Urinary tract infection . Approximately 2. 0% to 2. UTI sometime during their lifetime, and acute UTIs account for approximately 7 million healthcare visits per year for young women. About 2. 0% of women who develop a UTI experience recurrences. Women are more prone to UTIs than men because of natural anatomic variations. The female urethra is only about 1 to 2 inches in length, whereas the male urethra is 7 to 8 inches long. The female urethra is also closer to the anus than the male urethra, increasing women’s risk for fecal contamination. The motion during sexual intercourse also increases the female’s risk for infection. Urinary reflux is one reason that bacteria spread in the urinary tract. Vesicourethral reflux occurs when pressure increases in the bladder from coughing or sneezing and pushes urine into the urethra. When pressure returns to normal, the urine moves back into the bladder, taking with it bacteria from the urethra. In vesicoureteral reflux, urine flows backward from the bladder into one or both of the ureters, carrying bacteria from the bladder to the ureters and widening the infection. If they are left untreated, UTIs can lead to chronic infections, pyelonephritis, and even systemic sepsis and septic shock. If infection reaches the kidneys, permanent renal damage can occur, which leads to acute and chronic renal failure. Causes. The pathogen that accounts for about 9. Invasion and multiplication of microorganisms in body tissues, as in an infectious disease. The infectious process is similar to a circular chain with each link. UTIs is Escherichia coli. Other organisms that are commonly found in the gastrointestinal tract and may contaminate the genitourinary tract include Enterobacter,Pseudomonas, group B beta- hemolytic streptococci, Proteus mirabilis,Klebsiella species, and Serratia. Two growing causes of UTIs in the United States are Staphylococcus saprophyticus and Candida albicans. Predisposing factors are urethral damage from childbirth, catheterization, or surgery; decreased frequency of urination; other medical conditions such as diabetes mellitus; and, in women, frequent sexual activity and some forms of contraceptives (poorly fitting diaphragms, use of spermicides). Genetic considerations. Increased susceptibility to UTIs has been observed in women and female children who have no anatomic predisposing factors, making genetic contributions suspect. Incidence of UTIs among first- degree female relatives has been reported to be 5. INDICATIONS. ABILIFY MAINTENA (aripiprazole) is indicated for the treatment of schizophrenia . DOSAGE AND ADMINISTRATION Dosage Overview For The. Chronic pain affects an estimated 86 million American adults to some degree. Here you'll find the latest pain management information including treatments, as well as. Your first trimester is often the toughest. Here you'll learn about common first trimester issues pregnant women experience including spotting, cramps, and more. WebMD explains the symptoms of kidney disease. You might not notice any problems if you have chronic kidney disease that’s in the early stages. Pancreatic ductal adenocarcinoma accounts for 90% of cancers of the pancreas. The diagnostic and therapeutic approaches outlined here integrate the AGA guidelines for. What if a person has frequent or chronic nosebleeds? What remedies or medications can you take to prevent nosebleeds? First trimester: weeks 1 to 12. You're pregnant: congratulations! The first weeks of your pregnancy are a vital time as your pregnancy gets established. In some families, the predisposition has suggested a dominantly inherited trait determined by a single gene, while in others, recessive or polygenic inheritance seems more likely. Gender, ethnic/racial, and life span considerations. UTIs are uncommon in children. The largest group of individuals with UTI is adult women, and the incidence increases with age.
Once young and adult women become sexually active, the incidence of UTI increases dramatically. UTIs are common during pregnancy and are caused by the hormonal changes and urinary stasis that result from ureteral dilation. Men secrete prostatic fluid that serves as an antibacterial defense, particularly during their teen and early adulthood years. As men age past 5. As women age, vaginal flora and lubrication change; decreased lubrication increases the risk of urethral irritation in women during intercourse. By age 7. 0, prevalence is similar for men and women. There are no known ethnic and racial considerations. Global health considerations. In men living in developed nations, the incidence is comparable to that in the United States, but in developing nations with a shorter life expectancy, rates are lower than in the United States. Urinary tract infections in both developed and developing nations are extremely common in women. Assessment. History. The patient with a UTI has a variety of symptoms that range from mild to severe. The typical complaint is of one or more of the following: frequency, burning, urgency, nocturia, blood or pus in the urine, and suprapubic fullness. If the infection has progressed to the kidney, there may be flank pain (referred to as costovertebral tenderness) and low- grade fever. Question the patient about risk factors, including recent catheterization of the urinary tract, pregnancy or recent childbirth, neurological problems, volume depletion, frequent sexual activity, and presence of a sexually transmitted infection (STI). Ask the patient to describe current sexual and birth control practices because poorly fitting diaphragms, the use of spermicides, and certain sexual practices such as anal intercourse place the patient at risk for a UTI. Physical examination. Physical examination is often unremarkable in the patient with a UTI, although some patients have costovertebral angle tenderness in cases of pyelonephritis. On occasion, the patient has fever, chills, and signs of a systemic infection. Inspect the urine to determine its color, clarity, odor, and character. Surveillance for STIs is recommended as part of the examination. Psychosocial. UTIs rarely result in disruption of the patient’s normal activities. The infection is generally acute and responds rapidly to antibiotic therapy. The general guidelines to increase fluid intake and concomitant frequent urination may be problematic for some patients in restrictive work environments. The accompanying discomfort may result in temporary restriction of sexual activity, especially if an STI is diagnosed. Diagnostic highlights. General Comments: UTIs are very easy to diagnose; follow- up testing demonstrates the effectiveness of treatment. Test. Normal Result. Abnormality With Condition. Explanation. Leukocyte esterase dip test. Negative. Positive (purple shade)Presence of leukocyte esterase indicates UTI; 9. WBCs) in the urine. Urine culture and sensitivity< 1. L> 1. 