ATI MED SURG STUDY GUIDE - Verified Study Guide 2021

ATI MED SURG STUDY GUIDE Urinary System: ch. Chapters 65-66 -UTI- assessment findings, nursing interventions/treatment, prevention, urinalysis results/lab results. Cystitis vs pyelonephritis. ● UTI: infection occurring in any area of the urinary tract and kidney. Bacteria (sometimes fungi) move up urinary tract from external urethra to bladder to cause infectious cystitis. Less commonly spreads through blood and lymph. Invading bacteria with special adhesions are more likely to cause ascending UTIs that start in urethra/bladder and move to ureters/kidneys ○ 90% of UTIs are caused by E.coli but can also be caused by Staph, klebsiella pneumoniae, or Candida ○ Uncomplicated UTI = no anatomic or functional abnormality of the urinary tract or condition that increases the risk for infection or possibility of treatment failing to resolve infection ○ Factors that contribute to complicated UTI = pregnancy, male gender, obstruction, diabetes, neurogenic bladder, CKD, reduced immunity ○ Risk factors: obstruction (urine pools and bacteria grows), stones obstructing urine flow, diabetes mellitus (excessive glucose in urine provides for bacterial growth), women: use of douches, diaphragms, perfumed toilet paper, bladder displacement during pregnancy; men: enlarged prostate; elderly, sexual intercourse, recent use of antibiotics ○ Assessment: frequency, urgency, and dysuria are common symptoms of a UTI; cloudy, foul smelling, blood-tinged urine; changes in LOC in the elderly, have patient void urine before physical assessment, assess vital signs, palpate bladder for distention after emptying, check for vaginal discharge and irritation, check prostate in men. ○ Urinalysis/lab results: Clean-catch urine specimen in two containers, one is used for urinalysis to check for positive leukocyte esterase and nitrate (68-88% sensitive in diagnosis of UTI) and presence of WBCs, RBCs, and casts in urine (indicative of a UTI) and the other is analyzed as a urine culture if UTI is complicated ■ UTI is confirmed when more than 10^5 (10^3 in non-catheterized patients) colony-forming units/mL are in the urine from the patient in urine culture ■ "Left shift” in WBCs indicate reduced immunity, most often occurs with urosepsis and rarely with uncomplicated cystitis