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UTI Flashcards

1
Q

UTIs are the ___ most common type of infection

A

2nd

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2
Q

In what gender are UTIs most common?

A

female

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3
Q

UTIs cause about ____ of all hospital- acquired infections

A

50%

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4
Q

What is the most common cause of hospital-acquired UTI?

A

catheter-acquired (cauti)

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5
Q

What structures and infections involve the lower urinary tract?

A

involves the bladder and structures below the bladder (aka: cystitis)
- prostatis
- urethritis

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6
Q

What structures does an upper urinary tract infection involve?

A
  • involves the kidneys and ureters (ex. pyleonephritis)
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7
Q

What are most uncomplicated lower UTIs caused by?

A

E coli

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8
Q

What percent of UTIs are caused by E coli?

A

75-90%

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9
Q

How does E coli cause UTI?

A

bacteria surface has adhesins which allow attachment to the mucosal surface

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10
Q

What bacterias cause complicated UTIs?

A
  • staphylococcus saprophyticus
  • klebsiella pneumoniae
  • proteus mirablis
  • pseudomonas species
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11
Q

Where does bacteria usually enter the urinary tract?

A

usually enter through the urethra

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12
Q

What is different about the anatomical structure of the urinary tract that causes women to get more UTIs?

A

women have shorter urethras

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13
Q

the distal urethra often has ____________; the urine formed in the kidney and the bladder is usually ____________

A

pathogen; sterile

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14
Q

When does the washout phenomenon occur?

A

occurs when urine washes out the bacteria in the urethra during urination

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15
Q

What are examples of anatomic urinary obstructions that cause UTI?

A
  • stones
  • BPH
  • pregnancy
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16
Q

What are examples of functional urinary obstructions that cause UTI?

A
  • neurogenic bladder
  • infrequent voiding
  • detrusor (bladder) muscle instability
  • constipation
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17
Q

What is utetervesical reflux?

A

in women urine moves from the bladder into the urethra and then flows back into the bladder during activities such as coughing & squatting

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18
Q

What is vesicoureteral reflux?

A

occurs at the level of the bladder & ureter; think like back flow of urine

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19
Q

Who is at risk for UTI?

A
  • sexually active women
  • post menopausal women
  • pregnancy
  • bladder cancer
  • renal stones (calculi)
  • men with prostate abnormalities
  • older adults
    others at risk:
  • catherization
  • instrumentation
  • diabetes
  • use of abx
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20
Q

What is the defense sytem challenged by?

A

the virulence of the pathogen

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21
Q

What structure of the bladder protects against bacteria?

A

the protective mucin layer

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22
Q

What reacts to bacteria in the urinary tract?

A

local immune system reacts; IGa & phagocytic cells remove the bacteria

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23
Q

What helps prevent bacteria from getting to the bladder?

A

urine helps decrease bacteria getting to the bladder

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24
Q

What do women naturall have in their flora to protect against UTI?

