Acute Life Threatening Conditions: Pathophysiology, Nursing Priorities and Interventions

This article discusses the pathophysiology, nursing priorities and interventions for acute life-threatening conditions. It covers the case study of a patient with urosepsis and urinary tract infection.

Running head: ACUTE LIFE THREATENING CONDITIONS
ACUTE LIFE THREATENING CONDITIONS
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1ACUTELIFE THREATENING CONDITIONS
Question 1
Taking insights from the case study, it can be observed that the concerned patient Mr.
Kirkman, is inflicted with sepsis caused from the progression of symptoms related to urinary
tract infection, otherwise known as urosepsis. UTI, otherwise known as urinary tract infection,
implies emergence of infection caused in the urinary tract, due to interference by pathogenic
microbial strains and is associated with harmful effects on excretory activities of kidneys, due to
after progressing throughout the compartments of the urinary tract system, that is the ureters,
urethra and urinary bladder (Mulvey, Klumpp & Stapleton, 2017). An individual may acquire
symptoms of urinary tract infection after pathogenic microbial strains find entry into to urethra,
especially after performing self-care hygiene tasks in insanitary conditions, due to
inappropriately wiping after urination or engagement in sexual intercourse without protection.
This leads to symptoms like perception of burning or irritation sensations during urination,
feeling the urgency to urinate even after immediate urinary and production of urine which is
dark, concentrated and thick, and radiating lower abdominal pain in the kidney or right flank
areas - which can be prevalently observed upon reading Mr. Kirkman’s case study
(Wagenlehner, Tandogdu & Johansen, 2017).
Upon infiltration by infectious microbes, the innate immunity and defense mechanisms of
the body aim to combat further aggravation of symptom. However, lack of timely administration
of treatment and increments in the rates of inflammation due to immunological mechanisms
results in progression of the disease towards the kidneys hence affecting normal rates of
excretory mechanisms (Lange & Chew, 2015). Kidneys are the organs solely responsible for
removal of toxic nitrogenous wastes like creatinine and urea, along with maintaining

2ACUTELIFE THREATENING CONDITIONS
recommended levels of hydration and electrolytes in the body. From the case study, it can be
observed that Mr. Kirkman has been presented with abnormally high levels of potassium,
sodium, creatinine and urea in the serum which implies that normal excretory functioning of his
kidneys are clearly impaired due to the result of progression of UTI symptoms from the urinary
bladder to the kidneys (Cunha, 2016).
UTI progresses to urosepsis due to increments in the proliferation of infection to
surrounding organs via the bloodstream. To combat pathogenic UTI symptoms, immunological
processes such as T cell activation are conducted. Often however, the body may lose tolerance
against these mechanisms resulting in malfunction in the immunological processes and triggering
pathologies of multiple organ failure and septic shock. This results in symptoms of alterations in
mental state, increased respiratory rate an abnormal reductions in blood pressure (Tonolini,
2018). The above pathophysiology can hence be observed and related in Mr. Kirkman, who is
unable to engage in normal speech and cognition and has symptoms of abnormally high
respiration and body temperature, hypoxia, abnormally low blood pressure resulting in the
flushing of his face.
Questions 2
As per Australian Therapeutic Guidelines, the nursing priority to be addressed here is
infection prevention (Fasugba et al., 2017). It is worthwhile to note that the key mechanisms
underlying Mr. Kirkman’s present condition is due to the pathogenic progression of his UTI
symptoms to surrounding tissues and cerebral areas of his brain resulting in urosepsis. Urosepsis
is a harmful condition with serious fatal symptoms due to circulating presence of pathogens and
inability of the immunological processes of the body to ward off the same. Hence, the lack of

3ACUTELIFE THREATENING CONDITIONS
timely treatment of the progression underlying his infection will further increase pathogenic
progression to additional organs and tissues of his body increasing his susceptibilities to acquire
multiple organ failure and death due to septic shock. Hence, with infection prevention as
rationale and priority the nurse must seek to engage in antimicrobial therapy (Mulvey, Klumpp
& Stapleton, 2017). This will involve the nurse engaging in Nursing and Midwifery Practice
Standards of collaborative working and multidisciplinary approaches of care comprising of the
nurse, nephrologist and allocated physician (Nagle et al., 2017). Antibiotic treatment will require
the nurse to promptly administer intravenous antibiotics such as cefotaxime, getamicin, penicillin
or amoxillin. The care plan will also require the nurse to monitor invasive equipment like
installed catheters in order to ensure routine disinfection, sanitation and hence the resultant
prevention of pathogenic progression of microbial strains to Mr. Kirkman’s urinary tract
(Johansen & Naber, 2015). The overall rationale associated with the above care prioritization
and nursing intervention include: prevention pathogenic disease progression to surrounding
organs and eradication of possible fatal symptoms of multiple organ failure, septic shock and
hence, death (Meddings et al., 2017).
Questions 3
Inadequate compensation and emergence of acidosis can be implied from Mr. Kirman’s
arterial blood gas results. Reductions in normal pH levels of 7.35 to 7.45, indicates acidosis
which is harmful since it leads to denaturation of tissue proteins and loss of enzymatic
functioning resulting in immunological and gastrointestinal deficits. For compensation,
inhalation of carbon dioxide is increased leading to increases in bicarbonate buffers in the blood
and a state of alkalosis to achieve an equilibrium in pH (Ranson & Pierre, 2016). Similar

4ACUTELIFE THREATENING CONDITIONS
compensation in kidneys occur via urinary secretion of acidic hydrogen. However, urosepsis, as
observed in Mr. Kirkman, hinders normal kidney function and difficulties to compensate during
acidosis. Indeed the loss of compensation is evident in Mr. Kirkman, due to urosepsis induced
loss in renal functioning resulting in increased urea, creatinine and hydrogen retention and hence
a state of acidosis indicated in his pH. Additionally, it must be noted that Mr. Kirkman has a
history of smoking and chronic bronchitis which decreases his lung’s abilities to inhale
adequately and hence engage in compensatory mechanisms of acquiring carbon dioxide to
produce bicarbonate ions meant for alkalosis. Hence, such losses in his ability to perform
compensation due to smoking and bronchitis is evident in abnormal blood gas results of low
carbon dioxide and bicarbonate ions (Woods & Hodgson, 2015). It can also be observed that Mr.
Kirman has high levels of the compensatory product lactate – which indicates hypoxia, high
tissue perfusion and reduced oxygenation. This can be associated with his condition of urosepsis
- a condition known to exert multiple organ damage and loss of organ systems to induce
compensatory mechanisms (Boulain et al., 2016). Thus, the nurse must also aim to address
additional priorities in Mr. Kirman, which is include, alleviation of acidosis symptoms and
management of chronic lifestyle and pulmonary problems since a lack of the same will lead to
immunological deficits, altered mental states, protein denaturation and high rates of catabolism
(Larkin & Zimmanck, 2015).

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