Urological and GI Flashcards
When is trimethoprim-sulfamethoxazole (Bactrim) given?
First line for UTIs
When is ciprafloxacin given?
For UTIs when there is a sulfa allergy
When is Nitrofurantoin (Macrodanti/Macrobid) given?
For recurring lower UTIs
UTI antibiotics teaching
Need to finish course of antibiotics even if your symptoms disappear sooner
Phenaxopyridine (Pyridium)
Urinary tract analgesic; for relief of pain due to UTI
Phenazopyridine (Pyridium) MOA and SE
Dye used in paint; local analgesic action; SE—reddish, orange urine, will stain
Mirabegron (Myrbetriq) MOA
Antispasmodic that targets the bladder; electively stims beta-3 adrenergic receptors, relaxes bladder smooth muscle
Mirabegron SE
HTN, urinary retention, UTI, headache
Mirabegron NC
Monitor BP and not good for ppl with already high BP, can cause UTIs from urinary retention
Oxybutynin (Oxytrol) Class and indications
Anticholinergic med; overactive bladder, incontinence
Anticholinergic med MOA
Blocks action of Ach (prevents action of smooth muscle contractions)
Anti-cholinergic SE and NC
dry mouth, constipation; can be in EC form; try non-pharm intx first—pelvic floor training
constipation
small, infrequent, or difficult BM (<3 BM/wk)
Causes of constipation
diet low in fiber, lack exercise, dec peristalsis, obstruction or diverticulitis–pathologic
impaction
unrelieved constipation–firm stool obstructs lower GI tract and liquid squeezes around
impaction sx
N/V, lose appetite, cramps and pain, distention
diarrhea
inc freq/fluidity of BM
Acute diarrhea causes
infection, emotional stress, some meds, liquid stool
chronic diarrhea
> 4 weeks; chronic GI infection, altered motility, malabsorption, endocrine dx
Episodic diarrhea
food allergy/irritants, caffeine, enteral feeding
Main concerns with diarrhea
skin b/d, fluid imbalance, nutritional concerns
Osmotic diarrhea
inc osmotically active solutes like mag sulfate and epsom salts; Na and water rush in, causing diarrhea (common with tube feed)
secretory diarrhea
bacteria/toxin like Vibriocholerae and Staph
exudative diarrhea
active inflammation in bowel lumen resulting in exudate of blood, mucus and protein–open wounds; pull water into intestines, Crohn’s and UC
motility disturbance of diarrhea
dec abs of small intestine; dumping sx and IBS
UTI and most common type
infection of lower tract and bladder; E. coli is most common
Bacteriuria
bacteria in urine; not always causing infection
Urethritis
infection in urethra
cystitis
infection in the bladder causing frequency, urgency, suprapubic discomfort, dysuria
Risk factors for UTI
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
Why are men more likely to have recurring UTIs?
bacteria can hide by prostate and retention occurs with BPH
UTI diagnosis
H&P, Urinalysis, urine culture, CBC
UTI sx
asymptomatic, urgency, problems urinating, hematuria, dysuria, cloudy urine, fever, chills, fatigue
UTI tx
antibiotics, inc fluids, avoid irritants, wear loose cotton clothes, frequent peeing, probiotics, don’t try to hold your pee
Atypical UTI manifestations in kids
fever, irritability, vomit, poor eating, diarrhea, look ill, old enough to verbalize
Atypical UTI manifestation in older adults
anxiety, confusion, lethargy, anorexia, hx of falls; not as likely to have urgency
Protective fx for UTIs
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
Bladder structure
Made of smooth muscle
How much can the bladder hold before saying it needs to pee
300-500
Overactive bladder
Bladder muscles contract involuntarily even when the bladder amount is low; results in increased urge and frequency (8+/24h), nocturia
Nocturia
Waking up more than 2x/night to pee
Causes of overactive bladder
Neuro disorder, DM, UTI, hormone change, tumors/stones, obstructions
Incontinence
Involves leakage of urine immediately after a sudden need to urinate
Is incontinence a normal part of aging?
Not normal but can be age related
Cause of incontinence
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
Stress incontinence
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
Causes of stress incontinence
Lose pelvic floor muscle or loss of fascial support of bladder and urethra
Risk factors of stress incontinence
Age, obesity, childbirth trauma, pelvic surgery
Mixed incontinence
Combination of stress and urge
Overflow incontinence
Bladder is so full it leaks (BPH)
Functional incontinence
Physical/environmental limits that prevent getting to the toilet like cognitive and physical factors
Transient incontinence
Sudden onset of incontinence; reversible
Problems associated with incontinence
Psychosocial, skin b/d—pain, swelling, itching, susceptible to bacterial infections; high risk in butt, genitals, inner thighs
