Urinary Tract Infections (UTIs) Overview
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Questions and Answers

What are some lower UTIs

  • Pyelonephritis
  • Urethritis
  • Prostatitis
  • urethritis-inflammation of uerthra..............prostatitis..........cystitis-inflammation of bladder wall (correct)

What are the classic signs and symptoms of UTI?

  • Urgency • Frequency • Burning • Cloudy urine • Foul-smelling urine • Hematuria • Dark Urine 5 (correct)
  • Frequency, chills, atypical symptoms
  • Nausea/vomiting, costovertebral tenderness, high fever
  • Dark urine, foul-smelling urine, hematuria

What are UTI risk factors

  • Stasis of Urine
  • Previous UTIs
  • Female Anatomic/Genetic Differences
  • Stasis of Urine Contamination Instrumentation infection Faulty valves Previous UTIs Female Anatomic/Genetic Differences Aging (correct)

What are upper UTIs

<p>pyelonephritis-infection of one or both kidneys..............ureteritis (D)</p> Signup and view all the answers

What are some specific symptoms of pyelonephritis?

<p>Costovertebral tenderness – High fever – Chills – Nausea/vomiting (B)</p> Signup and view all the answers

What is a potential consequence of untreated urosepsis?

<p>Sepsis that occurs from an untreated UTI – Drop in BP, Increase in HR, Temp and RR – Changes in mental status – Organ failure – Blood cultures x 2 8 (C)</p> Signup and view all the answers

What are nursing interventions for UTIs

<p>Phenazopyridine (Pyridium) • Antibiotics Medications • Foods to prevent UTI (polyphenols) • Encourage increased fluid consumption • Void Q3-4 Hours while awake • Hygiene • Avoid tight clothing • Void after sex Nonpharmacological 9 (B)</p> Signup and view all the answers

What are some urological obstructions

<p>From point of obstruction Urine backs up • (distention of kidney) Hydronephros is occurs------ then Builds up pressure---then Kidney damage ---then Impaired function then ------CKD (C)</p> Signup and view all the answers

Which factor contributes to the development of urological obstructions/strictures

<p>Narrowing of the lumen of the urethra (scar tissue) • Causes – Diminished urinary stream – Frequency – Urgency – Dysuria – Frequent UTI’s 11 (D)</p> Signup and view all the answers

What are urethral stricture treatments

<p>Catheterization • Mechanical dilation • Endoscopic urethrotomy • Urethroplasty • Implantation of stent 12 (B)</p> Signup and view all the answers

Which mineral is commonly associated with renal calculi urolithiasis

<p>Pathophysiology • Minerals and salts • High uric acid • Substances that inhibit stone formation are low Types • Calcium • Uric acid • Struvite • Cystine 13 (B)</p> Signup and view all the answers

Renal calculi stuff to know

<p>RENAL CALCULI (UROLITHIASIS) 14 • DM, gout, HTN, intestinal disorders, obesity, Genetics Medical conditions Chronic high pH Chronic UTI • ASA, indinavir, topiramate, triamterene, vitamin C supplements, vitamin D, calcium supplements, Dehydration Excessive sweating DIET• low in calcium, phytate, and potassium • high in fructose, oxalate, animal protein, vitamin C, sodium, and sucrose Medication (B)</p> Signup and view all the answers

What are renal calculi signs and symtoms

<p>nephrolithiasis • Flank Pain • Hematuria ...............Ureterolithiasis • Severe colicky pain • Flank, side, or lower abdominal pain • Intense urge to void • Frequency • Dysuria • Hematuria • N/V.............. Bladder Stones• Hematuria • Oliguria 15 (B)</p> Signup and view all the answers

What are some renal calculi diagnostics

<p>Blood Tests • BUN/creatinin e • Calcium • Uric acid ----------Urinalysis • Hematuria • Crystals • WBC • Bacteria------------ 24-hour urine collection • Calcium • Sodium • Uric acid • Oxalate • Citrate • Creatinine -----------------Imaging test • Noncontrost CT • Renal ultrasound • IV pyelography (B)</p> Signup and view all the answers

Which therapeutic measure is recommended for preventing the occurrence of small renal calculi?

