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326 Acute & Chronic Exam 1 > UTI > Flashcards

UTI Flashcards

1
Q

List the 4 types of UTIs.

A
  1. Pyelonephritis
  2. Cystitis
  3. Urethritis
  4. Urosepsis
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2
Q

Where is a pyelonephritis infection located?

A

Infection of the kidney or renal pelvis

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3
Q

Where is a cystitis infection located?

A

Infection of the bladder

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4
Q

Where is a urethritis infection located?

A

Infection of the urethra

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5
Q

What is a urosepsis infection?

A

a UTI that has spread systemically and can be life threatening

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6
Q

List the 4 ways that bacteria can enter the urinary tract.

A
  1. Ascending Infection
  2. Hematogenous Spread
  3. Lymphatogenous Spread
  4. Direct Extension
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7
Q

What causes an ascending infection?

A
  • Infection acquired through the urethra is the most common cause of UTI in men and women.
  • Short urethra and rectal bacteria increases risk in women.
  • Sexual intercourse shown to be a major precipitating factor of UTI.
  • Urologic Instrumentation
  • Catheterization
  • Cystoscopic examination
  • Allows bacteria that are normally present at the opening of the urethra to enter into the urethra or bladder
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8
Q

What causes hematogenous infections?

A
  • Blood-borne bacteria secondarily invade the kidneys, ureters, or bladder from elsewhere in the body.
  • There must be a prior injury to the urinary tract, such as obstruction of the ureter, damage caused by stones, or renal scars, for a kidney infection to occur via this route.
  • Occurs infrequently, but can also occur with:
    ~ Tuberculosis
    ~ Renal abscesses
    ~ Perinephric abscesses.
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9
Q

What causes lymphatogenous infections?

A
  • Rare
  • Bacteria travel thru rectal & colonic lymphatics to:
    ~ Prostate and bladder in males and
    ~ Thru periuterine lymphatics to the female genitourinary tract.
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10
Q

What causes direct extension infections?

A
  • From another organ
  • Occurs with:
    ~ Intraperitoneal abscesses, especially those associated with inflammatory bowel disease,
    ~ Pelvic inflammatory disease
    ~ Paravesical abscesses
    ~ Genitourinary tract fistulas.
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11
Q

Describe clinical manifestations of lower UTIs.

A
  • Frequency (more than q 2 hours)
  • Urgency
  • Dysuria (burning on urination)
  • Cloudy or foul-smelling urine
  • Suprapubic discomfort or pressure
  • Hematuria (red blood cells in the urine)
  • Pyuria (white blood cells in the urine)
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12
Q

Describe clinical manifestations of upper UTIs.

A
  • Fever
  • Flank pain
  • Costovertebral angle tenderness
  • Nausea
  • Vomiting
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13
Q

Describe clinical manifestations of clients who are asymptomatic or have minimal symptoms.

A
  • Fatigue
  • Anorexia
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14
Q

Describe clinical manifestations of UTIs in older adults.

A
  • Older adults tend to experience non-localized abdominal discomfort rather than dysuria and suprapubic pain.
  • They may also have cognitive impairment
  • Less likely to experience a fever so this is not a good indicator for older adults.
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15
Q

What are the two ways to get a urine culture? Which one is most accurate?

A
  • Clean-catch urine specimen
  • Specimen via catheterization (most accurate)
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16
Q

How do you obtain a clean-catch urine specimen?

A

Clean the area and then collect the urine

17
Q

When should you obtain urine cultures? Why is the timing of this important?

A
  • It is crucial that urine cultures are obtained prior to antibiotic therapy to:
    ~ Confirm the organism’s sensitivity
    ~ To decrease the development of resistant organisms.
18
Q

Describe the process of urine culture.

A
  • 24-48 hours are usually required to determine the results.
  • A broad-spectrum antibiotic may be prescribed until results are obtained
19
Q

What lab values determine a positive urine culture?

A
  • Growth of a single pathogen in excess of 100,000 colony-forming units (CFU)/ml of urine in a clean catch or catheterized specimen is considered clinically significant.
  • Growth as low as 100 or 1000 CFU/ml with clinical manifestations of an UTI.
20
Q

List 3 non-pharmacologic treatment options.

A
  • Increase fluid intake
  • Sitz baths
  • Cranberry juice
21
Q

Describe what increasing fluid intake does for managing UTIs.

A
  • Increase fluid intake. It is recommended that fluid intake is half a person’s weight.
    ~ Dilutes urine
    ~ Lessens irritation and burning
    ~ Provides a continual flow of urine to minimize stasis and multiplication of bacteria in the urinary tract.
22
Q

What are sitz baths used for?

A

Sitz baths may provide comfort for the individual with urethritis.

23
Q

How would you explain a sitz bath to a patient?

A

They will sit in 2-3 inches of warm water. The water just needs to be in contact with the urethra. It’s not going to get rid of the infection, but it is warm and soothing to help with the discomfort. (They’re not in a tub full of water)

24
Q

Describe how cranberry juice can be used to manage UTIs.

A
  • Cranberry juice also has been shown to have positive effects on UTIs.
  • Make sure the cranberry juice is 100% juice.
  • Quality cranberry juice produces hippuric acid in the urine which acidifies the urine and prevents bacteria from sticking to the walls of the bladder.
    ~ Drink 2-3 glasses daily
25
Q

List 3 pharmacologic therapies for UTIs.

A
  1. Trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim, Septra)
  2. Nitrofurantoin (Macrodantin)
  3. Phenazopyridine (Pyridium)
26
Q

Describe Trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim, Septra).

A
  • Relatively inexpensive
  • Taken BID (2x/day)
  • E-Coli tends to be resistant to this drug.
27
Q

Describe Nitrofurantoin (Macrodantin).

A
  • 3-4x/day (what is the challenge in a patient taking a med 3-4x/day versus 2x/day)
  • Avoid/limit sunlight/photosensitivity
  • Avoid if the patient’s creatinine clearance is less than 30ml/min
  • Take with meals to avoid GI side effects (nausea/vomiting)
  • Do not take if patient has liver disease- it is hepatotoxic (can cause a hepatitis-like syndrome)
    ~ monitor AST & ALT
28
Q

Describe Phenazopyridine (Pyridium).

A
  • Urinary analgesic that will act relieve the discomfort from dysuria
  • May cause the urine to turn orange or red.
    ~ tell patients this beforehand so they aren’t alarmed
  • Usually obtain pain relief in about 2 days.
    ~ explain that they may get relief, but they need to continue to take antibiotics until they are gone

326 Acute & Chronic Exam 1 (7 decks)

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