chap 89 patho

Recurrent UTI: Relapse

-20% recolonization with the original infecting organism -Suggests structural abnormality of urinary tract, involvement of kidneys, or chronic bacterial prostatitis

Recurrent UTI: Reinfection

-80% of recurrent UTIs in females -Usually involves lower urinary tract and may be related to sexual intercourse

Acute uncomplicated pyelonephritis commonly found in...

-Children -older adults -women of child-bearing age

Acute Cystitis symptoms

-Dysuria -urinary urgency -urinary frequency -suprapubic discomfort -pyuria -bacteriuria (subclinical pyelonephritis)

Acute uncomplicated pyelonephritis symptoms

-Fever, chills, -severe flank pain, -dysuria, -urinary frequency and urgency, -pyuria -usually bacteriuria

Nitrofurantoin AE

-N/V -Pulmonary reactions: Acute and subacute -Hematologic effects -Peripheral neuropathy: Demyelinization and nerve degeneration can occur and may be irreversible -Hepatotoxicity -Birth defects

Urinary Tract Antiseptics

-Nitrofurantoin -Methenamine

The drugs used for treatment of choice for OP therapy of UTIs

-TMP/SMZ -Nitrofurantoin

How to check for which Microorganism?

-Urinalysis -72 hr Culture and sensitivity

Acute bacterial prostatitis associated with...

-indwelling urethral catheter -urethral instrumentation -transurethral prostatic resection (TURP) for prostate cancer

Acute bacterial prostatitis

-inflammation of the prostate caused by local bacterial infection -responds well to antimicrobial therapy

Nitrofurantoin uses

-lower UTIs -prophylaxis -recurrent lower UTIs

UTI general knowledge

-second most common Infection -sexually active young active develop at least one a year -older adult women in nursing home -less frequent in male

Acute Cystitis therapy

-single-dose therapy -short-course therapy (3 days) -Conventional therapy (7 Day)

UTI areas affected

-upper kidney -lower bladder and urethra

Which patient would most likely need intravenous antibiotic therapy to treat a urinary tract infection? A. A patient with an uncomplicated urinary tract infection caused by Escherichia coli B. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain C. A patient with acute cystitis who complains of dysuria, frequency, and urgency D. A patient with acute bacterial prostatitis with a mild fever, chills, and nocturia

Answer: B Rationale: Severe pyelonephritis requires intravenous antibiotic therapy

Which patient does the nurse identify as most likely to need treatment with trimethoprim/sulfamethoxazole [Bactrim] for a period of 6 months? A. A female patient with acute pyelonephritis B. A male patient with acute prostatitis C. A female patient with recurring acute urinary tract infections D. A male patient with acute cystitis

Answer: C Rationale: Female patients with relapses of urinary tract infection may need long-term therapy up to 6 months with trimethoprim/sulfamethoxazole

Which drug does the nurse identify as a urinary tract antiseptic? A. Ciprofloxacin B. Ceftriaxone C. Nitrofurantoin D. Ceftazidime

Answer: C Rationale: Two urinary tract antiseptics currently are available: nitrofurantoin and methenamine. Ciprofloxacin, ceftriaxone, and ceftazidime are antimicrobials

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 E Complicated UTIs occur in males and females and usually are associated with some predisposing factor, such as calculi, prostatic hypertrophy, or catheters. Uncomplicated UTIs occur primarily in women of child-bearing age and are not associated with any specific predisposing factor. Fair skin tone is unrelated to UTI occurrence.

Nitrofurantoin high concentration

Bactericidal

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

Dyspnea with chills Nitrofurantoin, a urinary tract antiseptic, may induce a pulmonary reaction that manifests with dyspnea, chest pain, and chills. These symptoms, which resolve 2 to 4 days after the drug is stopped, are thought to be hypersensitivity reactions. Hyperpigmentation of the palms, gum irritation with bleeding, and scalp tenderness and thinning hair are not side effects associated with nitrofurantoin.

80% of uncomplicated, community acquired UTIs are caused by?

E. Coli

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.

E. coli 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.

complicated UTI

Female and male patients with structural or functional abnormality of the urinary tract

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

Flank Pain 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. Incontinence, 3+ pedal edema, and hyperactive bowel sounds are unrelated to acute cystitis.

The nurse is working with a patient who has a UTI. Because patient adherence to a medication regimen is a concern, the nurse anticipates use of which medication? a. Fosfomycin b. Amoxicillin c. Cephalexin d. Trimethoprim

Fosfomycin When adherence is a concern, fosfomycin, which requires just one dose, is an attractive choice. As a rule, amoxicillin and cephalexin are avoided, because they are less effective than the alternatives and are less well tolerated. Trimethoprim requires a longer course of therapy than fosfomycin.

Acute bacterial prostatitis symptoms

High fever, chills, malaise, myalgia, localized pain, dysuria, nocturia, urinary urgency, frequency, and retention

mild pyelonephritis

Moderate infection (treatment at home with oral antibiotics)

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

Muscle weakness and tingling Nitrofurantoin is used in acute infections of the lower urinary tract only. Muscle weakness and tingling may indicate irreversible damage to sensory and motor nerves caused by demyelinization of nerves. Patients should be informed of these symptoms and taught to report them immediately. Gastrointestinal (GI) effects may be minimized by taking the drug with milk or food. Brown urine is a harmless effect of the urinary excretion of the medication. Headache and drowsiness are less common adverse effects that are readily reversible.

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

Oral antibiotics in the home setting Except for pyelonephritis, most UTIs can be treated with oral therapy at home.

complicated UTI Symptoms

Patient may develop systemic illness manifesting as fever, bacteremia, and septic shock

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

Women of child-bearing age Acute cystitis is a lower urinary tract infection that occurs most often in women of child-bearing age.

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 e 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.

Nitrofurantoin low concentration

bacteriostatic

Hospital-acquired UTI

frequently caused by: --Klebsiella --Proteus --staphylococci --E. coli

Severe pyelonephritis

requires hospitalization and IV antibiotics