NUR 635 Topic 11 DQ 2

Sample Answer for NUR 635 Topic 11 DQ 2 Included After Question

Jill, a 30-year-old, presents with discomfort when urinating and mentions a burning sensation. Lately, she has been complaining of sudden urges to urinate and finds it difficult to control. Other symptoms include pain in the low abdomen which is sometimes relieved by urination. Based on the patient’s presentation, Jill is diagnosed with acute uncomplicated cystitis. She states an allergy to sulfa. Use the guidelines and relevant literature in your topic Resources to discuss the following: 

  • Differentiate between cystitis and pyelonephritis urinary tract infects.
  • What factors are associated with uncomplicated and complicated urinary tract infections?
  • Briefly describe the bacteria associated with acute uncomplicated cystitis. Include which bacteria are associated with the highest prevalence and how these bacteria are classified (e.g., gram-negative, gram-positive, etc.)
  • Determine a treatment strategy for Jill. If choosing a pharmacologic approach include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication, including spectrum of coverage and mechanism of action. 
  • Determine monitoring, side effects, and drug-drug interactions associated with each medication.
  • How would you address Jill’s pain associated with acute uncomplicated cystitis?
  • In the event Jill is pregnant, how would this change your treatment plan. Explain your rationale.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 11 DQ 2

Title: NUR 635 Topic 11 DQ 2

1. Cystitis and pyelonephritis are both types of urinary tract infections (UTIs) but affect different parts of the urinary tract. Cystitis is an infection of the bladder, the organ that stores urine. On the other hand, pyelonephritis is an infection of the kidneys responsible for filtering and excreting waste products from the blood in urine. In terms of symptoms, cystitis typically presents with discomfort or burning during urination and an increased frequency and urgency to urinate. At the same time, pyelonephritis may cause fever, chills, and flank pain (Kolman, 2019).


2. Uncomplicated UTIs occur in otherwise healthy individuals with a normal urinary tract and no underlying health conditions. These infections are usually caused by bacteria that enter the urinary tract through the urethra and can typically be treated with a short course of antibiotics. Complicated UTIs, on the other hand, are those that occur in individuals with underlying health conditions that increase their risk of developing UTIs, such as urinary tract abnormalities, a weakened immune system, or a history of recurrent UTIs. These infections may require more prolonged treatment and a different approach to treatment (Zare, 2022)


3. The most common bacteria associated with acute uncomplicated cystitis include Escherichia coli (E. coli), Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus saprophyticus. E. coli is the most prevalent, accounting for approximately 85% of UTIs. These bacteria are classified as gram-negative, as they have a thin cell wall that stains pink with the gram stain test. Gram-negative bacteria are known to cause more severe infections due to their ability to produce toxins and resist many types of antibiotics (Hayami et 2019)


4. For Jill’s treatment, I recommend a 3-day course of trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 160/800 mg twice daily. This medication combines trimethoprim and sulfamethoxazole antibiotics and is commonly used to treat uncomplicated UTIs caused by E. coli. TMP-SMX works by inhibiting the production of folic acid, which is essential for bacterial growth. It has a broad spectrum of coverage, making it effective against many types of bacteria that commonly cause UTIs (Fernandez et., 2019),


5. The most common side effects of TMP-SMX include nausea, vomiting, and allergic reactions. It may also cause an increased risk of sun sensitivity, so patients should be advised to avoid prolonged sun exposure while taking this medication. Drug-drug interactions associated with TMP-SMX include interactions with blood thinners, seizure medications, and certain diabetes medications. It is essential to review Jill’s current medications to check for potential drug interactions before starting her on TMP-SMX (Krantz et al., 2020).


6. To address Jill’s pain associated with acute uncomplicated cystitis, I would recommend over-the-counter pain relievers such as ibuprofen or acetaminophen. These medications can help relieve the discomfort and burning sensation during urination. Additionally, increasing fluid intake and frequent urination can help alleviate pain and discomfort (Faltynek, 2020).


