Health and Illness III (UTI & Sepsis)

Antibiotic Levaquin (Inpatient/ Complicated)

Pharmacologic class: fluroquinolone MOA: inhibits DNA synthesis of bacteria Priority nursing assessments: can cause EKG changes. cleared by kidneys, high resistance

Antibiotics: Bactrim (Outpatient/Uncomplicated)

Pharmacological class: Sulfa ABX MOA: Bactericidal. prevents metabolism of folic acid Primary nursing assessment Steven Johnson syndrome photosensitivity=sundburns Urine crystals=drink water

Analgesic: Pyridium/ Phenazopyridine

Pharmacological class: nonopoid analgesic MOA: Analgesic to urinary mucosa Priority nursing assessments DO not report orange urine Do report jaundice no contacts specks only (stains contacts)

Normal lactic acid levels

0.5-1.5 mEq/L

Creatine

0.6-1.2

Normal WBC

5,000-10,000

Normal BUN levels

6-20 mg/dL

Target MAP

>/= 65 mmHg

Kidney Pain

Dull: Flank pain

Most common sepsis culprits

Pneumonia, pyelonephritis that is caused by bacteria

Most Important Lab Values

Procalcitonin- biomarker of sepsis and used for antibiotic stewardship C-reactive protein- Protein produced to inflammation Higher levels=more severe infection Hyperglycemia without diabetes

Lactic Acid is a sign of

Tissue hypo-perfusion

Nursing Teaching

Increase fluid intake by 2000 ml/day Void after sex Cranberry supplements Avoid caffeine Avoid alcohol Finish antibiotics wipe from front to back

Sepsis

Infection with signs of overwhelming inflammation developing from an abnormal immune response

A Glasgow under 8 means

Intubate

Symptoms NCLEX Most Tested

LBP Less that 80 systolic Cold, Clammy skin Delayed capillary refill Mental Status Change Confusion Disorientation High WBC Temp very high or very low 96

Blood Infection Attacks Vessels

Leaking Everywhere cause swelling

Septic Shock

Life-threatening condition when sepsis progresses to profound circulatory, cellular, and metabolic dysfunction

Complications to Anticipate in Elderly or Immunocomprimised

Most Likely=Delirium Worst Possible= Urosepsis

Systemic Inflammatory Response Syndrome (SIRS)

Occurs as a result of infection or other non-infectious condition such as trauma, ischemia, or inflammation

Severe sepsis

Occurs when sepsis progresses and causes acute organ dysfunction

Secondary Infection

PICC line with an infection

Chronic pyelonephritis

Renal papillary necrosis Perinephric abscess Urosepsis--commonly caused by E.coli

When caring for a patient who has septic shock, which assessment finding is mostimportant for the nurse to report to the health care provider

Skin cool and clammy

Relevant Labs

UA-Bacteria, RBC, WBC, Nitrites Urine culture- E.coli, enterococci, Klebsiella, Proteus, and streptococci BUN/Creatinine Not UTI specific but kidney function specifically Diagnostics related to symptomology US, CT, MRI

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation

Urination is less painful. Phenazopyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination.

Primary Infection

Virus and bacteria was introduced

UTI to sepsis

WBC normal Dysuria , urgency, frequency & suprapubic pain +Leukocytes Urine Lower/Urethra to bladder Becomes acute pyelonephritis

Diagnostic Tests

X-rays MRI CAT PET and indium scans

Acute Pyelonephritis(UTI moves up)

indwelling catheters Diabetes mellitus pregnancy obstruction in urinary tract WBC high Flank pain, CVA pain, fever, pain, chills, nausea or vomiting +Leukocytes +Nitrites Blood and Urine Upper/Kidney Leads to chronic pyelonephritis, stage horn stones or sepsis

Ureteral pain

super painful

MAP formula (mean arterial pressure)

(systolic) + 2(diastolic)/3

A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen (BUN) level drops to which value?

15 mg/dL. The normal BUN level is 6 to 20 mg/dL (2.1 to 7.1 mmol/L). BUN/Creatinine, while not UTI specific, is VERY specific for kidney function. While a high BUN could be just dehydration, the fact that the patient has a UTI tells us it's probably BOTH. High-level question. Nice job

Which newly admitted client does the nurse consider to be at highest risk for the development of sepsis?

68-year-old woman 2 days postoperative from bowel surgery. The 68-year-old woman has several risk factors. First, she is an older adult, and her immune function decreases with age. The greatest risk factor is that she has just had bowel surgery. Not only does major surgery further reduce the immune response, but the bowel also cannot be "sterilized" for surgery. Therefore the usual bacteria of the bowel have the chance to escape the site and enter the bloodstream when the bowel is disrupte

What is a common dysrhythmia associated with sepsis

A-fib r-r is irregular. It is caused by inflammation that triggers the heart

Ways to Categorize infections by classification

Bacterial infections (neutrophil count will be high) Viral Infection Fungal Infection Parasitic or protozoal infections

A 80 years old patient sees his primary health provider due to foul-smelling urine and burning on urination. Which contributing factors for a UTI should the health provider consider?

Benign Prostatic Hyperplasia (BPH) BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, but a diet high in purines is associated with renal calculi.

Your patient, who is post-op from a kidney transplant, has developed septic shock. Which statement below best reflects the interventions you will perform for this patient?

Collect cultures and then administer IV antibiotics. Yes! This is the only correct option. Option A is wrong because fluids are administered first, and if they don't work vasopressors (Norepinephrine) is administered. Option C is wrong because although blood glucose levels should be measured, it does not take precedence over other treatments. Option D is wrong because Drotrecogin alpha should be given within 24-48 hours of septic shock to be the most effective.

Worsening

Confusion, decreased LOC, hypotension, warm/sweaty skin

Late Assessment Findings

Cool/cyanotic, mottled skin, organ failure

Your patient's blood pressure is 72/56, heart rate 126, and respiration 24. The patient has a fungal infection in the lungs. The patient also has a fever, warm/flushed skin, and is restless. You notify the physician who suspects septic shock. You anticipate that the physician will order what treatment FIRST?

Crystalloids IV fluid bolus YES! The first treatment in regards to helping maintain tissue perfusion is fluid replacement with either crystalloid or colloid solutions. THEN vasopressors like Norepinephrine are ordered if the fluids don't help.

What not to do/ Nursing Teaching

Douche Spermicide Deodorant products Spandex No bubble bath

Most common type of bacteria associated with UTI's

E.coli

Early Assessment Findings

Fever, tachypnea, tachycardia, diaphoresis, BP WNL or low

Most Important Medications

Fluids Crystalloid IV fluids Antibiotics Norepinephrine/Vasopressin MOA= Vasoconstriction=Target MAP 65 Priority Nursing Assessments-Hemodynamic monitor/ICU

Risk Factors for Cystitis

Frequent sexual intercourse Diabetes mellitus Indwelling catheter Impaired bladder emptying BPH Neurological Damage Opioids decrease bladder sensation

A 21-yr-old female patient received instructions on how to prevent recurrence of urinary tract infections. Which statement indicates that teaching was effective?

I will urinate before and after intercourse.