NRNP 6550 FINAL EXAM

NRNP 6550 FINAL EXAM Urine culture with UTI Correct answer- 100.000 colonies in asymptomatic: bacteruria 10 - 10.000 colonies in symptomatic patients but also pyuria pyuria: more than 10 leukocytes elevated erythrocytes with pyelonephritis WBC in urine false positive with tumor, urethritis and poor collection technique Repeat in pregnant women Lower urinary tract UTI and upper urinary tract UTI Correct answer- bladder and urethra: cystitis/ urethritis/ prostatitis kidney and ureters: pyelonephritis/ renal abcess Uncomplicated and complicated uti Correct answer- Uncomplicated: in normal working urinary tract Complicated: defects in urinary tract or with other health problems Common pathogens for UTI Correct answer- E.coli (elderly women) Staphylococcus proteus mirabilis (elderly men) Klebsiella enterecoccus pseudomonas Providencia (institutionalized) Fungus: candida Risk factors for UTI Correct answer- Female critically ill elderly catheter (caused by biofilm) DM calculi, tumor, stricture neurogenic bladder Women: sexual intercourse or new sex partner pregnancy previous UTI Men: prostate enlargement prostatitis lack of circumcision gay HIV Findings UTI Correct answer- Lower: Dysuria/ urgency/ frequency/ incontinence suprapubic pain hematuria fever/ chills uncommon No flank pain Upper: flank pain fever and chills hematuria n/v ams (in elderly) malaise tachycardia/ tachypnea Testing and results for UTI Correct answer- Gold standard: urine culture and sensitivity: detection of bacteria. Start with POC: urine analysis. UA: pos for nitrite or leukocyte or blood CBC: leukocyte with left shift in pyelonephritis For recurrent UTI in women or UTI in men rule out obstruction, calculi, or necrosis with: xr voiding CT abdomen US pelvis MRI pelvis Management acute cystitis Correct answer- First line: - Single dose Fosfomycin (monurol) - 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby, give cephalexin instead) or sulfa - 5 days: nitrofurantoin, caution in elderly Second line: - qiunolones: ciprofloxain or levofloxacin for 3 days (not for pregnant women!) - B-lactams: amoxi-clav, cefdinir for 3 - 7 days Management uncomplicated upper UTI Correct answer- Outpt: quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days Sulfa: trimethoprim/ sulfa (bactrim) for 14 days Inpt: Ceftriaxone or cefotaxime Ampicillin CAUTI: bacterial: treat with AB for 7 days Candiduria: fluconazole for 14 days Discomfort: Pyridium Management acute complicated bacterial pyelonephritis Correct answer- - Admit - Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on renal function (trough less than 2 and peak level 5-10mg/L) and do not give for CKD - Ampicillin - Cefazolin - Cefotaxime and Ceftriaxon based on obesity and pulm disease Urine analysis: glucose and ketones Correct answer- Serum glucose at least 180mg/dl for glucose to appear in urine Glucose in ua caused by: - Fancone Syndrome (bad wall: caused by ahminoglycosides for example) - DM - Cushing's - Vit C can give false negative Ketones in urine: - Alcohol - Diabetic - Starvation Acute Kidney Injury Correct answer- -Acute renal function loss with inability to excrete metabolic waste products (urea nitrogen and creatinine) to inability to maintain fluid and electrolyte balance. - Resolves within 3mo - classified with RIFLE or etiology RIFLE Correct answer- Risk: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO less than 0.5ml/kg/hr for 6hr Injury: creatinine up x 2 from baseline, GFR decrease more than 50% and UO less than 0.5ml/kg/hr for 12hr Failure: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO less than 0.3ml/kg/hr for 12hr or anuria for 12hr Loss: Complete loss of renal function for more than 4 weeks