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ACTUAL NRNP 6550 FINAL EXAM 2023/2024 GRADED A
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ACTUAL NRNP 6550 FINAL EXAM 2023/2024 GRADED A Urine culture with UTI (ANS - 100.000 colonies in asymptomatic: bacteruria 10 - 10.000 colonies in symptomatic patients but also pyuria pyuria: more than 10 leukocytes elevated erythrocytes with pyelonephritis WBC in urine false positive with tumor, urethritis and poor collection technique Repeat in pregnant women Lower urinary tract UTI and upper urinary tract UTI (ANS - bladder and urethra: cystitis/ urethritis/ prostatitis kidney and ureters: pyelonephritis/ renal abcess Uncomplicated and complicated uti (ANS - Uncomplicated: in normal working urinary tract Complicated: defects in urinary tract or with other health problems Common pathogens for UTI (ANS - E.coli (elderly women) Staphylococcus proteus mirabilis (elderly men) Klebsiella enterecoccus pseudomonas Providencia (institutionalized) Fungus: candida Risk factors for UTI (ANS - Female critically ill elderly catheter (caused by biofilm) DM calculi, tumor, stricture neurogenic bladder Women: sexual intercourse or new sex partner pregnancy previous UTI Men: prostate enlargement prostatitis lack of circumcision gay HIV Findings UTI (ANS - Lower: Dysuria/ urgency/ frequency/ incontinence suprapubic pain hematuria fever/ chills unco mmon No flank pain Upper: flank pain fever and chills hematuria n/v ams (in elderly ) malaise tachycardia/ tachypnea Testing and results for UTI (ANS - Gold standard: urine culture and sensitivity: detection of bacteria. Start with POC: urine analysis. UA: pos for nitrite or leukocyte or blood CBC: leukocyte with left shift in pyelonephritis For recurrent UTI in women or UTI in men rule out obstruction, calculi, or necrosis with: xr voiding CT abdomen US pelvis MRI pelvis Management acute cystitis (ANS - First line: - Single dose Fosfomycin (monurol) - 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby, give cephalexin instead) or sulfa - 5 days: nitrofurantoin, caution in elderly Second line: - qiunolones: ciprofloxain or levofloxacin for 3 days (not for pregnant women!) - B-lactams: amoxi -clav, cefdinir for 3 - 7 days Management uncomplicated upper UTI (ANS - Outpt: quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days Sulfa: trimethoprim/ sulfa (bactrim) for 14 days Inpt:The benefits of buying summaries with Stuvia:
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