Final Exam: NR570/ NR 570 (Latest 2024/ 2025 Update) Common Diagnosis & Management in Acute Care Review| Questions and Verified Answers| 100% Correct |Grade A – Chamberlain
Final Exam: NR570/ NR 570 (Latest 2024/
2025 Update) Common Diagnosis &
Management in Acute Care Review|
Questions and Verified Answers| 100%
Correct |Grade A – Chamberlain
Q: UA
Answer:
WBC and Nitrite=(gram (-) convert nitrate into nitrite) high indicators of UTI
in what test
Q: possible contamination
Answer:
urine sample. (squamous epithelial cells) indicates
Q: Casts
Answer:
indicates severe renal disease. other then hyaline cast
Q: Glomerulonephritis, Renal infarction, collagen vascular disease, or sub- acute bacterial
endocarditis
Answer:
presence of edema, weight gain, brown urine, or hypertension. can indicate what
Q: RBC casts
Answer:
(bleeding in the glomeruli if you find
Q: Renal parenchymal infection (pyelonephritis, acute glomerulonephritis, and interstitial
nephritis
Answer:
presence of WBC casts may indicate what disease
Q: nephrosis, heavy metal poisoning, acute tubular necrosis, and glomeru- lonephritis
Answer:
presences of Epithelial cases may indicate what disease
Q: Urine Culture and Sensitivity (C&S)
Answer:
gold standard test, organism count of >
100,000, > 100,000 tested for the effectiveness of various antibiotics.
Q: Asymptomatic Bacteriuria=do not need to be treated except in
Answer:
· pregnant women (due to ureteral dilation and increased risk of pyelonephritis)
· males undergoing urinary surgery where mucosal bleeding is expected
· children with vesicoureteral reflux
Q: Uncomplicated UTI Treatments
Answer:
nitrofurantoin (Macrobid) 100 mg by mouth twice daily x 5 days
trimethoprim-sulfamethoxazole (Bactrim) 160 mg/800 mg by mouth twice daily x 3 days
fosfomycin (Monurol) 3 gm by mouth x 1 dose
Q: Phenazopyridine (Pyridium)
Answer:
200 mg by mouth three times daily x 2 days may be given for bladder spasms but should be
avoided in patients with liver or renal failure.
Q: Complicated UTIs: send UA and C&S before antibiotics
Answer:
· ciprofloxacin
(Cipro) 500 mg IV/PO once daily x 7-10 days levofloxacin (Levaquin) 750 mg IV/PO
once daily x 5 days trimethoprim-sulfamethoxazole (Bactrim) 160 mg/800 mg by mouth twice
daily x 7-10 days (in adults able to take oral medication)
Q: upper UTI
Answer:
is uncommon in males, they should also be referred to a urologist to rule out ureteral stricture,
infected kidney stones, anatomical abnormality.
Q: pyelonephritis definition
Answer:
refers to an infection of lower urinary tract which has progressed to an upper urinary tract
infection into the kidney. cause acute renal failure if it is not treated.
Q: lab worksymptoms
Answer:
Fever, chills, nausea, vomiting, and costovertebral angle (CVA) tenderness, flank pain, Malaise,
hallmark= (CVA) tenderness over one kidney, elderly patients= vague abdominal pain, altered
mental status, and lethargy. Low grade fever
Q: Protein
Answer:
in the lumen of the kidney tubules has solidified, especially in the nephron. This indicates
kidney disease rather than cystitis.
Q: pyelonephritis lab work include
Answer:
complete blood count (CBC) will show leuko- cytosis and neutrophilia
chemistry profile to assess renal function
blood cultures to assess for bacteremia/sepsis test for
Q: (KUB)
Answer:
may help exclude nephrolithiasis.
Q: First line pyelonephritis treatment
Answer:
Ciprofloxacin 500 mg by mouth twice daily x 7 days; Ciprofloxacin ER 1000 mg by mouth once
daily x 7 days, or; levofloxacin
750 mg by mouth once daily x 5 days, where the resistance pattern to fluoro- quinolones is <
10%
Q: Second line pyelonephritis.
