NUR 530 Quiz 3 Study Guide 2024

Study Guide #3 Chapters 30 & 31 Know the signs and symptoms of UTI’s and the most common organisms associated with them. UTI (acute cystitis) Urinary tract infections (UTIs) – inflammation of the urinary epithelium usually caused by bacteria from gut flora. Urinary tract infections (UTIs) are commonly caused by the retrograde movement of bacteria into the urethra and bladder. Urinary tract infections (acute cystitis) S/S Common Organism associated with Elderly are commonly asymptomatic (highest risk UTI) Clinical manifestations of cystitis are related to the inflammatory response: • Frequency • Urgency • Dysuria (painful urination • Suprapubic and low back pain More serious s/s • Hematuria • Cloudy urine • Flank pain 10% of individuals with bacteriuria have no symptoms 30% with symptoms are abacteriuric Elderly may be asymptomatic or confused or vague abd pain. Elderly with recurrent UTIs and comorbidities have a higher risk of mortality Cystitis is an inflammation of the bladder commonly caused by bacteria and may be acute or chronic. The MOST common infecting microorganisms are uropathic strains of Escherichia coli and the second most common is Staphylococcus saprophyticus. Less common: Klebsiella, Proteus, Pseudomonas, fungi, viruses, parasites, or tubercular baccilli Schistosomiasis Most Common cause of parasitic invasion (infects 200 mill – association with bladder Ca) Gram-negative bacilli move into the urethra and bladder then to ureter and kidney. Uropthic stains of E. coli have type-1 fiimbrae bind to latex catheters. These stains have P fimbrae (pyelonephritis- associated fimbriae) and bind to uropithelium of individuals with P blood group antigen. Some women are genetically susceptible to certain strains of E coli Painful bladder syndrome/interstitial cystitis includes nonbacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal), noninfectious cystitis (i.e., radiation injury), and interstitial cystitis, which is related to autoimmune injury. Types of incontinence Type Description Urge incontinence (Most common in older adults) Involuntary loss of urine associated with abrupt & strong desire to void (urgency), often associated with involuntary contractions of detrusor; when associated with neurologic disorder, this called detrusor hyperreflexia; when no neurologic disorder exists, this called detrusor instability, may be associated with decreased bladder wall compliance Stress incontinence (most common in women 60 & men who have had prostate surgery) Involuntary loss of urine during coughing, sneezing, laughing or other physical activity associated with increased abdominal pressure Overflow incontinence Underactive bladder (UAB) is a condition in which the duration or strength of contraction is inadequate to empty the bladder, resulting in distention and overflow incontinence. Involuntary loss of urine with overdistention of bladder; associated with neurologic lesions below S1, polyneuropathies, and urethral obstruction (e.g. enlarged prostate) Mixed incontinence (most common in older woman) Combination of both stress and urge incontinence Functional incontinence Involuntary loss of urine attributable to dementia or immobility Pyelonephritis s/s Glomerulonephritis s/s Acute pyelonephritis s/s: (an infection of one Acute glomerulonephritis: commonly results or both upper urinary tracts) Pyelonephritis is an acute or chronic inflammation of the renal pelvis often related to obstructive uropathies and may cause abscess formation and scarring with an alteration in renal function. (e.g. ureter, renal pelvis, & interstitial) Causes: • Kidney stones • Vesicoureteral reflux • Pregnancy • Neurogenic bladder • Instrumentation • Female sexual trauma Microorganisms: E. coli, Proteus or Pseudomonas S/S: Onset is usually acute: fever, chills, & flank or groin pain. Similar to UTI S/S: • Frequency • Dysuria • Costovertebral tenderness Older adults’ nonspecific symptoms: low-grade fever & malaise Most common condition associated with development of acute pyelonephritis is urinary tract obstruction Chronic Pyelonephritis a persistent or recurrent infection of the kidney leading to scarring of one or more kidneys. from inflammatory damage to the glomerular filtration membrane as a consequence of