A

lactobacillus is part of the normal flora of the periurethral area

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25
What do men naturally have to protect against UTI?
prostatic fluid containing immunoglobulins (IgA, IgG)
26
What is the mucin layer?
- epithelial cells that line the bladder & produce protective substances - believed that by binding water provides a barrier between the bacteria & the bladder epithelium
27
What hormone plays a role in the mucin layer?
estrogen; older women & post menopausal women do not have as much mucin
28
what does lactobacillus do and when is that flora disturbed?
lactobacillus keeps other bacteria out - decrease estrogen - abx
29
What is the benefit of prostate secretions in terms of UTI?
prostate secretions for men have antibacterial properties which protect the urethra from colonization
30
Why do young men not get UTIs?
- urethral length - drier periurethral environment
31
What puts men at risk for UTI?
- lack of circumcision - anal intercourse
32
Are UTIs in men considered complicated or uncomplicated and why?
all UTI in men are considered complicated; more of an issue because of longer urethra
33
What are sx of uncomplicated UTI?
- dysuria - frequency - urgency - hematuria - suprapubic pain
34
What are Sx of complicated UTI?
- may be asymptomatic or present w/ septic shock - fever - chills - N/V - back/flank pain
35
What is urosepsis?
spread of infection from urinary tract to bloodstream
36
What are UTI sx in older adults?
- incontinence - foul smelling concentrated urine - fatigue - confusion - dementia (develop/ worsen it) - hallucinations
37
UTIs occur ______ frequently in boys up to 3 months & _______ frequently in girls after 3 months of age
more; more
38
What children are at increased risk for developing UTI?
- premature infant discharged from NICU - those with systemic or immunologic disease - those with urinary tract abnormalities (neurogenic bladder or vesicoureteral reflux)
39
What part of the urinary tract do childhood UTIs often involve?
frequently involve upper urinary tract
40
What is interstitial cystitis characterized by?
- pain - urgency - feeling of bladder fullness - pressure in pelvic area
41
In what condition are sx variable?
interstitial cystitis
42
In what gender is interstitial cystitis more common in?
women
43
What is the cause of interstitial cystitis?
exact cause is unknown; believed that there is more than 1 mechanism involved
44
What are the three possible mechanisms involved in interstitial cystitis?
- defects in part of the mucus layer of the bladder that protects the bladder - defects may allow toxins in urine to leak through & damage nerve and muscle tissues which trigger pain & hypersensitiviy - infection or autoimmune
45
interstitial cystitis is a ________ condition; the goal is the __________ sx
chronic; manage
46
What are clinical manifestations of interstitial cystitis?
- chronic pelvic pain - chronic perineal pain - bladder fullness - urgency & frequency - remission & exacerbation
47
How do you dx interstitial cystitis?
- med hx - physical exam - cytoscopy - urodynamic testing - r/o infection - r/o endometriosis
48
What does specific gravity test?
amount of solutes to pure water more solutes = higher specific gravity
49
What is the normal for specific gravity?
no true normal as it depends on individual reference level = 1.010
50
What is the consideration for specific gravity?
extremes of either side can be indicative of pathology
51
What does pH measure?
acid-base
52
What is normal pH?
6.5-7 in AM 7.5-8 PM
53
What is the consideration for pH?
can be affected by food
54
What are leukocytes in UA?
enxyme given off by WBC
55
What is the normal for leukocytes?
negative
56
What is the consideration for leukocytes?
present in all patients with UTIs
57
What is nitrite n a UA?
enxyme released by enterobacteriaceae
58
What is the normal for nitrite?
negative
59
What are considerations for nitrite?
can be negative and still a UTI
60
What is blood in a UA?
can be micro or macrocytic
61
What is the normal for blood in a UA?
negative
62
What is the consideration for blood in a UA?
can be seen in trauma, hemolysis, UTI, or malignancy
63
What is protein in a UA?
albumin is protein measured
64
What is the normal range for protein in a UA?
negative
65
What are considerations for protein in a UA?
renal disease, pregnancy or inflammation
66
What is glucose in a UA?
renal threshold to eliminate glucose
67
What is normal for glucose in a UA?
negative
68
What are ketones in a UA?
measures metabolites of fat metabolism
69
What is normal for ketones in a UA?
negative
70
What are considerations for ketones in a UA?
insulin insufficiency, starvation, vomiting
71
What is normal for bilirubin in a UA?
negative
72
What are considerations for bilirubin in a UA?
liver disease, obstruction
73
What is normal for urobilinogen in a UA?
negative
74
What are considerations for urobilinogen in a UA?
- liver disease - hemolysis - mono - cirrhosis
75
What are casts in a UA?
coagulated protein by kidney cells
76
What is normal for casts in a UA?
- negative - hyaline (0-5) in healthy people - cellular not normal
77
What are considerations for casts in a UA?
- hyaline are clear - can have cellular RBC or WBC
78
What are crystals in a UA?
- waste solutes - based on pH and urine temp
79
What is normal for crystals in a UA?
none but some are ok
80
What does management of UTIs?
- pharmacologic therapy - patient education
81
How are acute UTIs treated?
3 or 7 day course of antibiotics, if uncomplcated
82
How are chronic or relapse UTIs treated?
up to 2 week course of abx
83
How are upper urinary tract infections treated?
- 2 week course - may require up to 6 weeks
84
What medications are commonly used to treat UTIs?
- cephalexin - ciprofloxacin - levofloxacin - ampicillin - amoxicillin - bactrim
85
Are cranberry pill/capsules or juice effective to treat UTI?
no; thought to create a more acidic environment but research does not back that up; does help with voiding if drinking juice simply due to hydration
86
What is one of the most important factors when treating UTI?
hydration!
87
What should you educate pt on when they have a UTI?
- hydration - voiding before & after sexual intercourse (prevents reflux that may occur) - avoid douching - take abx as prescribed - avoid tight/restrictive clothing - shower dont bathe - personal hygiene

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