Urinary Tract Infections Retention, Reflux & Incontinence Flashcards
Urinary Tract Infections?
- Most common reason of infections health care
- Most common bacterial infection in women
- Common site of acquired infection
- May be caused by a variety of disorders including tuberculosis, fungal and parasitic infections
**Bacterial infection is most common
***Escherichia coli (E.coli) most common pathogen
-Counts of 10 5th CFU/mL or more indicate signs/symptoms are indicative of UTI - Counts as low as 10 2nd in a person with symptoms is indicative of UTI
Classification of Urinary Tract InfectionsUpper versus lower
Lower UTI?
- Usually no systemic manifestations
**Cystitis –inflammation of the bladder
**Prostatitis
**Urethritis-inflammation of the urethra
Upper UTI
- Renal parenchyma, pelvis, and ureters
- Typically causes fever, chills, flank pain
** Pyelonephritis: acute and chronic:
Inflammation of renal parenchyma and collecting system
Interstitial nephritis
Renal abscess and perirenal abscess
se refiere estrictamente a los rinones
Classification of UTI. Urosepsis
- UTI that has spread systemically
- Life-threatening condition requiring emergent treatment
- Can lead to septic shock and death
Factors Contributing to UTI
- Bacterial invasion of the urinary tract
- Urethrovesical reflux, ureterovesical reflux
- Uropathogenic bacteria
- Shorter urethra in women
- Risk factors
Risk for Urinary Track Infection
Patients at Risk:
Immunosuppressed
Diabetic
Have kidney problems
Have undergone multiple antibiotic courses (build resistance)
Have traveled to developing countries: Travel to developing countries can increase the risk of urinary tract infections (UTIs) due to various factors such as poor sanitation, lack of access to clean water, and exposure to different strains of bacteria.
In developing countries, the risk of UTIs may be higher due to poor hygiene practices and limited access to proper medical care.
Classification of UTI
- Complicated versus uncomplicated
Uncomplicated
**Occurs in otherwise normal urinary tract: Like in someone like me who doesn’t have any other conditions like diabetes hbp etc
**Usually only involves the bladder
-Complicated
Coexists with presence of
**Obstruction or stones
**Indwelling urinary catheters or stents
**Urinary diversions
**Abnormal GU tract
**Diabetes/neurological disease
**Resistance to antibiotics
**Immunocompromised
**Pregnancy induced changes
***Recurrent infection
Etiology & Pathophysiology of 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)
Etiology & Pathophysiology
- Organisms introduced via ascending route form urethra and originate in the perineum
**Gram-negative bacilli normally found in the GI tract are a common cause
**Urologic instrumentation allows bacteria to enter urethra and bladder
**Sexual intercourse promotes “milking” of bacteria from perineum and vagina
***May cause minor urethral trauma - Less common routes
**Bloodstream
**Lymphatic system
Etiology & Pathophysiology 2.0 of a UTI
- Rarely results via hematogenous route meaning trough an injury on your arm for example. Blood !!!
