24 Sep Post Douglas
Respond on two different days who selected at least one different factor than you, in one or more of the following ways:Offer alternative diagnoses and prescription of treatment options for urinary tract infections.Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives
Main Post
Urinary tract infections (UTI) are one of the most common infections in the world, and advanced practitioners must be able to diagnose and treat the varying types of UTIs. Understanding the location of the UTI, upper or lower, the pathophysiology, and specific signs and symptoms are crucial for treatment. An advanced practitioner must also be aware of the roles that gender and age play in the development of a UTI. UTIs are common in the outpatient setting but can also happen in the hospital and can also be caused by a Foley catheter, which is considered a hospital-acquired event that the hospital will not receive reimbursement.
Pathophysiology of Lower Urinary Tract Infection
A lower urinary tract infection involves the path of least resistance or the most opportunistic point of entry for an organism, usually bacterial and involves the urethra and the bladder. An infection in the urethra or bladder (cystitis) are considered a lower urinary tract infection. The microbial spectrum of UTIs consists mainly of Escherichia coli, with occasional other species of Enterobacteriaceae such as Proteus mirabilis and Klebsiella pneumoniae and other bacteria such as Staphylococcus saprophyticus (Yamamichi, Shigemura, Kitagawa, and Fujisawa, 2018).
Pathophysiology of Upper Urinary Tract Infection
The upper urinary tract consists of the kidneys and ureters. Infection in the upper urinary tract generally affects the kidneys (pyelonephritis), which can cause fever, chills, nausea, vomiting, and other severe symptoms. It can be caused by an infection that has made its way up the urinary tract and can become a complicated infection from an obstruction, such as benign prostatic hypertrophy, and calculi.
Similarities and Differences
Although the location of the infection is different many of the signs and symptoms can present the same; fever, dysuria, frequency, or urgency may be present in both. Many lower tract UTIs may be asymptomatic, and in upper tract UTIs, the symptoms may be more severe, including nausea and vomiting, flank pain, or costovertebral angle tenderness. Finding the underlying cause and treatment is the same; antibiotics for bacterial infections and analgesics for pain control. Intravenous antibiotics are preferred for upper tract UTIs in an attempt to preserve organ damage, but mat be converted to oral after initial treatment.
Gender and Age as Factors
While common in both males and females, females are more prone to community-acquired UTIs than men, basically because of anatomical differences. Lema (2015) acknowledges that the close proximity of the vagina and urethral meatus to the anal opening, the shorter length of the female urethra, and the opportunity for trauma during intercourse allows for the opportunity for a UTI to be acquired. Although this happens across the lifespan of a woman, the peak times are from mid-teens to the early forties or the sexually active years. Young children, especially females, are a high-risk group due to not being able to clean themselves properly after using the bathroom or poor technique. Older patients are also high risk; men with prostate issues cannot empty their bladder are also at risk.
Diagnosis and Treatment
Diagnosis of a lower tract UTI can be done with the assessment of signs and symptoms and urine culture, midstream is preferred. Research by Lee (2018) acknowledges that patients with non-febrile uncomplicated UTIs, active pain control and minimal use of antibiotics should be prioritized, including uncomplicated cystitis. Pain in acute cystitis is a natural consequence of the inflammatory response, and pain-mediated urinary frequency or urgency is the chief complaint of patients. Painkillers, including nonsteroidal anti-inflammatory drugs (NSAIDs), are a good choice for managing symptoms while reducing the usage of antibiotics. Urinalysis and urine culture confirms the diagnosis of acute pyelonephritis and according to the Infectious Diseases Society of America (2019) a urine culture showing at least 10,000 colony-forming units (CFU) per mm3 and symptoms compatible with the diagnosis. Symptoms management and oral antibiotic therapy are needed, and in severe cases, hospitalization with intravenous antibiotic therapy may be required.
Conclusion
As future practitioners, understanding the pathophysiologies of an upper tract UTI and a lower tract UTI is paramount to obtaining a diagnosis. Untreated and under treated UTIs can lead to life-threatening complications. Management of the signs and symptoms is important, but the treatment of the underlying cause can stop a lower tract UTI from spreading into the upper urinary tract. Age and gender play significant roles in UTIs, women of childbearing years, and older men who have trouble emptying their bladder are at high risk. Assessment and quality interviews can assist the practitioner in prevention through education.
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