Case Study on Urosepsis

This case study explores the pathogenesis of urosepsis, appropriate nursing strategies, and analysis of arterial blood gases. It provides insights into the diagnosis and management of urosepsis.

Running head: CASE STUDY ON UROSEPSIS 1
Case study on urosepsis
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In one of the case studies, Mr. .Kirkham, a 75 year old male presented at the emergency
department. He complained of burning sensation while urinating as well as lower abdominal
pains that was radiating into the right flank. Later on, the patient was admitted to the ward after
being diagnosed with Urinary tract infection. NaCL and Sulfamethoxazole trimethoprim were
then administered IV. An indwelling catheter was inserted as well. Diagnosis indicated abnormal
levels of arterial blood gases and 24 hours, he was diagnosed with Urinary tract infection with
sepsis. Urinary tract infections are common infections affecting majority of the population.
Often, the condition is treated quickly with antibiotics. However, among people who do not
experience burning sensation below the waist or those who can’t speak for themselves, there is
delayed treatment of the UTI which later spread to the kidneys .This leads to more pain and
illness. Eventually, urosepsis occurs. Severe sepsis then develops to septic shock. Since Sepsis
and septic shock leads to death, it is imperative to comprehend the pathophysiology, diagnosis
and management of the condition. In the subsequent sections, there will be answers to the case
study of Mr. Kirkmann.
Question 1. Pathogenesis of Urinary Tract Infection with sepsis
Sepsis is a condition brought about as the immune system respond to an underlying
condition. This can be a urinary tract infection like in the case of Mr. Kirkmann. A urinary tract
infection according to the World Health Organization, is any condition that affect the urinary
system from kidneys, ureters, bladder and the urethra. In most cases, urinary tract infections are
as a result of bacterial infections. The body is generally designed in a manner that makes it
difficult to get bacterial UTI. However, in extreme conditions, bacteria from the genital area can
access the urethra or urinary tract through wiping after visiting the bathroom or sexual activity
(Dreger, Degener, Ahmad-Nejad, Wöbker, & Roth, 2015). Furthermore, bacteria can get access

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to the urinary system under unsanitary conditions like insertion of catheters like in the case of
Mr. Kirkmann. The UTI is then exhibited through signs and symptoms like burning sensation
during urination and lower abdominal pain radiating into the right flank. In most cases,
underlying UTIs can be effectively treated by antibiotics. If they are not treated well, it might
lead to a serious condition known as sepsis.
Studies show that gram negative bacteria responsible of Urinary Tract infections, have
endotoxins in their cell walls. A good example of the endotoxin is lipopolysaccharide. These
lipopolysaccharides activate the inflammatory, coagulation and complement systems. These
collectively stimulate production of monocytes, macrophages, neutrophils and dendritic cells
(Ghatak, 2016). Finally, the monocytes activate secretion of interlukin-1 and the tumor necrosis
factor alpha that eventually mediate sepsis that is characterized by signs and symptoms such as
fever, low blood pressure, increased heart rate and respiratory rate like it was seen in the case of
Mr. Kirkmann.
Question 2: An appropriate Nursing strategy
Fluid therapy is the best nursing strategy. The rationale of this intervention is to
resuscitate the patient. Studies recommend fluid therapy by using crystalloids like isotonic
sodium chloride or the lactated Ringers solution (Peach, Garvan, Garvan, & Cimiotti, 2016)..
However, it is recommended that it should be used in combination with other methods since fluid
therapy alone cannot repair central venous or wedge pressure.
Question 3: Analysis of arterial blood gases
According to the World Health Organization, an arterial blood gas is a blood test that
seeks to estimate the acidity, PH as well as the levels of oxygen, carbon dioxide from the

