Urinary tract infections Flashcards
Escherichia coli (E.coli)
most common pathogen
if lower urinary infection, it’s called
cystitis
if upper urinary infection, it’s called
nephritis
lower UTI symptoms
inflammation of bladder, prostate, or urethra. pain.
upper UTI symptoms
fever, chills, flank pain. can seem like back pain.
Pyelonephritis: acute or chronic?
both
Urosepsis
UTI that has spread systemically. can lead to death.
who is at risk for UTI?
immunosuppressed
Diabetic
Have kidney problems
Have undergone multiple antibiotic courses
Have traveled to developing countries
exam will usually be
benign
who is at higher risk for UTI?
Alteration of defense mechanisms increases risk for contracting UTI
Compromising immune response factors
Age, HIV, diabetes
Predisposing factors
Factors increasing urinary stasis
BPH, tumor, neurogenic bladder
Foreign bodies
Catheters, calculi, instrumentation
Anatomic factors
Obesity, congenital defects, fistula
Functional disorders
Constipation
Other
Pregnancy, multiple sex partners (women)
older age - do kidneys get smaller?
kidney gets smaller, loss of muscle tone. decrease in bladder capacity.
UTI - Bladder storage - Nocturia and Nocturnal enuresis
Nocturia- waking up 2 or more times to void
Nocturnal enuresis- loss of urine during sleep
how many ppl have incontenence?
15 - 35% over 60
Older adults - UTI
Symptoms often absent
Non localized abdominal discomfort rather than dysuria
Cognitive impairment possible
Change in behavior, confusion or agitation possible
Fever less likely
Dipstick urinalysis (dip into the night with white and luke)
Identify presence of nitrites, WBCs, and leukocyte esterase
objective signs of UTI
fever
Hematuria, foul smelling urine, tender/enlarged kidney
Leukocytosis, + bacteria, WBCs, RBCs, pyuria, ultrasound, CT scan, IVP
pylonephritis - palpation?
Costovertebral tenderness to percussion on affected side
pylonephritis relapses
Relapses are treated with 6 weeks of antibiotics
stress incontinence (the pregnancy is stressing me so I smoke and I’m obese)
pregnancy big one, post-menoupausal. smoking and obesity.
urge incontinence
from caffeine, nicotine, artificial sweeteners
mixed incontinence
stress and urged mixed
laterogenic incontinence
drug induced, muscle relaxants. pee all of the time.
Adults 60 years and older - residual, and how much?
50 to 100 mL of residual urine remaining in the bladder after voiding
kidney stone - how to diagnose? (cutie kidney stone)
CT scan w/out contrast. very specific. looking for swelling in kidneys. KUB - not as good.
stones larger than 10 mm
need surgery. under 5 mm can pass on their own.
prevent stones
lemons, lemonade, decrease sodium, no chocolate, rhubarb.
need 80 MAP for
good perfusion
pre-renal
blood not getting to kidney with enough pressure, hypovolemia, clot, anything obstructing the blood flow
blood supply to the kidneys
The kidneys receive unfiltered blood directly from the heart through the abdominal aorta which then branches to the left and right renal arteries. Filtered blood then returns by the left and right renal veins to the inferior vena cava and then the heart
elderly hang onto
CO2 more.
have to know lab values
in renal function lab values
BUN
8-25
creatinine (creatinine, the number of the beast)
.6 - 1.5 mg dl
bun/cr ratio
10:1 - 20:1
GFR normal
100 - 125
if rapid change in GFR, do (rapidly 24)
a 24 hour test
does GFR change with age?
goes down a tiny bit.
check
how to do JVD
where to listen for plural friction
rub
is age a high risk for UTIs?
yes
obese higher risk for UTIs?
yes