- Kidney function occurring from hematogenous transmission always preceded by injury to urinary tract
**Obstruction of the ureter
**Damage form stones
**Renal scars
Etiology & Pathophysiology 2.0
- Rarely results via hematogenous route
- Kidney function occurring from hematogenous transmission always preceded by injury to urinary tract
**Obstruction of the ureter
**Damage form stones
**Renal scars
Etiology & Pathophysiology 3.0 of a UTI
- Catheter-associated urinary tract infections (CAUTI) are the most common HAI
**Most are underrecognized and undertreated
***Often caused by E. coli and less frequently Pseudomonas species
Clinical Manifestations of UTI
- Range from painful urination in uncomplicated urethritis or cystitis
- To severe systemic illness associated with abdominal or back /flank pain, fever, urosepsis, and decreased kidney function or AKI in some cases of pyelonephritis (upper urinary tract)
Clinical Manifestations of UTI
- Symptoms r/t either bladder storage or bladder emptying
Bladder storage
**Nocturia- waking up 2 or more times to void
**Nocturnal enuresis- loss of urine during sleep
Bladder emptying
**Weak stream
**Hesitancy – difficulty starting the urine stream
**Intermittency – interruption of the urinary stream during voiding
**Postvoid dribbling – urine loss after completion of voiding
**Urinary retention – inability to empty urine from the bladder
**Dysuria –painful or difficult voiding
Clinical Manifestations 2.0
- Older adults
**Symptoms often absent
**Non localized abdominal discomfort rather than dysuria
**Cognitive impairment possible
**Change in behavior, confusion or agitation possible
**Fever less likely
UTI Diagnostic Studies
- History & physical examination
- Dipstick urinalysis
**Identify presence of nitrites, WBCs, and leukocyte esterase - Urine culture & sensitivity (if indicated)
**Clean-catch sample preferred
**Specimen by catheterization or supra needle aspiration more accurate
**Determine bacteria susceptibility to antibiotics
-Ultrasound
-CT scan (CT urogram)
UTI Interprofessional Care
- Drug therapy with antibiotics
Uncomplicated UTI – short term course (typically 3 days)
**Trimethoprim/sulfamethoxazole – inexpensive, taken twice daily
**Nitrofurantoin (Macrodantin) -3-4 x /day or Macrobid (long acting) 2x/day
***Ampicillin, amoxicillin, cephalosporins
-Complicated UTI – long term treatment (7-14 days or more)
**Fluoroquinolones –Ciprofloxacin (Cipro)
-Other
**Antifungals –amphotericin or fluconazole
**Urinary analgesic –used in conjunction with antibiotics; provides soothing effect on urinary tract mucosa; stain s urine reddish orange
**Prophylactic or suppressive antibiotics
Nursing Management of a UTI
- Health history
**previous UTI, calculi, stasis, retention, pregnancy, STIs;
**antibiotics, anticholinergics, antispasmotics;
**instrumentation, (instruments/tools used in the past to diagnose or treat this pt ex iodine, insertion of a catheter)
urinary hygiene
**ANV, chills, nocturia, frequency, urgency
*Suprapubic/LBP lower back pain, bladder spasms, dysuria, burning with urination - Objective
**Fever
**Hematuria, foul smelling urine, tender/enlarged kidney
**Leukocytosis, + bacteria, WBCs, RBCs, pyuria, ultrasound, CT scan, IVP
Nursing Management 2.0 of a UTI
- Acute care
**Adequate fluid intake
**Avoid caffeine, alcohol, citrus, chocolate, spicey foods
**Application of local heat (warm pack)
**Instruct patient about drug therapy and SE; full course
**Monitor for signs of improvement and cessation of symptoms
**Report onset of flank pain, persistence of symptoms, fever
**Educate patient about voiding after intercourse, temporality d/c contraceptive diaphragm, regular voiding (3-4 hours), f/u care
- Health Promotion
**Cranberry juice or tablets may reduce # of UTIs
**Avoid unnecessary catheterization; early removal of indwelling catheters
Acute Pyelonephritis
AFECTA 3 PARTES
Inflammation of 1 renal parenchyma and
2colleting system (including 3 the renal pelvis)
Most common cause is bacterial infection
Etiology and Pathophysiology Pyelonephritis
- Preexisting factor usually present
- Commonly starts in the renal medulla and spreads to adjacent cortex
- Recurrent episodes lead to scarred, poorly functioning kidney and chronic pyelonephritis
**Vesicoureteral reflux –retrograde (backward) movement of urine for the lower to the upper urinary tract
**Dysfunction of the lower urinary tract –obstruction from BPH; stricture, stone
**CAUTI
Clinical Manifestations Acute Pyelonephritis
- Mild fatigue, chills, fever, vomiting, malaise, flank pain
- LUTS characteristic of cystitis
**Dysuria, urgency, frequency - Costovertebral tenderness to percussion on affected side
- Manifestations may subside in a few days, even without therapy
**Bacteriuria and pyuria still persist
Diagnostics
- History and physical exam
- Laboratory tests
**Urinalysis (UA)
**Urine for C &S (Urine for C&S stands for urine culture and sensitivity)
**CBC with differential
**BC BLOOD CULTURE (means blood sample) if bacteremia suspected
**Ultrasound
**CT urogram
Interprofessional Care Acute Pyelonephritis
