Test #4 Chapter 69 Infectious Disorders Flashcards Preview

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Flashcards in Test #4 Chapter 69 Infectious Disorders Deck (56):
1

UTI’s- Things that contribute to UTI- At risk=

(Could be Multiple)

Females,

men 50 or older because of enlarged prostate (allows urine to sit in bladder to long)

UTI can lead to polynephritis (Kidney Infections),

elderly get more confused and is less painful,

younger people have more pain.

When a patient has a foley catheter, do foley care, make sure not kinked, bag below the bladder, get it out ASAP on med-surge floor,

monitor I&O’s.

If their catheter is not kinked and urine output is decreased, assess first, palpate, flush, must chart what you flushed it with and how much, if not working still must replace the foley.

It can get nasty crusty on the end if in longer than a week.

2

Cystitis

Inflammation of the bladder R/T irritation or infection from bacteria, viruses, fungi or parasites

3

What is the Etiology of Cystitis?

90% is related to E-coli because easy for that bacteria to migrate into the bladder.

Catheters are a big risk factor for UTI especially longer than a week.

Interventions. Remove asap, cath care, fluid intake,

4

*** Who is at greatest risk for fungal bladder infections?

mmuno-compromised (HIV, Cancer) , people that are on antibiotics for a long time

5

**S&S of a UTI:

frequency, urgency, dysuria (painful urination), lower back pain or lower abdomen area. These are classic symptoms.

****What makes it a complicated UTI is that they start having fever, chills, or flank pain. CVA tenderness.

6

***Gender/Age Considerations for UTI -

Could be Multiple

Females are at greater risk for UTI because shorter urethra,

older women have low estrogen which allows bacteria to adhere easier,

elderly are dehydrated.

Men at risk because of prostate.

If they are on steroids, it puts them at risk for UTI.

7

If a patient has UTI and they are elderly, and they have all of the symptoms such as flank pain, confusion, weak, ect.. What can happen with them that does not usually happen with the younger age group?

hey can transfer over to uro-sepsis so it can move up the urinary tract until it is in the blood stream.

8

If a patient comes in and the family tells you that they are confused, weak, and falling what will you do about it?

suspect UTI, get culture and send to the lab.

9

UTI Prevention:

Could be Multiple

Water intake 2-3 liters a day. Estrogen creams. Good Hygiene, wipe from front to back.

10

Laboratory for UTI-

May have to explain clean catch.

Only need 10-20 cc for lab.

Urine cultures take 2-3 days to get back.

11

Diagnostic tests for UTI other than UA

The other lab values that you run are a CBC.

If there is a shift to the left that could indicate urosepsis.

Segs are mature,

Bands are immature.

You should see more mature white blood cells floating around.

Shift to the left indicates infection.

So interventions include starting a good IV, fluids, and antibiotics.

12

A client who weighs 207lbs is to receive 1.5mg/kg of gentamicin sulfate (Garamycin) IV three times a day. How many mg of medication should the nurse administer for each dose?

141mg per dose

13

An 82 year old female comes to the ER with confusion. The nurse should ask the client or her family if she has:

a) hematuria
b) urinary frequency and burning upon urination
c) nausea
d) vomiting

b) urinary frequency and burning upon urination

14

NonSurgical Interventions

Nutrition- water 2-3 liters a day, avoid caffeine alcohol and carbonated beverages. They are hard on the bladder. Do not drink with antibiotics.

Drug Therapy:

Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)-
Nitrofurantoin (Macrobid)
Phenazopyridine (Pyridium)-
Amoxicillin (Amoxil)

15

Ciprofloxacin (Cipro)-

Medication Class Fluoroquinolones.

Kills Bateria & Inhibit Bacterial Reproduction.

No crush/chew because interferes with extended release.

Do not take within 2 hours of taking an antacid because interferes with absorption.

16

Levofloxacin (Levaquin)

-Medication Class Fluoroquinolones.

Kills Bacteria & Inhibit Bacterial Reproduction.

Teach Monitor Radial Pulse and Use sunscreen.

17

Amoxicillin (Amoxil)-

Medication Class Penicillins.

Kills Bacteria & Interrupts Bacterial Cell Wall Synthesis.

Use Another form of birth control if taking oral contraceptives.

Decreases its effectiveness of the contraception.

Take with food

18

Nitrofurantoin (Macrobid)-

Medication Class Urinary Antiseptics-

Inhibits bacterial Reproduction.

This med is hard on the kidney so Drink full glass of water with each dose.

Consume 3L of water daily,

No use during last month of pregnancy,

Take with food.

