UTIs,Overactive bladder, & incontinence Flashcards by Jacob Lucas

Most common sites for UTI

Lower urinary tract & bladder

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Are UTIs more common in women or men

More common IN WOMEN

(short urethra, incomplete emptying, irritation)

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what is a sign in the urine that could be concern for microorganism growth

Protein

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what is the most common bacteria in UTIs

E.coli

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Etiology of Lower UTI

bacteriuria

urethritis

cystitis

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bacteriuria =

bacteria in the urine NOT causing infection

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Urethritis =

infection in the urethra

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cystitis =

infection in the bladder

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S/S of UTI uncomplicated

Asymptomatic
urgency
frequency
dysuria
hematuria
cloudy/foul urine
fever/chills/fatigue

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diagnosis of UTI

H&P,
UA,
URINE CULTURE,
CBC

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Treatment of UTI

ANTIBIOTICS,
↑fluids,
avoid irritants,
loose cotton clothes, frequent urination, probiotics

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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

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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

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LOWER UTI: Clinical Manifestations

Urethritis:
Dysuria = difficulty/painful urination
Most common = ASYMPTOMATIC

Cystitis:
frequency
urgency
suprapubic discomfort
dysuria

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Atypical UTI manifestations:Children

Fever
Irritability
Poor feeding
Vomiting
Diarrhea
Ill appearance
Old enough to verbalize?

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Atypical UTI manifestations: Elderly

Anxiety
Confusion
Lethargy
Anorexia
History of falling!

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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