Pathology of Clinical Manifestations in a Case Study of Urinary Tract Infection

Running head: CASE STUDY
Assessment 2
Name of the Student
Name of the University
Author Note

CASE STUDY1
Introduction- Critical care nurses are entitled with the responsibility of providing
treatment modalities to patients who have been identified as acutely ill, and require
conduction of regular nursing assessments, thoroughly the implementation of effective
medications and/or life sustaining technology and drugs. The case study is based on Mr
Kirkman, a septuagenarian, who recently got admitted to emergency department of the
hospital, following manifestations of signs and symptoms that comprised of burning
sensation during urination, apart from pain in the lower abdomen, which radiated to his right
flank. Moreover, he had been diagnosed with urinary tract infection (UTI) and was under the
day-to-day administration of IV NaCl and IV Sulfamethoxazole-trimethoprim. Insertion of
indwelling catheter was another notable sign. This case study will analyse the pathology of
his clinical manifestations.
Clinical manifestation pathogenesis- Following admission of the patient to the
healthcare setting, a comprehensive physical assessment had been conducted, which provided
information on the presence of an unusually raised heart rate. In addition, the patient also
reported signs and symptoms of increased body temperature, reduced blood pressure, poor
levels of oxygen saturation, and an elevated respiratory rate. On analysing his presenting
complaints, it can be suggested that the patient was suffering from Urinary Tract Infection
(UTI) that generally occurs when pathogens such as, bacteria (Klebsiella or Escherichia coli)
enter the urinary bladder, primarily through the urethra (Walsh & Collyns, 2017).
Homeostasis refers to the tendency of the human body to maintain a state of equilibrium,
while adjusting the biological system to the physiological conditions that are considered
optimal for human survival. There is mounting evidence for the fact that natural resistance is
manifested by the body, in relation to changing conditions that helps in maintaining
homeostasis (Kotas & Medzhitov, 2015). The elevation in respiratory rate and pulse rate can

CASE STUDY2
be cited as a mechanism of homeostasis, in relation to pro-inflammatory response of the
body.
Time and again it has been proved that the immune system plays an important role in
maintaining homeostasis by fighting off infections, thereby protecting the body (Honda &
Littman, 2016). During onset of an infection, the immune system releases pyrogens that send
signals to the brain for increasing the temperature of the body, thereby causing fever. Hence,
high body temperature, as manifested by Mr Kirkman can be associated with pyrogen release
since they result in release of PGE2 or prostaglanding E2 that subsequently acts on
hypothalamus and causes heat-generating impacts on the body by creating systemic response
(Brito et al., 2016). Furthermore, pro-inflammatory cytokines like tumour necrosis factor
(TNF) and interleukin (IL)-1 also produce fever in an individual (Eskilsson et al., 2017). It is
a well-established fact that balance between anti-inflammatory and pro-inflammatory
cytokines is imperative for maintaining optimal health. However, pro-inflammatory
mediators have also been associated with inflammation in heart vasculature, thereby
activating the immune cells, and increasing the heart rate in the patient. Mr Kirkman was an
active smoker (Müller-Werdan, Prondzinsky & Werdan, 2016).
There is mounting evidence for the correlation between smoking and dysfunction of
the heart, which in turn increases chances for tachycardia (Linneberg et al., 2015). Taking
into consideration the fact that the patient was an alcoholic, it might have resulted in
electrical signal disruption, thus creating an impediment in the production of normal
heartbeat. Tachypnoea or increased respiratory rate in the patient can be associated with the
fact that there was a possibility of the pathogens getting dispersed all across the body, and
eventually affecting the lungs that lead to an activation of cytokine IL-1β
facilitated inflammatory cells (Hogmalm, Bry & Bry, 2018). In addition, C5a present in
neutrophils acts in the form of stimulant for chemokine and pro-inflammatory cytokine