- Hospitalization for patients with severe infections and complications
**N/V with dehydration
_Improve with treatment after 48-72 hours
-Antibiotics (IV then oral)
-NSAIDs or antipyretic drugs for fever or discomfort
-Urinary analgesics
-Relapses are treated with 6 weeks of antibiotics
Nursing Process: The Care of the Patient With a UTI—Assessment
- Pain, burning upon urination, frequency, nocturia, incontinence, hematuria
- About half are asymptomatic
- Association of symptoms with sexual intercourse, contraceptive practices, and personal hygiene
- Gerontologic considerations
- Assessment of urine, urinalysis, and urine cultures
- Other diagnostic tests
Nursing Process: The Care of the Patient With a UTI—Diagnoses
- Acute pain related to infection
- Deficient knowledge about:
**Factors predisposing patient to infection and recurrence
**Detection and prevention of recurrence
**Pharmacologic therapy
Collaborative Problems and Potential Complications
- Sepsis (urosepsis)
- Acute kidney injury
- Chronic kidney disease
Nursing Process: The Care of the Patient With a UTI—Planning
- Major goals may include:
**Relief of pain and discomfort
**Increased knowledge of preventive measures and treatment modalities (types of treatment ex, medication, surgury etc )
**Absence of complications
Interventions for UTI
- Relieving pain
- Medications as prescribed: antibiotics, analgesics, and antispasmodics
- Application of heat to the perineum to relieve pain and spasm
- Increased fluid intake
- Avoidance of urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol
- Frequent voiding
- Patient education
is the following statement true or false?
Older adult patients often lack the typical symptoms of UTI and sepsis
True
Older adult patients often lack the typical symptoms of UTI and sepsis
Urethrovesical and Uretherovesical Reflux?
Urethrovesical reflux and ureterovesical reflux are both conditions that involve the backflow of urine from the bladder up into the urethra and/or the ureters.
Urinary Incontinence
Affects more than 25 million adults in the United States
Underdiagnosed and underreported
Affects women and men
Risk factors: refer to chart 55-6
Symptom of many possible disorders
Types of Urinary Incontinence
Stress
Urge
Functional
Iatrogenic
Mixed incontinence
Types of Urinary Incontinence
Stress
Urge
Functional
Iatrogenic
Mixed incontinence
Patient Education #1
- Urinary incontinence is not inevitable and is treatable
- Management takes time (provide encouragement and support)
- Education verbally and in writing (Chart 55-9)
- Develop and use a voiding log or diary
- Behavioral interventions
- Medication education related to pharmacologic therapy
- Strategies for promoting continence
Is the following statement true or false?
Urinary incontinence is inevitable and is not treatable
False
Urinary incontinence is not inevitable and is treatable
Patient Education- Developing an Action Plan for Incontinence
- Develop an education plan for a patient with mixed stress and urge incontinence.
**Include the key points that are listed.
**Explain the voiding diary.
**Detail the behavioral interventions that may be used for a patient with stress and urge incontinence.
**List medications that may be used to treat stress and urge incontinence. Explain medication actions and the education needed for the classifications of medications used to treat stress and urge incontinence.
**Emphasize the importance of being culturally sensitive and the need to address the social needs of the patient.
Urinary Retention
- Inability of the bladder to empty completely
- Residual urine: amount of urine left in the bladder after voiding
-Causes include:
**Adults 60 years and older may have 50 to 100 mL of residual urine remaining in the bladder after voiding
**Postoperative spasms
**Diabetes, prostatic enlargement, urethral pathology, trauma, pregnancy, neurologic disorder
**Medications
Urinary Retention
- Inability of the bladder to empty completely
- Residual urine: amount of urine left in the bladder after voiding
-Causes include:
**Adults 60 years and older may have 50 to 100 mL of residual urine remaining in the bladder after voiding
**Postoperative spasms
**Diabetes, prostatic enlargement, urethral pathology, trauma, pregnancy, neurologic disorder
**Medications
Urolithiasis and Nephrolithiasis
-Calculi (stones) in the urinary tract or kidney
-Pathophysiology
-Causes: may be unknown
-Depends on location and presence of obstruction or infection
-Pain and hematuria
-Diagnosis: radiography, blood chemistries, and stone analysis; strain all urine and save stones
Potential Sites of Urinary Calculi? slide 40
Methods of Treating Renal Stones slide 41
Methods of Treating Renal Stones slide 42
No need it’s the same as 41-42-43
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Methods of reating Renal Stones. Slide 43
the same as 41-42
.
