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IOS 10 exam 4
UTI
Question | Answer |
---|---|
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 |