Cystitis
Inflammation of the Bladder
Assessment:
Frequency, urgency, dysuria, Low back pain
Urinalysis:
Pyuria and Hematuria
Avoid urinary stasis and fluid intake of 1-3L
 Antifungal agents – fungal infections
 Amphotericin B – daily bladder instillation
 Ketoconazole (Nizoral) – given orally
 Antispasmodic drugs – decrease bladder
spasm, promote complete bladder emptying
 Antibiotic therapy – bacterial UTIs
 3-day course of trimethoprim /
sulfamethoxazole or Fosfomycin –
community acquired UTIs in women
 7-21 days antibiotic – hospitalized patient
 Trimethoprim 100 mg daily – long-term
management older patient recurrent UTIs
 One low-dose tablet TMP – women
recurrent UTI after intercourse
 Estrogen – intravaginal cream
postmenopausal
Pyelonephritis
Infection of kidney and renal pelvis
Assessment:
(Acute) Fever, chills, Tachycardia, Tender CVA
(Chronic) Hypertension, Inability to conserve Na
Urinalysis:
Positive Leukocytes Esterase and Nitrite Dipstick Test,
+ WBC and Bacteria
 Antibiotic therapy (ciprofloxacin, gentamicin) –
first broad spectrum for 2 weeks
 Urinary antiseptic drugs (ex. Nitrofurantoin
[Macrodantin]) – specific antibiotic after urine and
blood C&S results are known
Urolithiasis
Presence of calculi in the Urinary Tract
Assessment:
Renal Colic, Oliguria, Anuria
Urinalysis:
Hematuria
Pain Relief
Drug therapy needed first 24-36 hrs when
pain is most severe
 Opioid analgesics – control severe pain
 Morphine (Statex) –given IV
 NSAIDs such as ketorolac (Toradol)
 Spasmolytic drugs such as oxybutynin
chloride (Ditropan) and propantheline
bromide (Pro-banthine, Propanthel)
Drug Therapy
 Broad spectrum antibiotics
aminoglycosides (ex. Gentamicin
(Garamycin) and cephalosporin (Keflex,
Novo-Lexin)
 Acetohydroxamic acid (Lithostat) and
hydroxyurea (Hydrea)
 Serum creatinine levels are monitored in
patients receiving acetohydroxide acid,
stopped if creatinine levels are above 2
mg/dL.
Immunologic Renal Disorders
GN
Inflammation of Glomeruli in both kidneys
Assessment:
Fluid overload, S3, SOB/DOB
Urinalysis:
Hematuria and Proteinuria, Inc. BUN and
Antitrypsin-O Titers, Dec. s. Albumin, GFR= 50
ml/min
Management of infection
• Antibiotic therapy for 7 to 10 days.
• Penicillin, erythromycin or azithromycin –
caused by streptococcal infection.
Prevention of Complications
• Diuretics and sodium and water restriction
are prescribed –patients with fluid overload,
hypertension, and edema.
• Antihypertensive drugs - control
hypertension.
Chronic GN CKD
Progressive and irreversible kidney injury-
becomes ESKD. Causes- DM and HPN
Assessment: Assessment:
Check for crackles, Inc. in BP and weight, S3, Uremia, F&E, A-B imbalance, lethargy,
Asterixis Hypervolemia, Uremic Frost
Urinalysis: Urinalysis:
Proteinuria, S.G= diluted, RBC, Low Creatine Excessive CHON, CHO, RBC, WBC, dec. Urine
Clearance, Inc. s. Creatinine and BUN osmolarity
• Phosphate binding agents such as calcium
acetate, calcium bicarbonate, sevelamer
hydrochloride (Renagel).
• Calcium and vitamin D supplements
• Antihypertensive drugs and cardiac
medications
• Antiseizure agents such as diazepam,
phenytoin
• Erythropoietin – Epogen IV or given SQ 3 times
a week.
OSA Pleurisy Pleural Effusion Pneumothorax
Breathing disruption that lasts atleast Inflammation of both layers of Collection of fluid in the pleural space Injury that allows air to enter
10 sec and occurs a min. of 5x in an hr. the pleura the pleural space

Pathophysiology: mechanical factors- Pathophysiology: accumulation of fluid

upper airway collapse- obstruction- Pathophysiology: may develop in the pleural space to a point at which it
repetitive apneic episode- hypoxia & in conjunction with pneumonia becomes clinically evident
hypercapnia- Sympathetic response-
risk of HPN, MI Stroke