immune reactions after a streptococcal infection. Primary glomerular injury, Including: Immunologic responses, Ischemia, Free radicals, Drugs, Toxins, Vascular disorder, Infection Glomerulonephritis – 15 yr old – caused post-strep infection Secondary glomerular injury is a consequence of systemic diseases, including: Diabetes mellitus, HTN, Bacterial toxins, Systemic lupus erythematosus, CHF, HIV - related kidney disease Most common causes: an antigen-antibody complex. Immune complex deposition in the glomerular capillaries & inflammatory damage. S/S: May be sudden; silent, mild, moderate, or severe in symptoms Sever or progressive glomerular disease causes: oliguria (urine output of 30ml hour or less), HTN, Renal failure Gross hematuria, edema, & HTN Two major symptoms distinctive of more severe glomerulonephritis are: (1) hematuria with red blood cell casts (2) proteinuria exceeding 3 to 5g/day with albumin (macroalbuminuria) as the major protein. Diabetic nephropathy is the most common cause of glomerular injury progressing to chronic kidney disease. Chronic glomerulonephritis: encompasses several glomerular diseases with a progressive course leading to chronic kidney failure. Common in individuals with renal infections associated with obstructive pathogenic conditions (renal stones & vesicoureteral reflux). (AKA chronic interstitial nephritis) S/S: Early S/S: • Often minimal HTN frequency dysuria Flank pain • Progressing to kidney failure particularly in obstructive uropathy or diabetes mellitus Hypercholesterolemia and proteinuria are associated with progressive glomerular and tubular injury. Diabetes mellitus and lupus are examples of secondary causes of chronic glomerular injury. Renal insufficiency begins 10 – 20 years, followed by nephrotic syndrome, progressing to end-stage renal failure. Dialysis or kidney transplantation ultimately may be needed. IgA = recurrent hematuria Chronic glomerulonephritis is related to a variety of diseases that cause deterioration of the glomerulus and a progressive loss of renal function. Nephrotic syndrome is the excretion of at least 3.5 g of protein (primarily albumin) in the urine per day because of glomerular injury with increased capillary permeability and loss of membrane negative charge. Principal signs: hypoproteinuria, hyperlipidemia, and edema. Vit D deficiency, hypothyroidism, lipiduria, & poroteinuria. The liver cannot produce enough protein to adequately compensate for urinary loss. Characteristics: hematuria and red blood cell casts with less severe proteinuria. S/S: Frothy urine, foaming urine Disorders in Children Glomerulonephritis is an inflammation of Nephrotic syndrome is a term used to describe a the glomeruli characterized by hematuria, edema, and hypertension. The cause is unknown but is often immune mediated. Glomerulonephritis may follow infections, especially those of the upper respiratory tract caused by strains of group A β-hemolytic streptococcus. Increases in glomerular capillary permeability lead to hematuria and proteinuria. IgA nephropathy occurs with deposition of IgA in the glomerulus, causing glomerular injury with gross hematuria. symptom complex characterized by proteinuria, hypoproteinemia, hyperlipidemia, and edema. Metabolic, biochemical, or physiochemical disturbances in the glomerular basement membrane may lead to increased permeability to protein. Urinary tract infections can result from general sepsis in the newborn but are caused by bacteria ascending the urethra in older children. The bladder alone is infected in cystitis. The infection ascends to one or both kidneys in pyelonephritis. Urinary tract anomalies may require surgical correction to prevent frequent recurrent infections. Chronic Renal Failure: the progressive loss of renal function. Acute Renal Failure: Sudden decline in kidney function with decrease in glomerular filtration and UO w/accumulation of nitrogenous waste products in blood demonstrated by elevated in plasma creatinine and blood urea nitrogen levels (BUN). Category GFR criteria Urine Output (UO) Criteria Risk Increased creatinine x 1.5 Or GFR decrease 25% UO 0.5 ml/kg/hr x 6 hr Injury Increased creatine x 2 or GFR decrease 50% UO 0.5 ml/kr/hr x 12 hr Failure Increase creatine x 3 or GFR decrease 75% UO 0.3 ml/kg/hr