Exam (elaborations)
NUR2063
- Institution
- Rasmussen College
Exam of 49 pages for the course NUR 2063 - NUR2063 Essentials Of Pathophysiology at Rasmussen College (FINAL EXAM)
[Show more]
Seller
Follow
Content preview
NR507 Final Exam 2024 / NR 507 Week 6 ExamAdvanced Pathophysiology Expected Questions and
Answers () (Verified Answers)- Chamberlain
written by
APlusAchiever
The Marketplace to Buy and Sell your Study Material
At Stuvia, you will find the best notes, summaries, flashcards & other study material. Search for your
school or uni and find the study material you need.
www.stuvia.com
Downloaded by: khadijaabdigaani | khadijagani44@gmail.com Want to earn $1.236
Distribution of this document is illegal extra per year?
, Stuvia.com - The Marketplace to Buy and Sell your Study Material
NR507 FINAL EXAM STUDY GUIDE
ALTERATIONS OF RENAL AND URINARY TRACT FUNCTION
URINARY TRACT INFECTIONS (UTI)
Bacteria from the gut can invade urinary epithelium to cause inflammation and infection anywhere along the urinary
tract.
o Urethra, bladder, ureter, or kidney/s.
Some individuals are predisposed to developing a UTI.
o more common in women especially when pregnant, sexually active, during post-menopause with estrogen
deficiency, and when being treated with antibiotics where normal bacteria flora is diminished.
o Although less common, men may develop a lower UTI.
Longer urethra and ureter structures can make it more difficult for bacteria to reach the kidney.
o An indwelling urinary catheter can also contribute to the development of UTI.
o Individuals who experience urinary obstruction, have DM, or neurogenic bladder.
Can be discussed in terms of severity.
Can be complicated or uncomplicated.
Can be discussed according to its location, where it can occur along the urinary tract (lower or upper).
Pathophysiology of UTI
Bacteria enters and contaminates the lower urinary tract.
o This causes colonization of bacteria in the urethra and the bladder triggers an inflammatory response in
the lower urinary tract.
Neutrophils are recruited to the area where the bacteria are present.
The bacteria multiply which allows them to evade the immune system due to virulent
factors.
o The bacteria can form BIOFILMS.
A biofilm is any group of microorganisms that allow them to stick to one another and adhere to
surfaces that help them survive.
If the UTI progresses, or is not treated, or if the patient is immunocompromised, the bacteria can ascend to the
kidneys and colonize there.
o The infection becomes an upper UTI.
If left untreated, the bacteria can spread into the circulation via the renal veins bacteremia septic shock.
UTI Risk factors
For women, pregnancy is a risk factor.
o Progesterone relaxes smooth muscle that causes stasis of urine bacteria colonize.
The female ureter is shorter and allows for entrance of bacteria into the urethra.
Postmenopausal women.
o Lack of estrogen results in vaginal and urethral dryness promotes an environment for bacteria to grow.
Sexual intercourse can easily introduce bacteria into the urethra; spermicides.
Indwelling urinary catheterization
o The bacteria will colonize in the bladder and initiate an immune response.
o The neutrophils enter the area to further promote inflammation.
o Fibrinogen accumulates on the catheter attachment of uropathogens that express fibrinogen-binding
proteins.
The bacteria will multiply to form biofilms.
this results in epithelial damage to the urinary tract kidney infection.
Lower vs. Upper Tract Disorders
Lower tract disorders
o Urethritis infection at the opening of the urethra.
o Cystitis bladder infection
Can occur in both males and females.
In males, cystitis may be associated with prostatitis.
o Symptoms:
Urgency associated with burning on urination.
1
Downloaded by: khadijaabdigaani | khadijagani44@gmail.com Want to earn $1.236
Distribution of this document is illegal extra per year?
, Stuvia.com - The Marketplace to Buy and Sell your Study Material
Frequency, dysuria, suprapubic pain.
The urine may appear cloudy and have an odor.
Upper Tract Disorders
o When the bacteria ascends to the kidney/s PYELONEPHRITIS.
Microorganisms associated include: E. coli and Pseudomonas
Escherichia coli (E. Coli)
o The most common organism contained in the fecal matter that is easily
accessible from the anus to the urethra.
Staphylococcus saprophyticus, Proteus mirabilis, Klebsiella
More commonly associated with infections after urethral instrumentation or urinary
tract surgery.
Also split urea into ammonia urine alkaline increases risk of stone formation.
Dissemination also may occur by way of the bloodstream, and both kidneys are usually involved.
The inflammatory process is usually focal and irregular, primarily affecting the pelvis, calyces, and
medulla.
The infection causes medullary infiltration of neutrophils with tubulointerstitial inflammation,
renal edema, and purulent urine.
In severe infections, localized abscesses may form in the medulla and extend to the
cortex.
Primarily affected are the renal tubules; the glomeruli are usually spared.
