Urologic Problems Flashcards
UTI most common sites
Lower urinary tract & bladder
Reasons UTI common in women
Short urethra
Incomplete emptying
Urethral irritation
UTI risk factor
Protein in urine is a great risk for microorganism growth
UTI most common bacteria
E.coli
Bacteriuria
Bacteria in the urine NOT causing infection but places at risk for UTI
Urethritis
Infection in the urethra
Lower UTI
Cystitis
Infection in the bladder
Lower UTI
UTI Uncomplicated S/S
Asymptomatic, urgency, frequency, dysuria, hematuria, cloudy/foul urine, fever/chills/fatigue
UTI Uncomplicated diagnosis
H&P, UA, URINE CULTURE, CBC—leukocytosis
UTI Uncomplicated treatment
ANTIBIOTICS, ↑fluids, avoid irritants (i.e., caffeine), loose cotton clothes, frequent urination, probiotics
UTI: Protective Factors
Acidic pH Presence of urea Men: prostatic secretions Women: urethral gland secretions Unidirectional urine flow One-way valve at ureteral attachment to bladder Immune system
UTI: Risk Factors
Catheters
Female sex (perineal irritation)
Older age (nursing home up to 50% have bacteriuria)
Pregnancy
Sexual activity (spermicide use with diaphragm or condom)
Urinary obstruction/reflux
UTI: Risk Factors
Immobility: urinary stasis
Bowel/urine incontinence
Decreased cognition
Bad personal hygiene
UTI in men
More likely to have recurrent UTI’s because bacteria can hide deep in the prostate/ BPH causing urinary retention
Urethritis/lower UTI s/s
Dysuria
Most common: ASYMPTOMATIC
Cystitis (bladder)/lower UTI s/s
Frequency Urgency Suprapubic discomfort Dysuria Hematuria
UTI s/s in children
Fever Irritability Poor feeding Vomiting Diarrhea Ill appearance Old enough to verbalize? Can be sign of sexual abuse
UTI s/s in elderly
Anxiety CONFUSION Lethargy Anorexia Falls
Lower UTI pharm
trimethoprim-sulfamethoxazole (Bactrim)
ciprofloxacin
nitrofurantoin (Macrodantin/Macrobid)
trimethoprim-sulfamethoxazole (Bactrim) for lower UTI
First-line
Don’t give if sulfa allergies
ciprofloxacin for lower UTI
For patients with sulfa allergies
nitrofurantoin (Macrodantin/Macrobid) for lower UTI
For recurring lower UTIs
Urinary tract analgesic
phenazopyridine (Pyridium)
phenazopyridine (Pyridium) indication
Relief of PAIN due to UTI
phenazopyridine (Pyridium) MOA
Dye used in paint; local analgesic action
phenazopyridine (Pyridium) SE
Well tolerated
REDDISH-ORANGE URINE
Anatomy
Bladder is composed of smooth muscle (detrusor muscle); holds about 300-500 mL of urine; pelvic floor muscle help control bowel and bladder
Overactive bladder
Occurs when bladder muscles involuntarily contract even when urine volume is low
Overactive bladder causes
Neurological conditions (CVA) DM UTIs Hormonal changes during menopause Badder tumors/stones
Overactive bladder s/s
Sudden urge to urinate (may experience urgency incontinence)
Increased frequency (usually >8x in 24 hrs)
Nocturia (wake up >2x during the night)
Overactive bladder causes
Neurological disorders Diabetes UTI's Hormonal changes Tumors/stones Obstructions
mirabegron (Myrbetriq) class
Antispasmotic (urinary)
Beta-3 adrenergic agonists–me
mirabegron (Myrbetriq) MOA
Selectively stimulates beta-3 adrenergic receptors, relaxing bladder smooth muscle
mirabegron (Myrbetriq)/antispasmotic route
PO
mirabegron (Myrbetriq)/antispasmotic SEs
HTN—must monitor BP
Urinary retention
UTI
Headache
Incontinence
Involuntary urine loss
Incontinence and older adults
NOT normal symptom of aging but may be related to functional changes associated with aging
Urgency incontinence
Involves the involuntary leakage of urine immediately after a sudden sensation to urinate
Urgency incontinence cause
Overactive detrusor muscle that suddenly contracts
Urgency incontinence risk factors
Older age
Bladder infection that irritates the bladder lining
Bladder outlet obstruction (enlarged prostate)
CNS conditions (Parkinson’s, dementia, MS, CVA)
Drugs (diuretics, alcohol)
Stress incontinence
Occurs when urine is involuntarily lost with increases in intraabdominal pressure
Precipitated by effort or exertion such as sneezing, coughing, or just bending down
Stress incontinence causes
Loss of pelvic muscle and/or loss of fascial support of bladder and urethra; without support any increase in intraabdominal pressure changes normal angle between bladder and urethra and urethra cannot close all the way, causing leakage of urine
Stress incontinence risk factors
Age (loss of pelvic floor muscle)
Obesity
Childbirth-related trauma
Pelvic surgery
Mixed incontinence
Combination of urge and stress
Common in older women
Overflow incontinence
Occurs when bladder is too full
Common in BPH-urinary retention
Functional incontinence
Related to physical & environmental limitations
Inability to get to toilet in time
Transient incontinence
Usually related to disease process
Sudden onset; reversible
Often related to UTI, constipation, or fecal impaction
Incontinence complications
Skin irritation/inflammation
Redness, pain, and itching
Swelling, blisters, dryness
Damaged skin now vulnerable to infection
Damp/warm skin is breeding ground for bacteria and fungi
Areas at risk areas: genitals, between buttocks, inner thighs
oxybutynin (Oxytrol) class
Anti-cholinergic
oxybutynin (Oxytrol) MOA
Blocks the action of acetylcholine (rest/digest)
Acetylcholine activates bladder smooth muscle contractions
oxybutynin (Oxytrol)/anti-cholinergic indications
Overactive bladder, incontinence
oxybutynin (Oxytrol)/anti-cholinergic SEs
Dry mouth, constipation
oxybutynin (Oxytrol)/anti-cholinergic form/route
Can be in extended- release forms
Only given PO
Transient incontinence
Causes by medical conditions
Incontinence type most likely associated with a UTI
Stress incontinence
Occurs due to weakness or injury to the urinary sphincter or pelvic floor muscles
Overflow incontinence
Often caused by an overdistended bladder