x 24hr or anuria x 12 hr Loss Persistent ARF – complete loss of kidney function 4 wks ESKD End-stage kidney disease (3 months) In children acute renal caused by hemolytic uremic syndrome (HUS) Prerenal acute kidney injury is caused by decreased renal perfusion with a decreased GFR, ischemia, and tubular necrosis. Intrarenal acute kidney injury is associated with several systemic diseases but is commonly related to acute tubular necrosis (ATN). Postrenal kidney injury is associated with diseases that obstruct the flow of urine from the kidneys. Oliguria is urine output that is less than 400 ml/24 hours. Plasma creatinine levels gradually become elevated as GFR declines; sodium is lost in the urine; potassium is retained; acidosis develops; calcium and phosphate metabolism are altered; and erythropoietin production is diminished. All organs systems are affected by CRF. diabetes mellitus (Most significant risk factor), HTN, or systemic lupus erythematous or intrinsic kidney diseases such as acute kidney injury, chronic glomerulonephritis, chronic pyelonephritis, obstructive uropathies, or vascular disorders anemia = lack of production of erythropoietin Metabolic acidosis develops LOW PROTIEN DIET Hypocalcemia – Bone fractures are at risk Dyslipidemia is common in CKD. High LDL low HDL Causing HTN and atheromatous plague formation ( cardiac diseases) Fluid overload, pulmonary edema Hematologic alteration – anemia RBC Malnutrition, metabolic acidosis and hyperglycemia suppress immune responses Uremic encephalopathy Uremic gastroenteritis – bleeding malnutrition Reduction in testosterone – impotent Oligospermia and germinal cell dysplasia infertility Reduction in estrogen levels, amenorrhea, difficulty staying pregnant – decrease libido Insulin resistance Thyroid hormone metabolism – hypothyroidism T3 levels decrease Primary vs secondary enuresis: Vesicoureteral reflux is the retrograde flow of bladder urine into the kidney or ureter, or both, increasing the risk for pyelonephritis. It can be unilateral or bilateral; primary or secondary. Urinary incontinence is the involuntary passage of urine. It may occur during the day (incontinence) or at night (enuresis), or both. Maturational delay, UTIs, constipation, and many other factors may contribute. Primary incontinence (enuresis) means the child has never been continent Secondary incontinence (enuresis) means the child has been continent for at least 6 months before wetting recurs. Chapters 33 &34 Yeast Vaginitis signs and symptoms: Vaginitis is irritation or inflammation of the vagina, typically caused by infection. It is usually caused by sexually transmitted pathogens or Candida albicans, which causes candidiasis is characterized by increase in WBC on saline wet prep examination. White copius discharge/itching Overgrowth of Candida albicans Dysfunctional uterine bleeding (DUB) is caused by: polycystic ovarian syndrome (PCOS), obesity, and thyroid disease. Dysfunctional uterine bleeding (DUB) is heavy or irregular bleeding in the absence of organic disease. Presenting S/S: Obesity, menstrual disturbance (uterine bleeding), oligomenorrhea, amenorrhea, regular menstrual, hyperandrogenism, infertility, asymptomatic Hormonal disturbances: Increased insulin, decreased SHBG, increased androgen (testosterone, androstenedione) , increased DHEA, Increased LH, increased prolactin, increased leptin Possible late sequelae: Dyslipidemia, diabetes mellites, CVD, endometrial hyperplasia and carcinoma Polycystic ovary syndrome (PCOS) is a condition in which excessive androgen production is triggered by inappropriate secretion of gonadotropins. This hormonal imbalance prevents ovulation and causes enlargement and cyst formation in the ovaries, excessive endometrial proliferation, and often hirsutism. Insulin resistance and hyperinsulinemia plays a key role in androgen excess. S/S Polycystic Ovary Syndrome (PCOS): Most common endocrine disturbances in women. Usually appear within 2 years of puberty, but may be after a period of normal menstrual function and pregnancy. S/S are related to anovulation and hyperandrogenism: Dysfunctional uterine bleeding or amenorrhea, hirsutism, acne, and infertility. (often leads to infertility) HTN and dyslipidemia are frequently found in association with PCOS. Clinical