infectious and inflammatory disorder of urinary tract Flashcards
UTIs
most common infection and second most common bacterial disease in women
Causes
- E.coli = most common (proximity to anus)
- Candida albicans = second most common –> indwelling catheter or asymptomatic colonization (also in obese)
- fungal and parasitic = uncommon
classification of UTI
Location upper = renal parenchyma, pelvis, ureters (pyeloephritis)
Location lower = bladder (cystitis) and urethra (urethritis)
Systemic spread = urosepsis (life threatening)
Uncomplicated = bladder only
Complicated = occur w/ struc or func prob in whole urinary tract
Sterility of urinary tract
Defense mechanisms
Usually sterile above urethra
Defense
- complete emptying with void
- ureterovesical junction competence
- ureteral peristalsis propels urine to bladder
- acidic pH (under 6)
- high urea
- glycoproteins (inhibit bacterial growth)
Risk factors for UTI
obstruction retention renal impairments foreign bodies anatomic factors comprised immune response functional disorders other
Entrance of pathogens to form UTIs
Microbes from perineum ascend urethra
- GI tract: G- bacteria
- contributing factors = urologic instrumentation and sexual intercourse
Hematogenous transmission
HAI –> MOST COMMON ONE
- catheter –> E.coli or pseudomonas
- increased risk with longer stay
Lower urinary tract symptoms (LUTS)
Emptying
-hesitancy, intermittency, post-void dribble, urinary retention/ incomplete emptying, dysuria
Storage
-urinary frequency, urgencym incontinence, nocturia, nocturnal enuresis
Hematuria and/or cloudy
LUTS isn’t same as UTI
Upper urinary tract symptoms
flank pain, chills, fever
Other: fatigue, anorexia, or asymptomatic
Older adults (no classical manifestations) -nonlocalized abdominal discomfort, cognitive impairments, or generalized deterioration; often afebrile
Asymptomatic bacteria - colonization of bacteria in bladder; screen and treat with pregnancy
Diagnostic studies for UTIs
Initial: dipstick for nitrates, WBCs, and leukocyte esterase
Urine culture/sensitivity
History: -recurring UTIs (more than 2-3/ yr) -comlicated UTIs -CAUTIs or HAI UTIs UTI unreponsive to empiric therapy
Imaging: ultrasound or CT scan
UTI interprofessional care:
management (uncomplicated)
Reccurent UTI
Management
- patient teaching: have whole prescription
- adequate fluids
- drug therapy: phenazopyridine and antibiotics (empiric) for 3 days
Recurrent
- as above plus susceptibility testing and possibly suppressive or prophylactic antibiotics
- antibiotics for 7-14+ days
UTI intraprofessional care
drug therapy
DON’T NECESSARILY NEED TO KNOW
Uncomplicated or initial UTIs
- trimethoprim/sulfamethoxazole (TMP-SMX)
- Nitrofurantoin Cephalexin
- Fosfomycin
- Others: ampicillin, amoxicillin, or cephalosporins
Complicated: fluoroquinolones
Fungal: fluconazole
Urinary analgesic: phenazopyridine (azo dye)
Prevention of CAUTI
Avoid unncessary catheterizations remove indwelling catheter early aseptic technique hand hygiene gloves for catheter care
Evidence based clinical tool from ANA
Acute Pyelonephritis etiology and pathophysiology
inflammation of renal parenchyma and collecting system
- common: bacteria (E.coli, proteus, klebisella, or enterobacter from intestinal tract)
- other: fungi, protozoa, or viruses
Urosepsis - systemic infection from urologic source
Pyelonephritis: where and how it starts NOPE
Where
- initial colonization and infection of lower urinary tract from urethra
- starts in renal medulla, spreads to cortex
How
- preexisting factors: vesicoureteral reflux or dysfunction of lower urinary tract
- CAUTI in long-term care residents
- pregnancy-induced changes
Pyelonephritis manifestations NOPE
Classic: fever, chills, nausea, vomiting, malaise, flank pain
Other: dysuria, urgency, frequency
Costovertebral angle tenderness
Diagnostic studies of Pyelonephritis NOPE
Urinalysis: pyuria, bacteriuria, hematuria, WBC casts
Urine cultures and sensitivities
Blood cultures
decreased kidney func test
ultrasuond
CT scan –> preferred imaging study
Interprofessional care for pyelonephritis NOPE
Mild symptoms (outpatient or short inpatient)
- fluids, NSAIDs, follow-up cultures and imaging
- antibiotics: oral 7-14 days or IV to oral 14-21 days (Sensitivity guided)
Severe symptoms