Answer:
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Urinary tract infections (UTIs) bacterial infections that affect part of the urinary tract, includes the lower urinary tract (urethra and bladder) and the upper urinary tract (ureters and kidneys), lower urinary tract can cause complications such as kidney disease or damage
UTI includes
Prostatitis (Male) Prostate infection
Pyelonephritis (Kidney infection) Fever, chills, nausea, vomiting, and costovertebral angle (CVA) tenderness along with the irritative symptoms
Cystitis (Bladder infection Urine that’s dark cloudy, Blood in the urine, Pain in your lower tummy, Pain and burning when you pee, Strong smelling urine, Needing to pee often, Pain during sex, Feeling sick and tired.
urethritis (gonococcal urethritis opening of the urethra infection
Escherchia coli (E. coli)-UTI Bacterial Infection, shorter female urethra, women are at a greater risk.(others include Staphylococcus saprophyticus, Proteus mirabilis, and Klebsiella pneumoniae.
(E. coli) symptom’s dysuria, urinary frequency, urgency, incomplete bladder emptying sensation, suprapubic pain, foul-smelling urine, hematuria, urethral discharge (associated with urethritis).
CAUTI
UTI sexual intercourse (new partner in the last year or multiple partners), contraception (condom, spermicides, diaphragm), fecal and urinary incontinence, pelvic organ prolapse, dementia, menopause.
Facilitate bacteria growth for UTI catheterization, urinary and fecal incontinence, bladder wall ischemia and urinary retention help
Reasons for decrease urine flow neurogenic bladder, decreased fluid intake, outflow obstruction (BPH, prostate cancer, cystocele, and urethral structure), diabetes (poor circulation/bladder retention) reasons for
Uncomplicated UTIs occur in otherwise healthy, non-pregnant, outpatient females before menopause, and patients with anatomically and functionally normal urinary tracts.
Complicated UTIs males, poorly controlled diabetics, pregnant women, young children, elderly, patients with structural or functional urinary tract abnormalities (renal calculi, reflux, obstruction), immunocompromised patients, instances where the infection extends beyond the bladder (kidney infection), instances where the patient does not respond to initial therapy, cystitis in the presence of intermittent catheterization, spinal cord injury patients.
Males with UTI “never “”normal”” suspicion for ureteral stricture, sexually transmitted infections, and acute prostatitis.”
Differential Diagnosis: acute cystitis, acute pyelonephritis, renal calculi, pelvic inflammatory disease, sexually transmitted infection, prostatitis, and epididymitis.
Detecting UTI The three parameters measured include physical, chemical, and microscopic. (UA) are for
Physical appearance of UTI Color, Appearance, Specific gravity, pH
Chemical test what may be present for UTI Glucose, Ketones, Blood, Protein, Bilirubin, Urobilinogen, Nitrite, Leukocyte esterase. can be in
Microscopic detection of UTI Casts, RBCs, Crystals, WBC, Epithelial cells are
UA
possible contamination urine sample. (squamous epithelial cells) indicates
Casts indicates severe renal disease. other then hyaline cast
Glomerulonephritis, Renal infarction, collagen vascular disease, or subacute bacterial endocarditis presence of edema, weight gain, brown urine, or hypertension. can indicate what
RBC casts (bleeding in the glomeruli if you find
Renal parenchymal infection (pyelonephritis, acute glomerulonephritis, and interstitial nephritis presence of WBC casts may indicate what disease
nephrosis, heavy metal poisoning, acute tubular necrosis, and glomerulonephritis presences of Epithelial cases may indicate what disease
Urine Culture and Sensitivity (C&S)
Asymptomatic Bacteriuria=do not need to be treated except in: · pregnant women (due to ureteral dilation and increased risk of pyelonephritis)· males undergoing urinary surgery where mucosal bleeding is expected· children with vesicoureteral reflux
Uncomplicated UTI Treatments: nitrofurantoin (Macrobid) 100 mg by mouth twice daily x 5 daystrimethoprim-sulfamethoxazole (Bactrim) 160 mg/800 mg by mouth twice daily x 3 daysfosfomycin (Monurol) 3 gm by mouth x 1 dose
Phenazopyridine (Pyridium 200 mg by mouth three times daily x 2 days may be given for bladder spasms but should be avoided in patients with liver or renal failure.