Patient Education #2 for kidney stones
- Signs and symptoms to report
- Follow-up care
- Urine pH monitoring
- Measures to prevent recurrent stones
- Importance of fluid intake
- Dietary education
- Medication education as needed
Types of Genitourinary Trauma
-Ureteral: motor vehicle accidents, sport injuries, falls
-Bladder: pelvic fracture, multiple trauma, blow to lower abdomen
-Urethral: blunt trauma to lower abdomen and pelvis
**s/s classic triad: blood visible at the meatus, inability to void, distended bladder
Genitourinary Trauma Management
-Medical management: control hemorrhage, pain and infection; monitor for oliguria, shock, s/s acute peritonitis (Peritonitis is a redness and swelling (inflammation) of the lining of your belly or abdomen.)
-Surgical management: suprapubic catheter, surgical repair
-Nursing management:
**Assess frequently
**Instruction about incision care and adequate fluid intake
**Changes to report: fever, hematuria, flank pain
Urinary Tract Infections:
Urinary tract infections (UTIs) are a common health issue that can affect both men and women, although they are more prevalent in women. They occur when bacteria, usually Escherichia coli (E.coli), enter the urethra and spread to the bladder, ureters, or kidneys. UTIs are the most common bacterial infection in women and a common site of acquired infection.
UTIs can be caused by a variety of disorders, including tuberculosis, fungal, and parasitic infections, but bacterial infection is the most common cause. The symptoms of a UTI can include painful urination, a strong urge to urinate, frequent urination, cloudy or strong-smelling urine, and pelvic pain.
A bacterial count of 10^5 CFU/mL or more in a urine sample is considered indicative of a UTI. However, in a person with symptoms, a count as low as 10^2 CFU/mL may be indicative of a UTI. It is important to seek medical attention if you suspect you have a UTI, as untreated infections can lead to more serious health complications.
Prostatitis is a medical condition characterized by inflammation of the prostate gland. The prostate gland is a walnut-sized gland located just below the bladder in men. It produces fluid that is part of semen.
Prostatitis can be caused by bacterial or non-bacterial factors. Bacterial prostatitis is caused by infection of the prostate gland by bacteria, while non-bacterial prostatitis can be caused by other factors, such as nerve damage, autoimmune disorders, or irritation of the prostate gland.
Lower UTI
Renal parenchyma UTI material
Urinary tract infections (UTIs) can affect any part of the urinary tract, including the renal parenchyma, which is the functional tissue of the kidneys. When the infection affects the renal parenchyma, it is known as pyelonephritis, which is a more serious type of UTI.
Pyelonephritis is typically caused by a bacterial infection, which can spread from the lower urinary tract to the kidneys. The most common pathogen is Escherichia coli (E.coli), which is responsible for about 80% of all UTIs.
upper UTI
upper uti causes more systematic symptomps ?
Yes, upper urinary tract infections (UTIs), such as pyelonephritis (an infection of the kidneys), can cause more systemic symptoms than lower UTIs. This is because upper UTIs involve not only the bladder and urethra but also the kidneys and renal pelvis.
Symptoms of upper UTIs may include fever, chills, nausea, vomiting, back pain, and general malaise. These symptoms can indicate a more serious infection and may require more aggressive treatment, such as hospitalization and intravenous antibiotics.
yes
what is septic shock?
Septic shock is a serious medical condition that occurs when an infection leads to a severe systemic inflammatory response in the body. It is a medical emergency that can quickly become life-threatening.
When an infection spreads throughout the body, it can trigger an exaggerated immune response, causing inflammation, damage to tissues and organs, and potentially leading to organ failure
Urosepsis can cause septic shock
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Uncomplicated urinary tract infections (UTIs) typically occur in an otherwise healthy urinary tract and usually only involve the bladder. This means that there are no underlying anatomical or functional abnormalities in the urinary tract that predispose to infections. Todo bien es solo azar mala suerte shit happens
In uncomplicated UTIs, the symptoms are generally limited to the lower urinary tract and may include a frequent urge to urinate, painful urination, and a feeling of incomplete bladder emptying. These symptoms are caused by the presence of bacteria in the bladder, which irritate the bladder lining and trigger an inflammatory response.
