UTIs,Overactive bladder, & incontinence Flashcards
Most common sites for UTI
Lower urinary tract & bladder
Are UTIs more common in women or men
More common IN WOMEN
(short urethra, incomplete emptying, irritation)
what is a sign in the urine that could be concern for microorganism growth
Protein
what is the most common bacteria in UTIs
E.coli
Etiology of Lower UTI
bacteriuria
urethritis
cystitis
bacteriuria =
bacteria in the urine NOT causing infection
Urethritis =
infection in the urethra
cystitis =
infection in the bladder
S/S of UTI uncomplicated
Asymptomatic
urgency
frequency
dysuria
hematuria
cloudy/foul urine
fever/chills/fatigue
diagnosis of UTI
H&P,
UA,
URINE CULTURE,
CBC
Treatment of UTI
ANTIBIOTICS,
↑fluids,
avoid irritants,
loose cotton clothes, frequent urination, probiotics
UTI: Protective Factors
pH = acidic
Presence of urea
Sex-specific factors:
Men = prostatic secretions
Women = urethral gland secretions
Urine flow is unidirectional
One-way valve at ureteral attachment to bladder
Immune system
UTI: Risk Factors
Catheterization: “CAUTIs”= catheter associated urinary tract infection
Sex = females higher risk
Perineal irritation
Age = increases
Nursing home up to 50% have bacteriuria
Pregnancy
Sexual activity
Spermicide use with diaphragm or condom
¼ sexually active women – 1/year
Urinary obstruction or reflux
Immobility
Incontinence
Urine or stool
Decreased cognition
Bad personal hygiene
Men – more likely to have recurrent UTI’s because bacteria can hide deep in the prostate and because of BPH causing urinary retention
LOWER UTI: Clinical Manifestations
Urethritis:
Dysuria = difficulty/painful urination
Most common = ASYMPTOMATIC
Cystitis:
frequency
urgency
suprapubic discomfort
dysuria
Atypical UTI manifestations:Children
Fever
Irritability
Poor feeding
Vomiting
Diarrhea
Ill appearance
Old enough to verbalize?
Atypical UTI manifestations: Elderly
Anxiety
Confusion
Lethargy
Anorexia
History of falling!
most common antibiotics used for lower UTIs
Trimethoprim-sulfamethoxazole (Bactrim)
First-line
Don’t give with sulfa allergies
Ciprofloxacin (For sulfa allergies)
Nitrofurantoin
(Macrodanti/Macrobid)
For recurring lower UTIs
Urinary tract analgesic med
phenazopyridine (Pyridium)
Therapeutic use for phenazopyridine
relief of pain due to UTI
MOA for phenazopyridine (Pyridium)
dye used in paint, local analgesic action
Side/Adverse Effects of phenazopyridine
Well tolerated
REDDISH-ORANGE URINE
causes of overactive bladder
Neurological disorders
Diabetes
UTI’s
Hormonal changes
Tumors/stones
Obstructions
what is overactive bladder
Sudden urge to urinate
May experience urgency incontinence
Increased frequency
Usually 8 or more times in 24 hrs
What is nocturia
Wake up more than 2 times during the night
mirabegron(Myrbetriq) class
Antispasmotic (urinary)
MOA of mirabegron(Myrbetriq)
selectively stimulates beta-3 adrenergic receptors, relaxing bladder smooth muscle
Adverse reactions of mirabegron(Myrbetriq)
HTN*
Urinary retention
UTI
Headache
incontinence types
urgency
stress
OTHERs
what is urgency incontinence
Involves the involuntary leakage of urine immediately after a sudden sensation to urinate.
causes of urgency incontinence
Overactive detrusor muscle that suddenly contracts
Increases with age
Bladder infection that irritate bladder lining
Bladder outlet obstruction (enlarged prostate)
CNS conditions
Drugs
what is stress incontinence
Occurs when urine is involuntarily lost with increases in intraabdominal pressure
Precipitated by effort or exertion
causes of stress incontinence
Loss of pelvic muscle and/or
Loss of fascial support of bladder and urethra
risk factors of stress incontinence
Age
Obesity
Childbirth-related trauma
Pelvic surgery
other types of incontinence
Mixed is a combination of urge and stress
Overflow is when bladder is too full
Functional is related to physical & environmental limitations and an inability to get to toilet in time
Transient is sudden onset that is reversible
What are some problems with incontinence
Incontinence can cause inflammation of the skin
Redness, pain, and itching
Swelling, blisters, dryness
Damaged skin now vulnerable to infection
Damp, warm skin is breeding ground for bacteria and fungi
Areas at risk
Genitals
Between buttocks
Inner thighs
class of Oxybutynin (Oxytrol)
anti-cholinergic
MOA of oxybutynin
block the action of acetylcholine
Acetylcholine activates smooth muscle contractions
Indications of oxybutynin
overactive bladder, incontinence
adverse effects of oxybutynin
dry mouth,
constipation
T/F oxybutynin can be in extended release forms
TRUE