Complicated UTIs: send UA and C&S before antibiotics · ciprofloxacin (Cipro) 500 mg IV/PO once daily x 7-10 days levofloxacin (Levaquin) 750 mg IV/PO once daily x 5 days trimethoprim-sulfamethoxazole (Bactrim) 160 mg/800 mg by mouth twice daily x 7-10 days (in adults able to take oral medication)
upper UTI is uncommon in males, they should also be referred to a urologist to rule out ureteral stricture, infected kidney stones, anatomical abnormality.
pyelonephritis definition refers to an infection of lower urinary tract which has progressed to an upper urinary tract infection into the kidney. cause acute renal failure if it is not treated.
symptoms
Protein in the lumen of the kidney tubules has solidified, especially in the nephron. This indicates kidney disease rather than cystitis.
pyelonephritis lab work include complete blood count (CBC) will show leukocytosis and neutrophiliachemistry profile to assess renal functionblood cultures to assess for bacteremia/sepsis test for
(KUB) may help exclude nephrolithiasis.
First line pyelonephritis treatment Ciprofloxacin 500 mg by mouth twice daily x 7 days; Ciprofloxacin ER 1000 mg by mouth once daily x 7 days, or; levofloxacin 750 mg by mouth once daily x 5 days, where the resistance pattern to fluoroquinolones is < 10% Second line pyelonephritis. trimethoprim-sulfamethoxazole (Bactrim) 160 mg/800 mg by mouth twice daily x 14 days (Bactrim should only be used if the bacteria is known to be susceptible) pyelonephritis inpatient high fever, leukocytosis, vomiting, dehydration, or evidence of sepsis) ampicillin 2 gm IV every 6 hours + tobramycin or gentamicin 6 mg/kg IV every 24 hours (if renal function is normal) x 14 days ciprofloxacin 400 mg IV every 12 hours x 14 days ceftriaxone 1-2 gm IV every 24 hours x 14 days, hydration, pain medications BPH non-cancerous condition in which the prostate becomes enlarged, develops over many years, symptoms include frequent, urgent, a weak or interrupted urine stream, and the inability to empty the bladder. kidney stone is a hard mineral deposit that forms in the urine. Treatment pain relievers and drinking plenty of water. kidney stone made of Risk factors for stones obesity, hypertension, diabetes, and low fluid intake, family history, gout, and bariatric surgery. what causes obstruction, pyelonephritis, and chronic kidney disease Traveling stones cause pain and bleeding, in renal pelvis tend to cause vague flank pain or acute colicky pain with increasing intensity Traveling stones s/s differential for abdominal and/or flank pain may include: · nephrolithiasis· pyelonephritis· ectopic pregnancy· ovarian or testicular torsion· appendicitis· bowel obstruction· diverticulitis· rupture aortic aneurysm what a KUB can see radiopaque stones (calcium oxalate). NOT radio translucent (uric acid). renal ultrasound beneficial in assessing for hydronephrosis not stones. KUB and Renal ultrasound good for diagnosing stones (common test) CT. Gold standard for diagnosing a renal stone Treatment for stones · fluids to facilitate stone passage· adequate pain control· antiemetics is nausea & vomiting is present hospitalization for stones include the inability to control pain, impaired renal function with an obstructive stone, infection (pyelonephritis or sepsis), or intractable nausea and vomiting. facilitate passage of the stone water, thiazide diuretics, alpha-blockers (terazosin), or calcium channel blockers may be initiated. <5mm easy to pass, >5mm difficult
24 Hour Urine Collection what test to analyze the total volume, pH, calcium, oxalate, uric acid, citrate, sodium, potassium, and creatinine.
calcium stones with high urinary calcium (limit calcium to 1000-1200mg) with
calcium oxalate stones with high urinary oxalate (limit rhubarb, spinach, chocolate, tea, and meats)
calcium stones with low urinary citrate · (limit non-dairy animal protein, more fruits, vegetables)
calcium stones or uric acid stones with high urinary uric acid (limit non-dairy animal protein)
cysteine stones ( limit sodium and protein)
Benign prostatic hyperplasia (BPH walnut-size gland affects men>40, reported 50%=60yrs, 90%=80yrs. risk factor age, due to testosterone and dihydrotestosterone (DHT), as may genetic predisposition, Obesity.
