting, no abd pain)
out pt PO/IM ATB repeat culture 48-72 hours sterile=complete atb, if not sterile repeat c/s and treat repeat culture 3-4 days p atb dome US and VCUG if indicated when sterile (up to 6 weeks)
78
UTI \< 5 years complicated pyelo (febrile, \<3-6 months, toxic, dehydrated, and/flank pain, vomiting)
in pt IV ATB repeat culture 48-72 hours sterile and stable= discharge home if not sterile repeat c/s and treat repeat culture 3-4 days p atb dome US and VCUG if indicated when sterile before d/c, after atb completion or up to 6 weeks as long as child is on pruphylactic atb until test done
79
Infants 2-24 months
for diagnosis should have suggestive ua (positive nitrates, lueks) followed by urine culture from sterile cath with \>50,000 cfu/ml
80
Bactrim dose adolescents | (uncomplicated cystitis)
160 mg of tmp componend Q12 (TMP cpmponent)
81
augmentin dose \<3 months | (uncomplicated cystitis)
30mg/kg/day two divided doses
82
augmentin dose \>3 months | (uncomplicated cystitis)
20-45mg/kg/day 2-3 divided doses
83
augmentin dose adolescents | (uncomplicated cystitis)
250-500 Q8 or 875 Q12
84
nitrofurantoin \> 1 month | (uncomplicated cystitis)
\> 1 month- 5-7mg/kg/day divided Q6 max 400mg in 24 hours
85
DMSA
to detect renal scars or parenchymal inflammation changes in the kidney, done 6 months after infection when inflammatory changes in the kidney have resolved
86
IVP
done if further definition of structure or function is needed - rare
87
asymptomatic bacturea does not need treatment if
there are no leukocytes
88
Nitrofurantoin adolescents | (uncomplicated cystitis)
adolescents 50-100mg/dose Q6 or 100mg BID (dual release)
89
Ammoxicillin \< 3 months | (uncomplicated cystitis)
20-30mg/kd/day two divided doses
90
ammoxicillin \> 3 months old | (uncomplicated cystitis)
25-50mg/kg/day two divided doses
91
Ammoxicillin adolescents | (uncomplicated cystitis)
250-500mg Q8 hrs or 875mg BID
92
Bactrim \> 2 months old
93
cephalexin | (uncomplicated cystitis)
50-100 mg/kg/day given Q6 max dose 4g/day
94
cefixime \>6 months old | (uncomplicated cystitis)
16mg/kg/day two divided doses max 400mg/kg/day
95
cefpodoxime proxetil 2 months - 12 years (uncomplicated cystitis)
10mg/kd/day two divided doses max 400mg/kg/day
96
cefixime adolescents | (uncomplicated cystitis)
400mg Q12-24 hours
97
cefpodoxime proxetil adolescents (uncomplicated cystitis)
200-800mg/day two divided doses max 800mg/day
98
ciprofloaxcin ER | (uncomplicated cystitis)
\<18 years old once daily X3 days
99
acute pyelo treatment choices in young children (uncomlicated)
cefixime ceftibuten augmentin
100
acute pyelo in adolescent treatment choices (uncomplicated)
augmentin 875/125 BID Cipro 500mg BID or cipro 1000mg ER daily
101
102
Cephalexin prophylactic dose
10mg/kg single daily dose
103
Ammox prophylactic dose
10mg/kg single daily dose can use in newborns/premies cant use past 2 postnatal months liquid good for 14 days

PNP1 Exam 3 (17 decks)

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