manifestations of PCOS Dermoid cysts: Dermoid cysts are ovarian teratomas that contains elements of all three germ layers: they are common ovarian neoplasms. Contain: Mature tissue of: skin, hair, sebaceous and sweat glands, muscle fibers, cartilage and bone. Dermoid cysts are usually asymptomatic and are found incidentally on pelvic examination. Dermoid cysts have malignant potential and should be removed. Treatment for endometriosis: Endometriosis is the presence of functional endometrial tissue (i.e., tissue that responds to hormonal stimulation) at sites outside the uterus. Endometriosis causes an inflammatory reaction at the site of implantation and is a cause of infertility. Emerging is the relationship between endometriosis and ovarian cancer. Uterus Ca: particularly the endometrium Medical treatment: suppression of ovulation with various medications such as noncyclic estrogen-progestin-combined oral contraceptive pill (COCs), depot medroxy- progesterone acetate (DMPA), danazol, GnRH agonist, mifepristone, or gestrinone, and promotion of atrophy of the endometrium with progestin or an LNG – IUD. Conservative surgical treatment includes laparoscopic removal of endometrial implants with conventional or laser techniques and presacral neurectomy for sever dysmenorrhea. Cervical cancer arises from the cervical epithelium and is triggered by human papillomavirus (HPV). The cellular transformational zone is called the squamocolumnar junction. The progressively serious neoplastic alterations are cervical intraepithelial neoplasia (cervical dysplasia), cervical carcinoma in situ, and invasive cervical carcinoma. Cocarcinogens immune responses, hormonal responses, and other environmental factors that determine regression or persistence of the HPV infection. Primary cancer of the vagina is rare. Risk factors include 60 or older, DES, HPV type 16, HIV, genital warts, and the relationship of developing precancerous cell changes called vaginal intra-epithelial neoplasia (VAIN) is controversial. Risk factors for vulvar cancer include HPV type 16 (cause), HIV, HPV-18 (probable cause), increasing age, previous cancer (untreated high-grade vulvar intraepithelial neoplasia [VIN]), cervical cancer survivor, previous cervical intraepithelial neoplasia, certain autoimmune conditions, organ transplant recipients (perhaps because of immunosuppression to clear HPV), and tobacco use (may relate to inability to clear HPV infection). HPV 16 and HPV 18 are the most important risk factors for cervical disease progression. HPV 16 accounts for 60% of cervical cancer cases. HPV infects immature basal cells of the squamous epithelium in the areas of epithelial breaks or injury, or immature metaplastic squamous cells in the mature squamous cells that over the ectocervix, vagina, or vulva requires damage to the surface epithelium. The cervix is vulnerable to HPV. Testing for a high-risk HPV is often positive for many years (10 or more) before dysplasia progresses to high-grade squamous cells. 90% of cervical cancers can be detected early through PAP smear and HPV testing. Symptoms include: vaginal discharge or bleeding. Bleeding occurs with intercourse or inbetween menstrual. Abnormal menses or post-menopausal bleeding. Common is serosanguineous or yellowish vaginal discharge. New or foul odor. Advanced disease many can urinary or rectal symptoms and pelvic and back pain. Endometrial cancer Carcinoma of the endometrium is the most common type of uterine cancer and most prevalent gynecologic malignancy. Primary risk factors for endometrial cancer include: exposure to unopposed estrogen (e.g. estrogen-only hormone replacement therapy, tamoxifen, early menarche, late menopause, nulliparity – never having children, failure to ovulate), chronic hyperinsulinemia, hyperglycemia, body fatness and adult weight gain, chronic inflammation, lack of physical exercise. (i.e. PCOS and anovulatory cycle typical of the late reproductive years). Risks: Type II diabetes. Long-cycle estrogen and progestin hormone replacement therapy (HRT) 95% of endometrial cancers occur in postmenopausal women. Peaks late 50’s and 60s. Lone dietary factor to decreasing risk is drinking coffee regularly. Endromtrial hyperplasia is associated with prolonged estrogenic stimulation of