Med Surg 2

Question 1

Lower UTI includes:

Answer 1

Cystitis (Bladder)

Urethritis (urethra)

Question 2

Upper UTI includes:

Answer 2

Pyelonephritis (kidneys)-risk for sepsis

Question 3

Bacteria that is most common cause of UTI

Answer 3

E. coli

Question 4

UTI are more common in men or women and why?

Answer 4

Women because they have a shorter urethra and their urethra is located close to the rectum

Question 5

Urinate after intercourse to prevent UTI. T/F?

Answer 5

True

Question 6

Signs of a Lower UTI (in bladder or urethra)

Answer 6

Dysuria (difficulty urinating), frequency and urgency, incontinence, hematuria (blood in urine), nocturia (urinating at night), suprapubic discomfort, burning, cloudy urine, increase in specific gravity (>1.029)

Question 7

Signs of Upper UTI (in kidneys-renal parenchyma, pelvis, ureters )

Answer 7

flank pain, chills, fever, N/V

Question 8

Pyelonephritis

Answer 8

inflammation of the renal parenchyma(consists of nephrons) and collecting system

Question 9

Cystitis

Answer 9

inflammation of the bladder

Question 10

Urethritis

Answer 10

inflammation of the urethra- may occur with cystitis, STD

Question 11

Urosepsis

Answer 11

UTI that has spread systemically, life threatening, NEEDS EMERGENCY TREATMENT, could start from catheter, bacteria may become resistant, fever, to treat get culture and sensitivity and give antibiotics

Could leave to septic shock and death

Question 12

Uncomplicated UTI

Answer 12

only affects the bladder

Question 13

complicated UTI

Answer 13

affects more than just the bladder, may affect more than one organ (i.e. kidney, bladder, urethra)

Question 14

Diagnosing a UTI

Answer 14

Urinalysis:

• dipstick-increase WBC, proteins and dead cells (cass)
• labs-Increase BUN, Creatinine, and Culture and Sensitivity
• nitrites present in urine
• increase WBC
• leukocyte esterase (urine test for the presence of white blood cells and other abnormalities associated with infection)

*******A urine culture is then completed with positive urinalysis

Question 15

What is completed for diagnosing UTI if positive urinalysis?

Answer 15

Urine Culture

Question 16

Meds for treating UTI

Answer 16

Antimicrobial, urinary analgesics, prophylactic or suppressive antibiotics

Question 17

Antimicrobial treatment of UTI in general

Answer 17

Bactrim (trimethoprim/sulamethoxazole), or trimethoprim alone if a sulfa allergy exists, nitrofurantoin (Macrodantin)

**Remember that sulfa drugs may cause crystals in the urine

Question 18

Antimicrobial treatment of uncomplicated UTI

Answer 18

Short course antibiotics, usually 1-3 days, some other ATB that could be used are Ampicillin, Amoxicillin and Cephalosporins

Question 19

Antimicrobial treatment of complicated UTI

Answer 19

Longer ATB treatment, usually 7-14 days or longer, some ATB such as Ciprofloxacin, levofloxacin, norfloxacin, ofloxacin

^^Note that the above ATB are all fluoroquinolones

Question 20

Urinary analgesics treatment for UTI

Answer 20

Pain management, oral phenazyopyridine(AZO, Pyridium), topical analgesic that effects urinary mucosa, MAY TURN URINE ORANGE/BRIGHT RED

Question 21

Prophylactic (preventative) or suppressive ATBS for repeat UTI

Answer 21

Take these meds daily, lose dose TMP/SMX, this use is limited because of the risk of ATB resistance with increased use

Question 22

Foods/Drinks to avoid with UTI

Answer 22

alcohol, caffeine, citrus juive, chocolate, spicy foods

Question 23

Does cranberry juice/tablets have an affect on UTIs?

Answer 23

Yes, risk of uti’s may DECREASE with daily intake of cranberry juice/tablets.
**enzymes present in cranberries inhibit attachment of urinary pathogens to the bladder wall

Question 24

Interventions a nurse can do to prevent UTI

Answer 24

provide adequate fluids, avoid bladder irritants (ETOH, caffeine, spicy, chocolate, citrus juice), empty bladder regularly, perennial hygiene (front to back), cranberry juice, STERILE CATH TECHNIQUE, keep a closed cath system,

Question 25

Pyelonephritis

Answer 25

Small abscesses on kidneys can become scar tissue

Question 26

Contributing factors to pyelonephritis

Answer 26

catheterization, pregnancy, immunocompromised, neurogenic bladder

Question 27

Acute pyelonephritis

Answer 27

inflammation of renal parenchyma and collecting system, can progress to chronic, begins with infection via ascending urethral route (starting at urethra and working its way up) **pre-existing factors causing acute pyelone= vesicoureteral reflux(backward flow of urine from bladder into kidneys) and dysfunction of lower urinary tract

Question 28

Chronic pyelonephritis

Answer 28

Recurring episodes of infection, obstructive, kidneys become small and loose (scarring), can become end-stage renal disease (ESRD), slow and progressive with acute attacks

Question 29

Treatment of pyelonephritis

Answer 29

IV antibiotics (used in severe), rehydration for N/V, fluid intake, NSAIDS or urinary analgesics (AZO, Pyridium), monitor or urosepsis (UTI that has spread to whole body) or septic shock

Question 30

Nursing Management for Pyelonephritis

Answer 30

fluid intake- 15 ml per pound of body weight per day drink at least 2-3 L of SUGARLESS fluid every day unless patient has fluid restriction adequate caloric intake, bedrest, prevent UTI, prepare for dialysis Monitor for hematuria (may indicate cyst rupture), hypernatremia

Question 31

Catheter Associate UTI (CAUTI)

Answer 31

Hospital Acquired Infection***(HAI)

Question 32

How to prevent CAUTI

Answer 32

appropriate use of catheter (early removal), proper STERILE technique during insertion

Question 33

Proper Cath. maintenance

Answer 33

closed system, label foley bag, keep bag below bladder, do not let any part of bag tough floor, change collection device every 24 hours

Question 34

Interstitial Cystitis (IC)/Painful Bladder Syndrome

Answer 34

IC-=chronic, painful inflammation of the bladder PBS=suprapubic pain related to bladder filling BOTH cannot be attributed to other causes such as infection or urinary calculi (kidney stones)

Question 35

Symptoms of IC

Answer 35

urgency, frequency, pain in bladder or pelvis, may have periods of exacerbation or remission

Question 36

Diagnosing IC

Answer 36

Cystoscopic exam may reveal a small bladder capacity and glomerulations ****urine cultures DO NOT find bacteria with IC/PBS; IC/PBS DOES NOT respond to ATB therapy