Final Exam Adult study Renal function Overview powerpoint, study!!!EXAM!!!

Final Exam Adult Make sure to look at A&P of kidney. Final: omn 17th, all day open, 75 Qs, 50:50%, please see the study guide Make sure to study Renal function Overview powerpoint, study!!!EXAM!!! 1. Cystitis/UTI • Cystitis is usually bladder leading from UTI and UTI is the actual urinary tract. They are interchangeable. Don’t worry so much about the term. But do know that just the first sentence. • Second most common bacterial disease and the most common bacterial infection in women • (anatomical reasons for it; the short urethra and the location of the urethral opening associated with peritoneum and also hygiene practices that predispose women to increase the risk of urinary tract infection and cystitis, also sex activity). • Pregnant woman at increased risk • Esp, pyelonephritis, cystitis, UTI cuz later trimestry they can’t empty their bladder completely. Pregnant women with cystitis should be treated right away, bc of high risk of pyelonephritis. • **individual w/DM has higher risk of getting it. • Due to physiological changes; hormones and pressure in the bladder from the enlarging uterus, which affect how the bladder can empty. Hence thesis of urine increases the chances of infections. • E.coli most common pathogen • Bacteria like to be in a warm moist dark environment hence replicate and grow rapidly. They also use sugar as food source. That’s why increased chance of UTI in Debates or obesity. • **UTI is infection of urethral lining (urethritis), but sometimes cystitis and urethritis are interchangeably used. Classification (different types of diseases that affect UTI) - **It’s important when we refer to lower vs. upper UTI.. what that means and how that affects treatment. • Pyelonephritis – It is seen as upper UTI, often consequence of unresolved or uncontrolled lower UTI. inflammation of the renal parenchyma and collecting system.. it’s a consequence of having lower UTI .. so complication of lower UTI is pyelonephritis • Cystitis – inflammation of the bladder walls • Urethritis – inflammation of the urethra.. Acutal UTI • Urosepsis – UTI that has spread into the systemic circulatory system • Regardless of lower or upper UTI, this UTI speeded to the systemic circulatory system and develops widespread blood septicemia. • We don’t want this to happen. Pt can have septic shock. With infections, esp UTI if not taken care of, esp older ppl, then they can end up with urosepsis (shock type state where hemodynamic changes, drop in BP, tachycardiac,, increase in temp) • Drop in BP less than 90/60? Or drop in individual baseline BP – YES to both. 120/80… -?>108/50……. You gotta look at the whole presentation.. -> tachycardic 80->120.. NCLEX – we look at clinical presentation so not only bp dropping, heart rate, resp rate, change in LOC, mean arterial pressure • Uncomplicated infections occur in an otherwise normal urinary tract and usually only involve the bladder • Isolation involving the bladder only. And short period of time that antibiotics should be used to treat • Complicated infections include those with co-existing presence of obstruction, stones, catheters; existing diabetes or neurologic changes (They can’t empty at all due to neurological defects, so they have to be catherlized -> can cause complications) , pregnancy- induced changes, or an infection that is recurrent-> affects how bladder empties • ** what’s important to defer is to differentiate signs and symptoms that correlate an upper UTI and s/s that correlates lower UTI. • **What correlates with upper UTI is more important. • For exam purpose, know the different s/s of lower and upper UTIs!!! • Complicated vs. uncomplicated TEST!!!! Etiology of cystitis/UTI (causes) • Urinary tract above the urethra is sterile (and urethra itself is sterile) • Risk factors: Elderly, DM, lower immune system, indwelling cat, badder issues, prostate problem, pregnant women • Physiologic defense mechanisms to assist in maintaining sterility include normal, frequent voiding with complete emptying of the bladder, ureterovesical junction competence and peristaltic activity that propels urine toward the bladder • This ureterovesical junction is an area that allows urine to flow forward and dose not allow for reflux back up into the ureters and the kidney. (one way valve) • Peristaltic action that propels urine toward the bladder also prevents bacteria from growing and replicating as urine pushes forward. • Antibacterial characteristics of urine –Urine is in acidic pH, glycoproteins that interfere with the growth of bacteria • Low pH decreases for bacteria to adhere to the walls of bladder and urethra, also decreases replication of the bacteria. • A lot of bacteria do not like acidic environment. • Anytime that urine is allowed to stagnate, stay static or stasis inside the bladder, it allows the bacteria to grow and replicate. Dark moist areas for bacteria. Think of those who are predisposed are at urinary retention. So retention means the inability to avoid completely. So you keep retaining small amounts of urine in your bladder over time without complete emptying. Those w/neurogenic conditions such as stones in the ureters or uretra then can cause complicated UTI in terms of treatments. • Anytime these physiological defense mechanisms are disrupted or impaired, it will predispose for the risk of UTI • When we think of urinary catheter, we think of Cauti (catheter UTI), which is nosocomial hospital acquired infection. We are introducing this to the pts as a result of our technique without maintaining sterility or asepctic technique. This is not insurance covered cuz it’s from the hospital. • Prolonged insertion of catheter caused widespread of UTI and urosepsis. So it is not used as primary practice anymore. Evidence shows that there has been increased risks. So we use for a couple days or for a week. So the pt moves to the bathroom and pees. Or they just pee in the diapeprs. • Propell -> moving urine forward… • Acidic environment in pH helps killing bacteira. Bacteria likes basic environment. • Anytime retained in the bladder, urinary retention allows the environment for the bacteria to grow and repliacate.. • Men with prostate issues.. prostate can press the urethra so can cause urinary retention -> UTI • Mysthesia gravis can also cause UTI.. -_-? • Douching also can disrupt pH in the vaginal area and cause UTI Pathophysiology for cystitis/UTI • Organisms are introduced via the ascending route form the urethra and originate in the perineum… this is why we see E.coli is the dominant infecting bacteria related to the relative location and hygiene practices. An access point to the opening. • Other less common routes include via the blood stream or lymphatic system • A common factor attributing to infection is urologic instrumentation exam (OBGYN and Cathter) and sexual intercourse • Nosocomial (HAI’s) infections – catheter acquired (CAUTIs) most common • So don’t put it for unnecessary reason or remove it soon. • Don’t use foley cats anymore due to increased infection ..........................................continued....................................................