endometrium. Most common clinical manifestation is abnormal vaginal bleeding. Pain and weight loss are advanced s/s Phimosis – and paraphimosis are both disorders in which the foreskin (prepuce) is too tight to move easily over the glans penis. The inability to retract the foreskin is normal in infancy and is caused by congenital adhesions. During the first 3 years of life, congenital adhesions (between the foreskin and glans) separate naturally with penile erections and are not an indication for circumcision. Phimosis can occur at any age is most commonly caused by poor hygiene and chronic infections. Reasons for seeking treatment include edema, erythema, and tenderness of the prepuce and purulent discharge; inability to retract the foreskin is a less common complaint. Phimosis is a condition in which the foreskin cannot be retracted back over the glans. Peyronie disease – (bent nail syndrome) is a fibrotic condition that causes lateral curvature of the penis during erection. Difficulty having sex his penis curves during erection Peyronie disease develops slowly, affects middle -aged men and is associated with painful erection, painful intercourse (for both partners) and poor erection distal to the involved area. Peyronie disease consists of fibrosis affecting the corpora cavernosa, which causes penile curvature during erection. Fibrosis prevents engorgement on the affected side, causing a lateral curvature that can prevent intercourse. Balanitis is an inflammation of the glans penis and usually occurs in conjunction with posthitis, an inflammation of the prepuce. It is associated with poor hygiene and phimosis. It is associated with phimosis, inadequate cleansing under the foreskin, skin disorders, and pathogens (e.g., Candida albicans). Urethritis: Disorders of the urethra include urethritis (infection of the urethra) and urethral strictures (narrowing or obstruction of the urethral lumen caused by scarring). Most cases of urethritis result from sexually transmitted pathogens. Urologic instrumentation, foreign body insertion, trauma, or an anatomic abnormality can cause urethral inflammation with or without infection. Urethritis causes urinary symptoms, including a burning sensation during urination (dysuria), frequency, urgency, urethral tingling or itching, and clear or purulent discharge. The scarring that causes urethral stricture can be attributed to trauma or severe untreated urethritis. Caused by Neisseria gonorrhoeae most of the time. Gonoccocal urethritis (GU) Nongonoccal urethritis: other microorganisms. S/S: Urethral tingling or itching or burning sensation, frequent / urgency urination. Purulent or clear mucous-like discharge. Epididymitis: Inflammation (ball sac). Epididymitis, an inflammation of the epididymis, is usually caused by a sexually transmitted pathogen that ascends through the vasa deferentia from an already infected urethra or bladder. Occurs in sexually active young male (35) Rare before puberty Usually cause in young men – STDs N. gonorrhoeae or C. trachomatis. Coliform bacteria common pathogen other age groups. Unprotected anal sex – Escherichia coli, Haemphilus influenza, tuberculosis, or Crytoccous or Brucella species. Older men 35, Enterobacteriaceae (intestinal bacteria) & Pseudomonas aeruginosa UTI bacteria and prostatitis. S/S: The main symptom is scrotal or inguinal pain caused by the inflammation. Pain is usually acute & severe Flank pain may occur with edematous swelling of the urethra cord and obstruction. Pyuria, bacteriuria, and urethral discharge. Scrotum will be red and edematous. Prostatitis is inflammation of the prostate. Prostatitis syndromes have been classified by the National Institutes of Health as (1) acute bacterial prostatitis (ABP), (2) chronic bacterial prostatitis (CBP), (3) chronic pelvic pain syndrome (CPPS), and (4) asymptomatic inflammatory prostatitis. signs and symptoms Inflammation of prostate (similar to UTI) Sudden onset of malaise, low back and perineal pain, high fever [104], and chills is common, as are dysuria, inability to+ empty the bladder, nocturia, and urinary retention. Syphilis infection raises the risk of acquiring and transmitting HIV infection. Half of MSM with syphilis also are infected with HIV. Treponema pallidum – organism causing syphilis