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Nurs G140 Exam 2 (MS) > Infection > Flashcards

Infection Flashcards

1
Q

Role of the RN (4)

A
  • collaborate for healing of infection
  • prevent complications
  • promote function
  • promote prevention of future infection
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2
Q

What is urinary elimination?

A

excretion of body wastes

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3
Q

What part of the urinary system is sterile?

A

the part above the urethra

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4
Q

examples of lower UTIs (3)

A

cystitis, prostatitis, urethritis

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5
Q

examples of upper UTIs (3)

A

pyelonephritis, renal abscess, nephritis

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6
Q

What is an uncomplicated urinary infection?

A

community acquired infection, usually non-recurrent

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7
Q

Ex of complicated urinary infection? Diseases that can cause it to be complicated and is it recurrent or nonrecurrent?

A

HAI, CAUTI, pregnancy, diabetes, obstruction, recurrent

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8
Q

UTI risk factors (6)

A
  • increased urine stasis: obstruction
  • foreign bodies: calculi
  • anatomy: shorter urethra in women
  • Immunocompromised, aging, DM, HIV
  • constipation, catheterization
  • pregnancy, personal hygiene, delay of urination (nurses bladder)
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9
Q

Causes of Lower UTIs (LUTI)

A
  • ineffective defense mechanisms of defense (normal flora, urinary IgA)
  • uretrovescial reflux (dysfunction, menopause)
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10
Q

What can cause lower UTIs from the transurethral route?

A

fecal contamination and sexual intercourse

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11
Q

Clinical manifestations of uncomplicated LUTIs (6)

A
  • burning during urination
  • urinary frequency
  • urgency
  • suprapubic/pelvic pain
  • hematuria
  • nocturia
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12
Q

Clinical manifestations of complicated LUTIs and evaluate for what?

A
  • from asymptomatic to sepsis with shock

- evaluate for urosepsis

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13
Q

How do LUTIs occur?

A

bacteria colonization of epithelium of urethra and/or bladder

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14
Q

Positive urine culture for LUTIs

A

> 100,000 CFU/ml from clean catch midstream or catheter sample

1000-100,000 CFU/ml may still indicate UTI, especially for a specimen taken at cystoscopy or other invasive procedure

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15
Q

LUTIs gerontological considerations

A
  • cognitive impairment
  • frequent use of antimicrobials, immunocompromised, infected pressure ulcers
  • multiple chronic medical conditions, indwelling catheter
  • urine stasis (older women incomplete bladder emptying), immobility
  • decreased bladder tone, neurogenic bladder (stroke), diabetic autonomic neuropathy
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16
Q

Gerontological considerations: Frequent ___ are common

A

reinfections

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17
Q

Gero considerations: subjective clinical manifestation

A

fatigue

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18
Q

Gero considerations: objective clinical manifestations

A

change in cognitive function

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19
Q

Gero considerations: s/s urosepsis (6)

A
  • ALOC
  • lethargy
  • anorexia
  • new incontinence
  • hyperventilation
  • low-grade fever
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20
Q

UTI assessment and diagnosis

A
  • pain, urine color and characteristics
  • past medical hx
  • medications
  • fluid intake
  • elimination patterns
  • paralyzed or chronically ill patient: ask about usual bladder pattern
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21
Q

Anuria

A

no urine output or less than 50 mL in 24 hours

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22
Q

Oliguria

A

urine output < 0.5 ml/kg/hr

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23
Q

hematuria

A

blood in urine

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24
Q

dysuria

A

pain upon urination

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25
Q

pyuria

A

pus (WBC) in urine

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26
Q

Normal UA (protein, glucose, ketones, pH, specific gravity, hematuria, WBC, casts)

A
  • no protein
  • no glucose
  • no ketones
  • pH: 4.0-8.0
  • specific gravity: 1.010-1.025
  • WBC: 0-5
  • no casts
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27
Q

What does a clean catch for urine C&S differentiate?

A

true bacteriuria from contamination

28
Q

clean catch urine steps (9)

A
  • wash hands with soap and water
  • remove lid of urine container; do not touch inside of container
  • clean urethral area with antiseptic wipes (no Betadine)
  • urinate small amount into toilet, then stop
  • place empty sterile container in the path of the urine stream
  • restart voiding into the container; stop when container is half full
  • finish urinating into the toilet
  • tightly screw the lid onto the urine container; do not touch the inside of the container
  • turn in sample as instructed
29
Q

How will a female clean her genitalia before doing a clean catch urine specimen?