Symptoms of BPH usually involve a combination of obstructive and irritative voiding complaints,
Obstructive symptoms include: hesitancy, starting and stopping, decreased stream, postvoid dribbling, sensation of incomplete bladder emptying, overflow incontinence, inability to voluntarily stop the urine stream, urinary retention, straining.
Irritative symptoms : nocturia, urinary frequency, urinary urgency, dysuria, urge incontinence.
BPH Physical exam findings enlarged prostate gland, smooth, rubbery consistency, in cases of advanced obstruction, the bladder may be palpable, the size of the prostate does not correlate with the severity of symptoms, a nodular or unusually firm prostate should raise suspicion for malignancy
Differential Diagnosis for BPH: · Obstructive: prostate cancer, urethral stricture, bladder neck contracture
Testing for BPH : urinalysis, urine C&S, cytology (bladder CA), renal labs, transrectal ultrasound (size), urodynamic studies (bladder emptying).
PSA elevated reasons- prostate cancer, BPH, prostatitis, and acute urinary retention.
Treatment Conservative BPH (monitoring, no caffeine, alcohol, and highly seasoned foods, decongestants and anticholinergics).
Pharmaceutical treat for BPH (alpha1-adrenergic antagonists relax the smooth muscle around the neck of the bladder) tamsulosin (Flomax) 0.4 mg-0.8 mg by mouth once daily
prostate (TURP) or prostatectomy surgically for AUASI score greater than 20, RI, urinary retention, failed medication.
when BPH is present Biggest problem is insertion of catheter, may need camera to insert.
2 mechanisms of obstruction in BPH: · Static Constriction: Direct obstruction of the bladder neck ( prostate tissue).· Dynamic Constriction: Indirect constriction( due to adrenergic stimulation),
4 types of prostatitis (acute or chronic, CPPS, inflammatory, noninflammatory, asymptomatic inflammatory.
Acute and chronic bacterial prostatitis infection from ascending urethra, acute in sexually active men between the ages of 30 and 50 ( always involves UTI), chronic in men older than 50 (recurrent UTI). Escherichia coli (highest in chronic bacterial prostatitis), Klebsiella, Pseudomonas aeruginosa, Enterococcus faecalis, Proteus mirabilis.
Differential Diagnosis: acute bacterial prostatitis:
Chronic bacterial prostatitis Differential Diagnosis: (BPH, bladder cancer, urinary tract stones, enterovesical fistula, foreign body)
Differential Diagnosis: chronic pelvic pain (BPH, bladder or prostate cancer, interstitial cystitis, radiation cystitis, ejaculatory duct dysfunction)
test for prostatitis: history and clinical findings, urinalysis, urine gram stain and culture, (acute), for (chronic) urinalysis, urine culture, and postvoid residual (PVR).
acute bacterial prostatitis: treat · Trimethoprim/sulfamethoxazole (TMP/SMX) 160 mg/800 mg by mouth twice daily x 7 days· fluoroquinolones should be used cautiously, tendon rupture· Ciprofloxacin 750 mg by mouth twice daily x 7-14 days· Levofloxacin 500 mg by mouth once daily x 7-14 daysUrethral catheterization is contraindicated
chronic · TMP/SMX (Bactrim)· Azithromycin (Zithromax)· Fosfomycin (Monurol)· If a fluoroquinolone must be used, (levofloxacin)
CPPS: NSAIDs, muscle relaxants, anticholinergics, alpha-blockers, warm sitz baths, nontraumatic sexual activity with regular ejaculation, and regular mild exercise