Urinary Tract Infections Flashcards by noelle wilson

What is the 2nd most common type of infection?

UTIs

How well did you know this?

Not at all

Perfectly

What gender do UTIs occur more frequently in & why?

Women → b/c their urethra is shorter & closer to the anus where bacteria is present

How well did you know this?

Not at all

Perfectly

What is the most common cause of UTIs?

E. coli

How well did you know this?

Not at all

Perfectly

UTIs account for ~ ____% of all HAIs & list the most common cause

~ 50%
Most common cause → Catheter acquired UTI (CAUTI)

How well did you know this?

Not at all

Perfectly

Which classification of UTI is more common?

Lower UTI → involves the bladder & structures below the bladder

How well did you know this?

Not at all

Perfectly

List 3 examples of lower UTIs

1) Cystitis
2) Prostatitis
3) Urethritis

How well did you know this?

Not at all

Perfectly

Which classification of UTI is much more serious & why?

Upper UTI → b/c it is deeper in the urinary tract & involves the kidneys & ureters

How well did you know this?

Not at all

Perfectly

List one example of upper UTI

1) Pyelonephritis

How well did you know this?

Not at all

Perfectly

What % of UTIs occur in women aged 20-50 yrs?

40-50%

How well did you know this?

Not at all

Perfectly

Most uncomplicated lower UTIs are caused by _____

E. coli (75-90%)

How well did you know this?

Not at all

Perfectly

How do lower UTIs caused by E. coli develop?

Bacteria surface has adhesins which allow attachment to the mucosal surface

How well did you know this?

Not at all

Perfectly

List 4 bacterias that cause complicated UTIs

1) Staphylococcus Saprophyticus
2) Klebsiella Pneumoniae
3) Proteus Mirablis
4) Pseudomonas species

How well did you know this?

Not at all

Perfectly

Where do UTIs usually enter & what occurs?

Usually enter through the urethra → distal urethra often has pathogens the urine formed in the kidney & in the bladder is usually sterile
Urinary tract usually sterile

How well did you know this?

Not at all

Perfectly

What is the washout phenomenon?

Occurs when urine washes out the bacteria in the urethra during urination

How well did you know this?

Not at all

Perfectly

List 2 main causes & sub causes of UTIs

1) Urinary obstruction
→ Anatomic
→ Functional
2) Reflux
→ Ureterovesical Reflux
→ Vesicoureteral Reflux

How well did you know this?

Not at all

Perfectly

List 3 anatomic causes of UTI

1) Stones
2) BPH
3) Pregnancy

How well did you know this?

Not at all

Perfectly

What is Benign Prostatic Hypertrophy/ Hyperplasia (BPH)?

A non-cancerous enlargement of the prostate gland, a common condition in older men that can cause urinary problems

How well did you know this?

Not at all

Perfectly

List 4 functional causes of UTIs

1) Neurogenic bladder
2) Infrequent voiding
3) Detrusor (bladder) muscle instability
4) Constipation

How well did you know this?

Not at all

Perfectly

How does ureterovesical reflux occur in women?

Urine moves from bladder into urethra & then flows back into the bladder

How well did you know this?

Not at all

Perfectly

What activities can trigger Ureterovesical reflux?

Coughing or squatting

How well did you know this?

Not at all

Perfectly

Where does vesicoureteral reflux occur?

At the level of the bladder & ureter → “back flow of urine”
brings bacteria back into bladder

How well did you know this?

Not at all

Perfectly

Why do we not want to leave foleys in for long periods of time?

They can cause CAUTIs → bag MUST be lower than the bladder!!

How well did you know this?

Not at all

Perfectly

List 11 populations at risk for UTIs

1) sexually active women
2) post menopausal women
3) pregnancy
4) bladder cancer
5) renal stones (calculi)
6) men w/ prostate abnormalities
7) older adults
8) catheterization
9) instrumentation
10) diabetics
11) pts using Abx

How well did you know this?

Not at all

Perfectly

Why are diabetics at risk for UTIs?

Bacteria loves glucose

How well did you know this?

Not at all

Perfectly

Pathophysiology: The defense system is challenged by what?

The virulence of the pathogen

Pathophysiology: What lines the bladder & protects against bacteria?

A protective mucin layer

Pathophysiology: What are the local immune system reactions?

IgA & phagocytic cells remove the bacteria

Pathophysiology: How does IgA play a role in prevention of UTIs?

An immunoglobulin that helps prevent the bacteria from adhering from the bladder wall

Pathophysiology: What is part of a woman's normal flora?

lactobacillus is part of normal flora of periurethral area

Pathophysiology: What contains immunoglobulins in men?

Prostatic fluid (IgA, IgG)

What is considered a sterile environment?

The urinary tract

Explain the osmolarity of urine

Urine has a high osmolarity → urea helps decrease bacteria from getting into the bladder

What occurs when we urinate?

We are removing some contaminated bacteria; inhibiting it from being able to move & cause infection

What can happen to lactobacillus (normal flora) from prolonged Abx use?