19

Phenazopyridine (Pyridium)-

Medication Class Bladder Analgesics-

Decreases bladder pain and burning by exerting a local anesthetic effect on the mucosa of the urinary tract.

Does not have any antibacterial actions.

Urine will turn red/orange.

Can cause GI problems so take with food.

20

Surgical Interventions-

Treat, Repair, Remove Obstruction. Use non surgical interventions first.

21

Urethritis-

Inflammation of the Urethra that causes symptoms similar to UTI.

22

Urethritis Etiology-

For men, related to STD.

Intervention is education and antibiotics.

Women- r/t decreased estrogen levels.

Interventions- estrogen cream.

23

Non-Infectious Disorders

Urethral Strictures-

Narrowing of the urethra.

24

Urethral Strictures Etiology-

(Could Be Multiple)

STD complications,
Trauma,
Child Birth.

This group is at risk for UTI because urine backs up from the bladder to the kidneys.

They also have overflow incontinence.

25

Treatments for Urethral Strictures-

go in for a simple procedure. Under conscious sedation, they will go in an stretch the area, open it up, maybe put a stent to allow more urine to flow.

26

Which of the following statements by the client would indicate that she is at high risk for recurrence of cystitis?

a) I can usually go 8- 10 hours without needing to empty my bladder.

b) I take a shower once a day and use mild soap.

c) I wipe from front to back after voiding.

d) I drink a lot of water during the day.

a) I can usually go 8- 10 hours without needing to empty my bladder.

27

A patient has been prescribed Macrodantin for treatment of a UTI. Which of the following instructions should the nurse include when teaching the patient how to take the medication? Select all that apply.

a) Take this medication on an empty stomach.

b) Increase your fluid intake to 3L daily.

c) Take this medication until your symptoms subside.

d) Take this medication with an antacid to decrease
gastrointestinal distress.

e) Drink a full glass of water with each dose.

b) Increase your fluid intake to 3L daily.

e) Drink a full glass of water with each dose.

28

Urinary Incontinence -

Involuntary loss of urine severe enough to cause social or hygienic problems and embarrassment.

It can be temporary like caused by child birth (stress incontinence)

or chronic like if someone had a stroke or spinal cord injury.

29

Education for Incontinence-

Could be Multiple

Fluid Intake- continue with the 2-3 liters a day. The worst thing that they can do is stop drinking.

Alcohol/Caffeine- Avoid because it is a bladder stimulant.


Obesity- will increase the intra-abdominal pressure which will make the incontinence worse. So need to loose weight.

30

Types of Urinary Incontinence

Stress Incontinence-

Urge Incontinence/Overactive Bladder-

Functional Urinary Incontinence

31

Stress Incontinence-

Most Common- might lose a little bit of urine when coughing or jogging.

Etiology- Difficult vaginal birth.

Loss of small amounts of urine


***NI: Nutrition- no caffeine, no alcohol. 2-3 liters of fluids, no SMOKING (irritates the bladder especially in this group), Kegal exercises

32

Urge Incontinence/Overactive Bladder-

Urgent need to urinate

NI: no caffeine, no alcohol. 2-3 liters of fluids, Slacks with elastic bands.

Meds, teach them not to drink all of their fluid before bed. Need to spread the 2-3 liters throughout the day.

They need to have pants that are easy to pull down.

Medications: Ditropan, Detrol & Pro-Banthine

33

Oxybutynin (Ditropan)-

Medication Class Anticholinergics,

Causes Bladder Muscle Relaxation and Suppresses the Urge to Void.

Monitor if patient has Glaucoma.

Increase patients fluid intake.

34

Propantheline (Pro-Banthine)-

Medication Class Anticholinergics,

Causes Bladder Muscle Relaxation and Suppresses the Urge to Void.

Monitor I&O.

35

Tolterodine (Detrol)-

Medication Class Anticholinergics-

Causes Bladder Muscle Relaxation and Suppresses the Urge to Void.

Increase fluid and fiber intake.

Causes constipation.

36

Functional Urinary Incontinence-

Loss of cognitive function- Dementia patients, stroke patients ect

NI: Slacks with elastic bands if in nursing home. ,

Nutrition- no caffeine, no alcohol. 2-3 liters of fluids, (water)

***If they are in the hospital make sure their call light is in reach.

Habit training helps with this group.

37

Bladder Training-

for alert and oriented patients only.

Cannot use on a patient has dementia.

Like potty training a child.

Hold for 30 min to a hour then go.

Increase each day until appropriate time frame.

