Upper/Lower Urinary Tract Disorders

Question 1

UTIs

Answer 1

causes: E coli, candida albicans, indwelling catheter or asymptomatic colonization, fungal and parasitic

risk factors: obstruction, retention
renal impairment, foreign bodies, anatomic factors, compromised immune response, functional disorders

Question 2

differentiate between upper and lower UTIs, complicated and uncomplicated

Answer 2

Upper UTI (Pyelonephritis):
Renal parenchyma
Renal pelvis
Ureters

Lower UTI:
Bladder (Cystitis)
Urethra (Urethritis)

Uncomplicated: Bladder only
Complicated: Occurs with structural or functional problem in urinary tract

Question 3

UTIs: management, treatment, considerations

Answer 3

Management (Uncomplicated): patient teaching, adequate fluids
Medications:
Phenazopyridine (Pyridium, Azo); Urinary analgesic

Antibiotics (empiric) for approximately 3-days

Recurrent UTI
Addition of susceptibility testing & possibly suppressive or prophylactic antibiotics
Antibiotics 7 to 14 days or longer

PREVENT THE NEXT ONE

Question 4

UTIs: sx/sx: lower

Answer 4

Emptying symptoms
Hesitancy, intermittency, post void dribbling, urinary retention or incomplete emptying, dysuria
Storage symptoms
Urinary frequency, urgency, incontinence, nocturia, nocturnal enuresis
Hematuria and/or cloudy appearance
Many problems can produce these symptoms, be confused with UTI

Question 5

UTIs: sx/sx: upper

Answer 5

Flank pain, chills, fever
Other: fatigue, anorexia, or asymptomatic
Older adults: Classic manifestations may be absent
Non-localized abdominal discomfort
Cognitive impairment, or generalized deterioration
Often afebrile
Asymptomatic bacteriuria: Colonization of bacteria in bladder
Screen & treat with pregnancy

Question 6

UTIs: Dx

Answer 6

H & P, urine dipstick for nitrates, WBCs, leukocyte esterase (infection that shows up in infection) patients subjective and your objective report/assessment,

Question 7

UTIs: Meds

Answer 7

uncomplicated or inital UTIs:
Trimethoprim/sulfamethoxazole (TMP-SMX) (Bactrim)
Nitrofurantoin
Cephalexin
Fosfomycin
Others:
Ampicillin
Amoxicillin
Cephalosporin’s

Complicated:
Fluoroquinolones
Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
Fungal: Fluconazole (Diflucan)

Question 8

Nursing assessment and health promotion

Answer 8

subjective:
past health hx
meds, surgery and other tx
functional health patterns

objective:
general
urinary

Question 9

preventing CAUTIs

Answer 9

Avoid unnecessary catheterization
Prompt removal of indwelling catheters
Hand hygiene
Gloves for catheter care
Sterile technique

Question 10

Acute Care Teaching

Answer 10

complete entire prescription
what to report to HCP
what improvement looks like
etc.