UTI and Pyelonephritis

Question 1

What do the kidneys do?

Answer 1

-filters waste products from the blood -maintains fluid, electrolyte and acid/base balance -excretes metabolic waste products -BP -erythropoiesis -bone mineral density

Question 2

What does the lower urinary tract do?

Answer 2

stores urine and empties the bladder

Question 3

Bacteria that causes UTI

Answer 3

gram negative: -escherichia coli or species of Klebsiella -Staphylococcus -Proteus, Pseudomonas, or Enterobacter

Question 4

Infections of lower UTI?

Answer 4

-Cystitis (inflammation of bladder) -Prostatitis (infection of prostate) -Urethritis (infection of urethra)

Question 5

Infections of upper UTI?

Answer 5

-Acute pyelonephritis (infection of kidneys; UTI makes its way up to kidneys) -Chronic pyelonephritis -Renal abscess -Interstitial nephritis -Perirenal abscess

Question 6

Uncomplicated UTI?

Answer 6

-normal UTI -acquired in community -more common in women (urethra is shorter)

Question 7

Complicated UTI?

Answer 7

-acquired in hospital (nosocomial) -some kind of urological abnormality/something else in urinary tract going on -pregnancy with UTI = complicated -diabetic causes complications cause there is sugar in the urine and bacteria likes sugar -recurrent UTI (3-4/year)

Question 8

Pathophysiology of Infections of the Urinary tract?

Answer 8

-washout- urine cleans out urinary tract there is a lining in the urinary tract that protects it from microbes -IGA- immunoglobin which protects from microbes ureter has peristaltic waves which moves bacteria away from kidneys and out of the body normal flora -in men- fluid secreted from the prostate protects from microorganisms

Question 9

Routes of Infection?

Answer 9

-Ascending infection: related to instrumentation like catheter’s -Hematogenic: spread through blood -direct extension: infection spreads to adjacent organs

Question 10

Ascending Route of Bacterial Invasion goes where?

Answer 10

to the kidneys (urine reflux into kidneys)

Question 11

major Predisposing Factors for Infection of the Urinary Tract?

Answer 11

-age (older) -gender (women) -obstruction to flow of urine -pregnancy -narrowing of urethra -kidney stones -urinary stasis (immobile, narcotics) -immunosuppression -diabetes

Question 12

Predisposing Factors for Infection of the Urinary Tract in the Elderly?

Answer 12

1. higher incidence of chronic illness 2. presence of infected pressure ulcers 3. immobility with incomplete bladder emptying 4. use of bedpans rather than commodes 5. persistent use of antimicrobial agents

Question 13

Clinical Manifestations of Lower UTI are related to difficulty with?

Answer 13

storage of urine -difficulty storing larger amount of urine in bladder -urgency of needing to pee due to less storage space -incontinent or nocturnal incontinence or difficulty emptying bladder -burning/pain -dribbling (at end of voiding) -weak stream of urine -may not be able to void at all -hesitancy voiding -intermittent (stopping and starting while urinating)

Question 14

Clinical Manifestations of UTI?

Answer 14

-Suprapubic/Pelvic Pain -hematuria -sediments in urine -strong foul odor -fever + chills (sometimes but more common in infection of kidney)

Question 15

Clinical Manifestations of Lower UTI in the Elderly?

Answer 15

-cognitive impairment (confusion/changes in LOC) -low-grade/no fever/below normal temperature -vague pain -fatigue/malaise feeling -anorexia -new incontinence

Question 16

Diagnostic Studies?

Answer 16

-Urine analysis (WBC, nitrites, RCB) -Urine culture and sensitivity for the following: Complicated UTI Hospital-associated UTI Intractable UTI Recurrent UTI (more than 2-3 episodes/year) Questionable diagnosis children, pregnant women, elderly will always have c/s done for complicated UTI

Question 17

Imaging studies?

Answer 17

-Intravenous pyelogram -Abdominal CT scan looking for kidney stone if ureter is swollen

Question 18

Goals of Treatment?

Answer 18

-Symptom relief -Prevention of complications: -progression of lower UTI to upper UTI (pyelonephritis) which could result in permanent renal damage and renal failure or sepsis, resulting on death -Sepsis which originates in urinary tract=urosepsis -Patient/family education to prevent recurrences

Question 19

Collaborative Care includes Antimicrobials for complicated/uncomplicated depends on?

Answer 19

-length of treatment depends on complicated or uncomplicated UTI -bactrum, septra, nitrofluantoine (antibiotics) 3-5 days for uncomplicated or 7-10 if longer treatment is needed

Question 20

Nursing assessment of the patient with uti?

Answer 20

-Health history specific to the GU system, medication and recent surgery/diagnostic procedures -Subjective data (symptoms reported by patient)-pain/burning -Objective data fever characteristics of urine (smell) lab findings

Question 21

USCR elimination care for pt?

Answer 21

-promote normal voiding -increase fluid intake to 2-2.5 liters/day to produce urine and promote washout

Question 22

Nursing care for comfort?

Answer 22

-Comprehensive pain assessment -Analgesics/combined agents Non-pharmacological pain relieving strategies -heat therapy

Question 23

Nursing Care - Patient Education?

Answer 23

-In abnormal states of health, self-care requisites arise from both the disease state and from the measures used in its diagnosis or treatment. -Nurses must assist individuals living with health deviations with their self-care and help them to become competent in managing their own self-care.

Question 24

Pathophysiology of Infections of the Upper Urinary Tract?

Answer 24

-Usually begins with infection of the lower urinary tract. -Pre-existing factor is often present -Vesicoureteral reflux (urine goes back into the bladder) -Dysfunction of the lower urinary tract such as an obstruction

Question 25

Pathogenesis of Acute Pyelonephritis?

Answer 25

Acute Pyelonephritis-> Urosepsis->Septic shock-> Death in 15% of cases of septic shock

Question 26

Clinical Manifestations of Acute Pyelonephritis?

Answer 26

Mild fatigue/malaise Sudden onset of: -Fever -Chills -Vomiting -Flank pain/Costovertebral tenderness on the affected side -S+S of lower UTI

Question 27

Treatment of Acute Pyelonephritis-Mild symptoms?

Answer 27

-Ambulatory care with antibiotics (short-term admission for IV antibiotics possible) for 14-21 days -Fluids -NSAIDs or antipyretics -Urinary analgesics -Follow-up culture after treatment

Question 28

Treatment of Acute Pyelonephritis-Severe symptoms?

Answer 28

-In-patient treatment with IV antibiotics. -IV fluids until PO intake tolerated -NSAIDs or antipyretics -Urinary analgesics -Follow-up culture after treatment

Question 29

Infection of the Upper Urinary Tract - Pyelonephritis?

Answer 29