Assessment Assessment
3s- Snoring, Signs of apnea, Sleepiness Decreased or absent breath sounds,
Assessment fremitus, and dull, flat on percussion Assessment
 Modafinil (Attenace, Provigil) - Severe, sharp, knifelike pain Reduced breath sounds,
promoting daytime wakefulness intensified during inhalation,  Thoracentesis hyperresonance, mediastinal
 Protryptilin (Triptil) – given pleuritic pain, pleural friction  Closed chest drainage shift
rub (early) (Thoracostomy tube)
bedtime, increase resp. drive and
 Adm analgesic agents as prescribed  Chest tube
improve upper airway muscle tone Thoracentesis  Thoracentesis, emergency
and as needed
 Medroxyprogesterone Actate thoracotomy, open
(Provera) & Acetazolamide  Analgesic agents thoracotomy
(Diamox) – associated w/ chronic  Indomethacin (Indocin) –  High concentration of oxygen
alveolar hypoventilation NSAIDS  Attached to pulse ox
 Adm low-flow oxygen at night  Intercostal nerve block
Reactive Airway Disorders
Asthma
Inflammatory disease of airways causes airway
hyperresponsiveness. Predisposing factor: Allergy
Pathophysiology: Predisposing factor- airway
inflammation-bronchoconstriction- activated
inflammatory response- increase blood flow-
attraction of white blood cells and mucus
secretion- narrowing of airway
Assessment:
Cough, Dyspnea, Wheezing, Barrel Chest
ABG: Decreased O2 and CO2
Laboratory: Elevated igE and dec. FEV1 and FVC
1. Quick relief medications – relax smooth
muscle, rescue medication
 SABA – Albuterol, Levalbuterol, Pirbuterol
 Anticholinergics (Ipaprotium) - inhibit
muscarinic cholinergic receptors, reduce
intrinsic vagal tone of airway
2. Long-acting control medications
 Corticosteroids (Methylprednisolone,
Prednisone) – inhaled form
 Mast cell stabilizer (Cromolyn sodium,
nedocromil)
 C/I acute asthma exacerbations
 LABA (Theophylline, Salmeterol, Formoterol)
– not indicated immediate relief of symptoms,
Status asthmaticus
Rapid, onset, does not respond to conventional therapy
Pathophysiology: Severe mucus plugging-asphyxia-
narrowing of airway
Assessment:
Extreme Labored breathing, Wheezing, Distended Neck
vein, Use of accessory muscles for breathing
Initially: short-acting beta2-adrenergic agonist and
systemic corticosteroids - to decrease the intense airway
inflammation and swelling.
1.Short- acting inhaled beta2-adrenergic agonists - most
rapid relief from bronchospasm.
• pMDI (Pressured Metered Dose Inhaler) or via a
nebulizer.
2. Supplemental oxygen and IV fluids for hydration.
• High flow supplemental oxygen is best delivered using a
partial or complete non-rebreathing mask.
• Sedatives are contraindicated.
3. Magnesium sulfate – smooth muscle relaxation
COPD
Airflow obstruction involving airways, pulmonary
parenchyma, or both
Physiology: Exacerbation/Remission- exposure to
noxious gases- inflammatory response-
hypersecretion of mucous- airway narrowing
Drug therapy involved the same inhaled and
systemic drugs as for asthma.
1. Bronchodilators - key symptom management
1.a. Beta-adrenergic agents (Long and Short
acting)
1.b. Cholinergic antagonists (Muscarinic
antagonist)
2. Methylxanthines
3. Corticosteroids
• Inhaled corticosteroids - frequently prescribed
• Long-term treatment in oral corticosteroids is
NOT recommended
• Combination long-term beta2-agonists plus
corticosteroids in one inhaler may be appropriate
•examples include: Formoterol/Budesonide
(Symbicort), Vilanterol/Fluticasone furoate (Breo
Ellipta) and Salmeterol/Fluticasone (Advair)
4. Other medications:
 Alpha1-antitrypsin augmentation therapy
 Mucolytic agents
 used with other medications in long term-  Antibiotics
control of asthma  Antitussive agents
3. Leukotriene modifiers/ antileukotrienes –  Vasodilators
dilate blood vessel and alter permeability,  Narcotic
alternative to inhaled corticosteroids, may be
added to a regimen of inhaled corti in more
severe asthma
 Montelukast (Singulair), zafirlukast (accolate),
Zileuton (zyflo)
4. Immunomodulators
 Omalizumab (Xolair) – patients with allergies
and severe persistent asthma
5. Methylxanthines – when others types of
management are ineffective
 Bronchodilators
 Theophylline, Aminophylline, Oxtriphylline
Emphysema (Pink Puffers) Bronchitis (Blue Bloaters) Atelectasis Pulmonary Edema Pneumonia PTB
Distention of air spaces Inflammation of Bronchi Closure or collapse of the Accumulation of Inflammation of lung Infection of lung
beyond terminal and bronchioles alveoli fluid in the lung parenchyma parenchyma caused by
bronchioles tissue. Frothy Pink because alveoli is mycobacterial invasion
Pathophysiology: Smoke Pathophysiology: Reduced Sputum filled with exudates
Pathophysiology: or environment- mucus ventilation- obstruct
Abnormal distention- plugging- reduce ciliary passage of air- reducing
disruption of the function- bronchial walls alveolar ventilation-
parenchymal tissues- become thickened- atelectasis
increase in dead space- narrowed bronchial
continuous destruction of lumen- altered alveolar
alveolar walls- pulmonary macrophages- more
HPN- dependent edema susceptible to respi
infection

