foreign ERS in this video today we're going to be talking about urinary tract infections so if you do like this video please give it a thumbs up comment down below don't forget to subscribe and check out engineer.org as for all of our illustrations and notes are for all the lectures we put up here are available for you guys so let's get started here with UTIs we're going to talk about the pathophysiology and when we're talking about UTIs we're focusing on the urinary tract so we're looking at the kidneys the ureters bladder and then our urethra right and what we're talking about here is what is the normal flow of a urinary tract what are we looking at we're looking at our kidneys that are producing filtrate filtrate that exits goes down into our bladder and then through urethra out our body okay and when we get an infection we can have many different types of viruses fungi or bacteria that can either accumulate cause travel up into our kidneys and then cause various types of infections or inflammation within those so we can think of a pilotonephritis we can think of cystitis and when we do have these different types of infections there's one common cause a causative agent or something that is going to make a UTI within our body or make us have an infection and that's E coli and if we think about the normal Anatomy of a urinary tract and how it all filters down through there is a nice little valve here our Ural vesicle valve that is allowing urine to go into the bladder and not backflow back into our ureter right and then flow urine out our urethra it's all going in this downward passage right in and out our body so when we have some type of issue of a backflow we have some type of blockage we have an obstruction we have some type of anomaly or abnormality within our structure we can get issues that are going to cause a UTI so what happens urine flows out so if we get E coli that essentially comes from nearby particularly the rectum it starts to ascend and it can Ascend up into the bladder once it gets into the bladder we maybe have a distension of the bladder we're holding our urine too long maybe there's a blockage down here from our prostate that's not letting us be able to pass urine so our bladder starts to distend and overflow it's causing pressure on this valve and then we get back flow up into the kidney right that can cause all types of issues within our urinary tract so remember urine is sterile and we want it to be flowing down right out through the urinary tract so keeping in mind that urine is sterile that this urine is going to flow down through we could have a lot of those causes or risk factors that can potentially make us more at risk for our UTI first one is being female okay one of the big issues for this is the shorter urethra and also the proximity of the rectum to the the opening the urethra is going to cause an issue for E coli to potentially be able to accumulate and then grow or go up into our bladder so that's our first cause the second cause could be different types of medications particularly thinking about antibiotics that can break down our good Flora or good bacteria that we have within this area and then allow the bad bacteria to grow up into our urinary tract other things we can think about are people that are on some type of immunosuppressant or they are immuno suppressed by having some type of issue going on or even diabetes can also cause an issue because we're going to have a lot of sugar within that urine and what is bacteria really to eat we like to eat I have that area for things to grow and then we can have bacteria shooting up back into that urinary tract another thing is also having a urinary catheter the urinary catheter right it's going to sit in our bladder here and it's going to come out through urethra and exit our body that's a nice little tunnel nice little Highway for any type of bacteria to climb up right into the bladder right it's going to even bypass the urethra right into that bladder and be able to cause some type of infection so we want to make sure that when we do have patients that have urinary catheters we are cleaning those catheters next one we talked about a little bit before any type of obstruction blockage right we have kidney stones we have an enlarged prostate that is compressing any type of issues with the valve where we're having issues of keeping urine within the bladder and not going back flowing up anything like that can also cause us to be at risk for UTI and then the last we can talk about is hygiene so some of the things that we want to talk about with patients that could be at risk for UTIs are using any type of perfume or soap any type of issues with hygiene where we're not cleaning as often as we should be we are not cleaning properly where for especially women we're wiping back to front which we're just taking any type of bacteria that is in the back right around the rectum and as we wipe we're pulling it closer to the urethra so any type of hygiene issue could also be causing a Savvy TI so when we look at this list here we're looking at all these different types of risk factors that can give us a UTI and when we think about a UTI and we think about a patient that has a UTI some of those symptoms are very very slight or very uh low maybe they notice it once and they're like I don't know something was off or it could manifest into a patient being full on septic so let's talk about those signs and symptoms now when we have a patient that has a UTI or comes in and we start to suspect that there may be UTI there is a grouping of signs and symptoms that we may point us into that direction of thinking there might be something going on with this patient so the first thing is going to be that burning right that pain when they go to the bathroom so that dysenteria and they might also complain of not only having pain but they feel like they're going to the bathroom often or they're also going but like nothing's not really coming out so they're either having some urgency or they're having frequency and then they might also complain of when they do go to the bathroom the urines either looking kind of dark maybe it's stinky it's like oh yeah this it's got a really strong odor it's stinky or smelly urine they might then also start to complain of some back pain and then they might also say I don't know I've been spiking a fever at home I just feel really hot kind of sweaty and when we talk about this back pain they may also be able to assess this right for our patients so we're going to ask them where is that back pain and they might point to their lower back kind of like the flank area a little bit higher okay and they're going to say oh no I was just looking at my lower back in the middle here and you can check for cost of vertebral tenderness so when we're doing this is that we're going to be looking at the CVA right here we're looking at this 12th Rim okay you're going to put this hand nice and flat you're going to palpate on one side put this hand in their back palpate on this side acid if that's tender okay what we're looking at here is is there tenderness within our our back here right here at our CVA our cost of vertebral angle that is indicating to us there may be something going on with the kidneys pgma also can be complaining of some nausea and vomiting and this patient if they're in the older category right there may be a geriatric patient they may present with us is to come some confusion or new onset incontinence meaning they are now not able to make it to the bathroom before they