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Medical Surgical GI Exam 3 > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

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USMLE® Step 1 flashcards
1
Q

What is an UTI

A

Most common bacterial infection in women

At least 20% of women will develop a UTI during their lifetime

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2
Q

What pathogen causes UTI’s

A

Escherichia coli most common pathogen

Fungal and parasitic infections can cause UTIs

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3
Q

Who is t risk?

A

Immunosuppressed

Diabetic

Having undergone multiple antibiotic courses

Have traveled to developing countries

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4
Q

What are the classifications of an UTI

A

Upper versus lower

Complicated versus uncomplicated

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5
Q

Where are upper UTI’s located and the S/S

A

Renal parenchyma, pelvis, and ureters

Typically causes fever, chills, flank pain

Example:

Pyelonephritis: inflammation of renal parenchyma and collecting system.

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6
Q

Lower UTI

A

Usually no systemic manifestations

Examples:

Cystitis: inflammation of bladder

Urethritis: inflammation of the urethra

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7
Q

Upper vs Lower Picture

A
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8
Q

What is an uncomplicated UTI

A

Occurs in otherwise normal urinary tract

Usually involves only the bladder

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9
Q

What is a complicated UTI

A

Coexists with presence of:

Obstruction

Stones

Catheters

Diabetes/neurologic disease

Pregnancy-induced changes

Recurrent infection

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10
Q

Alteration of defense mechanisms increases risk of contracting UTI Predisposing factors

A

Factors increasing urinary stasis

Foreign bodies

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11
Q

Examples of Factors increasing urinary stasis

A

BPH

tumor

neurogenic bladder

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12
Q

Examples of foreign bodies

A

catheters

calculi

instrumentation

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13
Q

Predisposing factors Anatomic factors examples

A

obesity

congenital defects

fistula

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14
Q

Predisposing factors Compromising immune response factors

examples

A

age

HIV

diabetes

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15
Q

Predisposing factors Functional disorders

examples

A

constipation- Due to make it harder for bladder to empty completely

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16
Q

Other causes examples

A

pregnancy

multiple sex partners

17
Q

Hospital-acquired UTI

A

accounts for 31% of all nosocomial infections

Causes:

Often: E. coli

Seldom: Pseudomonas species

Catheter-acquired UTIs

Bacteria biofilms develop on inner surface of catheter

18
Q

Symptoms

A

Urinary frequency

Abnormally frequent (more often than every 2 hours)

Urgency

Sudden strong desire to void immediately

Incontinence

Loss or leakage of urine

Bladder storage:

Nocturia

Waking up two or more times at night to void

Nocturnal enuresis

Loss of urine during sleep

Bladder emptying

Weak stream

Hesitancy

Difficulty starting the urine stream

Intermittency
Interruption of urinary stream during voiding
Postvoid dribbling
Urine loss after completion of voiding
Urinary retention
Inability to empty urine from bladder
Dysuria
Difficulty voiding

19
Q

Clinical manifestations in the older adult

A

Symptoms often absent

Nonlocalized abdominal discomfort rather than dysuria

Cognitive impairment possible

Fever less likely

20
Q

Diagnostic Studies

A

History and physical examination

Dipstick urinalysis

Identify presence of nitrites, WBCs,
and leukocyte esterase

Urine for culture and sensitivity
(if indicated)

Imaging studies

CT urography or ultrasonography when obstruction suspected

21
Q

Drug therapy

A

Antibiotics

Selected on empiric therapy or results of sensitivity testing

Uncomplicated cystitis

Short-term course (1 to 3 days)

Complicated UTIs

Long-term treatment (7 to 14 days)

22
Q

Antibiotics

A

Trimethoprim/sulfamethoxazole (TMP/SMX)- Bactrim

Nitrofurantoin (Macrodantin)

Ampicillin

amoxicillin

cephalosporins

Fluoroquinolones

23
Q

Trimethoprim/sulfamethoxazole (TMP/SMX)- Bactrim

A

Used to treat uncomplicated or initial UTI

Inexpensive

Taken twice a day- 3 days

24
Q

Nitrofurantoin (Macrodantin)

A

Given three or four times a day

Long-acting preparation (Macrobid) is taken twice daily

25
Q

amoxicillin

A

interferes wih oral birth control

26
Q

Fluoroquinolones

A

Treat complicated UTIs

Example: ciprofloxacin (Cipro)

27
Q

Antifungals

A

Amphotericin or fluconazole

UTIs secondary to fungi

28
Q

Urinary analgesic

A

Phenazopyridine (Pyridium)

Used in combination with antibiotics

Provides soothing effect on urinary tract mucosa

Avoid long-term use

Stains urine reddish orange

Can be mistaken for blood and may stain underclothing

29
Q

Other Urinary analgesic

A

Methenamine/phenyl salicylate (Urised)

Used in combination with antibiotics

Used to relieve UTI symptoms

Preparations with methylene blue tint urine blue or green

30
Q

Nursing Assessment

A

History
Objective data
Fever
Hematuria, foul-smelling urine, tender, enlarged kidney
Leukocytosis, positive findings for bacteria, WBCs, RBCs, pyuria, ultrasound, CT scan, IVP

31
Q

Planning

A

Patient will have:
Relief from lower urinary tract symptoms
Prevention of upper urinary tract involvement
Prevention of recurrence

32
Q

Nursing Implementation

A

Health promotion
Recognize individuals at risk
Debilitated persons
Older adults
Underlying diseases (HIV, diabetes)
Taking immunosuppressive drug or corticosteroids

33
Q

Health promotion

A

Emptying bladder regularly and completely
Evacuating bowel regularly
Wiping perineal area front to back
Drinking adequate fluids (person’s weight in pounds/2)
Twenty percent of fluid comes from food

Cranberry juice or cranberry tablets may reduce the number of UTIs
Avoid unnecessary catheterization and early removal of indwelling catheters
Aseptic technique must be followed during instrumentation procedures

Wash hands before and after contact
Wear gloves for care of urinary system
Routine and thorough perineal care for all hospitalized patients
Avoid incontinent episodes by answering call light and offering bedpan at frequent intervals

34
Q

Acute intervention

A

Adequate fluid intake
Patient may think condition will worsen because of discomfort
Dilutes urine, making bladder less irritable
Flushes out bacteria before they can colonize

Avoid caffeine, alcohol, citrus juices, chocolate, and highly spiced foods
Potential bladder irritants
Application of local heat to suprapubic or lower back may relieve discomfort

Emphasize taking full course of antibiotics despite disappearance of symptoms
Second or reduced dosage of a drug may be ordered after initial course in susceptible patients

Instruct patient to monitor for signs of improvement and decrease in or cessation of symptoms
Counsel on persistence of lower tract symptoms beyond treatment or onset of flank pain or fever: should be reported immediately

35
Q

Ambulatory and home care

A 
Emphasize importance of compliance with drug regimen
Take as ordered
Maintain adequate fluids
Regular voiding (every 3 to 4 hours)
Void after intercourse

Temporarily discontinue use of contraceptive diaphragm

Instruct on follow-up care

Recurrence of symptoms: typically 1 to 2 weeks after therapy

Medical Surgical GI Exam 3 (21 decks)

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