Rarely but possibly cause acute renal failure.
o Signs and symptoms of Pyelonephritis
The onset of symptoms is usually acute, with fever, chills, and flank or groin pain.
Symptoms characteristic of a UTI, including frequency, dysuria, and costovertebral tenderness.
Older adults may have nonspecific symptoms, such as low-grade fever and malaise.
There can also be signs of shock if the infection has entered the circulation from the kidney via the
renal vein.
Classic triad of symptoms: vomiting, flank pain, and fever.
The presence of systemic signs such as high fever, chills, and tachycardia may suggest severe
infection.
Urine Sample to Determine Lower vs. Upper UTI
Urine Dipstick
o (+) leukocyte esterase, (+) nitrites
Leukocyte esterase is an enzyme that is released by the WBCs.
Qualitative measure of WBCs in the urinary tract.
Presence of nitrites is highly specific for bacterial infection.
o Can be performed to identify hematuria, proteinuria, and presence of nitrites.
On microscopic exam of the urine:
o WBC > 5000 hpf and hematuria = Cystitis.
o WBC casts = Pyelonephritis
Presence of CASTS in the urine the protein in the lumen of the kidney tubules has solidified,
especially in the nephron.
Uncomplicated Vs. Complicated UTIs
Uncomplicated
Urinary tract and renal function is normal.
Individuals are treated for UTI only when they are symptomatic.
o Antibiotics only if patient is c/o symptoms.
Uncomplicated + symptomatic UTI (cystitis) = 3-7 days course of appropriate antibiotic therapy.
Complicated
Decreased renal function and abnormal urinary tract.
Presence of WBC casts = presence of kidney involvement more complicated treatment plan.
At higher risk for extensive and permanent kidney damage, as well as sepsis.
o Blood culture may be drawn to identify the causative organism.
More intervention required.
Will require IV antibiotics until the patient is afebrile, followed up by a course of PO antibiotics.
2
Downloaded by: khadijaabdigaani | khadijagani44@gmail.com Want to earn $1.236
Distribution of this document is illegal extra per year?
, Stuvia.com - The Marketplace to Buy and Sell your Study Material
Referral to a urologist if does not respond to antibiotic therapy, or there are recurrent UTIs (3 or more in 1 year), or
presence of hematuria.
o May be a presence of significant renal disease.
UTI in pregnancy due to ureteral dilation that occurs that increases the risk for pyelonephritis.
o Treatment initiated to prevent damage to the fetus in utero.
Associated with
o Indwelling catheter
o Renal calculi
o Diabetes
o Pregnancy
Urinalysis to Diagnose a UTI
Dipstick can be used to identify leukocyte esterase and nitrites.
o Nitrites
Detect the presence of Enterobacteriaceae (gram negative bacteria) family that converts nitrates
to nitrites.
Some bacteria are unable to produce nitrites (Enterococcus).
The presence of nitrites is the most specific finding and has the highest positive predictive value.
o Leukocyte esterase, WBCs and even bacteria not specific do not necessarily indicate infection.
Presence of symptoms + positive urine culture
Urine examined under microscopy:
o RBCs > 3RBCs/hpf = abnormal; abnormal morphology of the RBC strongly suggests glomerular disease;
RBCs are often present with hematuria.
o WBCs > 5 WBCs/hpf = abnormal
o Bacteria present
o Crystals
o Casts
Patient Education
Drink more water.
Although there are differences of opinions, cranberry juice and vitamin C can help to acidify the urine.
Urinate before and after sexual intercourse to remove bacteria from the urethral area.
Encourage the female to avoid holding urine for extended periods of time.
Avoid the use of hygiene sprays and spermicides because they alter the normal microbial flora to enhance the risk for
infection.
Encourage the female to wipe from front to back after a BM to avoid spreading bacteria to the urethra.
Encourage showers rather than bathing to avoid the spread of bacteria.
RENAL CALCULI
Pathophysiology of Renal Calculi
Renal calculi or kidney stones, can be found in the ureter or bladder.
Urine
o Consists of water and particles (Na+ and K+).
o The particles in the urine combine to form a stone.
Normally there should be no stone formation in the urine.
o Has inhibitors to prevent stone formation (citrate and magnesium).
o Contains calcium and oxalate.
Calcium + oxalate = stone.
Citrate and magnesium will prevent stone formation.
Individuals get kidney stones due to lack of water ingestion or by increase of particles or solute in the urine or by
decreased inhibitors present in the urine.
Stone can be easily eliminated in the urine, or if large, can lodge in the ureter.
o Stones that are < 0.5 cm can pass through the urine to be eliminated without difficulty.
o Stones that are > 1 cm are likely to cause an obstruction.
Most common sites of obstruction:
o Ureteropelvic junction
o Intersection of the ureter and iliac vessels
o Ureterovesicular junction
3
Downloaded by: khadijaabdigaani | khadijagani44@gmail.com Want to earn $1.236
Distribution of this document is illegal extra per year?
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller khadijaabdigaani. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $20.48. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
62555 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now