<p>Hydration – 2-3 quarts daily • Avoid sweetened beverages and grapefruit juice • DASH diet and Mediterranean diet recommended • Ambulate • Urocit-K (potassium citrate) (C)</p> Signup and view all the answers

What are therapeutic measures for renal calculi

<p>L E S S T H A N 1 0 M M I N S I Z E Hydrate • 2-3 quarts of fluid Pain control • NSAIDs • Opioids • Heat Strain all urine • Stone analysis Alpha-blocker • Tamsulosin (Flomax (C)</p> Signup and view all the answers

What are some therapeutic measures in renal calculi larger than 10 mm in size

<p>Cystoscopy(goes in head of penis and tap away the calculi) Ureteroscopy Lithotripsy • Shock-wave • Laser Percutaneous Nephrolithotomy 18 (C)</p> Signup and view all the answers

What is the primary focus of therapeutic measures in diabetic nephropathy?

<p>Caused by years of damage from elevated glucose levels to small blood vessels in kidneys Reduce risk in DM patients • Control BGL • Control HTN • Control weight • Smoking cessation • Caution with NSAIDs Strict control of BGL – AIC &lt;7 • Strict control of HTN – ACE inhibitors – ARBs • Cholesterol control – statins 23 (D)</p> Signup and view all the answers

What is nephrotic syndrome

<p>Massive loss of protein through urine Can be caused by many different conditions Increased glomerular permeability which leads to protein (albumin) being filtered into urine instead of staying in blood (C)</p> Signup and view all the answers

What are nephrotoxic signs and symtoms

<p>Anasarca(widespread edema) Ascites.... Low serum total protein and albumin Elevated serum cholesterol .....Foamy urine ..........Elevated BP (A)</p> Signup and view all the answers

In the context of diabetic nephropathy, what does A1C stand for?

<p>Average blood glucose concentration over the past 2-3 months (D)</p> Signup and view all the answers

What are therapeutic measures in nephrotic syndrome

<p>Decrease pressure • ACE inhibitors/ARBs Interventions for edema • Loop diuretics • Sodium restriction • Daily weights • Strict I&amp;Os • Abdominal girth measurements • Skin breakdown prevention Prevention of infection Dietary consult • Protein consumption (A)</p> Signup and view all the answers

What is glomerulonephritis

<p>Inflammation of the glomerulus • Altered filtration allows proteins, WBCs, RBCs, and electrolytes to be excreted in urine (A)</p> Signup and view all the answers

What are glomerulonephritis causes

<p>Post- streptococcal infection-Usually, strep throat or skin infection.......................Goodpasture Syndrome-autoimmune...........................Chronic Glomerulonephritis-Progressive inflammation of glomerulus (B)</p> Signup and view all the answers

glomerulonephritis signs and symptoms and diagnoses

<p>Oliguria • Fluid overload – HTN – Edema – electrolyte imbalance • Flank pain • Dark “cola-colored” urine – Sometimes foamy urine • Urinalysis – Hematuria – Proteinuria • Serum BUN/Creatinine – May be elevated • Ultrasound • X-Ray • Biopsy (C)</p> Signup and view all the answers

What is a key goal in managing acute glomerulonephritis?

<p>Acute disease usually resolves with symptomatic Tx within a week • Goal is prevention of progression to CKD – Rest – Edema treatment • Fluid restrictions • Na restrictions – Protein restriction • if increased BUN/creatinine – Education focused on prevention (B)</p> Signup and view all the answers

What is acute kidney injury (AKI)

<p>Rapid onset of decreased kidney function Combination of hypoperfusion, tissue injury/damage, and inflammation Causes waste products to accumulate in the bloodstream (azotemia) Kidneys are unable to filter waste products and may leak other products into urine Usually, reversible (C)</p> Signup and view all the answers

What are causes of acute kidney injury

<p>Prerenal • Decreased perfusion to kidneys Intrarenal • Damage to nephrons Postrenal • Obstruction (C)</p> Signup and view all the answers

Acute kidney injury stuff

<p>Nephrotoxins – Diagnostic Contrast Media (Dyes) – Medications – Heavy Metals – Organic Solvents (B)</p> Signup and view all the answers

What are common nephrotoxic meds in AKI

<p>Antibiotics: – Aminoglycosides – gentamycin, neomycin, tobramycin – Amphotericin B – Cephalosporins – Cefazolin, Cefdinir, Cefepime – Sulfonamides - Bactrim – Tetracyclines – doxycycline, Vibramycin • Analgesics – Acetaminophen – NSAIDs – Salicylates – ASA • Contrast media • Other meds: – ACE inhibitors – Amphetamines – Cisplatin – Dextran – Heroin – Interleukin-2 – Mannitol 34 (B)</p> Signup and view all the answers

AKI injury phases

<p>Initiating • Time of renal injury – occurrence of symptoms -------------------------OLIGURIC&lt;400mL of urine in 24 h • Fluid retained • Electrolytes imbalances • Waste products not excreted (azotemia) • Metabolic acidosis - ----------------DIURETIC• Kidneys begin to excrete 1 – 3L/day • Dehydration/hypotension are a concern • Monitor for hypovolemia, hyponatremia, hypokalemia, hypotension - ----------------Recovery• GFR rises • BUN and creatinine decrease (D)</p> Signup and view all the answers

What are acute kidney injury therapeutic measures

<p>Correcting the cause – prevent permanent damage • Treat s/sx – Restore fluid/electrolyte balance – DC nephrotoxic drugs – Bypass – Obstructions – Short-term CRRT (C)</p> Signup and view all the answers

What is the main function of Continuous Renal Replacement Therapy (CRRT)?

