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43 Cards in this Set

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definition ASB
asymptomatic bacteriuria: presence of any E. Coli or >50000 of other uropathogenic orgs on clean catch WITHOUT S/S OF UTI
definition cystitis
presence of any E. Coli or >50000 of other uropathogenic orgs on clean catch with s/s UTI
S/S UTI
frequency, urgency, dysuria, suprapubic tenderness, occult hematuria, abd cramping
definition pyelonephritis
UTI of kidneys associated with multiple organ dysfunction & PTL; s/s chills, fever, flank pain/CVAT, symptoms of lower UTI (or not), maternal & fetal tachycardia, N/V
biologic factors that predispose women more than men to UTIs
shorter urethra, urethra closer to rectum, women do not empty bladder as completely as men, massage of bacteria into urethra during sex
anatomic & physiologic changes of pregnancy that increase risk of UTI
dilation/kinking of ureters & renal pelvis, dec'd ureter peristalsis, dec'd bladder tone (capacity, residual vol, emptying), changes in urine (pH, glycosuria, estrogen), length of kidneys, bladder position, dec'd concentrating ability of kidney
How do changes in urine in pregnancy affect risk for UTI?
inc'd pH: acidic urine protects against bacteria.
glyosuria: sugar for bacterial growth.
estrogen: promotes bacterial growth.
List subjective info you'd gather if you suspected a UTI
Is she symptomatic?
Does she have RF?
PE for suspected UTI
VS: T & HR
PE: suprapubic tenderness, CVAT, may have abd cramping or tenderness, pelvic to r/o STI or vaginitis, r/o PTL, Pyelo may s/s dehydration
indications for UTI testing
initial prenatal screening; current UTI s/s; hx UTI; urine dip with hematuria, proteinuria, leukocytes, and/or nitrites; TOC; Hx RF
Risk Factors for UTIs
Hx UTI/pyelo or other infections, sexual activity, SST/SSD, older, DM, anemia, G6PD def, immunosuppression, recent catheterization
When is a UA positive for a UTI? (varying definitions)
lecture notes: any e.coli or >50,000 uropathgenic org.
acog 25,000-100,000; sweet & gibbs >100,000, >10,000 with GBS
Describe components of urine macroanalysis by dipstick. When is this diagnostic for UTI?
Never diagnostic. Looks at WBCs, nitrites, hematuria, proteinuria (and glucosuria?)
Discuss sensitivity and specificity of nitrites in UA.
Produced by breakdown of urinary nitrates by bacteria. UA high specificity, low sensitivity. If nitrites +, probably have UTI, if - might still have UTI.
Discuss sensitivity and specificity of leukocytes in UA.
high sensitivity, low specificity. If leuks -, probably don't have UTI, high false +.
Risk Factors for UTIs
Hx UTI/pyelo or other infections, sexual activity, SST/SSD, older, DM, anemia, G6PD def, immunosuppression, recent catheterization
When is a UA positive for a UTI? (varying definitions)
lecture notes: any e.coli or >50,000 uropathgenic org.
acog 25,000-100,000; sweet & gibbs >100,000, >10,000 with GBS
Describe components of urine macroanalysis by dipstick. When is this diagnostic for UTI?
Never diagnostic. Looks at WBCs, nitrites, hematuria, proteinuria (and glucosuria?)
Discuss sensitivity and specificity of nitrites in UA.
Produced by breakdown of urinary nitrates by bacteria. UA high specificity, low sensitivity. If nitrites +, probably have UTI, if - might still have UTI.
Discuss sensitivity and specificity of leukocytes in UA.
high sensitivity, low specificity. If leuks -, probably don't have UTI, high false +.
Risk Factors for UTIs
Hx UTI/pyelo or other infections, sexual activity, SST/SSD, older, DM, anemia, G6PD def, immunosuppression, recent catheterization
When is a UA positive for a UTI? (varying definitions)
lecture notes: any e.coli or >50,000 uropathgenic org.
acog 25,000-100,000; sweet & gibbs >100,000, >10,000 with GBS
Describe components of urine macroanalysis by dipstick. When is this diagnostic for UTI?