- IV fluids until oral tolerated
- combination parenreral antibiotics
Interprofessional care If pyelonephritis comes back NOPE
Relapse: 6 weeks antibiotics
Recurrent: prophylactic antibiotics
Urosepsis: monitor for and treat for septic shock to prevent irreversible damage or death
Assessment of Pyelenophritis NOPE
same as UTI:
Subjective: past health history meds surger/treatment fuc heaalth patterns
Objective:
general
urinary
possible diagnostic findings
Nursing diagnoses and planning goals for pyelonephritis NOPE
Diagnoses
- impaired urinary system func
- acute pain
- lack of knowledge
Goals for patient
- normal renal func
- normal body temp
- no complications
- no pain
- no recurrence of symptoms
Nursing implementation for pyelonephritis NOOPE
Heath promotion and maintenance
- similar to UTIs
- Early treatment of UTIs to prevent ascending infection
- regular medical care with strucural abnormalities
Patient teaching
- disease process
- take meds
- follow-up care
- signs and symptoms of relapse or recurrence
- adequate fluid intake (8 glasses/day)
- rest
Evaluation/ expected outcomes for pyelonephritis NOPE
patient will
- have normal urinary elimination patterns
- report relief of bothersome urinary tract symptoms
- state knowledge of treatment plan
Chronic Pyelonephritis NOPE
Kidneys inflamed caue scarring leading to loss of renal func
-result from anatomic abnormalities or recurrent infections of Upper urinary tract
Diagnosis: radiolofic imaging and biopsy
Treatment: treat infection and underlying contributing factors
- prevent progression to end-stage renal disease (ESRD)
- treat as chronic kidney disesase (CKD)
Urethritis what dif genders treatment teaching
Inflammation of urethra due to bacterial or viral infection
- trichomonas or moniia, chlamydia, or gonorrhea
- males: sexually transmitted (discharge, dysuria, urgency, frequency)
- females: diagnosis is dif. (LUTS)
- treatment = antimicrobials and sitz baths
- Patient teaching: no vaginal spray, perineal hygiene, no sex for a week, alert lovers
Urethral diverticula what who why symptoms
- Localized outpouchings of urethra from enlarged periurethral glands
- women more than men
Urethral: trauma, instrumentation, or dilation; vaginal delivery or frequent infections
Symptoms: dysuria, post voiding dribble, frequency, urgency, suprapubic discomfors, incomplete bladder emptying, incontinence, hematuria, cloudy urine, vaginal wall mass with purulent discharge —-> or asymptomatic
Urethral diverticula
diagnosis
treatment
complications
diagnosis
- ultrasound and MRI
- Voiding cystourethrography (VCUG)
- Urethroscopy
Treatment (surgical)
- transvaginal diverticulectomu
- marsupialization (spence procedure)
- urethroscopic surgical excision
Complications
- incontinence
- infection
- bleeding
- fistula
Interstitial Cyctitis (IC) and Painful bladder syndrome (PBS)
IC = Chronic, painful, inflammatory disease of the bladder which causes PBS
- urgency, frequency, bladder/pelvic pain
- urinary pain not attributed to other causes
- etiology is unknown
Possible factors:
- neurogenic hypersensitivity
- mast cell changes in muscle or mucosal layer
- infection
- toxic substance in urine
Manifestations and Diagnostic Studies for IC and PBS
Primary manifestation is pain and bothersome LUTS
- Severe: void more than 60 times/day or night
- Pain: usually suprapubic but might involve perineal areas
- increased pain with bladder filling, postponed urination, physical exertion, suprapubic pressure, certain foods, emotional distress
- decreased pain with voiding temporarily
- often misdiagnosed as chronic or recurring UTI or chronic prostatitis –> diagnosis of exclusion
- remissions and exacerbations
Treatment for IC and PBS NOPE
Nutritional and drug therapies
- reduce intake of bladder irritants
- calcium glycerophosphate reduces irritation
Stress management strategies
Tricyclic antidepressants, analgesics, antihistamines
Physical therapy and bladder hypodistention
Botox; cyclosporine A
Surgery (with debilitating pain)
Nursing management of IC and PBS NOPE
- Pain assessment
- dietaty/lifestyle factors that help or hurt
- bladder voiding log for 3 days –> pain record
- monitor for UTI with diagnostic studies
- monitor nutrition
- avoid restrictive clothing
- coping strategies/reassurance