A

separate genital folds and gently wipe inside folds with antiseptic wipes from front to back (2 or 3 times)

30
Q

How will a male clean his genitalia before doing a clean catch urine specimen?

A

if not circumcised pull foreskin back before cleaning; keep holding skin back until sample is collected- gently wipe the tip of the penis with antiseptic wipes (2 or 3 times)

31
Q

UTI diagnosis (3)

A
  • symptomatic UTI even if culture < 100,000 CFU/mL
  • urine culture if bacteriuria
  • pyuria, hematuria (50% of cases)
32
Q

situations when bacteriuria is present and a urine culture will be done (9)

A

men, diabetic patients, recent urinary tract procedure, recent admission or long-term care, recurrent UTIs, pregnancy, sexually active women, postmenopausal, immunocompromised

33
Q

LUTI Diagnostic Studies (5)

A
  • normal multiple test dipstick: no WBCs, no nitrates
  • test for STIs (similar symptoms)
  • CT scan: obstruction, abscesses
  • transrectal US: visualize prostate and bladder in men with recurrent, complicated UTIs
  • cytourethroscopy: Visualize ureters
34
Q

LUTI Medical management (5)

A
  • pharm therapy and patient education
  • short (3 d) or longer (7 day) course regimens
  • If anatomical abnormalities: self-test and antimicrobial standing order
  • long-term therapy for recurrent up to 6-7 months, after midstream clean catch for C&S
  • cranberry juice: daily intake to help prevent and control UTI symptoms
35
Q

LUTI nursing management: assessment (9), diagnosis (1), planning (1)

A
  • hx of pain
  • urgency
  • frequency
  • hesitancy
  • color
  • odor
  • risk factors
  • knowledge about prescribed therapy
  • prevention
  • collaborative dx
  • planning and goals
36
Q

LUTI nursing management: interventions (4)

A
  • relief of pain
  • fluid intake
  • use analgesics (phenazopyridine/pyridium-pt teaching)
  • prevent complications
37
Q

LUTI nursing management: adequate fluid intake

A

patient may think condition will worsen because of discomfort, but it dilutes urine, making bladder less irritable. flushes out bacteria before they colonize

38
Q

LUTI nursing management: frequent voiding

A

-decreases risk for reflux, contamination from urethra, q 2-3 hr with complete bladder emptying

39
Q

LUTI nursing management: hygiene and catheter management

A

-proper hygiene; EBP catheter management

40
Q

LUTI nursing management (what to avoid, what to instruct pt about, monitor)

A
  • avoid caffeine, alcohol, citrus juices, chocolate and highly spicy foods- potential bladder irritants
  • Instruct pt about drug therapy and side effects
  • monitor VS, LOC for pyelonephritis, sepsis
41
Q

LUTI nursing management: Ambulatory and home therapy (5)

A
  • emphasize importance of compliance with drug regimen
  • take medication as ordered
  • maintain adequate fluids
  • regular voiding (q 3-4h)
  • void after intercourse (NEVER ASSSUME PT ISNT SEXUALLY ACTIVE)
42
Q

LUTI nursing management: Pt teaching (5)

A
  • empty bladder regularly and completely
  • regular bowel evacuation
  • wipe front to back
  • adequate fluid intake
  • drink cranberry juice or tablets: urine acidification for recurrent infection
43
Q

LUTI Potential complications (5)

A
  • pyelonephritis
  • renal failure
  • sepsis
  • strictures and obstructions
  • CAUTI
44
Q

Quick risk assessment for sepsis: 10 s/s

A
  • increased RR
  • Increased HR
  • decreased BP
  • decreased UO
  • either increased or decreased BS
  • Increased or decreased temp
  • Increased neutrophils
  • Increased or decreased WBC
  • decreased O2 sat
  • ALOC
45
Q

qSOFA score (what is measured, scores, serum lactate level)

A
  • SBP at or less than 100 mmHg
  • RR at or above 22 bpm
  • any change in mental status

score of 2 or 3: increased risk for mortality or extended ICU stay

serum lactate level > 2 suggests hypoperfusion

46
Q

LUTI potential complications

A

CAUTI

47
Q

how to avoid CAUTI

A
  • frequent assessment of urine

- meticulous daily perineal care

48
Q

CAUTI Core prevention strategies (CDC) (7)

