Uti

Front 1

definition ASB

Back 1

asymptomatic bacteriuria: presence of any E. Coli or >50000 of other uropathogenic orgs on clean catch WITHOUT S/S OF UTI

Front 2

definition cystitis

Back 2

presence of any E. Coli or >50000 of other uropathogenic orgs on clean catch with s/s UTI

Front 3

S/S UTI

Back 3

frequency, urgency, dysuria, suprapubic tenderness, occult hematuria, abd cramping

Front 4

definition pyelonephritis

Back 4

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

Front 5

biologic factors that predispose women more than men to UTIs

Back 5

shorter urethra, urethra closer to rectum, women do not empty bladder as completely as men, massage of bacteria into urethra during sex

Front 6

anatomic & physiologic changes of pregnancy that increase risk of UTI

Back 6

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

Front 7

How do changes in urine in pregnancy affect risk for UTI?

Back 7

inc'd pH: acidic urine protects against bacteria.
glyosuria: sugar for bacterial growth.
estrogen: promotes bacterial growth.

Front 8

List subjective info you'd gather if you suspected a UTI

Back 8

Is she symptomatic?
Does she have RF?

Front 9

PE for suspected UTI

Back 9

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

Front 10

indications for UTI testing

Back 10

initial prenatal screening; current UTI s/s; hx UTI; urine dip with hematuria, proteinuria, leukocytes, and/or nitrites; TOC; Hx RF

Front 11

Risk Factors for UTIs

Back 11

Hx UTI/pyelo or other infections, sexual activity, SST/SSD, older, DM, anemia, G6PD def, immunosuppression, recent catheterization

Front 12

When is a UA positive for a UTI? (varying definitions)

Back 12

lecture notes: any e.coli or >50,000 uropathgenic org.
acog 25,000-100,000; sweet & gibbs >100,000, >10,000 with GBS

Front 13

Describe components of urine macroanalysis by dipstick. When is this diagnostic for UTI?

Back 13

Never diagnostic. Looks at WBCs, nitrites, hematuria, proteinuria (and glucosuria?)

Front 14

Discuss sensitivity and specificity of nitrites in UA.

Back 14

Produced by breakdown of urinary nitrates by bacteria. UA high specificity, low sensitivity. If nitrites +, probably have UTI, if - might still have UTI.

Front 15

Discuss sensitivity and specificity of leukocytes in UA.

Back 15

high sensitivity, low specificity. If leuks -, probably don't have UTI, high false +.

Front 16

Risk Factors for UTIs

Back 16

Hx UTI/pyelo or other infections, sexual activity, SST/SSD, older, DM, anemia, G6PD def, immunosuppression, recent catheterization

Front 17

When is a UA positive for a UTI? (varying definitions)

Back 17

lecture notes: any e.coli or >50,000 uropathgenic org.
acog 25,000-100,000; sweet & gibbs >100,000, >10,000 with GBS

Front 18

Describe components of urine macroanalysis by dipstick. When is this diagnostic for UTI?

Back 18

Never diagnostic. Looks at WBCs, nitrites, hematuria, proteinuria (and glucosuria?)

Front 19

Discuss sensitivity and specificity of nitrites in UA.

Back 19

Produced by breakdown of urinary nitrates by bacteria. UA high specificity, low sensitivity. If nitrites +, probably have UTI, if - might still have UTI.

Front 20

Discuss sensitivity and specificity of leukocytes in UA.

Back 20

high sensitivity, low specificity. If leuks -, probably don't have UTI, high false +.

Front 21

Risk Factors for UTIs

Back 21

Hx UTI/pyelo or other infections, sexual activity, SST/SSD, older, DM, anemia, G6PD def, immunosuppression, recent catheterization

Front 22

When is a UA positive for a UTI? (varying definitions)

Back 22

lecture notes: any e.coli or >50,000 uropathgenic org.
acog 25,000-100,000; sweet & gibbs >100,000, >10,000 with GBS

Front 23

Describe components of urine macroanalysis by dipstick. When is this diagnostic for UTI?

Back 23

Never diagnostic. Looks at WBCs, nitrites, hematuria, proteinuria (and glucosuria?)

Front 24

Discuss sensitivity and specificity of nitrites in UA.

Back 24

Produced by breakdown of urinary nitrates by bacteria. UA high specificity, low sensitivity. If nitrites +, probably have UTI, if - might still have UTI.

Front 25

Discuss sensitivity and specificity of leukocytes in UA.

Back 25

high sensitivity, low specificity. If leuks -, probably don't have UTI, high false +.

Front 26

Urine microanalysis

Back 26

microscopic exam, not diagnostic. >1 bacteria, any RBCs, and/or >10 WBCs per hpf suspicious for UTI, endothelial cells indicate contamination

Front 27

perinatal complications of UTI

Back 27

all about pyelo!
20-40% untreated ASBs turn into pyelo

Front 28

controversial complications of pyelo

Back 28

inc'd risk for PTL, LBW, preeclampsia, PIH, congenital anomalies (webct)

Front 29

known complications of pyelo

Back 29

multiple organ dysfunction, sepsis, DIC, ARDS, anemia, thrombocytopenia, transient renal insufficiency, PP endometritis

Front 30

perinatal complications of UTI

Back 30

all about pyelo!
20-40% untreated ASBs turn into pyelo

Front 31

controversial complications of pyelo

Back 31

inc'd risk for PTL, LBW, preeclampsia, PIH, congenital anomalies (webct)

Front 32

known complications of pyelo

Back 32

multiple organ dysfunction, sepsis, DIC, ARDS, anemia, thrombocytopenia, transient renal insufficiency, PP endometritis

Front 33

most common pathogens of UTI

Back 33

ANY e. coli (70-90%)
Klebsiella (15%)
Enterobacter, pseudomonas, citrobacter
GBS only pathogen in pregnancy

Front 34

Describe midwifery expectant mgmt for UTIs in pregnancy

Back 34

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

Front 35

what can you prescribe for severe dysuria?

Back 35

pyridium
200 mg PO tid x3

Front 36

ampicillin/amoxicillin

Back 36

GBS & enterococcus; avoid for e.coli due to resistance; avoid for penicillin allergy; $11

Front 37

Trimethoprim-sulfamethoxazole (Co-trimoxazole, Septra, Baactrim)

Back 37

avoid c sulfa allergy; use for gram - UTIs; avoid in 1st & late 3rd tri; $11

Front 38

Nitrofurantoin (Macrobid, Macrodantin)

Back 38

preferred for suppression of pyelo; avoid c saprophyticus & G6PD def; $43

Front 39

G6PD deficiency

Back 39

x-linked recessive hereditary disorder that causes hemolytic anemia under conditions of stress, infection and some medications

Front 40

Pt Ed re UTI

Back 40

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

Front 41

midwifery mgmt pyelo

Back 41

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

Front 42

hematuria of pregnancy
differential dx

Back 42

UTI/pyelo, vaginal bleeding (PTL, previa, vaginitis, trauma or STI), urolithiasis, renal disease, trauma, tumor

Front 43

midwifery mgmt persistant hematuria of preg

Back 43

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.