0,0. 00 bacteria/m. L or > 1. 00 in acutely symptomatic patients. Identifies causative organism; determines appropriate antibiotic. Urinalysis. WBCs: 0–4; red blood cells (RBCs): . A diet of meats, eggs, cheese, prunes, cranberries, plums, and whole grains can increase the acidity of the urine. Foods not allowed on this diet include carbonated beverages, anything containing baking soda or powder, fruits other than those previously stated, all vegetables except corn and lentils, and milk and milk products. Because the action of some UTI medications is diminished by acidic urine (nitrofurantoin), review all prescriptions before instructing patients to follow this diet. UTIs are treated with antibiotics specific to the invading organism. Usually, a 7- to 1. Most elderly patients need a full 7- to 1. Women being treated with antibiotics may contract a vaginal yeast infection during therapy; review the signs and symptoms (cheesy discharge and perineal itching and swelling) and encourage the woman to purchase an over- the- counter antifungal or to contact her primary healthcare provider if treatment is indicated. Pharmacologic highlights. Medication or Drug Class. Dosage. Description. Rationale. Cephalosporins. Varies with drug. Ceftriaxone (Rocephin), cephalexin monohydrate (Keflex)Bacteriocidal. Ciprofloxacin (Cipro)2. PO bid. Quinolone. Bacteriocidal. Sulfisoxazole (Gantrisin)Initially 2–4 g PO, then 1–2 g qid for 1. Anti- infective, sulfonamide. Bacteriocidal. Cotrimoxazole (Bactrim, Septra)1. Anti- infective, sulfonamide. Bacteriocidal. Nitrofurantoin (Macrodantin)5. PO qid for 1. 0–1. Urinary antiseptic. Bacteriocidal; concentrates in the urine and kidneys to kill bacteria. Phenazopyridine (Pyridium)1. PO tid until pain subsides. Urinary analgesic. Relieves pain. Other Drugs: Tobramycin (Nebcin), Ertapenem (Invanz), amoxicillin/clavulanate (Augmentin)Independent. Encourage patients with infections to increase fluid intake to promote frequent urination, which minimizes stasis and mechanically flushes the lower urinary tract. Strategies to limit recurrence include increasing vitamin C intake, drinking cranberry juice, wiping from front to back after a bowel movement (women), regular emptying of the bladder, avoiding tub and bubble baths, wearing cotton underwear, and avoiding tight clothing such as jeans. These strategies have been beneficial for some patients, although there is no research that supports the efficacy of such practices. Encourage the patient to take over- the- counter analgesics unless contraindicated for mild discomfort but to continue to take all antibiotics until the full course of treatment has been completed. If the patient experiences perineal discomfort, sitz baths or warm compresses to the perineum may increase comfort. Evidence- Based Practice and Health Policy. Chant, C., Smith, O. M., Marshall, J. C., & Friedrich, J. O. Relationship of catheter- associated urinary tract infection to mortality and length of stay in critically ill patients: A systematic review and meta- analysis of observational studies. Critical Care Medicine, 3. Results of a meta- analysis of 1. CAUTI) to 6. 0,7. CAUTI revealed an increased mortality risk by nearly double among patients with a CAUTI (9. CI, 1. 7. 2 to 2. Patients with a CAUTI experienced an increased length of stay in an intensive care unit by a mean of 1. CI, 9 to 1. 5; p < 0. CI, 1. 1 to 3. 2; p < 0. Documentation guidelines. Physical response: Pain, burning on urination, urinary frequency; vital signs; nocturia; color and odor of urine; patient history that may place the patient at risk. Location, duration, frequency, and severity of pain; response to medications. Absence of complications such as pyelonephritis. Discharge and home healthcare guidelines. Treatment of a UTI occurs in the outpatient setting. Teach the patient an understanding of the proposed therapy, including the medication name, dosage, route, and side effects. Explain the signs and symptoms of complications such as pyelonephritis and the need for follow- up before leaving the setting. Explain the importance of completing the entire course of antibiotics even if symptoms decrease or disappear. If the patient experiences gastrointestinal discomfort, encourage the patient to continue taking the medications but to take them with a meal or milk unless contraindicated. Miscarriages. Understanding Miscarriage. Losing a pregnancy can be heartbreaking. And unfortunately, miscarriages are fairly common. On average, about 1 in 5 pregnancies will end in a miscarriage — usually in the first trimester. In most cases, a miscarriage cannot be prevented because it is the result of a chromosomal abnormality or problem with the development of the fetus. Still, certain factors — such as age, smoking, drinking, and a history of miscarriage — put a woman at a higher risk for losing a pregnancy. While miscarriages usually cannot be prevented, by taking care of yourself and following your health care provider's recommendations, you can increase the chances that you and your baby will be healthy throughout the pregnancy. What Is a Miscarriage? A miscarriage is the loss of a pregnancy (the loss of an embryo or fetus before it's developed enough to survive). This often happens even before a woman is aware that she is pregnant. A miscarriage usually happens in the first 3 months of pregnancy, before 1. A small fraction of pregnancy losses — happening in less than 1% of pregnancies — are called stillbirths, as they happen after 2. Symptoms of a Miscarriage. Many women don't even know that they've had a miscarriage (since they hadn’t known they were pregnant), thinking that it's just a particularly heavy menstrual flow. Some women experience cramping, spotting, heavier bleeding, abdominal pain, pelvic pain, weakness, or back pain. Spotting is often not a sign of a miscarriage; many women experience it early on in pregnancy. But just to be safe, if you have spotting or any of these other symptoms anytime during your pregnancy, talk with your doctor.
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