A
  • insert catheters only for appropriate indications
  • leave catheters in place only as long as needed
  • ensure only properly trained personnel insert and maintain catheters
  • Insert catheters using aseptic technique and sterile equipment (Acute care setting)
  • following aseptic insertion, maintain a closed drainage system
  • maintain unobstructed urine flow
  • hand hygiene and standard precautions
49
Q

Upper Urinary Tract Infections (UUTI): pyelonephritis, how it can happen (2)

A

contamination from bladder: vesicoureteral reflux, obstruction, BPH

from blood stream: systemic infections

50
Q

Acute pyelonephritis

A

inflammation with enlargement of kidneys and possible renal dysfunction

51
Q

chronic pyelonephritis

A

scarring, contraction, dysfunction, leading to CKD

52
Q

Acute pyelonephritis clinical manifestations (3)

A
  • chills, fever, leukocytosis, bacteriuria, pyuria, n/v
  • possible LUTI symptoms, positive urinalysis
  • low back pain, flank pain, costovertebral angle tenderness
53
Q

Pyelonephritis Diagnosis (5)

A
  • urinalysis
  • US, CT scan: locate obstruction, abscess
  • IVP pyelogram: renal abnormalities suspected
  • urine C&S
  • CBC: leukocytosis, shift to the left (bands?)
54
Q

Pyelonephritis management (5) (if uncomplicated, how long antibiotic course, follow up, risk for, what needs to be done if adequate kidney fxn)

A
  • uncomplicated: outpatient treatment (no sepsis, dehydration, n/v)
  • 2-week antibiotic tx
  • must have follow-up culture 2 weeks after therapy completion
  • risk for chronic asymptomatic infection: antibiotic therapy up to 6 months if relapse
  • oral/IV hydration if adequate fxn: flush urinary system
55
Q

Pyelonephritis complication: urosepsis (what is it, what needs to be done promptly, can lead to, monitor what?)

A
  • systemic infection from urologic source
  • prompt dx/tx critical (IV antibiotics and fluids)
  • can lead to septic shock and death
  • monitor VS (hypotension, tachycardia, etc)
56
Q

Pyelonephritis complication: CKD (what it occurs from, what it is, monitor what?)

A
  • from chronic pyelonephritis
  • progressive loss of nephrons from chronic inflammation and scarring
  • monitor renal fxn tests (creatinine, BUN)
  • monitor CBC
57
Q

Anatomy of Urinary system (3)

A
  • urinary tract is sterile above the urethra
  • normal flora of vagina and urethra interferes with bacterial adherence
  • urinary immunoglobulin in urethra provide a barrier to bacteria
58
Q

Host defenses for UTI (5)

A
  • physical barrier of urethra
  • urine flow
  • ureterovesical junction competence
  • antibacterial enzymes/bacteria
  • anti-adherent effects of bladder mucosa
59
Q

patho of UTI

A

bacteria gain access to bladder –> attach and colonize to epithelium of urinary tract to avoid being washed out with voiding –> evade host defense mechanisms –> initiate inflammation

60
Q

Urethrovesical reflux (what it is, that causes it)

A
  • backward flow of urine from urethra to bladder

- coughing, sneezing

61
Q

ureteovesical reflux (what it is, that causes it)

A

backward flow of urine from bladder to ureters

-valve impairment due to congenital or ureteral abnormalities

62
Q

UTIs in older adults

A
  • most common infection of OA
  • bacteriuria increases with age
  • gap between genders narrow later in life
63
Q

Risk factors for older women

A

-estrogen levels decrease or are absent causing an increase of adherence of bacteria to vagina and urethra

64
Q

risk factors for older men

A

lack antibacterial activity of prostatic secretions

65
Q

most common bacteria causing UTI

A

E.coli

66
Q

common bacterias for patient with indwelling catheter causing UTI

A

-proteus, Klebsiella, Pseudomonas, Staph

67
Q

S/S chronic pyelonephritis

A
  • fatigue
  • HA
  • poor appetite
  • polyuria
  • excess thirst
  • weight loss

Nurs G140 Exam 2 (MS) (6 decks)

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