7. If Jill is pregnant, the treatment plan may need to be adjusted. TMP-SMX is not recommended for use during pregnancy, as it may increase the risk of congenital disabilities or complications. In this case, I would consider 7-day nitrofurantoin or Fosfomycin as an alternative treatment option. Nitrofurantoin is a bacteriostatic antibiotic that works by inhibiting bacterial growth, and it is safe to use during pregnancy. Fosfomycin is also a safe option for pregnant women, and it works by interfering with the bacterial cell wall, leading to bacterial death. Both of these medications have a narrower spectrum of coverage compared to TMP-SMX, so they may be less effective against certain strains of bacteria. However, they are still effective in treating uncomplicated UTIs caused by E. coli. Close monitoring and follow-up with her healthcare provider would also be essential to ensure the infection is fully resolved (Bakdach & Elajez, 2020)

References:

Bakdach, D., & Elajez, R. (2020). Trimethoprim-Sulfamethoxazole: new lessons on an old antimicrobial; a retrospective analysis. Journal of Pharmaceutical Health Services Research, 11(3), 269-274.

Faltynek, C. R. (2020). PAIN: Why do we continue to suffer?: The culture and science of pain. Outskirts Press.

Fernández-Villa, D., Aguilar, M. R., & Rojo, L. (2019). Folic acid antagonists: antimicrobial and immunomodulating mechanisms and applications. International journal of molecular sciences, 20(20), 4996.

Hayami, H., Takahashi, S., Ishikawa, K., Yasuda, M., Yamamoto, S., Wada, K., … & Goto, H. (2019). Second nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by the Japanese Surveillance Committee from 2015 to 2016: antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus. Journal of Infection and Chemotherapy, 25(6), 413-422.

Kolman, K. B. (2019). Cystitis and pyelonephritis: diagnosis, treatment, and prevention. Primary Care: Clinics in Office Practice, 46(2), 191-202.

Krantz, M. S., Stone, C. A., Abreo, A., & Phillips, E. J. (2020). Oral challenge with trimethoprim-sulfamethoxazole in patients with “sulfa” antibiotic allergy. The Journal of Allergy and Clinical Immunology: In Practice, 8(2), 757–760.

Zare, M., Vehreschild, M. J., & Wagenlehner, F. (2022). Management of uncomplicated recurrent urinary tract infections. BJU International, 129(6), 668-678.

A Sample Answer 2 For the Assignment: NUR 635 Topic 11 DQ 2

Title: NUR 635 Topic 11 DQ 2

Difference between Cystitis and Pyelonephritis

Cystitis and pyelonephritis are both urinary tract infections (UTIs) but affect different parts of the urinary system. Cystitis is an infection of the bladder, typically caused by the invasion of bacteria from the urethra. It often presents with symptoms such as dysuria (painful urination), frequency, urgency, and suprapubic pain (Kaur & Kaur, 2021). On the other hand, Pyelonephritis, pyelonephritis is a more severe infection that involves the kidneys. It results from the ascent of bacteria from the bladder into the upper urinary tract and is characterized by symptoms like fever, flank pain, and systemic signs of infection. It poses a greater risk to the patient’s overall health compared to cystitis.

Factors Associated with UTI Complexity

Uncomplicated UTIs typically involve an otherwise healthy individual with no structural or functional abnormalities in the urinary tract. Factors associated with uncomplicated UTIs include gender, with females being more susceptible due to shorter urethras that facilitate bacterial entry (Seid et al., 2023). Sexual activity, especially with a new partner, can introduce uropathogens into the urinary tract. Additionally, factors such as the use of spermicides, diaphragms, and a history of previous UTIs may increase the risk of uncomplicated UTIs. Conversely, complicated UTIs involve underlying conditions, such as structural abnormalities (e.g., kidney stones or urinary tract obstructions), functional issues (e.g., neurogenic bladder), or comorbidities like diabetes or immunosuppression.

