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IOS 10 exam 4


Cystitis is Dysuria, frequency,urgency, superpubic tenderness,hematuria (no vagina symptoms or discharge)
Pyelonephritis is Maliase,fever, flank pain, costovertal tenderness, abdominal pain, nausea, vomiting,elevated WBC count
Urosepsis-is Mental status changes, failure to thrive, change in urinary habits, dehydration, hypotension. Cystitis (bladder inflammation) fever, elevated WBCs, (+) urinealysis, pre-renal azeotemia
Prostatis is Sudden onset of high fevers, chills, malaise, myalgias, locialized pain, urinary symptoms
Microscopic analysis WBC, RBC, epithelial cells, casts, bacteria.
Macroscopic analysis- standard dipstick- Color, pH, glucose, protein, ketone, bilirubin, blood, nitrite, leukocyte esterase, Casts:
pathophysiology of urinary tract infections Bacteria usually originate from the bowel and ascend urethra and vagina. More common in women.
mechanisms and bacterial virulence Urine: low pH, Micturition (complete emptying of the bladder), Prostatic secretions in men, Lactobacillus in the vaginal flora, One-way vesicoureteral valve,Epithelial cells of the bladder coated with glycosaminoglycan, Tamm-Horsfall p, Secretory IgA
Bacterial virulence characteristics Innoculum size, Pathogenic organisms with mannose-resistance P-fimbriae (resistant to removal by glycosaminoglycans), Production of hemolysin – lyse PMNs, Aerobactin
Lueokocyte esterase indicates WBC or Lysed wbc's
Nitrite positive indicates Gram - bacteria that can reduce nitrates
Acute uncomplicated cyctitis female (15-50) Dysuria, frequency, urgency, superpubic tenderness, hematuria (rare symptomatic)
Uncomplicated or complicated pyelonephritis Flank pain, maliase, fever, costovertal tenderness, abdominal pain, elevated WBC
Treatment of Uncomplicated cyctitis (15-50) Bactrim, Fluorquinolones, Augmention, nitrofurantion) 7days
Complicated cycstitis >50, men Fluoroquinolones, bactrim DS 7-14 days
Asymptomatic bacteriumia in pregnancy treatment Augmentin, cephalosporins, nitrofurantion (not 36 wwek) 3-7 days
Acute pyelonephritus treatment-mild to moderate Fluoroquinolones, bactrium 7-14 days
Acute pyelonephrtis Moderate to sever IV fluoroquinolones, 3rd cephalosporins, Unasyn or Zosyn 14-days
Urosepsis treatment IV fluoroquinolones, 3rd cephalosporins, Unasyn or Zosyn 14-days
Acute or chronic prostatitis treatment bactrim, fluoroquinolones, treat 3-4 weeks for acute or 4-6 weeks up to 12 weeks
Acute uncomplicated Cystitis monitor Resolution of symptoms within 24-48 hrs & re-evaluate if symptoms persist or re-occur
Acute pyelonephritis- monitor Resolution of S/S within 12-24 hours and significant improvement. WBC & temperature improvement should occur within 72hours. Follow-up in 2 weeks.
Urosepsis-monitor Resolution of mental status changes, temperature, WBC, kidney function, Bp, Follow-up 2 weeks
Recurrent Uncomplicated Cystitis- Relapse Infection- Same organism, occur within 2 weeks- Obtain culture & sensitivities Check for underlying causes for relapse and treat for an additional 2-6 weeks
Recurrent Uncomplicated Cystitis- Re-infection New microorganism (species or strain)- Occur >2 weeks post treatment
a. Uncomplicated Cystitis-Recurrent Cystitis – No Relation to Intercourse- Prophylaxis x 6-12 months then stop & observe
b. Uncomplicated Cystitis-Relation to Intercourse Post-intercourse prophylaxis & Voiding after intercourse
asymptomatic or symptomatic candiuria treatment Asymptomatic no treatment- except (ICU),symptomatic- fluconazole 200-400 mg po qd x 7-14d or IVAmphotericin B
Created by: liza001