Assessment: Assessment: Assessment: Assessment: Assessment: Assessment:

Dyspnea at rest, Tripod position, barrel Dyspnea, cough, cyanosis, Tachycardia, JVD, Productive cough, Afternoon fever,
productive cough, barrel chest, chronic cough, tachypnea, tachycardia, noisy breathing, dyspnea, fever, hemoptysis, weight loss
chest, prolonged cyanosis breathlessness pleuritic friction rub,
expiratory grunt, pursed Hallmarks of severity: rales/ crackles
lip ABG: Tachypnea, dyspnea, mild Oxygen therapy,
Respiratory Acidosis to moderate hypoxemia diuretics  CBR  CBR
ABG: (furosemide),  St  Strict respiratory
PO2 Elevation and CO2 Laboratory: decreased ABG: vasodilators (IV  Broad spectrum isolation
depression- Respi Aci FEV1 Laboratory: Low ox sat nitroglycerin, antibiotics  Adm 02 inhalation
nitroprusside)  Penicillin  DBE and coughing
Laboratory: Decreased Deep breathing exercises,  Anti-pyrectics  Nebu and suction
FVC incentive spirometry,  Mucolytics PRN
coughing – first line  Postural drainage  Short course chemo:
 Bronchodilators measures to improve intensive phase:
 Antimicrobials ventilation  Ethambutol
 Corticosteroids  Isoniazid – 4 mo
 Mucolytics/expectorants  Rifampicin and
 Low inflow O2 admin Pyrazinamide – 2 mo
 INH, PZA, Rifampicin
given simultaneously
prevent development
of resistance
 Standard reg:
Streptomycin inj

CAD- 5E’s Angina MI

Obstructed blood flow through the coronary
arteries
Pathophysiology: waxy cholesterol deposits-
atheroma- protrude into the lumen- necrosis-
obstruct blood flow
Assessment:
Pain, retrosternal squeezing, weakness,
sweating and clammy skin
ECG: ST depression and T wave inversion
Paroxysms of pain or pressure in the anterior
chest. May relieve in rest and NTG
Pathophysiology: Presences of AHD-
Myocardial Ischemia- Angina
Assessment:
Pain in the center of the chest that radiates
to left arm
ECG: ST depression and T wave inversion
Occlusion of a coronary artery followed by
cessation of blood flow to a part of the
myocardial tissue
Pathophysiology: change in condition of
plaque- activation of platelets- thrombus
formation- ischemia- less supply than
demand- myocardial cell death
Assessment:
S3, S4, JVD, High BP, dyspnea, tachypnea,
oliguria, cyanosis

Laboratory: Normal Cardiac Enzymes
 Low dose aspirin therapy
 Niacin or nicotinic acid
 Bile-acid-binding resins
(Cholestyramine)
 Nitrates SL (Nitroglycerin)
 Beta-blockers (Metroprolol, Atenolol,
Propranolol, Lopressor, Toprol)
 Calcium channel blockers (Amlodipine,
Diltiazem, Felodipine, Isradipine,
Nifedipine, Nisoldipine)
ECG: St elevation, t wave inversion, abnormal
q wave, Atrial Fibrillation
 MONA (morphine, oxygen, nitroglycerin,
aspirin)
 Morphine sulfate – reduce pain & anxiety
  Cholesterol synthesis inhibitors -  Antiplatelet & anticoagulant (Aspirin,  Aspirin – beta-blocker for dysrhythmia,
STATINS Clopidogrel, Heparin Na, Warfarin Na, low heparin or LMWH
molecular weight heparin)  Stool softener
 Glycoprotein IIb/IIIa (Abciximab,  Analgesic
Eptifibatide)  ACE inhibitors
 Statins (Simvastatin)  EPCI
 ACE inhibitors (Captopril)  Thrombolytics
 Oxygen adm. – non-invasive vent >95%
room air

Drugs

Ampothericin B- bladder instillation /Ketoconazole (Nizoral)

Trimethoprim/Sulfamethoxazole or Fosfomycin – treat uncomplicated community acquired UTI

Imaging Assessment