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Fundamentals of Nursing > infectious and inflammatory disorder of urinary tract > Flashcards

infectious and inflammatory disorder of urinary tract Flashcards

1
Q

UTIs

A

most common infection and second most common bacterial disease in women

Causes

  • E.coli = most common (proximity to anus)
  • Candida albicans = second most common –> indwelling catheter or asymptomatic colonization (also in obese)
  • fungal and parasitic = uncommon
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2
Q

classification of UTI

A

Location upper = renal parenchyma, pelvis, ureters (pyeloephritis)
Location lower = bladder (cystitis) and urethra (urethritis)

Systemic spread = urosepsis (life threatening)
Uncomplicated = bladder only
Complicated = occur w/ struc or func prob in whole urinary tract

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3
Q

Sterility of urinary tract

Defense mechanisms

A

Usually sterile above urethra

Defense

  • complete emptying with void
  • ureterovesical junction competence
  • ureteral peristalsis propels urine to bladder
  • acidic pH (under 6)
  • high urea
  • glycoproteins (inhibit bacterial growth)
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4
Q

Risk factors for UTI

A 
obstruction
retention
renal impairments
foreign bodies
anatomic factors
comprised immune response
functional disorders
other
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5
Q

Entrance of pathogens to form UTIs

A

Microbes from perineum ascend urethra

  • GI tract: G- bacteria
  • contributing factors = urologic instrumentation and sexual intercourse

Hematogenous transmission

HAI –> MOST COMMON ONE

  • catheter –> E.coli or pseudomonas
  • increased risk with longer stay
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6
Q

Lower urinary tract symptoms (LUTS)

A

Emptying
-hesitancy, intermittency, post-void dribble, urinary retention/ incomplete emptying, dysuria

Storage
-urinary frequency, urgencym incontinence, nocturia, nocturnal enuresis

Hematuria and/or cloudy

LUTS isn’t same as UTI

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7
Q

Upper urinary tract symptoms

A

flank pain, chills, fever

Other: fatigue, anorexia, or asymptomatic

Older adults (no classical manifestations)
-nonlocalized abdominal discomfort, cognitive impairments, or generalized deterioration; often afebrile

Asymptomatic bacteria - colonization of bacteria in bladder; screen and treat with pregnancy

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8
Q

Diagnostic studies for UTIs

A

Initial: dipstick for nitrates, WBCs, and leukocyte esterase

Urine culture/sensitivity

History: 
-recurring UTIs (more than 2-3/ yr)
-comlicated UTIs
-CAUTIs or HAI UTIs
UTI unreponsive to empiric therapy

Imaging: ultrasound or CT scan

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9
Q

UTI interprofessional care:
management (uncomplicated)
Reccurent UTI

A

Management

  • patient teaching: have whole prescription
  • adequate fluids
  • drug therapy: phenazopyridine and antibiotics (empiric) for 3 days

Recurrent

  • as above plus susceptibility testing and possibly suppressive or prophylactic antibiotics
  • antibiotics for 7-14+ days
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10
Q

UTI intraprofessional care
drug therapy

DON’T NECESSARILY NEED TO KNOW

A

Uncomplicated or initial UTIs

  • trimethoprim/sulfamethoxazole (TMP-SMX)
  • Nitrofurantoin Cephalexin
  • Fosfomycin
  • Others: ampicillin, amoxicillin, or cephalosporins

Complicated: fluoroquinolones

Fungal: fluconazole

Urinary analgesic: phenazopyridine (azo dye)

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11
Q

Prevention of CAUTI

A 
Avoid unncessary catheterizations
remove indwelling catheter early
aseptic technique
hand hygiene
gloves for catheter care

Evidence based clinical tool from ANA

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12
Q

Acute Pyelonephritis etiology and pathophysiology

A

inflammation of renal parenchyma and collecting system

  • common: bacteria (E.coli, proteus, klebisella, or enterobacter from intestinal tract)
  • other: fungi, protozoa, or viruses

Urosepsis - systemic infection from urologic source

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13
Q

Pyelonephritis: where and how it starts NOPE

A

Where

  • initial colonization and infection of lower urinary tract from urethra
  • starts in renal medulla, spreads to cortex

How

  • preexisting factors: vesicoureteral reflux or dysfunction of lower urinary tract
  • CAUTI in long-term care residents
  • pregnancy-induced changes
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14
Q

Pyelonephritis manifestations NOPE

A

Classic: fever, chills, nausea, vomiting, malaise, flank pain

Other: dysuria, urgency, frequency

Costovertebral angle tenderness

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15
Q

Diagnostic studies of Pyelonephritis NOPE

A

Urinalysis: pyuria, bacteriuria, hematuria, WBC casts

Urine cultures and sensitivities

Blood cultures

decreased kidney func test

ultrasuond

CT scan –> preferred imaging study

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16
Q

Interprofessional care for pyelonephritis NOPE

A

Mild symptoms (outpatient or short inpatient)

