Pathogenesis of Urinary Tract Infection and Nursing Strategies

Medical
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Pathogenesis:
Urinary tract infection is associated with infection due to different enterobacterias. Patients
with risk of sepsis are prone to develop bacteraemia following urinary tract infection.
Urosepsis patients are prone to develop urolithiasis, prostatic adenoma, urologic carcinoma,
and other urologic diseases. UTI mainly occurs due to interaction among uropathogen and
host. Uropathogens get attached to the epithelial surface and subsequently it colonises and
distributes through the mucosa which results in the tissue damage. Bacterial adhesins and its
relevant epithelial binding sites are mainly responsible for progression of infection.
Progression of infection results in the pyelonephritis and renal impairment (Stapleton, 2014;
Haak and Wiersinga, 2017).
Infection results in release of pathogens and pathogen products like pathogen associated
molecular pattern (PAMP) and danger-associated molecular patterns (DAMP). These
pathogen or pathogen products get recognized through receptors of the cells like complement
system, endothelium and adipose tissue which are called as pattern recognition receptors
(PRRs). PAMP bind to PPR present on the surface of macrophages, neutrophils, and
endothelial or urothelial cells. PRRs modulate immunological pathways post infection
through release of pro- and anti-inflammatory mediators and biomarkers. The transcription
factor NF-κB is responsible for the release of pro-inflammatory cytokines like IL-6, IL-12,
and TNFα. In the process, further inflammatory mediators like chemokines, prostaglandins,
thromboxans, and leukotrienes get released (Anderberg, Luther, and Frithiof, 2017; Pop-
Began, Păunescu, Grigorean, Pop-Began, and Popescu, 2014). Nitric oxide (NO) are
produced through endothelial cells which reduces the vascular tone. Reduced vascular tone
results in hypotension. It is evident that Kirkman is associated with hypotension because his
recorded blood pressure is 80/42. Sepsis of the urinary tract infection is associated with
Systemic inflammatory response syndrome (SIRS) and tachycardia is the prominent symptom
of SIRS. Sepsis patients are associated with cardiac arrythmias due to excessive inflammation
and secretion of excessive stress hormones. Infection in sepsis patients also lead to
development of fever. In case of Kirkman also body temperature increased to 39°C which
indicate development of fever. There would be increase in the heart rate in patients with
fever. In sepsis patients, there might be growth of bacteria in the bladder and urethra. It could
lead to pain in patients with UTI and irritation during urination. Kirkman also was
experiencing burning sensation during urination and abdominal pain radiating towards right
flank. Color of the urine get changed in patients with UTI due to pus and tinge of blood. In
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patients with sepsis, there are chances of reduced levels of haemoglobin. Haemoglobin levels
get reduced due to reduced red blood cells production due to systemic inflammatory response
and augmented red blood cells destruction as result of haemolysis and bleeding (Detweiler,
Mayers, and Fletcher, 2015).
In case of Kirkman, haemoglobin level reduced to 8.4mmol/L. Normal haemoglobin level in
male should be 8.67 - 10.8 mmol/L. Reduced haemoglobin levels would lead to impairment
in the oxygen consumption and tissue oxygenation. Reduced haemoglobin level also
produces reduced oxygen carrying capacity of the blood and there would be reduced partial
oxygen pressure and oxygen saturation. In case of Kirkman also oxygen saturation (SPO2)
was reduced to 82%. Normal SPO2 should be between 95 – 100 %. Reduced levels of oxygen
levels in the blood lead to increased work on breathing. Lungs starts breathing at the faster
rate to breath in more oxygen to compensate reduced levels of oxygen in the blood. Hence,
breathing rate would be increased in the patients with sepsis. Normal respiratory rate in an
adult should be between 12 to 20 breaths per minute; however, in case of Kirkman observed
respiratory rate was between 35 breaths per minute. Urinary tract infection is associated with
reduced urine output mainly because body goes into the shock. It led to reduced blood flow to
the organs including kidney. It results in the reduced glomerular filtration; hence, it results in
reduced cardiac output. Hence, in patients with urinary tract infection, urine output gets
reduced. In case of Kirkman also, urine output reduced. Reduced urine output results in the
reduced excretion of elements like Na+, K+ and Cl-. Hence, there would be increased levels of
these electrolytes in patients with urinary tract infection. In case of Kirkman also, there was
slight increase in the electrolyte concentration. WBC count in sepsis patients increased due to
infection and inflammation. WBC count increase in patients with sepsis to fight against
infection. Infection activates immune system and increase number of white blood cells to
destroy infection. Different types of white blood cells act differently to fight against
infection. Lymphocytes produces antibodies to fight against bacteria in sepsis patients.
Neutrophils act as powerful destroyer of bacteria. Basophils play role in alerting body about
infection by releasing chemicals in the blood stream. Macrophages increase in the sepsis
patients to remove damaged tissue due to infection and regulate immune response (McLellan
and Hunstad, 2016).
Nursing strategy:
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