Health Variation 4

Running head: HEALTH VARIATION 4 1
Health Variation 4
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HEALTH VARIATION 4 2
Health Variation 4
Q. 1 Urinary tract infections (UTI) are common bacterial infections that affect different parts
of the urinary tract. The incidence of these infections is high in male adults over 50 years often
requiring an indwelling catheter (Tan & Chlebicki, 2016). Urinary tract infections can be
classified as simple or complicated. Appropriate classification guides in the management and
treatment plans of affected patients. Physicians base the diagnosis of UTIs on history and
individual factors. While oral antibiotics are used in uncomplicated UTI infections, imaging and
referral to the emergency departments are fundamental in treating complicated infections.
Escherichia coli remains the prominent causative microbe in uncomplicated UTIs: amoxicillin in
combination with clavulanic acid can be used to treat these infections (McLellan & Hunstad,
2016). With an appropriate history investigation and antibiotics, doctors can manage most
uncomplicated and complicated urinary tract infections in the elderly. More also, proper
management will help reduce any incidence of antibiotic resistance.
Pathogenesis and Clinical Manifestation
Urinary tract infections affect both the upper and lower tract of the urinary system, which
consists of the bladder, urethra, ureter, and kidneys. A relationship exists between a patient,
bacteria, and the environment. The urethra connects a patient’s bladders to the possible infection
site in the perineum. The urethra passes through a urogenital diaphragm that is responsible for
the creation of a high-pressure zone. As a defense mechanism, this high-pressure zone prevents
the ascension of bacteria colonized in the urethra or bladder (McLellan & Hunstad, 2016). A
patient’s defense mechanism determines if the uropathogenic E. coli bacteria persist or die.
Notably, coliforms, E. coli, and enterococci colonize the perineum (Grabe et al., 2015). Most

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affected patients rely on catheters for bladder emptying, but in most cases, it is responsible for
the development of urinary tract infections.
Normal flora in the regions around the urethra or vagina include lactobacilli, streptococci,
and staphylococci; they often form a barrier to most pathogenic microbes (Tandogdu &
Wagenlehner, 2016). In most patients, and in this case Mr. Kirkman, uropathogens originate
from rectal flora. These microbes enter the urinary system through the urethra, and later into the
bladders. Though this ascending route, uropathogens adhere and colonize the urethra. According
to Grabe et al., (2015), soiling around the perineum, for instance, in patients with catheters,
exacerbates the ascending route. Bacteria that ascend into the renal pelvis penetrate the renal
parenchyma hence destroying the renal tubules. Alteration of the renal and periurethral mucosa
decreases pH that in turn makes a patient more receptive to more uropathogens (Grabe et al.,
2015). Besides, renal obstruction and static urine flow alter a patient’s immune mechanisms
predisposing them to complicate UTIs. Mr. Kirkman’s indwelling catheter is an ideal media for
pathogens to colonize, which results in clinical presentations. According to Saint et al. (2018),
patients with indwelling catheters present up to 100% bacteriuria. The clinical manifestation of
complicated urinary infection results in upper and lower tract irritative signs and symptoms (Tan
& Chlebicki, 2016). Severe systemic symptoms arise due to sepsis or trauma to the genitourinary
tract.
Mr. Kirkman’s risk factors for urinary tract infection include age (75 years), mental
status, distress, previous UTI history, and age-related reduced immune response. Mr. Kirkman’s
complains of a burning sensation during urination and a lower abdominal pain on the right flank.
The presence of an indwelling catheter correlates with Mr. Kirkman’s signs, which indicates UTI
with severe sepsis. The physician’s physical assessment shows increased heart rate, respiration,