PBL questions 2 Flashcards
(46 cards)
causes of UTI
bacteria from stool entering urinary tract via urethra
pregnancy
blockage of the urinary tract - kidney stones
difficulty emptying bladder -enlarged prostate and constipation
urinary catheters
weakened immune system - diabetes, chemo, HIV
contraceptive diaphragm or condom coated in spermicide
symptoms of UTI - general
urinary frequency sudden urge to urinate dysuria pain/ burning on micturition smelly urine cloudy urine pain in lower abdomen malaise feeling unwell loin pain and fever - upper UTIs
symptoms of UTI in elderly
changes in behaviour
confusion
agitation
symptoms of UTI in children
appear generally unwell irritable not feeding properly pyrexic wetting the bed/ themselves deliberately retaining urine due to pain
diagnosis of UTIs
urinalysis - WBCs, RBCs, bacteria (nitrates), proteins, pH, glucose, bilirubin
urine culture
CT or MRI if frequent UTIs
cystoscopy if recurrent UTIs
treatment for UTIs
short course of antibiotics
different for different populations
plenty of fluids
pain relief - paracetamol
most commonly used antibiotic for an uncomplicated UTI
trimethoprim
nitrofurantoin
how do UTIs affect brain function in an acute setting?
elderly patients with serious infection can sometimes not exhibit characteristic signs such as fever due to the inability of the immune system to mount a response.
the bacteria in urine spread into blood stream
they can cross the BBB
causes confusion and cognitive difficulties - agitation and withdrawal
in people with a memory impairment or dementia a UTI can cause sudden and severe confusion - worsening their symptoms
what are the types of bladder incontinence?
stress
urge
overflow
total
stress incontinence
when urine leaks out at times when the bladder is under pressure - coughing/ laughing
urge incontinence
when urine leaks as you feel a sudden, intense urge to urinate or soon after
overflow incontinence
unable to fully empty the bladder, causing frequent leaking
total incontinence
when the bladder cannot store any urine at all, causing urine to be passed constantly and frequent leaking
causes of bladder incontinence
weakened or damaged pelvic floor muscles
weakened or damaged urethral sphincter muscles
overactivity of detrusor muscles
obstruction or blockage in bladder
spinal injury
fistula
what increases risk of bladder incontinence?
pregnancy vaginal birth obesity family history of incontinence increasing age
how is bladder incontinence diagnosed?
history taking bladder diary - physical examination dipstick test residual urine test - ultrasound scan cystoscopy urodynamic tests
what physical examinations are done in diagnosis of bladder incontinence
pelvic
vaginal
prostate
digital rectal
what is involved in a bladder diary?
3 days fluid intake type of fluids taken frequency of urination volume of urine how many episodes of incontinence number of times you experience urge
what is involved in urodynamic tests?
check function
measure pressure using a catheter
treatment for bladder incontinence
lifestyle changes pelvic floor exercises bladder training NHS continence services incontinence products Duloxetine antimuscarinics surgery urethral bulking agents artificial urinary sphincter botox injections sacral nerve stimulation posterior tibial nerve stimulation urinary diversion catheterisation augmentation cystoplasty
anticholinergic medications
class of drugs that block acetylcholine in CNS and PNS. Treat conditions associated with activation of the parasympathetic nervous system
side effects of anticholinergic medications
dry mouth blurred vision dry eyes constipation urinary retention dizziness due to drop in BP - postural hypotension cognitive problems - confusion heart rhythm disturbance these are common especially in the elderly
urinary retention
the inability to completely or partially empty the bladder
unable to start urination or fully empty the bladder
there are 2 types
what are the types of urinary retention?
obstructive
non-obstructive
