Urinary- 6 questions DONE

Question 1

Types of UTI according to site.

Pyelonephritis?
Cystitis?
Urethritis?
Urosepsis?

Answer 1

Pyelonephritis
Infection of the kidney or renal pelvis

Cystitis
Infection of the bladder

Urethritis
Infection of the urethra

Urosepsis
a UTI that has spread systemically and can be life threatening

Question 2

Various ways that pathogens enter the urinary tract to cause an infection. Don’t just memorize the types. Be able to identify them based on a clinical scenario

4 ways

Answer 2

1. Ascending Infection (10) ⬆️
   Upwards through the urethra
   MOST COMMON entry method
   Most common in women due to shorter traveling distance
   Intercourse = major precipitating factor
   Can happen from:
   Urologic instrumentation
   Catheterization
   Cystoscopic examination
2. Hematogenous Spread 🩸
   Blood-borne bacteria that secondarily invade the kidneys, ureters, or bladder
   MUST be prior injury to the urinary tract for kidney infection to happen through this route.
   Ex:
   Obstruction of ureter
   Damage from stones
   Renal scars
   Rarely occurs, but can happen with
   TB
   Renal abscesses
   Perinephric abscesses
3. Lymphogenous Spread (16) 🦠
   Rare
   Bacteria travel thru rectal & colonic lymphatics to the urinary tract
4. Direct Extension (18)
   Infection from another organ

Question 3

Clinical manifestations based on site and age

UPPER UTI

Answer 3

Fever (higher up you go, systemic symptoms seen)
Nausea
Vomiting
Flank pain
CVA tenderness

Question 4

LOWER UTI

Answer 4

*Frequency (more than q2 hours)
Urgency
*Dysuria (burning on urination)
*Pyuria (WBC in the urine)

Cloudy or foul-smelling urine
Suprapubic discomfort or pressure
Hematuria (RBC in the urine)

Question 5

Obtaining a clean catch urine specimen. In class, I mentioned that you should know how to get a clean catch

Answer 5

Collect via catheterization (more accurate due to sterility)

Question 6

Urine culture and sensitivity… What is a CFU and what do the numbers mean regarding diagnosis of UTI?

Answer 6

CFU = colony forming unit (counts bacterial load)

More than 100K CFU = clinically significant. May be UTI
Less than 100 CFU = also significant = may be immunocompromised

Question 7

Non-pharmacologic management, treatment, and prevention of UTIs

Answer 7

1. Increase fluid intake (half your weight in oz)
2. Sitz baths
3. Cranberry juice

Question 8

There is a question (in italics) on your powerpoint slides abut sitz baths. Be able to answer that question

Answer 8

Sit in 2-3 inches of water, warm water should come in contact with urethra.

Goal:
Helps with discomfort related to urethritis

Question 9

Nitrofurantoin

Answer 9

avoid/limit sunlight/photosensitivity

Avoid if the patient’s creatinine clearance is less than 30ml/min

Take with meals to avoid GI side effects (nausea/vomiting)

Do not take if patient has liver disease- it is hepatotoxic - check AST, ALT

Question 10

TMP-SMX

Answer 10

Relatively inexpensive

Taken twice a day

E-Coli tends to be resistant to this drug.

Question 11

PhenAZOpyridine

Answer 11

Urinary analgesia that relieves discomfort from dysuria

May cause urine to turn orange or red

May be nephrotoxic check BUN and Creatinine Clearance

dont use for more than 2 days