Nutrition- no caffeine, no alcohol. 2-3 liters of fluids, (water)

38

Habit Training-

much harder because they are cognitively impaired.

This is kind of like scheduled toileting where you take them at scheduled intervals to keep them from going on themselves.

This is to avoid skin breakdown.

39

If a person has urinary incontinence, aside from interventions and education, what are you going to run to check for infection?

UA

40

Diagnostic tests for incontinence-

go look into the ureter and bladder to see if obstruction or stricture.

It can determine how much urine can hold.

x-rays ect.

41

The nurse finds a container with the client’s urine specimen sitting on the counter in the bathroom. The client states that the specimen has been sitting in the bathroom for at least 2 hours. The nurse should:

a) Discard the urine and obtain a new specimen.

b) Send the urine to the laboratory as quickly as possible.

c) Add fresh urine to the collected specimen and send to the laboratory.

d) Refrigerate the specimen until it can be transported to the laboratory.

a) Discard the urine and obtain a new specimen.


Rationale. Once it has sat for more than an hour, it has to be thrown out.

42

Urolithiasis

Presence of calculi (stones) in the urinary tract. Very Painful

43

Urolithiasis Etiology

Could be multiple

1. Slow urine flow

2. Damage to lining of urinary tract

3. Decreased inhibitor substance

In order for a form to form, they must have these three things present.

They can vary in size.

Usually 3mm or less can pass on their own.

Greater than that are harder to pass.

44

Urolithiasis
Prevention-

3-4 liters of water a day.

Walk Daily- helps promote things to move.

45

Urolithiasis
S&S:

could be multiple

Excruciating pain (Flank pain),

Hematuria,

Hydronephrosis (if there is a blockage somewhere, the urine will just backflow into the kidney),

Oliguria and Anuria.

46

Urolithiasis Interventions
Non-Surgical -

most people will be in this group.

Once the stones are greater than 3mm it would start to be a problem.

Always give them a urine strainer.

Give them pain management.

Can do shock wave treatement to break up the stones.

Can give them ice packs.

47

Urolithiasis Interventions
Surgical -

need an x-ray to confirm . Usually 3mm or bigger.

Can put stents in so that the stone can get through.

Do not cut them open. They sedate them. Usually just go and grab it.

****If they do get cut open, normal post-op includes- respiratory, SCD’s, Getting them up ASAP. Ect. Monitor bleeding, infection, and PNEUMOTHORAX.

48

Urolithiasis: Prevention

Nutrition: 3-4L of water/daily

Walk Daily- helps promote things to move.

49

Urolithiasis Medication:

Hydrochlorothiazide (HydroDIURIL) Hypercalciuria-


Chlorothiazide (Diuril)


Allopurinol (Zyloprim) Hyperoxaluria-


Acetohydroxamic Acid (Lithostat)-

50

Hydrochlorothiazide (HydroDIURIL) Hypercalciuria-

Medication Class
Thiazide Diuretics.

Promotes Calcium Resorption from the Kidney Tubules (used for increased calcium) .

Dizziness Orthostatic Hypotension.

Pulls off fluid so need to dangle them, make sure they are getting enough fluids.

51

Chlorothiazide (Diuril)-

Medication Class Thiazide Diuretics.

Promotes Calcium Resorption from the Kidney Tubules.

Dizziness Orthostatic Hypotension.

Pulls off fluid so need to dangle them, make sure they are getting enough fluids.

52

Allopurinol (Zyloprim) Hyperoxaluria-

Medication Class Xanthine Oxidase Inhibitors.

Reduces the Production of Uric Acid in the Body.

Take with food. Can cause Drowsiness.

Give if uric acid problems.

53

Acetohydroxamic Acid (Lithostat)-

Medication Class Urease Inhibitor.

Prevents bacteria from increasing ammonia levels in urine.

Take on empty stomach.

Avoid Alcohol.

Monitor Kidney Function (creatinine) After 2 they will stop this med. .

(Used for Struvite stones)

Long term monitoring for urine infections.

54

Urothelial Cancer

Malignant tumors of the urothelium.

R/T smoking, chemical exposures, diet

Diagnosing- CT- Biopsy

55

Urothelial Cancer Non-Surgical Interventions

Intravesical Chemo, Radium Implant into the bladder that is peed out.

So Interventions include teach to use a separate bathroom at home.

They need to be in a private room in the hospital.

***Cannot be used if cancer has metastisized.

56

Urothelial Cancer Surgical Interventions

Cystectomy- Bladder removal.

Post-op - pt will have illoconduit. Monitor stoma. Pink beefy red, not blue or crusty.