Uncomplicated UTIs are generally treated with a short course of antibiotics.
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An abnormal genitourinary (GU) tract refers to any anatomical or functional defect or disorder affecting the organs of the urinary and genital systems.
VAMOS QUIERE DECIR ANYTHING OUT OF THE NORM
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uti Most common reason of infections health care
Urinary tract infections (UTIs) are one of the most common reasons for healthcare-associated infections. This is because catheterization and other invasive procedures that are commonly performed in healthcare settings can introduce bacteria into the urinary tract and increase the risk of infection.
tuberculosis, fungal and parasitic infections
can cause uti’s
Bacterial infection is most common cause of UTI ?
Oui
***Escherichia coli (E.coli) most common pathogen of these bacteria
In the context of a urine culture, CFU stands for colony-forming units, which are used to measure the number of bacteria present in a urine sample.
A count of 10 5th CFU/mL or more indicates that there is a significant amount of bacteria present in the urine, which is generally considered indicative of a urinary tract infection (UTI). This is because the urinary tract normally contains very few bacteria, so the presence of a large number of bacteria in the urine suggests that there is an infection present.
EVEN WITHOUT SYMPTOMPS
CFU stands for colony-forming units
Counts as low as 10 2nd in a person with symptoms is indicative of UTI
even it it has not reached the threshold of
10 5nd
parenchyma etymology
The word “parenchyma” comes from the Greek words “para” (meaning “beside” or “alongside”) and “enkhuma” (meaning “infusion” or “fluid”), which together roughly translate to “something that is infused beside (other tissue)”. The term was originally used to describe the soft, functional tissue of an organ, as opposed to its harder, structural tissue (known as the stroma). Today, the term “parenchyma” is used more broadly to refer to the functional tissue of an organ, regardless of its consistency or location within the organ.
functional tissue of an organ, as opposed to its harder, structural tissue (known as the stroma like bone ).
perineum
The perineum is the area of the body located between the pubic bone at the front of the pelvis and the tailbone at the back of the pelvis. It is a diamond-shaped region that includes the external genitalia (vulva or penis)
Urologic instrumentation allows bacteria to enter urethra and bladder
Urologic instrumentation refers to medical procedures that involve inserting instruments into the urinary tract, such as catheters, scopes, or other devices. These procedures can increase the risk of introducing bacteria into the urinary tract, as they can disrupt the natural barriers that normally help prevent infections.
When an instrument is inserted into the urethra, it can cause small abrasions or tears in the tissue, which can provide a pathway for bacteria to enter the bladder or other parts of the urinary tract.
Sexual intercourse promotes “milking” of bacteria from perineum and vagina
During sexual intercourse, the movements and friction of the penis or other object against the perineum and vagina can cause the “milking” or movement of bacteria from these areas into the urethra. This is particularly true in women, as the urethra is located very close to the vagina and anus, which are both sources of bacteria.
In women, sexual activity can also cause microabrasions or tiny tears in the tissue of the vaginal wall or vulva, which can provide an entry point for bacteria into the urinary tract. Men can also experience microabrasions on the penis, particularly if there is vigorous or prolonged sexual activity.
It is not necessarily true that kidney function occurring from hematogenous transmission is always preceded by injury to the urinary tract. Hematogenous transmission refers to the spread of infection through the bloodstream, which can sometimes lead to the development of kidney infections (pyelonephritis) without any prior injury to the urinary tract.
However, injury or obstruction to the urinary tract can certainly increase the risk of developing kidney infections, as it can create an environment where bacteria can easily grow and multiply.
HAI stands for healthcare-associated infection
what causes painful urination in UTI ?
Painful urination, also known as dysuria, is a common symptom of urinary tract infections (UTIs). It is caused by irritation and inflammation of the lining of the urethra and bladder, which can occur when bacteria infect the urinary tract.
When bacteria enter the urethra and bladder, they can attach to the lining of these structures and cause inflammation. This inflammation can make it difficult and painful to pass urine