This document is a case study on urosepsis, analyzing the pathogenesis and clinical manifestations of the condition. It also discusses appropriate nursing strategies and provides an analysis of arterial blood gases. The study highlights the importance of understanding the immune response and its impact on vital organs.
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Running head: A CASE STUDY ON UROSEPSIS1 A case study on urosepsis Name: Institution: Tutor: Date:
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A CASE STUDY ON UROSEPSIS2 Question 1: Analyze the pathogenesis in relation to the clinical manifestations in the case study. 20-30% of sepsis according to recent studies, are due to urinary tract infections. A urinary tract infection (UTI) according to both the World Health Organization and the Centre for Disease and Control is alteration to the urinary system such it is unable to eliminate urine from the body effectively(Singer,Deutschman & Seymour,2016).The components of the urinary system include bladder, ureters and the urethra. All these components according to Abraham are sterile and it’s difficult for any pathogen or foreign agent under normal conditions to invade (Abraham, 2016). However, in extreme conditions like unprotected sexual intercourse and unhygienic insertion of indwelling catheters, the bacteria, mostly gram negative can invade the urinary system. Rarely can bacteria from the colon get access to the urinary system. The bacteria then multiply randomly in the urethra leading to a condition known as urethritis (Sprung & Reinhart, 2016). If at this point the bacteria are not controlled, they move to the bladder and randomly multiply leading to cystitis. Multiplication of bacteria in the bladder and urethra is responsible for the itchy or burning sensation as experienced by Mr. Kirkmann. The patient can also experience lower abdominal discomforts with pain radiating from the right flank if the bacteria multiply in the bladder. At this stage, it is easy to combat the bacteria by using antibiotics. However, it is important to carry out culture test to identify the type of bacteria and then carry out a sensitivity test to find out the best antibiotic to be used. Failure to treat the UTI at this stage, the patient is at risk of severe complication such as sepsis. Sepsis, according to numerous studies is an immune response of the body that might injure some of the vital organs of the body. In one study, results show that the gram negative bacteria such as klebsiella, proteus, and E.coli and staphylococcus aureus have
A CASE STUDY ON UROSEPSIS3 lipopolysaccharides in their cell walls. It is the endotoxin lipopolysaccharide that is responsible to mediate or activate the immune system (Tandogdu, Bjerklund Johansen, Bartoletti, & Wagenlehner, 2016). The study established that this endotoxin activate the different components of the immune system such as monocytes, dendritic cells, macrophages, inflammatory and the coagulation and complement systems. Besides mediating clinical sepsis, studies elaborate that monocytes produce tumor necrosis alpha and interleukin 1 at different concentrations. Response of the immune system according to studies results to inflammation and injury to vital organs such as the heart and the lungs (Deutschman & Singer, 2016). Inflammation leads to high temperature and that is why Mr.Kirkmann had fever. Injury to organs also leads to high levels of coagulation factors like platelets as seen in the diagnosis of Mr.Kirkmann. Furthermore, injury to vital organs like lungs and heart lead to respiratory failure and that is why Mr.Kirkmann experience high heart and breathing rates of above 90 beats and 20 breathes per minute respectively. Respiratory failure also leads to low blood pressure and in this case study, it was 80/42mmHg.Tissue perfusion due to sepsis leads to metabolic acidosis and that is why there were abnormal values in arterial blood gases. Question 2: Appropriate nursing strategy The appropriate nursing strategy for the case of Mr.Kirkmann is oxygen therapy. Based on the ABCDE framework of nursing assessment, the health problem to be given the first priority is difficulty in breathing. Mr.Kirkmann is finding it hard to breath. This can be seen through a high breathing and heart rate (Gerlach, 2018). Studies note that sepsis leads to respiratory failure leading to tissue perfusion. In this case, the objective of oxygen therapy is to provide extra oxygen so as to optimize the functioning of vital organs and tissues. The nurse in this case should administer highly concentrated oxygen. Before administration however, the
A CASE STUDY ON UROSEPSIS4 nurse should record oxygen saturation sometimes referred to as the 5thvital sign. This can be achieved through pulse oximetry. The other important signs include pulse, blood pressure, temperature and finally the respiratory rate. Furthermore, oxygen should be administered to reach the recommended 94-98% saturation. In this case, oxygen is supposed to be administered by an experienced staff with the help of appropriate devices and at a desirable flow rate to obtain the desired oxygen saturation. Once the desired oxygen saturation has been achieved, the nurse should then cross off the drug chart after discontinued administration. Question 3: Analysis of arterial blood gases An arterial blood gas test is routinely carried out in the Intensive care department and the ER setting where the patients are experiencing difficulties in breathing. This test is carried out to find out the PH, oxygen, lactate, base excess and carbon dioxide levels in circulation. The rationale is to find out if the lungs are effective or not. However, an arterial blood gas is not only limited to the Intensive Care Department (Rather & Kasana, 2015). The test can also be conducted depending on the diagnosis of the patient like in the case of Mr. Kirkmann. A full arterial blood gas profile is composed of PH, partial pressure for both oxygen and carbon dioxide, lactate, bicarbonates and the Base excess. The International Quality Assurance has conducted several trials across the world and come up with normal ranges of the particular parameters of the arterial blood gases. However, these values may vary depending on altitude. The normal range for PH should be between 7.35 and 7.24.The normal partial pressure for carbon dioxide should be between 35 and 45 mmHg while that of oxygen is estimated to be between 75 and 100 mmHg. Those of Bicarbonates is 22 and 26 mEq/L .Finally, the recommended or normal values for base excess is between -2 and +2 mmol/L. The values for lactate is between 0.3 and 0.8 mmol/L.
