VUR & UTIs

Question 1

What is Vesicoureteral Reflux ?

Answer 1

abnormal retrograde flow of bladder urine into the ureters
- primary or secondary

Question 2

What are some clinical manifestations or diagnosis of VUR ?

Answer 2

• many cases are asymptomatic
• UTIs (infant crying when peeing, urine dark, with pus or rotten smell, with children incontinence)
• Voiding cystourethrogram (VCUG)
• abdominal ultrasounds

Question 3

What are some medical management of VUR ?

Answer 3

• long term low dose antibiotic prophylactually to prevent UTIs
• annual VCUG to assess the status of reflux
• inter catheterization to keep the bladder empty
• most will outgrow it as the ureters elongate with age and function of valve improves
• if severe enough the possible surgery to correct ureters and prevent reflux

Question 4

What is some Post-Op RN interventions of VUR ?

Answer 4

• pain control (analgestics and muscle relaxants)
• foley
• possible stents and drains
• incision care/ dressing changes
• normal to have small amount of blood in urine and drainage (clots or dark red urine must report)

Question 5

What is the most common pathogen that causes a UTI ?

Answer 5

E. Coli
- lives in our gut and could get into perineal area

Question 6

What is urethritis ?

Answer 6

inflammation of urethra

Question 7

What is cystitis ?

Answer 7

inflammation of the bladder wall, and urinary system

Question 8

What is pyelonephritis ?

Answer 8

inflammation usually due to infection to the renal parenchyma and collecting system
- renal infections can cause back pain

Question 9

What is Urosepsis ?

Answer 9

a UTI that has spread into the systemic circulation
- life threatening emergency

Question 10

What are some possible causes of UTIs ?

Answer 10

• poor hygiene practices
• catheterization
• intrinsic obstructions (stone/tumor)
• urinary impairment (Neurogenic bladder)
• renal impairment
• menopause in women can be a factor due to the changes in vaginal pH

Question 11

What are some S&S of cystitis ?

Answer 11

• frequency, urgency
• suprapubic pain
• dysuria
• hematuria
• fever
• confusion in older adults

Question 12

What are some S&S of pyelonephritis ?

Answer 12

• flank pain
• dysuria
• pain at costovertebral angle
• same S&S as cystitis

Question 13

What are some diagnostic tests for UTIs ?

Answer 13

• urinalysis: looking for WBCs, nitrates (indicates bacteriuria)
• urine culture: (clean catch) to determine specific bacteria and target antibiotic tx

Question 14

What is acute pyelonephritis ?

Answer 14

inflammation of the renal parenchyma and collecting system

Question 15

What is chronic pyelonephritis ?

Answer 15

kidneys have become small, atrophied, and lost function due to scarring or fibrotic
- pre-existing conditions cause: VUR issues with chronic UTIs

Question 16

What is Phenazopyridine (Pyridium) ?

Answer 16

urinary analgesic
- muscle relaxer that helps with bladder spasms and pain
- used in combo with antibiotics
- provides soothing effect on urinary tract mucosa
- only works on urinary tract
- changes urine to reddish-orange (can be mistaken for blood and can stain underclothing)

Question 17

What is a Foley Catheter ?

Answer 17

indwelling
- inserted through the urethra and drains urine from the bladder

Question 18

What is a Suprapubic catheter ?

Answer 18

surgically placed puncture to the pubic area
- drains urine from the bladder

Question 19

What are Nephrostomy tubes ?

Answer 19

drain urine directly from the kidneys
- placed surgically
- good for pt’s with kidneys infections because the infection can cause the kidneys and ureters to be so inflamed that urine won’t come out

Question 20

What are some causes of urinary incontinence ?

Answer 20

confusion, depression, infection, atrophic vaginitis, urinary retention, restricted mobility, fecal impaction, or drugs
- incontinence has high prevalence in older women and men but it’s not a natural consequence to aging