Can cause destruction of normal flora that will actually cause a UTI to develop

Explain the purpose of prostate secretions in men

These secretions have antibacterial properties which protect the urethra from colonization

List 2 reasons young men do not get UTIs as often

1) Urethral length (longer) 2) Drier periurethral environment

List 2 risk factors for men developing UTIs

1) Lack of circumcision 2) Anal intercourse

All UTIs in men are considered _____. Why?

**Complicated** → b/c of the longer urethra

List 5 clinical manifestations of uncomplicated UTIs

1) Dysuria 2) Frequency 3) Urgency 4) Hematuria 5) Suprapubic pain

List 6 clinical manifestations of complicated UTIs

1) Asymptomatic or present w/ septic shock! 2) Fever 3) Chills 4) Nausea 5) Vomiting 6) Back pain/ Flank pain

Define urosepsis

Spread of infection from urinary tract to blood stream

List 6 clinical manifestations seen in older adults

1) Incontinence 2) Foul smelling concentrated urine 3) Fatigue 4) Confusion 5) Dementia → could develop/ make Sx worse 6) Hallucinations

What does it mean if a patient with a UTI develops a fever?

The UTI has traveled deeper & further in the bladder to the kidneys causing pyelonephritis (very bad)

What can back pain / flank pain indicate?

Pyelonephritis

What can bladder pain indicate?

UTI

What is interstitial cystitis?

Characterized by pain, urgency & feeling of bladder fullness; also pressure in pelvic area **Chronic condition** **Sx are variable**

Is interstitial cystitis more common in males or females?

Females

List 4 possible causes of interstitial cystitis

1) Believe > 1 mechanism is involved 2) Defects in part of mucus layer of bladder that protects the bladder 3) defects may allow toxins in urine to leak through & damage nerve & muscle tissue which trigger pain & hypersensitivity 4) Infection or autoimmune

List 5 clinical manifestations of interstitial cystitis

1) Chronic pelvic pain 2) Chronic perineal pain 3) Bladder fullness 4) Urgency & frequency 5) Remission & exacerbation

List 6 ways to Dx interstitial cystitis

1) Medical Hx 2) Physical exam 3) Cystoscopy 4) Urodynamic testing 5) R/o endometriosis 6) R/o infection (i.e. UTI)

Urinary testing: What is specific gravity

Amount of solutes: pure water More solutes higher specific gravity

Urinary testing: Normal Specific gravity

No true normal as it depends on individual reference level 1.010

Urinary testing: Considerations for specific gravity

Extremes of either side can indicate pathology

Urinary testing: Normal pH

6.5-7 in the AM 7.5-8 in the PM

Urinary testing: pH considerations

Can be affected by food etc

Urinary testing: Normal Leukocytes (WBCs)

Negative

Urinary testing: Leukocyte (WBC) considerations

Present in ALL patients with UTIs

Urinary testing: Normal Nitrites

Negative **Enzyme released by enterobacteriaceae**

Urinary testing: Nitrite considerations

Can be negative and still have UTI

Urinary testing: Normal blood

Negative **Micro or macrocytic**

Urinary testing: Blood considerations

Can be seen in trauma, hemolysis, UTI, malignancy

Urinary testing: Normal protein

Negative **Albumin is the protein measured**

Urinary testing: Protein considerations

Renal disease; pregnancy; inflammation

What is microscopic and won't be seen unless UA is sent out for culture?

Hematuria

Urinary testing: What is glucose

Renal threshold to eliminate excess glucose

Urinary testing: Normal glucose

negative

Urinary testing: What are ketones

Measures metabolites of fat metabolism

Urinary testing: Normal ketones

Negative

Urinary testing: Ketone considerations

Insulin insufficiency, starvation, vomiting **Think DKA**

Urinary testing: Normal bilirubin

Negative

Urinary testing: Bilirubin considerations

Liver disease obstruction

Urinary testing: Normal urobilirubin

Negative

Urinary testing: Urobilirubin considerations

Liver disease; hemolysis; mono; cirrhosis

Urinary testing: What are casts

Coagulated protein by kidney cells

Urinary testing: Normal casts

Negative Hyaline (0-5) in healthy people Cellular not normal

Urinary testing: Casts considerations

Hyaline are clear Can have cellular RBC or WBC

Urinary testing: What are crystals

Waste solutes Based on pH & urine temperature

Urinary testing: Normal Crystals

None but some are ok

How do we manage acute UTIs?

3 or 7 day course of Abx if uncomplicated

How do we manage chronic or relapsed UTIs?

Up to 2 week course of Abx

How do we manage an upper UTI?

2 week course of Abx (May require up to 6 weeks)

Explain the reasoning for using cranberry pills/ capsules to help Tx UTIs

**Thought to create more acidic environment; research shows this is not the case** → b/c they are acidic it does prevent bacteria from adhering to bladder wall → does help to void → for it to work we would need to drink a gallon a day

What 7 important patient education teaching points when managing/ Tx UTIs?

1) Hydration!! 2) Void before & after intercourse (reflux could occur) 3) Avoid douching 4) Take Abx as prescribed 5) Avoid tight/ restrictive clothing 6) Shower instead of baths 7) Good personal hygiene

What may be needed/ ordered in an older adult experiencing recurrent UTIs?

1) Could actually order PT 2) Worst case → may have surgery of some kind