Urological and GI

Question 1

When is trimethoprim-sulfamethoxazole (Bactrim) given?

Answer 1

First line for UTIs

Question 2

When is ciprafloxacin given?

Answer 2

For UTIs when there is a sulfa allergy

Question 3

When is Nitrofurantoin (Macrodanti/Macrobid) given?

Answer 3

For recurring lower UTIs

Question 4

UTI antibiotics teaching

Answer 4

Need to finish course of antibiotics even if your symptoms disappear sooner

Question 5

Phenaxopyridine (Pyridium)

Answer 5

Urinary tract analgesic; for relief of pain due to UTI

Question 6

Phenazopyridine (Pyridium) MOA and SE

Answer 6

Dye used in paint; local analgesic action; SE—reddish, orange urine, will stain

Question 7

Mirabegron (Myrbetriq) MOA

Answer 7

Antispasmodic that targets the bladder; electively stims beta-3 adrenergic receptors, relaxes bladder smooth muscle

Question 8

Mirabegron SE

Answer 8

HTN, urinary retention, UTI, headache

Question 9

Mirabegron NC

Answer 9

Monitor BP and not good for ppl with already high BP, can cause UTIs from urinary retention

Question 10

Oxybutynin (Oxytrol) Class and indications

Answer 10

Anticholinergic med; overactive bladder, incontinence

Question 11

Anticholinergic med MOA

Answer 11

Blocks action of Ach (prevents action of smooth muscle contractions)

Question 12

Anti-cholinergic SE and NC

Answer 12

dry mouth, constipation; can be in EC form; try non-pharm intx first—pelvic floor training

Question 13

constipation

Answer 13

small, infrequent, or difficult BM (<3 BM/wk)

Question 14

Causes of constipation

Answer 14

diet low in fiber, lack exercise, dec peristalsis, obstruction or diverticulitis–pathologic

Question 15

impaction

Answer 15

unrelieved constipation–firm stool obstructs lower GI tract and liquid squeezes around

Question 16

impaction sx

Answer 16

N/V, lose appetite, cramps and pain, distention

Question 17

diarrhea

Answer 17

inc freq/fluidity of BM

Question 18

Acute diarrhea causes

Answer 18

infection, emotional stress, some meds, liquid stool

Question 19

chronic diarrhea

Answer 19

> 4 weeks; chronic GI infection, altered motility, malabsorption, endocrine dx

Question 20

Episodic diarrhea

Answer 20

food allergy/irritants, caffeine, enteral feeding

Question 21

Main concerns with diarrhea

Answer 21

skin b/d, fluid imbalance, nutritional concerns

Question 22

Osmotic diarrhea

Answer 22

inc osmotically active solutes like mag sulfate and epsom salts; Na and water rush in, causing diarrhea (common with tube feed)

Question 23

secretory diarrhea

Answer 23

bacteria/toxin like Vibriocholerae and Staph

Question 24

exudative diarrhea

Answer 24

active inflammation in bowel lumen resulting in exudate of blood, mucus and protein–open wounds; pull water into intestines, Crohn’s and UC

Question 25

motility disturbance of diarrhea

Answer 25

dec abs of small intestine; dumping sx and IBS

Question 26

UTI and most common type

Answer 26

infection of lower tract and bladder; E. coli is most common

Question 27

Bacteriuria

Answer 27

bacteria in urine; not always causing infection

Question 28

Urethritis

Answer 28

infection in urethra

Question 29

cystitis

Answer 29

infection in the bladder causing frequency, urgency, suprapubic discomfort, dysuria

Question 30

Risk factors for UTI

Answer 30

being female (shorter urethra), incomplete emptying, protein in urine, foleys, peri irritation, incontinence, inc age, preg, sexually active female, spermicide use before sex, urinary obstruction or reflex, immobility, dec cognition, poor hygiene

Question 31

Why are men more likely to have recurring UTIs?

Answer 31

bacteria can hide by prostate and retention occurs with BPH

Question 32

UTI diagnosis

Answer 32

H&P, Urinalysis, urine culture, CBC

Question 33

UTI sx

Answer 33

asymptomatic, urgency, problems urinating, hematuria, dysuria, cloudy urine, fever, chills, fatigue

Question 34

UTI tx

Answer 34

antibiotics, inc fluids, avoid irritants, wear loose cotton clothes, frequent peeing, probiotics, don't try to hold your pee

Question 35

Atypical UTI manifestations in kids

Answer 35

fever, irritability, vomit, poor eating, diarrhea, look ill, old enough to verbalize

Question 36

Atypical UTI manifestation in older adults

Answer 36

anxiety, confusion, lethargy, anorexia, hx of falls; not as likely to have urgency

Question 37

Protective fx for UTIs

Answer 37

acidic urine, presence of urea in the urine, prostatic secretions in men, urethral gland secretions in women, unidirectional urine flow (one way valve at urethral attachment to bladder); strong immune system

Question 38

Bladder structure

Answer 38

Made of smooth muscle

Question 39

How much can the bladder hold before saying it needs to pee

Answer 39

300-500

Question 40

Overactive bladder

Answer 40

Bladder muscles contract involuntarily even when the bladder amount is low; results in increased urge and frequency (8+/24h), nocturia

Question 41

Nocturia

Answer 41

Waking up more than 2x/night to pee

Question 42

Causes of overactive bladder

Answer 42

Neuro disorder, DM, UTI, hormone change, tumors/stones, obstructions

Question 43

Incontinence

Answer 43

Involves leakage of urine immediately after a sudden need to urinate

Question 44

Is incontinence a normal part of aging?

Answer 44

Not normal but can be age related

Question 45

Cause of incontinence

Answer 45

Overactive detrusor muscle that suddenly contracts (inc w/ age), bladder infection that irritates the bladder lining, bladder outlet obstruction such as large prostate, CNS condition like MS or Park’s, drug like diuretics

Question 46

Stress incontinence

Answer 46

When urine is involuntarily lost with an inc in intraabdominal pressure; precipitated by effort or exertion; angle of abdominal/pelvic muscle is changes do muscle does not close all the way—leakage

Question 47

Causes of stress incontinence

Answer 47

Lose pelvic floor muscle or loss of fascial support of bladder and urethra

Question 48

Risk factors of stress incontinence

Answer 48

Age, obesity, childbirth trauma, pelvic surgery

Question 49

Mixed incontinence

Answer 49

Combination of stress and urge

Question 50

Overflow incontinence

Answer 50

Bladder is so full it leaks (BPH)

Question 51

Functional incontinence

Answer 51

Physical/environmental limits that prevent getting to the toilet like cognitive and physical factors

Question 52

Transient incontinence

Answer 52

Sudden onset of incontinence; reversible

Question 53

Problems associated with incontinence

Answer 53

Psychosocial, skin b/d—pain, swelling, itching, susceptible to bacterial infections; high risk in butt, genitals, inner thighs