  • fluids, NSAIDs, follow-up cultures and imaging
  • antibiotics: oral 7-14 days or IV to oral 14-21 days (Sensitivity guided)

Severe symptoms

  • IV fluids until oral tolerated
  • combination parenreral antibiotics
17
Q

Interprofessional care If pyelonephritis comes back NOPE

A

Relapse: 6 weeks antibiotics

Recurrent: prophylactic antibiotics

Urosepsis: monitor for and treat for septic shock to prevent irreversible damage or death

18
Q

Assessment of Pyelenophritis NOPE

A

same as UTI:

Subjective:
past health history
meds
surger/treatment
fuc heaalth patterns

Objective:
general
urinary
possible diagnostic findings

19
Q

Nursing diagnoses and planning goals for pyelonephritis NOPE

A

Diagnoses

  • impaired urinary system func
  • acute pain
  • lack of knowledge

Goals for patient

  • normal renal func
  • normal body temp
  • no complications
  • no pain
  • no recurrence of symptoms
20
Q

Nursing implementation for pyelonephritis NOOPE

A

Heath promotion and maintenance

  • similar to UTIs
  • Early treatment of UTIs to prevent ascending infection
  • regular medical care with strucural abnormalities

Patient teaching

  • disease process
  • take meds
  • follow-up care
  • signs and symptoms of relapse or recurrence
  • adequate fluid intake (8 glasses/day)
  • rest
21
Q

Evaluation/ expected outcomes for pyelonephritis NOPE

A

patient will

  • have normal urinary elimination patterns
  • report relief of bothersome urinary tract symptoms
  • state knowledge of treatment plan
22
Q

Chronic Pyelonephritis NOPE

A

Kidneys inflamed caue scarring leading to loss of renal func
-result from anatomic abnormalities or recurrent infections of Upper urinary tract

Diagnosis: radiolofic imaging and biopsy

Treatment: treat infection and underlying contributing factors

  • prevent progression to end-stage renal disease (ESRD)
  • treat as chronic kidney disesase (CKD)
23
Q 
Urethritis
what
dif genders
treatment
teaching
A

Inflammation of urethra due to bacterial or viral infection

  • trichomonas or moniia, chlamydia, or gonorrhea
  • males: sexually transmitted (discharge, dysuria, urgency, frequency)
  • females: diagnosis is dif. (LUTS)
  • treatment = antimicrobials and sitz baths
  • Patient teaching: no vaginal spray, perineal hygiene, no sex for a week, alert lovers
24
Q 
Urethral diverticula
what
who
why 
symptoms
A
  • Localized outpouchings of urethra from enlarged periurethral glands
  • women more than men

Urethral: trauma, instrumentation, or dilation; vaginal delivery or frequent infections

Symptoms: dysuria, post voiding dribble, frequency, urgency, suprapubic discomfors, incomplete bladder emptying, incontinence, hematuria, cloudy urine, vaginal wall mass with purulent discharge —-> or asymptomatic

25
Q

Urethral diverticula
diagnosis
treatment
complications

A

diagnosis

  • ultrasound and MRI
  • Voiding cystourethrography (VCUG)
  • Urethroscopy

Treatment (surgical)

  • transvaginal diverticulectomu
  • marsupialization (spence procedure)
  • urethroscopic surgical excision

Complications

  • incontinence
  • infection
  • bleeding
  • fistula
26
Q

Interstitial Cyctitis (IC) and Painful bladder syndrome (PBS)

A

IC = Chronic, painful, inflammatory disease of the bladder which causes PBS

  • urgency, frequency, bladder/pelvic pain
  • urinary pain not attributed to other causes
  • etiology is unknown

Possible factors:

  • neurogenic hypersensitivity
  • mast cell changes in muscle or mucosal layer
  • infection
  • toxic substance in urine
27
Q

Manifestations and Diagnostic Studies for IC and PBS

A

Primary manifestation is pain and bothersome LUTS

  • Severe: void more than 60 times/day or night
  • Pain: usually suprapubic but might involve perineal areas
  • increased pain with bladder filling, postponed urination, physical exertion, suprapubic pressure, certain foods, emotional distress
  • decreased pain with voiding temporarily
  • often misdiagnosed as chronic or recurring UTI or chronic prostatitis –> diagnosis of exclusion
  • remissions and exacerbations
28
Q

Treatment for IC and PBS NOPE

A

Nutritional and drug therapies

  • reduce intake of bladder irritants
  • calcium glycerophosphate reduces irritation

Stress management strategies

Tricyclic antidepressants, analgesics, antihistamines

Physical therapy and bladder hypodistention

Botox; cyclosporine A

Surgery (with debilitating pain)

29
Q

Nursing management of IC and PBS NOPE

A
  • Pain assessment
  • dietaty/lifestyle factors that help or hurt
  • bladder voiding log for 3 days –> pain record
  • monitor for UTI with diagnostic studies
  • monitor nutrition
  • avoid restrictive clothing
  • coping strategies/reassurance

Fundamentals of Nursing (13 decks)

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