Contagious respiratory illness ranging from milt to severe ‣Abrupt onset of fever accompanied by chills, HA, myalgia, malaise, •anorexia Non-productive cough, nasal discharge, sore throat •≤25% with pulmonary symptoms ‣>65 y.o, asthma, diabetes, heart disease, pregnant females, young •children Influenza associated pneumonia •Typical symptoms then rapid respiratory decompensation Lung tissue defense impairment/dysregulation ‣May be complicated by bacterial pneumoniaeS. Pneumoniae, S. Aureus ‣Considered in pts with severe disease, remain ill, worsen, or acute onset of ‣high fever or respiratory distress after initial improvement
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Urinary Tract InfectionsUTI•Presence of microbial pathogens w/i urinary tract ≥10^5 bacteria/ml‣Classification based by site of infection Urine- bacteriuria ‣Bladder - cystitis (lower UTI)‣Non-systemic in symptomatology •Kidney - pyelonephritis (upper UTI)‣Systemic infection •Prostate - prostatitis ‣Additional Classification Uncomplicated v complicated ‣Most episodes of cystitis and pyelonephritis are uncomplicated •Complicated UTI is associated with underlying condition that increases •risk of infection or failing of therapy Mild, moderate, or severe illness ‣Asymptomatic bacteriuria ‣Routes of infection •Ascending route Bacterial colonization of urethra —> bacteria multiply in bladder —> ascend ‣to ureters Primarily from colonization of vaginal area by fecal flora •Short length of female urethra and proximity to perinatal area predispose •Hematogenous route (descending)Dissemination of microorganisms from distant sites of infection through blood ‣or due to bacteremia (less common) Lymphatic route Bowel, blade, and kidney potentially connected by lymphatic pathways ‣Clinical Presentation •Signs and symptoms Lower UTI (cystitis)‣Dysuria •Urgency and frequency •Suprapubic heaviness •Gross hematuria •Upper UTI (pyelonephritis) ‣May or may not have s/s of cystitis concurrently •Flank pain or CVA tenderness•Fever •N/V•Altered mental status •Physical Examination
Upper UTI: flank pain‣Lab tests Urinalysis ‣Pyuria (WBC > 10 cells/mm)•Nitrite-positive urine •Leukocyte esterase positive urine •Bacteriuria (>10^5 cfu/ml)‣Urine culture ‣Reports bacterial speciation and drug sensitivities •Pathogens •E. Coli (75-90%)Proteus mirabilis Klebsiella pneumonia or oxytocaStaph saphrophyticus (more often in young women) Enterococcus spOther gram negative rods (dependent on pt specific factors)Pseudomonas (especially in pts with recent healthcare contact)‣Enterobacter sp‣Citrobacter sp‣Others ‣Question 1: Upper or lower UTI•Important to determine for several reasons:Bacterial infection that has ascended past bladder has greater consequences ‣if not treated properly Can enter blood •
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