NU 682 Exam 1 Study Guide
With Solution
Risk factors for UTI
o Most common in sexually active, increased in obesity, increasing age,
anatomic or neurologic abnormalities, DM, and Sickle-cell
o Higher in men than women
o Commonly present with: urethritis or cystitis
S/S of UTI
- Dysuria
- urinary urgency
- frequency
- Hematuria
- Foul smelling urine
- Scant voiding
- Can't empty bladder
- Lower abdominal pain
- Lower back pain
- Flank pain (always worry about polynephritis)
,- No fever (maybe 99.6, 99.8), no N/V
Diagnosis a UTI
- Urinalysis (clean catch is ideal): look for WBC, protein, nitrites, RBC, cast
- POC urine dipstick
- May order urinalysis with microscopy in ED setting
- Culture: if patient is recurrent or refractory infections and in high risk
patients (pregnant patients, immunocompromised, DM)
- Culture and sensitivity are often ordered due to amount of abx resistance
seen now, especially with Bactrim (E. Coli is a big culprit)
E. Coli
most common source of UTI
Treatment of UTI
- Uncomplicated: oral abx
- Initial treatment: trimethoprim-sulfamethoxazole, nitrofurantoin, or a
fluoroquinolone for 3-7 days
- Pyelonephritis: inpatient with IV abx; 14 day antimicrobial therpay
Menstrual Cycle
- FHS released from pituitary gland results in the development of ovarian
follicle which produces estrogen
- Day 14 there is a spike in LH which results from the estrogen surge and
results in ovulation followed by the development of the corpus luteum which
,secretes progesterone
- If fertilization does not occur, the corpus luteum degenerates and
menstruation occurs because of decreased progesterone levels
Perimenopause
- Transition from normal menstrual cycle to menopause
- Results from progressive ovarian failure and may last from 2-8 years prior
to the final menstrual cycle
- May still ovulate and are potentially fertile until one year after the FMP
- Counsel on contraception
- Menopausal symptoms are the worst: vasomotor symptoms (night sweats,
hot flashes and mood swings), irritability, depression, inability to sleep
Menopause
- 12 months of amenorrhea after FMP in the presence of no pathological or
physiological changes
presentation of menopause
vulvovaginal dryness (c/o of burning, itching and irritation), dysuria or
, recurrent UTIs, Dyspareunia, loss of vaginal rugae, pale, dry epithelium,
fragility and petechiae, abnormal discharge, pH greater than 5
Management of Menopause
- vaginal moisturizers/ lubricants (Replens, Vagisil, KY Liquibeads), Topical
estrogen, Ospemiphene, Vaginal DHEA
- Vaginal lubricants can be used as needed or daily
- Topical estrogen can be a cream, a ring, or suppository. Done daily for 2-4
weeks, then twice weekly. Vaginal ring is inserted and used for 3 months.
Ospemiphene is an oral medication. Vaginal DHEA can be inserted vaginally
daily.
Ospemifene in menopause
a third-generation selective estrogen receptor modulator (SERM), that is
administered orally at the dose of 60 mg daily.
Vaginal DHEA
can help by increasing estrogen levels in the body and providing benefits for
genitourinary health. The only FDA-approved vaginal DHEA is Intrarosa
(prasterone), which is a suppository that's inserted daily with a vaginal
applicator
Osteoporosis
- 5x more frequently with men than women
- Eval all postmenopausal women older than 50 and all women 65 and older
annually
With Solution
Risk factors for UTI
o Most common in sexually active, increased in obesity, increasing age,
anatomic or neurologic abnormalities, DM, and Sickle-cell
o Higher in men than women
o Commonly present with: urethritis or cystitis
S/S of UTI
- Dysuria
- urinary urgency
- frequency
- Hematuria
- Foul smelling urine
- Scant voiding
- Can't empty bladder
- Lower abdominal pain
- Lower back pain
- Flank pain (always worry about polynephritis)
,- No fever (maybe 99.6, 99.8), no N/V
Diagnosis a UTI
- Urinalysis (clean catch is ideal): look for WBC, protein, nitrites, RBC, cast
- POC urine dipstick
- May order urinalysis with microscopy in ED setting
- Culture: if patient is recurrent or refractory infections and in high risk
patients (pregnant patients, immunocompromised, DM)
- Culture and sensitivity are often ordered due to amount of abx resistance
seen now, especially with Bactrim (E. Coli is a big culprit)
E. Coli
most common source of UTI
Treatment of UTI
- Uncomplicated: oral abx
- Initial treatment: trimethoprim-sulfamethoxazole, nitrofurantoin, or a
fluoroquinolone for 3-7 days
- Pyelonephritis: inpatient with IV abx; 14 day antimicrobial therpay
Menstrual Cycle
- FHS released from pituitary gland results in the development of ovarian
follicle which produces estrogen
- Day 14 there is a spike in LH which results from the estrogen surge and
results in ovulation followed by the development of the corpus luteum which
,secretes progesterone
- If fertilization does not occur, the corpus luteum degenerates and
menstruation occurs because of decreased progesterone levels
Perimenopause
- Transition from normal menstrual cycle to menopause
- Results from progressive ovarian failure and may last from 2-8 years prior
to the final menstrual cycle
- May still ovulate and are potentially fertile until one year after the FMP
- Counsel on contraception
- Menopausal symptoms are the worst: vasomotor symptoms (night sweats,
hot flashes and mood swings), irritability, depression, inability to sleep
Menopause
- 12 months of amenorrhea after FMP in the presence of no pathological or
physiological changes
presentation of menopause
vulvovaginal dryness (c/o of burning, itching and irritation), dysuria or
, recurrent UTIs, Dyspareunia, loss of vaginal rugae, pale, dry epithelium,
fragility and petechiae, abnormal discharge, pH greater than 5
Management of Menopause
- vaginal moisturizers/ lubricants (Replens, Vagisil, KY Liquibeads), Topical
estrogen, Ospemiphene, Vaginal DHEA
- Vaginal lubricants can be used as needed or daily
- Topical estrogen can be a cream, a ring, or suppository. Done daily for 2-4
weeks, then twice weekly. Vaginal ring is inserted and used for 3 months.
Ospemiphene is an oral medication. Vaginal DHEA can be inserted vaginally
daily.
Ospemifene in menopause
a third-generation selective estrogen receptor modulator (SERM), that is
administered orally at the dose of 60 mg daily.
Vaginal DHEA
can help by increasing estrogen levels in the body and providing benefits for
genitourinary health. The only FDA-approved vaginal DHEA is Intrarosa
(prasterone), which is a suppository that's inserted daily with a vaginal
applicator
Osteoporosis
- 5x more frequently with men than women
- Eval all postmenopausal women older than 50 and all women 65 and older
annually