Never diagnostic. Looks at WBCs, nitrites, hematuria, proteinuria (and glucosuria?)
Discuss sensitivity and specificity of nitrites in UA.
Produced by breakdown of urinary nitrates by bacteria. UA high specificity, low sensitivity. If nitrites +, probably have UTI, if - might still have UTI.
Discuss sensitivity and specificity of leukocytes in UA.
high sensitivity, low specificity. If leuks -, probably don't have UTI, high false +.
Urine microanalysis
microscopic exam, not diagnostic. >1 bacteria, any RBCs, and/or >10 WBCs per hpf suspicious for UTI, endothelial cells indicate contamination
perinatal complications of UTI
all about pyelo!
20-40% untreated ASBs turn into pyelo
controversial complications of pyelo
inc'd risk for PTL, LBW, preeclampsia, PIH, congenital anomalies (webct)
known complications of pyelo
multiple organ dysfunction, sepsis, DIC, ARDS, anemia, thrombocytopenia, transient renal insufficiency, PP endometritis
perinatal complications of UTI
all about pyelo!
20-40% untreated ASBs turn into pyelo
controversial complications of pyelo
inc'd risk for PTL, LBW, preeclampsia, PIH, congenital anomalies (webct)
known complications of pyelo
multiple organ dysfunction, sepsis, DIC, ARDS, anemia, thrombocytopenia, transient renal insufficiency, PP endometritis
most common pathogens of UTI
ANY e. coli (70-90%)
Klebsiella (15%)
Enterobacter, pseudomonas, citrobacter
GBS only pathogen in pregnancy
Describe midwifery expectant mgmt for UTIs in pregnancy
Culture on clean catch @ 1st visit for pts at risk (or all pts); urine dipstick at each visit; if + UTI, check for s/s pyelo and pt allergies, order UA c C&S, and tx presumptively; reeval abx with C&S results; TOC after tx
what can you prescribe for severe dysuria?
pyridium
200 mg PO tid x3
ampicillin/amoxicillin
GBS & enterococcus; avoid for e.coli due to resistance; avoid for penicillin allergy; $11
Trimethoprim-sulfamethoxazole (Co-trimoxazole, Septra, Baactrim)
avoid c sulfa allergy; use for gram - UTIs; avoid in 1st & late 3rd tri; $11
Nitrofurantoin (Macrobid, Macrodantin)
preferred for suppression of pyelo; avoid c saprophyticus & G6PD def; $43
G6PD deficiency
x-linked recessive hereditary disorder that causes hemolytic anemia under conditions of stress, infection and some medications
Pt Ed re UTI
normal changes that inc risk; s/s should abate within 48 hrs of tx; take ALL med as prescribed; risks of pyelo; drink fluids, esp acidic cranberry, plum, prune, or apricot; avoid caffeine & carb bevs; hygiene; voiding before/after sex; ed re other infections as indicated
midwifery mgmt pyelo
dx & refer; r/o STIs, vaginitis, appendicitis; order labs: CBC, lytes, serum cr, blood cultures, STI tests; admit, lower T, balance lytes, strict I&O, monitor for complications
hematuria of pregnancy
differential dx
UTI/pyelo, vaginal bleeding (PTL, previa, vaginitis, trauma or STI), urolithiasis, renal disease, trauma, tumor
midwifery mgmt persistant hematuria of preg
urine C&S; UA c micro (r/o stones); serum cr (r/o kidney disease); renal u/s; wet mount (r/o vaginitis or cervicitis); CT/GC
Pt. Ed. s/s pre-eclampsia, idopathic hematuria normal for some, should resolve after preg
f/u: inc'd monitoring for probs, if hematuria persists @ 6w PP, consult urology; before urology visit, recent UA c micro, renal u/s, & serum cr.