Chapter 89: Drug Therapy for UTIs
Methenamine drug interactions
urinary alkalizer and sulfonamides
Methenamine
used for chronic lower UTIs but TMP/SMZ is preferred; generally well tolerated and relatively safe
How will severe pyelonephritis be treated?
will require hospitalization and IV antibiotics
How can we obtain the number of bacteria in the urine to see whether or not acute pyelonephritis is mild or severe?
running a urinalysis
Which complications are likely to cause UTIs in males?
septicemia and pyelonephritis
Will antibiotics be given for a shorter or a longer period of time for acute bacterial prostatitis?
longer than a UTI
Which bacteria is the main cause of UTIs?
E. coli
How will mild pyelonephritis be treated?
at home with an oral antibiotic
urinary tract infection (UTI)
2nd most common infection common in sexually active women and older adults in nursing homes.
Reinfection UTI
A new event with reintroduction of bacteria into urinary tract that usually involves the lower urinary tract and could be related to sexual intercourse
A nurse assesses the history of a patient who has had multiple complicated UTIs for which risk factors? (Select all that apply.) A. Female gender, child-bearing age B. Indwelling catheter C. Prostate hypertrophy D. Fair skin tone E. Urinary tract stones
B, C, and E Rationale: complicated UTIs occur in males and females with a predisposing factor like kidney stones, enlarging of the prostate or catheters.
Which drug does the nurse identify as a urinary tract antiseptic? A. ciprofloxacin B. ceftriaxone C. nitrofurantoin D. ceftazidime
C. Rationale: there are two urinary tract antiseptics that are available; nitrofurantoin and methenamine
Recurrent UTI
Repeated episode of bacteriuria or symptomatic UTI that can occur when someone doesn't finish their antibiotic or somehow all of the bacteria were not killed
Lower urinary tract infection
acute cystitis and acute urethral syndrome; only encompasses the bladder and the urethra (the bacteria have not gotten into the kidneys through the ureters)
Acute uncomplicated pyelonephritis
common in young children, older adults, and women of childbearing age;
Course of treatment for acute cystitis
depends on the significance of symptoms and whether or not they have recurrent UTIs (won't use single dose) single dose therapy, short course therapy (3 days), and conventional therapy (5-7 days)
Recurrent UTIs
some people are more prone for UTIs and they become used to identifying the symptoms themselves
Severe symptoms of a complicated UTI:
systemic illness manifesting as fever, bacteremia (bacteria in the blood), and septic shock
Nitrofurantoin is toxic to which organ?
the liver
3 primary drugs for treatment of UTIs
trimethoprim/sulfamethoxazole (TMP/SMZ) and nitrofurantoin (Macrobid)
Which outcomes should a nurse establish when planning care for a patient taking methenamine [Mandelamine]? (Select all that apply.) A. Maintains a urine pH of 5.5 or lower. B. Consumes 3000 mL of liquid daily. C. Uses an enteric-coated formulation. D. Avoids sulfonamide medications. E. No elevation in liver enzymes.
A, C, and D Rationale: To prevent the dose from being converted to formaldehyde in an acidic stomach, an enteric-coated formula may be used. Ingestion of large volumes of fluid dilutes methenamine and raises the urinary pH. Hepatotoxicity is not associated with methenamine [Mandelamine].
The nurse identifies which statements about frequent urinary tract reinfections as true? (Select all that apply.) A. Reinfections are considered frequent if the individual has three or more a year. B. Prophylactic therapy should continue for at least 2 months. C. If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. D. Single-dose nitrofurantoin 50 mg taken 1 hour before intercourse has been found to reduce the rate of reinfection. E. If a symptomatic episode occurs, the standard therapy for acute cystitis should be used.
A, C, and E Rationale: Prophylactic therapy should continue for at least 6 months. Single-dose trimethoprim/sulfamethoxazole, taken after intercourse, has been found to reduce the risk of reinfection. The other three statements are true.
Upper urinary tract infection
acute pyelonephritis and acute bacterial prostatitis; bacteria got into the ureter and went up into the kidneys and it is likely the infection has been around longer because it bypassed the protective mechanisms in the urinary tract
Acute bacterial prostatitis
only in men because women do not have prostates; inflammation of the prostate caused by a local bacterial infection
Methenamine contraindications
patients in renal and liver failure
A patient who has acute cystitis is receiving treatment with trimethoprim/sulfamethoxazole. Which manifestation should indicate to a nurse that the patient's condition is worsening? A. Incontinence B. Flank pain C. 3+ pedal edema D. Hyperactive bowel sounds
B. Rationale: Flank pain may indicate continued infection or pyelonephritis. When acute cystitis is treated with a traditional agent of choice, such as trimethoprim/sulfamethoxazole, manifestations of dysuria, urinary urgency and frequency, suprapubic discomfort, and bacteriuria improve.
