Case Study Assessment: Pathophysiology, Nursing Priority, and ABG Assessment

Case study assessment
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Introduction
This case study assesses patient Kirkman aged 75 years old admitted in the emergency
department with complains of a burning sensation while urinating and lower abdominal parts
of the body. Diagnosis reveals urinary tract infection with sepsis. This essay has focussed on
the pathophysiological of the patent state, nursing priority and ABG assessment.
Pathogenesis
Urinary tract infections can lead to severe sepsis occurrence associated with pulmonary
and abdominal infections couples with urinary infections. Sepsis occurs more in men
compared to women, having a reported mortality rate of 20-42%, it is highly associated with
high mortality rates among vulnerable groups such as the elderly (Grabe et al., 2015).
Patient Kirkman path physiology of UTI involves the spread of urinary tract infection
entering the bladder through the urethra and another infection occurring in the lymph. It is an
assumption that the bacteria are transmitted to the urethra from the bowel, females are often
at greater risks due to the anatomical structure. The common inoculation organisms involve
gram-negative aerobic bacilli from the gut with Escherichia coli. In normal hosts the
occurrence of infection occurs in the portions of the genitourinary tract, the prostate. It begins
with the colonization of the urethral meatus due to uropathogens obtained from the fecal fora
which are closely followed by the ascension in the urethra into the bladder (Gupta et al.,
2011).
Older males tend to have prostatic hypertrophy with incomplete bladder emptying,
which often predisposes them to urinary sepsis. The key reason for this is depicted by the
urinary burning sensation which is causing discomfort from the patient during a urinary
period.
After the elapse of the 24 hours the patient state is deteriorating indicating the bacterial
entry into the bladder, it is attached to the walls of the bladder and form biofilms which result
in decreased body's immune system. Escherichia coli is the common form of microorganism
followed by Klebsiella and Proteus spp which causes urinary tract infection. The entry of
microorganism into the prostate gland which occurs via urethra with the reflux of urine
making the bacteria migrates through the ducts. Other entries can occur through the
hematogenous route through the lymphatic rectum. The presence of gram-positive bacteria
such as Enterococcus and Staphylococcus are elevated. The increased urinary pathogens

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resistance lead to anti microbes such as quinolones can lead to its overuse. Excebaration of
the lower output volume of the body indicates loss of key nutrients such as electrolyte and
creatine excretion which are low (Flores-Mireles, Walker, Caparon & Hultgren, 2015).
A small quantity of urine is usually controlled naturally in the bladder mechanism. The
microorganism exists in high numbers in the perineum, intermittent catheterization has been
demonstrated to effectively empty the bladder, which may be another causative factor for
UTI occurrence. However, despite this, the patient is producing lower urine output indicating
dysfunction of the urinary thus affecting the flow of urine from the bladder. Hence sepsis
levels are likely to decrease the urine output levels in the patient state (Miller, 2018).
The patient vital state is worsening indicating signs of severe sepsis linked to septic
shock associated with significant substantial mortality. Urinary tract infection can lead to
characterize symptoms which are linked to asymptomatic to sepsis, and even sepsis shock.
The patient state has increased in terms of fever, temperature, heart rate, and blood pressure
and generally looks unwell.
Nursing strategy-
Management of Acute Respiratory Distress Syndrome
Patient signs and symptoms depicting rapid breathing, shortness of breath, difficulty
talking, low blood pressure and organ dysfunction in removing urine due to underlying UTI.
Key nursing strategy management to be initiated to the patient is the application of high flow
nasal cannula and noninvasive ventilation, which is a novel oxygen therapy for the patient
which allows for oxygen increase for up to 100% of heated and humidified air through the
nasal cannula at the rate of 60L/min. This is likely to decrease the patient risks of intensive
care unit admission and a reduction of about 90-day mortality in generally (Frat et al., 2015).
The occurrence of acute respiratory distress Syndrome depicts a major health problem
for the patient. This results in an infectious pathogenicity in the urinary tract leading to
infection likely to cause septic shock on the patient. Acute Respiratory Distress Syndrome is
a devastating state and a complication occurring in sepsis state. Sepsis cases have a high
mortality rate and hence high risks, thus initiating this nursing strategy to the patient is key
eliminating complications (Steingrub et al., 2014).