you know urinate so to those two sloughs together could also be how a UTI is depicted within the geriatric population although any patient of any age or gender can have any of these symptoms so once we have a patient then we think has UTI or we're suspecting a UTI we can get some Diagnostics done and we can do a bunch of blood work right make sure that's okay but the big thing that's going to tell us that this patient has UTI is or urinalysis so what we want is we want to clean catch mid-stream your analysis we want to make sure the patient has cleaned themselves with the white before we get this urine because we want to make sure that we're getting the best sample so that we can test it correctly so we instruct our patient make sure they wipe pee a little bit get that urine put the cap on Don't Touch the inside of the lid don't touch the inside of the container and then bring it to us and we send it down to the lab we send it down to the lab and then it may show us that there's blood within the ear and they may show us that there's white blood cells within the urine they may also show that there is some bacteria right and then we can send it all for urine culture we see that there's blood white blood cells bacteria within the urine we send it all for a urine culture what is urine culture so I'm going to take the urine we put it with an agar and a petri dish we let it grow for a couple days if you'll be able to show us what type of bacteria or fungus or anything else that is growing within that urine so that we can identify the type and what it is it's gonna be able to tell us what type of antibiotic this patient might need to go on it's also going to be able to tell us where that UTI is is possibly within the body because remember within the urinary tract we have our kidneys our ureters our bladder and our urethra so a UTI is involving any or all of those right so we want to make sure that we know with this we're able to treat that correctly we can also do an ultrasound or a CT that's going to be able to tell us like we talked about before any types of abnormalities obstructions the stone uh benign prosthetic hyperplasia or anything else that could be causing issues within the urinary tract to retain and or cause an infection once we've identified this patient has a UTI then we can talk about treatment now for treatment when we have a patient that has a UTI we can treat them very specifically to what type of causative agent or bacteria that they have going on within this UTI but typically there's antibiotics that we give there's those have all mines or the sulfa drugs that we give them so as long as they're not allergic to the sulfur drugs if they ever had it before it can also teach the patient a little bit about any type of allergic reaction swelling within the lips the tongue right hives itchiness swelling within the throat you know we want to make sure that we tell them about those reactions so that they can get help okay and we also want to make sure they know that they should avoid sun exposure because the sulfur drugs are usually the area where people are allergic to those antibiotics there's also the fluoroquinolones that we can give them as well biggest thing to remember for that for the NCLEX is that Achilles rupture so they need to report any new muscle pain to the doctor so that we can maybe take them off that antibiotic and there's many other antibiotics that we can give the patients but these are the two most common ones that we're going to be giving for UTIs then we can also give the patients some analgesics one of the most common ones that they give them is the finance also known as Pyridium this is the medication that turns the urine orange so if you have a patient that's never taken this before you want to make sure that they know that's going to turn their urine orange and let them be able to assess and be aware of that and it should be orange and orange for a couple days but then it should go away and they want to make sure that they're able to know that in case one that scares them and two they can notify their PCP if there's any change within their urine and then we can go into their education now if this patient has a substantial infection where they maybe also have to take some other medications giving them Tylenol to treat their fever giving them Zofran to treat their nausea right we can also do that but the education is the most important thing is to finish the round of antibiotics particularly the medications that are prescribed to them so they're going to be taking those medications say we put them on a sulfa drug they went home they start taking it and then their urine culture came back showed us that it was a different type of bacteria we wanted to switch it to a floor cleaner loan we can right we want to make sure we call the patient tell them stop taking the sofa let's take the fluoroquinolone this will treat that better because you want to make sure that we're treating the infection that they have not every UTI is the same for every patient so we want to make sure they take the medication as prescribed and then we also want to promote fluids so when a patient is experiencing UTI we want them to intake around three liters depending on what their issue is three liters of fluid a day and we can also encourage cranberry juice the only reason or one of the reasons but one of the only ones that the NCLEX usually hit on is they cannot take the cranberry juice if they have cystitis or irritation within the bladder because the cranberry juice can actually make more of an irritation so we want to promote fluids around three liters per day water cranberry juice in order to help flush bacteria out because remember urine sterile we also want to be able to push that bacteria out we're going to be taking the antibiotics to treat the infection but we want to make sure that it's not ascending any higher so as we flush that urinary tract it's going to push the rest of the bacteria and keep it where it's at where out the body promoting good hygiene remember we talked about this before patients that are making sure they're wiping correctly right we're wiping front to back we are taking showers daily okay we're not taking baths wet swimsuits if we're sending those over the summer right it's going to create a nice little moist area bacteria be able to grow and Ascend right into our urethra so we want to make sure perfumes any type of menstrual products tampons pads all of those are creating good hygiene that we're keeping everything clean down there we also want to encourage our patient to be able to urinate around every three to four hours even if they don't have the urge to go to the bathroom we should have them still be able to go to the bathroom and try to avoid that is to just make sure that we're emptying that bladder there's no retention in the bladder the bladder it's not over distended it's not causing an issue with that valve to have too much pressure where we're having urine go up into our ureters we also want to make sure that we're avoiding after intercourse and then a couple things to avoid are alcohol or coffee right these are going to create these diuretic effects right we want to make sure that we're avoiding this with our patients so we're able to create a nice urinary tract that is going to be able to go back to normal get rid of this infection and hopefully not have a reoccurrence so I hope this video made sense to generous hope you learned something good luck on your next exam and as always until next time [Music] thank you