Which pt would most likely need IV antibiotic therapy to treat a UTI? A. a pt with an uncomplicated UTI caused by E. coli B. a pt with pyelonephritis with symptoms of high fever, chills, and severe flank pain C. a pt with acute cystitis who complains of dysuria, frequency, and urgency D. a pt with acute bacterial prostatitis with mild fever, chills, and nocturia
B. Rationale: IV antibiotics for UTIs are given for severe pyelonephritis and the infection will be complicated so A is incorrect because it is uncomplicated. C are symptoms of uncomplicated UTIs.
Most cases (more than 80%) of uncomplicated, community-acquired urinary tract infection (UTI) are caused by which bacteria? A. Klebsiella pneumoniae B. Escherichia coli C. Enterobacter spp. D. Pseudomonas spp.
B. Rationale: Most cases of uncomplicated, community-acquired UTI are caused by E. coli. In rare cases, other gram-negative bacilli (eg, K. pneumoniae, Enterobacter spp., and Pseudomonas spp.) are the cause.
A patient is taking nitrofurantoin [Macrodantin]. Which finding should a nurse recognize as an indication that the treatment is having an undesired effect? A. Hyperpigmentation of the palms B. Dyspnea with chills C. Gum irritation with bleeding D. Scalp tenderness and thinning hair
B. Rationale: nitrofurantoin can cause pulmonary reactions that can manifest as dyspnea, chest pain, and chills. These symptoms can go away within 2-4 days after the drug is started
Which pt doeshte nurse identify as the most likely to need treatment with trimethoprim/sulfamethoxazole (TMP/SMZ) (Bactrim) for a period of 6 months? A. a female with acute pyelonephritis B. a male with acute prostatitis C. a female pt with recurring UTIs D. a male pt with acute cystitis
C. Rationale: treatment of acute infections are generally quicker than 6 moths but recurrent infections might need to be treated long-term
The nurse is aware that acute cystitis occurs most often in which patient population? A. Older-adult male patients B. Children younger than 12 years C. Women of child-bearing age D. Women older than 50 years
C. Rationale: Acute cystitis is a lower urinary tract infection that occurs most often in women of child bearing age
A patient is to begin taking nitrofurantoin [Macrodantin]. The nurse should teach the patient that which manifestation should be the priority to report to the healthcare provider? A. Headache and drowsiness B. Brown-colored urine C. Nausea and vomiting D. Muscle weakness and tingling
D. Rationale: adverse effects of nitrofurantoin include GI effects (upset stomach), pulmonary reactions, hematologic effects, peripheral neuropathy, hepatotoxicity, and birth defects.
With the exception of pyelonephritis, the nurse is aware that most urinary tract infections are treated by which method? A. IV antibiotics at the hospital B. IV antibiotics in the urgent care setting C. IM antibiotics at the primary physician's office D. Oral antibiotics in the home setting
D. Rationale: except for pyelonephritis, most UTIs can be treated at home with oral antibiotics
Adverse effects of nitrofurantoin
GI effects (upset stomach), pulmonary reactions, hematologic effects, peripheral neuropathy, hepatotoxicity, and birth defects
What is an infection called when it infiltrates the kidneys?
pyelonephritis
Why are UTIs less common in males?
The male urethra is shorter so the bacteria have a longer path to get from the urethra to the urinary tract. Women have shorter urethras so it is less distance for the bacteria to travel.
Uncomplicated vs. complicated UTI?
Uncomplicated: Seen in healthy, nonpregnant women Complicated: Ascending infection in women, any UTI in a male or pregnant woman, or UTI with underlying structural disease or immunosuppresion
Antiseptics used in the urinary tract to kill the bacteria
nitrofurantoin and methenamine
Symptoms of acute cystitis
dysuria (painful urination), urinary urgency and frequency, suprapubic discomfort, pyuria (pus in urine), bacteriuria (bacteria in the urine), possibly minor back pain
Complicated UTI
female and male patients with structural or functional abnormalities of the GI tract; anything that impedes the flow of urine (includes renal calculi or kidney stones, prostatic hyperplasia (enlarged prostate), renal or bladder tumors, tightening of urethra or indwelling catheters)
Symptoms of acute uncomplicated pyelonephritis
fever, chills, severe flank pain (back), dysuria, urinary urgency and frequency, pyuria, and usually bacteriuria
Symptoms of acute bacterial prostatitis
high fever, chills, malaise, myalgia, localized pain, dysuria, nocturia (urinating frequently at night), urgency and frequency, and urinary retention
Nitrofurantoin
in low concentrations it is bacteriostatic, in high concentration it's bactericidal (used for lower UTIs, prophylaxis, and recurrent lower UTIs
What is acute bacterial prostatitis usually caused by/associated with?
indwelling catheters, urethra instrumentation (putting a scope through the urethra to see the prostate), and removal of part of the prostate
Why do we check to see if the patient has a UTI before we put the catheter in?
insurance companies have started not reimbursing hospitals when patients get CAUTIs so we try to make sure they don't already have a UTI when we insert the catheter
