Lab 10 - UTI/Sepsis

What are urinary tract infections (UTIs)?

An infection that occurs in any area of the urinary tract and the kidneys.

What is the most common pathogen causing urinary tract infections?

Escherichia coli

What factors influence the virulence of the causative agent in UTIs?

The ability to gain access and thrive in the urinary tract.

What do you call it when the patient has bacteriuria but no symptoms of infection?

Colonization or asymptomatic bacteureia.

What are some risk factors for developing UTIs?

Immunosuppression, diabetes, multiple courses of antibiotic treatment, and travel to certain developing countries.

What are 2 classifications of UTI based on location?

Upper and lower

Lower tract UTI is more dangerous that upper tract UTI d/t systemic s/s (True/False).

False

What is included in the upper urinary tract?

Kidney and ureters.

What is included in the lower urinary tract?

Bladder and urethra.

What are common symptoms of upper tract UTIs?

Fever, flank pain, chills/rigors, malaise, costovertebral angle tenderness, and pelvic and/or perineal pain.

What is pyelonephritis?

An upper tract UTI that causes inflammation of the renal parenchyma and collecting system.

What is cystitis?

A lower tract UTI that causes inflammation of the bladder wall.

What are 2 classifications of UTI based on severity?

Uncomplicated and complicated

How are uncomplicated UTIs classified?

They occur in otherwise a normal urinary tract and usually only involves the bladder

How are complicated UTIs classified?

They occur in individuals with coexisting conditions such as obstruction, stones, catheters, diabetes, or neurological diseases.

What are some defense mechanisms that maintain sterility in the urinary tract?

Peristaltic activity, acidic pH of urine, high urea concentration, abundant glycoproteins, complete emptying of the bladder, and ureterovesical junction competence.

Which part of the urinary tract is unsterile?

Distal urethra.

What are less common routes for organisms to cause UTIs?

Bloodstream and lymphatic system.

What predisposing factors increase the risk of contracting a UTI?

Urinary stasis due to BPH, tumors, neurogenic bladder, and foreign bodies like catheters.

What is a common cause of hospital-acquired UTIs?

E. coli and Pseudomonas, often associated with catheter use.

What are some common s/s of UTIs?

Urinary frequency, dysuria, retention, urgency, incontinence, flank pain, chills, fever, nocturia, nocturnal enuresis, and painful voiding.

What are the 3 hallmark s/s of UTIs?

Frequency, dysuria, and urgency

How do symptoms of UTIs differ in older adults?

Symptoms are often absent, may include nonlocalized abdominal discomfort, cognitive impairment, and are less likely to present with fever.

What diagnostic tests are used for UTIs?

History and physical examination, dipstick urinalysis, culture and sensitivity (C&S), and imaging studies like CT or IV Pyelogram.

Which values are we looking for in dipstick urinalysis with regards to a UTI?

Nitrites, WBCs, and leukocytes.

Nitrites are converted into nitrates in the urine by bacteria (True/Flase)

False

Which diagnostic assessments are used when urinary retention and obstruction are suspected to be the cause of a UTI?

Pelvic ultrasound or CT scan.

Which diagnostic assessments are used when urine reflux is suspected to be the cause of a UTI?

Voiding cystourethrography.

Which diagnostic procedure is used when a patient has recurrent UTIs?

Cystoscopy.

What is the recommended duration for treating uncomplicated cystitis?

1 to 3 days.

What is the recommended duration for treating complicated UTIs?

7 to 14 days.

What is the first-line antibiotic treatment for uncomplicated UTIs?

Trimethoprim/sulphamethoxazole (TMP/SMX).

What is the first-line antibiotic treatment for long-term treatment of UTIs?

Nitrofurantoin.

What is the first-line antibiotic treatment for complicated UTIs?

Fluoroquinolones like diprofloxacin.

Which UTI patients are hospitalized?

Those with severe infections and complications, such as nausea and vomiting with dehydration.

What is the expected timeline for symptom improvement after starting UTI therapy?

Within 48 to 72 hours.

What are some main nursing interventions for a patient with UTI?

- Emptying bladder completely and frequently

- Evacuating bowel regularly

- Wiping perineal area from front to back

- Drinking adequate fluids

- Washing hands before and after contact

- Wearing gloves

- Routine perineal care

- Regular toileting

- Answering call light as soon as possible

- Application of local heat

How much fluid should patients with UTI drink?

33ml/kg.

Which foods and drinks should be avoided for someone with a UTI?

Caffeine, alcohol, citrus, chocolate, and spicy foods.

What is bacteremia or urosepsis?

A systemic infection caused by a urological cause.

What is sepsis?

An extreme response to infection that can cause tissue damage, organ failure, and death

What commonly causes sepsis?

Gram positive and gram negative bacteria.

Sepsis can progress to severe sepsis and then septic shock (True/False).

True

What is a septic shock?

A subset of sepsis in which circulatory, cellular, and metabolic abnormalities substantially increase the risk of death.

What are the 2 components of septic shock?

Systemic inflammatory response syndrome and multiple organ dysfunction syndrome.

What are 2 phases of septic shock?

Warm shock and cold shock.

What is warm shock?

The early phase of septic shock when there is low systemic vascular resistance and normal or increased cardiac output with warm extremities and reduction in capillary refill.

What is cold shock?

The late phase of septic shock where peripheral vascular resistance increases in order to shunt blood away from nonvital organs to vital organs.

What increases during sepsis?

Temperature, heart rate, respiratory rate, lactate, and WBCs.

What decreases during sepsis?

Blood pressure and urine output.

What are some non-specific s/s of sepsis or septic shock for older adults?

Altered mental status, lethargy, agitation, irritability, dizziness, weakness, loss of appetite, dehydration, incontinence, and tachypnea

What should be done within one hour that sepsis is suspected?

Measure lactate levels, collect blood cultures, administer broad-spectrum antibiotics, and begin fluid replacement if needed.

You should start the patient on antibiotics first before collecting blood culture for someone with suspected sepsis (True/False).

False

When should you start a septic patient on fluid replacement therapy?

When they're hypotensive or have a lactate level >4mmol/L

What should you do if a septic patient is still hypotensive after fluid replacement therapy?

Apply vasopressors to keep MAP >65.

What are the laboratory hallmarks of sepsis?

A rising serum procalcitonin level, an increasing serum lactate level, a normal or low total white blood cell (WBC) count, and a left shift.

What is a left shift?

Increased numbers of immature neutrophils in the blood.