Project #91048 - Responses

Wk10 Responses

 

Response # 1 to Jennifer Shah

 

Initial Discussion Post

The urinary tract is comprised of the urethra, the bladder, the ureters, the kidneys, and the prostate in men (Huether & McCance, 2012).  Like most parts of the body, the urinary tract can be infected by invading microorganisms.  Each year, 10 million people will see their primary care provider regarding a possible urinary tract infection (UTI) (National Kidney Foundation, 2015). 

Lower Urinary Tract Infection

Most infections involve the lower tract, the urethra and the bladder (Mayo Clinic, 2015).  Cystitis is an infection of the bladder and is the most common site for colonization and urethritis is infection of the urethra (Mayo Clinic, 2015). Bacteria and other microorganisms enter the urethra and travel upwards and colonize.  Common microorganisms include Escherichia coli, Staphylococcus saprophyticus, Klebsiella, Proteus, Pseudomonas fungi, viruses, parasites or tubercular bacilli (Huether & McCance, 2012).  The urine, which is normally sterile, is now infected and the bacteria cannot be flushed out during micturition (Huether & McCance, 2012). 

Upper Urinary Tract Infection

            Pyelonephritis is an infection of the upper tract consisting of the ureter and kidney.  Some of the same bacteria that causes lower UTIs travel in an ascending manner causing an upper UTI, but bloodborne bacteria may also cause pyelonephritis (Huether & McCance, 2012).  The inflammation from the infection affects the pelvis, calcyes, and the medulla (Huether & McCance, 2012).  Infection leads to medullary infiltration of white blood cells (WBC) with the inflammation, edema, and purulent urine (Huether & McCance, 2012).  Upper UTIs are less common as most people have the infection treated while the bacteria are still in the bladder.  

Similarities and Differences

            The invading microorganisms for both types of infection are often the same due to the ascending nature of the infections.  Some common offenders are E. coli, Proteus, and Pseudomonas (Huether & McCance, 2012).  Symptoms are often similar but can vary slightly depending on location and in some cases, patients do not present with symptoms.  Symptoms of lower UTI often include burning while urination, frequency, hematuria, odor, pain, and cloudy urine (Mayo Clinic, 2015).   With upper UTIs, symptoms are often the same as lower UTIs but also include fever, chills, flank pain, and malaise (Huether & McCance, 2012). 

Gender and Behavior

            While UTIs do affect men, they are more common in women.  This is often contributed to anatomy as a woman’s urethra is close to the vagina and anus and the length of the urethra is shorter than in a man.  Young girls are often taught how to wipe after a bowel movement to prevent bacteria transfer from the anus to the urethra.   Women are often taught that certain risk factors will make them more prone to UTIs include douching, pre and post coital voiding patterns, tight and restrictive clothing and holding their bladder, but Kodner and Thomas Gupton (2010) disagree.  Kodner and Thomas Gupton (2010) suggest the frequency of intercourse is the strongest risk factor for recurrent UTIs. 

            Diagnosis of a UTI requires urine analysis/culture and sometimes a blood sample as well (National Kidney Foundation, 2015).   Once the microorganism is isolated, proper medication can be prescribed.  Common antibiotics treat common bacteria and the dose and course can be determined by how complicated the UTI is.  Huether and McCance (2012) state three day courses of antibiotic therapy is sufficient for an uncomplicated UTI with three to seven days being the most common.  Complicated UTIs can require seven to fourteen days of treatment (Huether & McCance, 2012).  Hydration and pain relievers are also prescribed (National Kidney Foundation, 2015).   It is not uncommon for urine to be cultured again after the course of antibiotics is complete (Huether & McCance, 2012).   Because women are more prone to UTIs then men, there is a risk for antibiotic resistance, so repeat cultures may be necessary as well as teaching the importance of completing the entire course of medication.

References

Huether, S., & McCance, K. (2012). Understanding pathophysiology (Laureate Custom ed.). St. Louis, MO: Mosby.

Kodner, C., & Thomas Gupton, E. (2010). Recurrent urinary tract infections in women: diagnosis and management. American Family Physician, 82(6), 638-643.

