Week 4 UTI.pdf

CONCEPT: ELIMINATION EXEMPLARS: URINARY TRACT INFECTION LEWIS CH. 49 & 50 NURS120 M/S ATI CH. 62 PROFESSOR FERNANDEZ FUNDS ATI CH. 44 MSN ED, RN, FNP-C  GENITOURINARY SYSTEM REVIEW RENAL SYSTEM URINARY...

CONCEPT: ELIMINATION EXEMPLARS: URINARY TRACT INFECTION LEWIS CH. 49 & 50 NURS120 M/S ATI CH. 62 PROFESSOR FERNANDEZ FUNDS ATI CH. 44 MSN ED, RN, FNP-C  GENITOURINARY SYSTEM REVIEW RENAL SYSTEM URINARY SYSTEM (2) KIDNEYS + URINARY SYSTEM (2) URETERS + BLADDER + URETHRA FUNCTIONS: TYPICALLY, STERILE* ENVIRONMENT MAINTAIN FLUID VOLUMES ANTIBACTERIAL PROPERTIES OF URINE REGULATE BLOOD PRESSURE ACIDIC PH ( THAN 10,000), AND/OR Leukocyte Esterase (AN ENZYME IN WBCS INDICATING PYURIA) → UTI URINE CULTURE AND SENSITIVITY: NEEDED IN PRESENCE OF PERSISTENT BACTERIURIA, RECURRING UTI (2-3/YR), CAUTI, HAI UTI IDENTIFIES BACTERIA’S SUSCEPTIBILITY TO ANTIBIOTICS DETERMINE EFFECTIVE ABX THERAPY WHEN AND HOW TO OBTAIN URINE SPECIMEN?  OTHER DIAGNOSTICS KUB LEWIS TABLES 49.9 ULTRASOUND 44.12 CT SCAN RENAL SCAN 24 HOUR URINE SPECIMEN ANALYSIS MEASURES CREATININE CLEARANCE CLOSELY APPROXIMATES GFR CREATININE IS A WASTE PRODUCT EXCRETED BY KIDNEYS → ANALYSIS IS INDICATOR OF RENAL FUNCTION  DRUG THERAPY ANTIBIOTICS SELECTED ON EMPIRIC THERAPY OR RESULTS OF SENSITIVITY TESTING TRIMETHOPRIM/SULFAMETHOXAZOLE (TMP/SMX) (BACTRIM)(SEPTRA) USED TO TREAT UNCOMPLICATED OR INITIAL UTI INEXPENSIVE TAKEN TWICE A DAY E. COLI RESISTANCE TO TMP-SMX ↑ NITROFURANTOIN (MACRODANTIN) GIVEN THREE OR FOUR TIMES A DAY LONG-ACTING PREPARATION (MACROBID) IS TAKEN TWICE DAILY (MORE COMMON) AMPICILLIN, AMOXICILLIN, CEPHALOSPORINS TREAT UNCOMPLICATED UTI  DRUG THERAPY ANTIBIOTICS URINARY ANALGESIC FLUOROQUINOLONES PHENAZOPYRIDINE (PYRIDIUM) TREAT COMPLICATED UTIS USED IN COMBINATION WITH EXAMPLE: CIPROFLOXACIN (CIPRO) ANTIBIOTICS ADVERSE REACTIONS TO WATCH FOR PROVIDES SOOTHING EFFECT ON TENDONITIS AND ACHILLES TENDON RUPTURE URINARY TRACT MUCOSA ANTIFUNGALS STAINS URINE REDDISH ORANGE AMPHOTERICIN B OR FLUCONAZOLE CAN BE MISTAKEN FOR BLOOD AND MAY STAIN UNDERCLOTHING UTIS SECONDARY TO FUNGI  NURSING ASSESSMENT SUBJECTIVE DATA IMPORTANT HEALTH INFORMATION PAST HEALTH HISTORY MEDICATIONS (NEPHROTOXIC MEDS, DIURETICS, ETC) SURGERY OR OTHER TREATMENTS LEWIS TABLES 49.4 49.7  SUBJECTIVE DATA FUNCTIONAL HEALTH PATTERNS HEALTH PERCEPTION–HEALTH MANAGEMENT PATTERN NUTRITIONAL-METABOLIC PATTERN (DEHYDRATION/FLUID STATUS) ELIMINATION PATTERN (VOIDING FREQUENCY, URGENCY, INCONTINENCE, RETENTION, CHANGES IN COLOR, USAGE OF CATHETERS) ACTIVITY-EXERCISE PATTERN (LEVEL OF ACTIVITY- SEDENTARY= STASIS OF URINE) SLEEP-REST PATTERN (NOCTURIA) COGNITIVE-PERCEPTUAL PATTERN (CHANGE IN ALERT/ORIENTED, PAIN) SELF-PERCEPTION–SELF-CONCEPT PATTERN (LOSS OF SELF-ESTEEM, NEG BODY IMAGE) ROLE-RELATIONSHIP PATTERN & SEXUALITY-REPRODUCTIVE PATTERN  OBJECTIVE DATA PHYSICAL EXAM INSPECTION SKIN, MOUTH, S/S EDEMA WEIGHT AUSCULTATE BOWEL SOUNDS PRESENT? PERCUSSION SHOULD BE ABSENT OF PAIN TENDERNESS MAY INDICATE KIDNEY INFECTION OR DISEASE PALPATION KIDNEYS DIFFICULT TO PALPATE D/T SPLEEN BLADDER WILL BE SENSITIVE TO PALPATION IF DISTENDED NURSING DIAGNOSIS AND PLAN NURSING DIAGNOSIS IMPAIRED URINARY ELIMINATION READINESS FOR ENHANCED SELF-HEALTH MANAGEMENT NURSING PLAN PATIENT WILL HAVE RELIEF FROM LOWER URINARY TRACT SYMPTOMS PREVENTION OF UPPER URINARY TRACT INVOLVEMENT PREVENTION OF RECURRENCE  NURSING IMPLEMENTATION ACUTE INTERVENTIONS HEALTH PROMOTION PREVENTION EDUCATION Encourage fluids (IV/PO) 2-3L fluids daily Adhere to abx regimen Void Q 3-4hr while awake to Peri hygiene empty bladder Incontinence care Wash hands Foley care: Wipe front to back Aseptic technique on (women)/perihygiene insertion Avoid caffeine, alcohol, citrus Early DC juices, chocolate and spicy Assess Q shift for need food/drinks Regular BMs 1Cranberry juice/capsules Void before and after sex (women)  NURSING EVALUATION THE PATIENT WITH A UTI WILL EXPERIENCE NORMAL URINARY ELIMINATION PATTERNS REPORT RELIEF OF BOTHERSOME URINARY TRACT SYMPTOMS VERBALIZE KNOWLEDGE OF TREATMENT REGIMEN