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arteries. The rationale of the test is to find out if the lungs of the patient are working well or not.
The test is frequently conducted in the Intensive Care Unit and ER setting. However, it can also
be done on any patient depending on their diagnosis. Furthermore, ABGs can be drawn for
diverse reasons such as concerns for shock, kidney failure and lung failure.
The key components of an arterial blood gas test include PH, oxygen saturation, partial
pressure of oxygen, partial pressure of carbon dioxide and finally Bicarbonate. The normal
ranges for the above components as stipulated by the National Institute of Health are 7.35-7.45
for the PH. The normal partial pressure of oxygen is between 75 to 100 mmHg (Peach, Garvan,
Garvan, & Cimiotti, 2016). The normal level of oxygen saturation on the other hand is between
94 to 100% while those for Bicarbonates are between 22 and 26 mEq/L. Finally, the normal
partial pressure of carbon dioxide is between 35 and 45 mmHg.
In the case study of Mr. Kirkman, the results for the ABGs were as follows: The PH was
7.25 while the partial pressure of oxygen was 75mmHg. The partial pressure of carbon dioxide
was 32mmHg.The Bicarbonate was 15mmol/l. The BE was -6mmol/l. Finally, Lactate was 3.2
mmol/L. Compared with the stipulated normal ranges by the National Institute of Health, all the
parameters were outside the normal ranges. This is due to the defects brought about by the
Urinary Tract Infections.
Sepsis leads to low partial pressure for oxygen. Partial pressure for oxygen according to
the World Health organization is a measure of oxygen in arterial blood. It indicates how well
oxygen can move from lungs to the blood. Studies explain sepsis as the response of the body or
immune system to an infection. In the case study of Kirkmann, the body was responding to the
Urinary tract infection. The same study note that the end results of inflammation are
hemodynamic changes and respiratory failure (Schneeberger, Holleman, & Geerlings, 2016).

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These two conditions ultimately lead to reduced tissue oxygenation and that is why the partial
pressure for oxygen of the patient was lower than the normal ranges. Furthermore, studies have
established that sepsis leads to tissue perfusion. Once oxygen is not available for the body to
breakdown carbohydrates, amino acids and fats, anaerobic metabolism starts. During this
process, pyruvate is broken down by lactate dehydrogenase to produce lactate. Lactate then
leaves the body cells into bloodstream where it travels to the liver. This is the reason why the
level of lactate in Mr. Kirkmann was elevated beyond the normal ranges. In a study by
Wagenlehner, Pilatz, Weidner, & Naber conducted in 2015,lactic acid above 4mmol/L like in the
case study of Mr. Kirkmann, tips the acid base balance and may lead to PH below 7.35 as was in
the case study with a PH of 7.25 (Wagenlehner, Pilatz, Weidner, & Naber, 2015). The partial
pressure for carbon dioxide, HCO3‾ and the Base Excess in the case study were also low than the
normal ranges. This is due to poor tissue perfusion that elevate minute ventilation that blows off
carbon dioxide leading to low HCO3‾ and the Base Excess as well.
Conclusion
Urinary Tract Infections if not properly treated with antibiotics, lead to Urinary Tract
infection with sepsis. Sepsis is a life threatening condition contributing to high rates of
mortalities globally. Severe sepsis is characterized by high heart rates, fever and low platelet
counts. Sepsis is basically an infection brought about by the immune response to an underlying
condition like UTI in the case of Mr. Kirkmann. Sepsis is known to alter the Arterial Blood
Gases in different ways. Since sepsis is life threatening, it is imperative that nurses understand
the pathophysiology and management of the condition to protect the general population.

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References
Dreger, N. M., Degener, S., Ahmad-Nejad, P., Wöbker, G., & Roth, S. (2015). Urosepsis—
Etiology, Diagnosis, and Treatment. Deutsches Aerzteblatt Online.
doi:10.3238/arztebl.2015.0837
Ghatak, I. (2016). Analysis of Arterial Blood Gas Report in Chronic Kidney Diseases –
Comparison between Bedside and Multistep Systematic Method. JOURNAL OF
CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/jcdr/2016/19830.8252
Peach, B. C., Garvan, G. J., Garvan, C. S., & Cimiotti, J. P. (2016). Risk Factors for
Urosepsis in Older Adults. Gerontology and Geriatric Medicine, 2,
233372141663898. doi:10.1177/2333721416638980
Schneeberger, C., Holleman, F., & Geerlings, S. E. (2016). Febrile urinary tract infections.
Current Opinion in Infectious Diseases, 29(1), 80-85.
doi:10.1097/qco.0000000000000227
Wagenlehner, F. M., Pilatz, A., Weidner, W., & Naber, K. G. (2015). Urosepsis: Overview
of the Diagnostic and Treatment Challenges. Microbiology Spectrum, 3(5).
doi:10.1128/microbiolspec.uti-0003-2012