NRNP 6550 Final EXAM WITH ANSWERS |\ |\ |\ |\ |\
Urine culture with UTI
|\ |\ |\
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
|\ |\ |\ |\ |\ |\ |\ |\
bladder and urethra: cystitis/ urethritis/ prostatitis
|\ |\ |\ |\ |\
kidney and ureters: pyelonephritis/ renal abcess
|\ |\ |\ |\ |\
Uncomplicated and complicated uti |\ |\ |\
Uncomplicated: in normal working urinary tract |\ |\ |\ |\ |\
Complicated: defects in urinary tract or with other health |\ |\ |\ |\ |\ |\ |\ |\ |\
problems
,Common pathogens for UTI |\ |\ |\
E.coli (elderly women)
|\ |\
Staphylococcus
proteus mirabilis (elderly men)
|\ |\ |\
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized) |\
Fungus: candida |\
Risk factors for UTI
|\ |\ |\
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 |\
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 |\ |\ |\ |\
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 |\ |\
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!) |\
Urine culture with UTI
|\ |\ |\
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
|\ |\ |\ |\ |\ |\ |\ |\
bladder and urethra: cystitis/ urethritis/ prostatitis
|\ |\ |\ |\ |\
kidney and ureters: pyelonephritis/ renal abcess
|\ |\ |\ |\ |\
Uncomplicated and complicated uti |\ |\ |\
Uncomplicated: in normal working urinary tract |\ |\ |\ |\ |\
Complicated: defects in urinary tract or with other health |\ |\ |\ |\ |\ |\ |\ |\ |\
problems
,Common pathogens for UTI |\ |\ |\
E.coli (elderly women)
|\ |\
Staphylococcus
proteus mirabilis (elderly men)
|\ |\ |\
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized) |\
Fungus: candida |\
Risk factors for UTI
|\ |\ |\
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 |\
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 |\ |\ |\ |\
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 |\ |\
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!) |\
