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issues and policy > UTI > Flashcards

UTI Flashcards

1
Q

Lower UTI cause

A

cystitis, dysuria, frequency syndrome,

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2
Q

upper UTI cause

A

pyelonephritis, Renal abcess etc

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3
Q

S and S of lower UTI

A 
DYSURIA is the key symptom
frequency
nocturia
urercy
HEMATURIA OCCURS IN 40-60%
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4
Q

s and s labs

A

UA- pyuria >10wbc
nitrate on dipstic is specific but not sensitive (shows when they dont have it less than when they do)
esterace detection by dipstic is sensative but not specific (if have it, most likely they have UTI

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5
Q

management of lower UTI

A

3 day therapy
bactrim, cipro, or augmentin

during pregnanacy- amoxil, macrobid, keflex for 7 to 10 days

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6
Q

upper UTI sx

A

FLANK PAIN
FEVER AND CHILLS
N/V
mental stauts change in the elderly

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7
Q

Upper UTI - ESR

A

seen with pyelonephritis,

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8
Q

Management of upper UTI

A

14 day vs 6 week course
bactrim, cipro, augmentin or aminoglycosides, (gentor torbra)
pts with puelonephritis with N and V should be hospatilized

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9
Q

Renal insufficiency

A

decrease in renal funciton resulting in a decrease in GFR and reduction in clearence of slutes, GFR goes down with age

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10
Q

Causes of Renal Insufficiency

A

hypertensive nephrosclerosis
glomerulonephritisdiabetic neuropathy
inerstitial nephritis
polycystic kidney disease

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11
Q

Renal insufficiency symptoms

A

asymptomatic till late

systemic changes are not evided untill overall renal function is less than 20 to 25% of normal

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12
Q

acute kidney injury

A

BUN 7 to 20 mg/dL (2.5 to 7.1 mmol/L) is increased out of proportion to serum creat 0.84 to 1.21 milligrams per deciliter
caused by obstruction or acute tubular necrosis
reversible with proper therapy

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13
Q

chronic kidney injury

A

steady increase in BUN and creat ration 10:1 (normal is 10:1)
can slow prgress but damage is irreversable

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14
Q

stages of renal failure

A

diminishde renal reserve: 50% ephro loss creat doubles
renal insufficiency: 75% nephron loss mild azotemia present
ESRD: 90% nephron damage, azotemai and metabolic alterations

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15
Q

critera for dialysis

A 
Acidosis or azotemia
Electrolytes 
Intoxication 
Oliguria 
Uremia-urine in the blood
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16
Q

acute kidney injury management

A

find the cause and intervene to prevent permanent damage

17
Q

chronic kidney damage management

A 
diiuretics to reduce volume
monitor and treat metabolic acidosis
monitor electrolytes- hypercalcemia 
aceI to reduce renal vasoconstriction
treat anemia- 
treat azotemia with HD
18
Q

Acute renal failure pre-renal causes

A

outside kidney
caused by conditions that impair perfusion
(shock, hypovolemia, dehydratioon)
BY definition acute renal failure is only pre-renal if it is reversed by fixing the hypoperfusion,
NO DAMAGE TO RENAL TUBULES

19
Q

Intrarenal (intrinsic or in the kidney)

A

diseases that effect the renal cortex, or medula such as hyersensitivity drug reactions, renal embolism or thrombus, most common cause is nephrotoxic drugs, mismatched blood transfusion.
results in nephron damage acute tubular necrosis

20
Q

post renal below kidney

A

urine flow obstruction
mechanical: tumor bph or stones
functional - neurogenic bladder or diabetic neuropathy

21
Q

pre-renal labs

A 
serum BUN to Creat Ratio: over 10:1
Urine sodium: less than 20mmol.dl
Specific Gravity: over 1.015
sediment: normal or few casts 
Fractional excretion of sodium: less than 1

expand intravascular volume consider dopamine

22
Q

intra renal labs

A 
serum BUN to Creat Ratio: 10:1
Urine sodium: over 40mmol/dl 
Specific Gravity: less than 1.015
sediment: granular white casts 
Fractional excretion of sodium: over 3

stop nephrotoxic drugs, RRT

23
Q

post renal labs

A 
serum BUN to Creat Ratio: 10:1
Urine sodium: usually over 40mmol/dl 
Specific Gravity: less than 1.015
sediment: normal 
Fractional excretion of sodium: usually over 3

remove obstruction, CT renal ultrasound

24
Q

Renal calculi types

A

calcium 80%- frequently familial, more common in men, over 30 years of age

uric acid: more common in men, associated with gout

struvite- mainly in women, result for UTI’s knwn as mag ammonium phosphate stones, can fill the renal pelvicce and calyces

cystine stones-only amino acid tht becomes insouble in urine - tough to manage

25
Q

kidney stone S and S

A

usually pain and bleeding
acute colic like flank pain usually seen with increasing intensity
radiation of pain down to the groin indicates that the stone has passed the lower third of the uriter
stone in the ureter witin the bladder causes frequency urgency and dysuria

26
Q

kidney stone labs,

A

crystas in urine,
ct should be performed
ab x-ray my be diagnostic as most stones are radiopaque

27
Q

Kidney stone management

A

morpehne, toradol and reglan,
obstructing outflow, or infection removal is indicated
larger fragments can be dc’d by cystoscopy

28
Q

BPH definition

A

progressive, condition characterized by enlargment of the prostate gland, in me greater than 50

29
Q

BPH urinary flow

A

starting and stopping

30
Q

PSA values- over 4ng/ml, abnormal age specific ranges,

A

almost 40% of patients with prostate ca have a normal psa

40-49 less than 2.5
50-9 less than 3.5
60 to 69 less than 4.5
70 to 79 less than 6.5

31
Q

BPH and alpha blockers

A

terazocin (hytrin) prazocin (minipress), tamsulsin (flomax) to relax bladder muscles.
alpha reductase inhibitors- finasteride (proscar) avodart to shrink the prostate

surgery if symptoms persit (turp)

32
Q

BPH avoid

A

benedryl, sudafed afrin and SSRI’s diuretics and narcotic pain relivers

33
Q

cockroft-gault equation:

A

creatine clearance ml/min

140 minus years in age x body weight in KG
divided by
72x serum creat in mg/dl

in females multiply the result by .85

34
Q

normal creatinine clearence in adults Gero

A

males les than 40 107-139 ml/min or 1.8-2.3 ml per sec

females less than 40 87-107 ml/min or 1.5 to 1.8 ml per sec

issues and policy (22 decks)

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