<p>Alternative to dialysis • Removes fluid and solutes in a controlled continuous manner • Uses temporary vascular access • Blood flows through the hemofilter: excess fluids and solutes flow into bag – Remaining blood returns to the patient via venous access – May give electrolytes through access • Nursing considerations – Hourly vitals – Monitor vascular access – Strict I&amp;O – Electrolytes – Daily weights (D)</p> Signup and view all the answers

What is AKI prevention

<p>Check creatinine/GFR before contrast dye or medication administration • Monitor levels routinely as indicated • Follow hydration protocols for contrast dye • Prevention of kidney stones (D)</p> Signup and view all the answers

What is CKD

<p>Gradual progressive, irreversible deterioration in renal function. – Unable to maintain metabolic, fluid and electrolyte balance – Nitrogenous waste accumulates – Uremia occurs • Diagnosed when 75% of nephron function is lost – Renal insufficiency s/sx occur • ESRD occurs when 90% function is lost – BUN and creatinine are always elevated 39 (C)</p> Signup and view all the answers

Chronic kidney disease diagnostics

<p>ABG – Metabolic Acidosis decreased RBCs – elevated BUN - elevated Creatinine - elevated Magnesium - elevated Potassium - elevated Sodium – elevated........ Calcium – decreased----------------------------stage 1 slight decrease 90 or greater.....stage 3 moderate decrease 45-59.......stage 5 dialysis/transplant &lt;15 (D)</p> Signup and view all the answers

What are CKD signs and symptoms

<p>Disturbance in Water Balance – Edema – SOB – Crackles/wheezes – HTN – Polyuria, oliguria, or anuria • Disturbance in Electrolyte Balance – Hypernatremia – water retention, edema, HTN – Hyponatremia due to vomiting or diarrhea – confusion – Hyperkalemia – muscle weakness, abdominal cramping, diarrhea, confusion – Hypocalcemia – increased risk for fractures – Hyperphosphatemia – severe itching 41 (B)</p> Signup and view all the answers

More CKD symptoms

<p>Disturbance of Removal of Waste Products – Azotemia – Weakness/fatigue – Confusion, seizures, – Asterixis – N/V – lack of appetite – Metallic taste – Yellowish skin – Itching – Uremic Frost • Disturbance in Maintaining Acid-Base Balance – hydrogen excretion affected – Metabolic acidosis • Disturbance in Hematologic Function – anemia 42 (D)</p> Signup and view all the answers

What is CKD diet

<p>Depends on pt’s condition High calorie, low fat Protein restriction unless on dialysis Na+/K+/phosphorus restriction Supplements Fluid restriction as needed Can be anorexic and have N/V (C)</p> Signup and view all the answers

CKD medications u use

<p>Tx for hyperkalemia • Kayexalate, insulin (+D50), Lasix, albuterol • Place on cardiac monitor – Vitamin/electrolyte supplements • Ex: Calcium gluconate – Sodium Bicarbonate – Diuretics for fluid overload – Sevelamer hydrochloride (Renagel) – Control HTN – Control DMII (C)</p> Signup and view all the answers

What is hemodualysis

<p>Definitive tx of CKD/ESRD/uncontrolled hyperkalemia • Intermittent artificial blood filtration –Vascular Access • Temporary- central line • Permanent- AV fistula or graft (D)</p> Signup and view all the answers

What is peritoneal dialysis

<p>PERITONEAL DIALYSIS • Continuous Dialysis Done by Patient – Peritoneal membrane used to filter out waste via peritoneal vessels – Peritoneal catheter inserted between layers of the peritoneum • Exchange Process 1. Fill 2. Dwell 3. Drain (B)</p> Signup and view all the answers

What are hemodialysis vascular acess care treatment

<p>Thrill- palpable tremor Bruit- swishing sound when auscultating PROTECT Postoperative • Neurovascular Checks – What do you do if there are concerns? • Elevate, ROM, control pain (C)</p> Signup and view all the answers

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