Bacteria in Acute Uncomplicated Cystitis

Acute uncomplicated cystitis is primarily caused by uropathogenic Escherichia coli (UPEC), which is a gram-negative bacterium (Ghazvini et al., 2019). UPEC is responsible for the highest prevalence of this urinary tract infection (UTI). Other less common gram-negative bacteria, such as Klebsiella pneumoniae and Proteus mirabilis, and occasionally gram-positive organisms like Staphylococcus saprophyticus, can also be associated with acute uncomplicated cystitis. However, UPEC is the predominant culprit, accounting for approximately 80-85% of all cases. UPEC possesses specialized virulence factors that allow it to adhere to and colonize the urothelium lining the bladder, evade the host’s immune defenses, and cause infection. These virulence factors include fimbriae, such as P-fimbriae, that aid in attachment, and toxins like hemolysin that contribute to tissue damage.

Treatment Strategy for Jill

For Jill’s case of acute uncomplicated cystitis, an appropriate treatment strategy would involve using nitrofurantoin due to her allergy to sulfa drugs. Nitrofurantoin is a suitable choice for this condition, as it is effective against a broad spectrum of bacteria, primarily in the urinary tract. The recommended dose is 100 mg taken twice daily for a duration of 5 days. Nitrofurantoin’s mechanism of action involves inhibiting bacterial enzymes and interfering with the synthesis of bacterial DNA, which leads to bactericidal effects (Alam et al., 2019). This antibiotic is particularly effective against common pathogens responsible for cystitis, such as E. coli, which is a frequent culprit in uncomplicated urinary tract infections. By targeting these bacteria, nitrofurantoin provides an effective and targeted treatment approach. Moreover, the choice of nitrofurantoin minimizes the risk of allergic reactions in Jill, ensuring her safety during the treatment course. The 5-day duration of therapy is in line with current guidelines for acute uncomplicated cystitis and should help alleviate her symptoms and eliminate the infection without the need for prolonged antibiotic use, thereby reducing the risk of antibiotic resistance.

Monitoring, Side Effects, and Drug-Drug Interactions:

Monitoring Jill’s progress during treatment is crucial. The primary focus should be on the improvement of her symptoms, including the discomfort when urinating, burning sensation, and the relief of abdominal pain with urination. Additionally, it is important to watch for any signs of complications, such as the spread of the infection to the kidneys, which can lead to more severe symptoms and potentially life-threatening issues.

Common side effects associated with nitrofurantoin include gastrointestinal upset, which may manifest as nausea, vomiting, or diarrhea (Milazzo et al., 2022). While these side effects are generally mild, it’s important to educate Jill about them so she knows what to expect during treatment. Rarely, nitrofurantoin can cause pulmonary toxicity, which could result in symptoms like cough, shortness of breath, or chest pain. If she experiences any of these symptoms, she should seek immediate medical attention.

References

Alam, M. S., Rana, K., Bhardwaj, S., Kaliaperumal, J., Hussain, M. S., & Mittal, A. (2019). Role of nitrofurantoin in the management of urinary tract infection–a systematic review. Journal of Evolution of Medical and Dental Sciences8(50), 3805-3812.

Ghazvini, H., Taheri, K., Edalati, E., Miri, A., Sedighi, M., & MIRKALANTARI, S. (2019). Virulence factors and antimicrobial resistance in uropathogenic Escherichiacoli strains isolated from cystitis and pyelonephritis. Turkish journal of medical sciences49(1), 361-367.

Kaur, R., & Kaur, R. (2021). Symptoms, risk factors, diagnosis and treatment of urinary tract infections. Postgraduate Medical Journal97(1154), 803-812.

Milazzo, E., Orellana, G., Briceño-Bierwirth, A., & Korrapati, V. K. (2022). Acute lung toxicity by nitrofurantoin. Drug and Therapeutics Bulletin60(7), 108-111.

Seid, M., Markos, M., Aklilu, A., Manilal, A., Zakir, A., Kebede, T., … & Endashaw, G. (2023). Community-Acquired Urinary Tract Infection Among Sexually Active Women: Risk Factors, Bacterial Profile and Their Antimicrobial Susceptibility Patterns, Arba Minch, Southern Ethiopia. Infection and Drug Resistance, 2297-2310.