Mayo Clinic. (2015). Urinary Tract Infection (UTI). Retrieved from http://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/basics/definition/con-20037892

National Kidney Foundation. (2015). Urinary Tract Infections. Retrieved from https://www.kidney.org/atoz/content/uti

 

Response # 2 to Chelsea Van Rooy

 

Urinary Tract Infections

Chelsea Van Rooy

Main Discussion Post

            Urinary tract infections can range from acute cystitis, to acute and chronic pyelonephritis (Heuther & McCance, 2012). The purpose of this discussion is to review the pathophysiology of upper and lower urinary tract infections (UTI). The discussion will then cover how age and gender affect the pathophysiology, diagnosis, and treatment of UTI’s.

Pathophysiology of Urinary Tract Infections

            According to Heuther and McCance (2012), UTI’s begins as a bacterium that invades urinary epithelium and causes inflammation. Acute cystitis causes inflammation of the bladder that may range from a mild inflammatory state to full ulceration and necrosis (Heuther & McCance, 2012). Cystitis is usually caused by bacterial contamination of normally sterile urine (Heuther & McCance, 2012). Escherichia coli (E. coli) is the most common offending bacterium (Heuther & McCance, 2012). Clinical manifestations can include bladder and flank pain, frequency, urgency, as well as bacteriuria and pyuria (McPhee & Hammer, 2012).

            Pyelonephritis occurs when there is infection and inflammation of the ureter, kidney, or interstitium (Heuther & McCance, 2012). Causes of pyelonephritis may include obstruction and urinary reflux (Heuther & McCance, 2012). Like cystitis, pyelonephritis can be caused by E. coli, as well as Proteus, and Pseudomonas (Heuther & McCance, 2012). Renal tubules are primarily affected and healing causes fibrosis and atrophy (Heuther & McCance, 2012). Clinical manifestations are similar to cystitis and can include fever, chills, flank and groin pain, dysuria, and malaise (Heuther & McCance, 2012).

Diagnosis and Treatment

            Diagnosis of cystitis consists of urine samples cultured for varying microorganisms (Heuther & McCance, 2012). Urine is also checked for leukocyte esterase and nitrate reductase (Heuther & McCance, 2012). Microorganism specific antibiotics are prescribed based on urine sampling results (Heuther & McCance, 2012). Antibiotic therapy may last from three days to 14 days (Heuther & McCance, 2012). Repeat cultures should be collected to ensure eradication of the bacteria (Heuther & McCance, 2012).

            Diagnosis of pyelonephritis begins the same as procedures for cystitis. Differentiating between the two can be difficult (Heuther & McCance, 2012). Physical exam findings, as well as white blood cells in the urine, can be a determining factor (Heuther & McCance, 2012). Blood cultures and urinary tract imaging may also be needed (Heuther & McCance, 2012). Usual treatment involved 2-3 weeks of microorganism specific antibiotics and follow-up urine cultures (Heuther & McCance, 2012).

Age and Gender

            Our older generations are more susceptible to the effects of infection. According to Armstrong (2015) a “lack of physiologic reserve (frailty) and 50 % less total body water” contribute to a higher risk of dehydration and confusion in older adults (p. 226). The elderly may have symptoms such as urinary incontinence, offensive urine, and increased the incidence of falls (Armstrong, 2015).  In addition to regular diagnostic and treatment procedures, the elderly should be monitored for intake and urine output. The elderly may also be at higher risk for UTI due to an increased use of catheters and improper insertion hygiene (Armstrong, 2015). Treatment considerations for the elderly should include proper hydration. Drug interactions and multiple comorbidities should also be considered when prescribing medications. The patient’s history and lifestyle should be taken into account. Education about proper hygiene and catheter care may be needed.

            Females are more at risk for UTI’s due to their shorter urethras and the proximity of the urethra to the anus (Heuther & McCance, 2012). Diagnosis is similar between genders but treatment plans differ. Treatment for females includes short-term antibiotics with urine rechecks (Armstrong, 2015). UTI’s in men are uncommon and often call for a week long course of antibiotics and often a referral to urology (Armstrong, 2015). As always, a proper history and physical exam should be taken into consideration.

Conclusion

            UTI’s are a common occurrence, especially in the female population. According to Heuther and McCance (2012), 50% of women will have a UTI in their lifetime. Advanced practice nurses should understand the pathophysiology, diagnosis, and treatment options for these infectious processes. Age and gender should be taken into account when treating a patient with UTI.  

References

Armstrong, K. (2015). Diagnosing and treating urinary tract infections in older people. British Journal of Community Nursing, 20 (5), 226-230). Retrieved from http://www.jcn.co.uk/

Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.

McPhee, S. J., & Hammer, G. D. (2012). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.

 

 

 

 

Subject Medicine
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