Chlamydia intreated and undertreated chlamydial infections are the primary cause of preventable infertility and ectopic pregnancy. Chlamydia is caused by Chlamydia trachomatis Chapters 36 & 37 Abdominal pain is caused by stretching, inflammation, or ischemia (insufficient blood supply). Abdominal pain originates in the organs themselves (visceral pain) or in the peritoneum (parietal pain) and can be acute or chronic. Visceral pain is often referred to the back. Obvious manifestations of gastrointestinal bleeding are hematemesis (vomiting of blood), melena (dark, tarry stools), and hematochezia (frank bleeding from the rectum). Occult bleeding can be detected only by testing stools or vomitus for the presence of blood. Dysphagia is difficulty swallowing. It can be caused by a mechanical or functional obstruction of the esophagus. Functional obstruction is an impairment of esophageal motility. Achalasia is a form of functional dysphagia caused by loss of esophageal innervation. Gastroesophageal reflux disease is the regurgitation of chyme from the stomach into the esophagus, resulting in an inflammatory response (reflux esophagitis) when the esophageal mucosa is repeatedly exposed to acids and enzymes in the regurgitated chyme. Gastritis is an acute or chronic inflammation of the gastric mucosa. Occurrence of (GER) is highest in the premature infants – within the pediatric population Signs/symptoms of Wilson Disease: Metabolic disorder autosomal recessive: defect on chromosome 13 (ATP 7B) Decrease copper excretion, leading to deposition of copper in the liver (can lead to cirrhosis), brain (which can cause movement disorders), and/or the eyes (which can result in Kayser Fleischer ring. Liver biopsy demonstrating excess copper can confirm the diagnosis. One of the four most common metabolic disorder that cause liver damage in children. Inherited as genetic traits and allow toxins to accumulate in the liver. S/S: Intention tremors, indistinct speech, dystonia, greenish/yellow rings in cornea, hepatomegaly, jaundice, anorexia, renal tubular defects Intussusception: is a condition in which one portion of the bowel telescopes, or invaginates, into another, most commonly in the area of the ileocecal junction, and causes obstruction. The telescoping of proximal segment of intestine into a distal segment, causing an obstruction. Abdominal pain, irritability, & vomiting followed by passing of “currant jelly” stools. Ultrasound reveals intestinal obstruction-the ileum collapsed through the ileocecal valve. Classic symptoms: Colicky abd pain, irritability, knees drawn up to chest, abd mass, vomiting, & bloody (Currant jelly) stools. Definition of GERD is the reflux of acid and pepsin or bile salts from the stomach into the esophagus that causes esophagitis. Can be painful (e.g. heartburn, sour taste in the mouth, chest pain) and it is typically worse when bending over or when lying down after eating. Complications of GERD: Esophagitis, Barrett esophagus (BE), Cough, recurrent otitis media (OM). Gastroesophageal reflux disease is the presence of symptoms related to the return of stomach contents into the esophagus caused by relaxation or incompetence of the lower esophageal sphincter that results from immaturity of the gastroesophageal sphincter. Definition of reflux esophagitis Reflux esophagitis is an esophageal mucosal injury that occurs secondary to retrograde flux of gastric contents into the esophagus. Clinically, this is referred to as gastroesophageal reflux disease (GERD). Typically, the reflux disease involves the distal 8-10 cm of the esophagus and the gastroesophageal junction Adenocarcinomas are more prevalent in males and are associated with GERD Hiatal hernia is the protrusion of the upper part of the stomach through the hiatus (esophageal opening in the diaphragm) at the gastroesophageal junction. Hiatal hernia can be sliding or paraesophageal. Hiatal hernia are often asymptomatic. Generally, a wide variety of symptoms develop later in life and are associated with other gastrointestinal disorders, including GERD. Symptoms include: Heartburn, regurgitation, dysphagia, and epigastric pain. Ischemia from major complication is hernia strangulation causes acute, severe chest or epigastric pain, nausea, vomiting and GI bleeding.