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A CASE STUDY ON UROSEPSIS5 Certain physiological abnormalities may lead to discrepancies in arterial blood gases like it was the case for Mr.Kirkmann. All the values in this case were outside the normal ranges and is due to an interplay of different factors. The World Health Organization define sepsis as an immune response to an underlying condition. The response is associated with certain hemodynamic changes as well as the respiratory failure. A partial pressure oxygen test is conducted to find out how well oxygen is circulating through the body from the lungs to tissues (Seymour et al., 2016). Since sepsis brings about hemodynamic changes and respiratory failure however, this means that less oxygen moves from the lungs to tissues and this why the partial pressure for Mr.Kirkmann in the case study was below the normal range at 75 mmHg. A partial pressure for carbon dioxide test is done to find out how well tissues get rid of carbon dioxide. With tissue perfusion in sepsis however, less carbon dioxide is eliminated and this is why the partial pressure for carbon dioxide in the case study was below the normal ranges(Shankar-Hari et al., 2016). Under normal circumstances, the cells use oxygen during aerobic metabolism to produce energy for cells. In sepsis, tissue perfusion means oxygen is unavailable. The cells therefore metabolize carbohydrates and amino acids through anaerobic respiration. Lactate dehydrogenase is the enzyme that breaks down pyruvate to produce lactic acid. This leads to a buildup of lactic acid in blood that causes low PH of 7.25 in the case of Mr.Kirkmann. With increased lactic acid, it tips the acid base balance leading to low Bicarbonates, base excess which was exhibited in the case of Mr.Kirkmann at 3.2 mmol/L and -6mmol/L respectively.
A CASE STUDY ON UROSEPSIS6 References Abraham,E. (2016). New Definitions for Sepsis and Septic Shock.JAMA,315(8), 757. doi:10.1001/jama.2016.0290 Deutschman,C.S., & Singer,M. (2016). Definitions for Sepsis and Septic Shock—Reply. JAMA,316(4), 458. doi:10.1001/jama.2016.6389 Gerlach,H. (2018). Faculty of 1000 evaluation for Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).F1000 - Post-publication peer review of the biomedical literature. doi:10.3410/f.726165855.793550942 Rather,A.R., & Kasana,B. (2015). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).JMS SKIMS,18(2), 162-164. doi:10.33883/jms.v18i2.269 Seymour,C.W., Liu,V.X., Iwashyna,T.J., Brunkhorst,F.M., Rea,T.D., Scherag,A., … Angus,D.C. (2016). Assessment of Clinical Criteria for Sepsis.JAMA,315(8), 762. doi:10.1001/jama.2016.0288 Shankar-Hari,M., Phillips,G.S., Levy,M.L., Seymour,C.W., Liu,V.X., & Deutschman,C.S. (2016). Developing a New Definition and Assessing New Clinical Criteria for Septic Shock.JAMA,315(8), 775. doi:10.1001/jama.2016.0289 Singer M, Deutschman CS, Seymour C.(2016).The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):801-810. Sprung,C.L., & Reinhart,K. (2016). Definitions for Sepsis and Septic Shock.JAMA, 316(4), 456. doi:10.1001/jama.2016.6377
A CASE STUDY ON UROSEPSIS7 Tandogdu,Z., Bjerklund Johansen,T.E., Bartoletti,R., & Wagenlehner,F. (2016). Management of the Urologic Sepsis Syndrome.European Urology Supplements, 15(4), 102-111. doi:10.1016/j.eursup.2016.04.004