Urinary Tract Infection Case Scenario

This case scenario discusses the pathophysiology, nursing strategy, and analysis of arterial blood gas in a patient with urinary tract infection.

Running head: SEPSIS 1
Urinary Tract Infection Case Scenario
Student’s Name
Institution’s Affiliations
Date

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Urinary Tract Infection Case Scenario
Pathophysiology of the Disease
Mr. Kirkman’s presented with a number of complaints to the ED which according to the
clinical history from the ED notes had greatly contributed to the currently diagnosed condition.
He is a heavy social drinker and a smoker since his teen ages. He has had a previous case of
urinary tract infection and had no clinical history of heart failure. The pathophysiology therefore
of the current condition is can be explained in the relation of Mr. Kirkman's previous urinary
tract infection, lifestyle and other previous infections. His heart rate is far much above the
normal range of 100 heartbeats per minute. He has a heart rate of 135. Usually, the common risk
factors associated with septic shock include previous chronic infections, age, immunosuppressive
agents aid in disease progression (Craft et al, 2015). The septic shock result in myocardial valve
abnormalities that present with increased rapidity of the heart rate due to the body's localized
inflammatory response to counter the condition. These as well might have been accelerated by
the fact that Mr. Kirkman’s is a heavy smoker, and a social drinker and this is worsened by the
fact that he had previously contracted chronic bronchitis and was on Vent Olin and Atrovent.
Severe sepsis is also a circulatory failure manifested characterized by continually
persisted hypotension (Gordon, et al, 2015). He also presents with an extremely low blood
pressure of 80/42, this is as a result of systemic response that leads to tissue hypoperfusion that
manifest as low blood pressure. This is also shown by decreased urinary output even after the
administration of intravenous fluids. The release of cytokines during large scale inflammatory
response result in vasodilatation leading to low blood pressure (Marie & Hoehn, 2014). This
may as well be contributed by the defect in the urinary tract as a result of the urinary tract
infection that he was suffering from. A normal respiratory rate for an adult Respiratory rate is

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about 12-20 minutes per minute (Lemone & Burke, 2014) .Mr. Kirkman’s diagnosis reveals that
he had a respiratory rate of 35 which very high above the normal. Severe sepsis is associated
with tachycardia which an elevated breathing rate. This is linked to the fact that Mr. Kirkman’s
suffered previously from chronic bronchitis which congested the lungs leading to increased
respiratory rate. Although Mr. Kirkman looks generally well, his body temperature is high, that
is, 39 degrees Celsius. In comparison to the normal 37 degrees Celsius, it is very high.
Inflammatory responses are usually accompanied by hyperthermia (Hardin-Pierce & Wagner,
2014). Mr. Kirkman’s case is a urinary tract infection coupled with sepsis. As the body fights the
infection causing bacteria, a lot of energy is being produced and thus leads to the high
temperature seen.
Mr. Kirkman complains of painful sensation on the lower abdomen and radiating into the
right flank resulting from bacterial agents. There could also be stones of calcium oxalate
originating from the ureter that can clog the urethra causing a pain sensation. The kidney stones
result in a flank pain that migrates around the abdomen as the stone also moves (Lemone &
Burke, 2014). This often is associated with microscopic or macroscopic hematuria resulting in
the presence of blood in the urine. Acute pyelonephritis is associated with the obstruction of the
urinary tract need an emergency review of the ureter. The uretic stones were the ones presenting
with of painful sensation on the lower abdomen and radiating into the right flank into the
scrotum examinations of the abdominal region may reveal tenderness along the ureter but in
most cases, the condition is usually milder In comparison to the pain reported by Mr.Kirkman.
Nursing Strategy
From Mr. Kirkman's case, it is very evident that urinary tract infections are among the
most commonly encountered problems among aged people. Due to the complexity of its

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pathogenesis, initiation of prompt treatment prognostic strategy is necessary to decrease the risk
of subsequent related infections. The most appropriate nursing strategy in this case scenario is
oxygen administration as an initial means of intervention (Gordon, et al, 2015). This is because
in Mr. Kirkman’s case, he had cases of respiratory failure and drop in blood pressure which led
to poor blood circulation. He thus was suffering from hypo perfusion.
Oxygen therapy could be done through quick assessment of the patency of the airway,
general breathing and circulation. A high concentration oxygen should then be administered
through a reservoir mask or through tubes via the nostrils (McLean, 2012). A high amount to
achieve the target concentration of 88-92% should be administered, that is, at 4 Liter/minute
through the venture mask. This would help stabilize the abnormalities in the arterial blood gas as
seen in Mr. Kirkman’s case and to cater for the imbalances rendered by respiratory and
myocardial dysfunction. This rationale has been recommended among many nursing
organizations. In current practice, the rationale is used to give a supplement of oxygen as part of
strategy to manage sepsis. This step may help prevent metabolic associated with high carbon
dioxide tension and maintain proper aerobic metabolism (Marieb & Hoehn, 2013). The
recommendation is based on the existing from the British Thoracic society (BTS) as a
preliminary step in the treatment of severe sepsis with related infections.
Analysis of Arterial Blood Gas
The body fluid pH is 7.25 which is lower than normal ranges. Low blood pH implies
acidosis which is the increased incidence of acidity in blood (Hoehn & Marieb, 2013). The
dysfunction of the lungs due to smoking is the main factor that resulted in the lower pH. The
inability of the heart to supply enough blood to all parts of the body is also another factor that
caused in acidity, therefore, there is an improper filtration of bicarbonates in the renal tract

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making a good amount of it being lost in urine (Aitken, Elliot & Chaboyer, 2015). The chronic
bronchitis is the main cause of the decrease in partial pressure of oxygen. This decrease in the
pressure of oxygen worsens the condition.
In the pathogenesis of urinary tract infection, the metabolic acids played a role in the
reported symptoms, for instance, calcium deposits in the kidneys resulted to kidney stones,
dehydration and lower abdominal pain (McLean, 2012). For the lowered oxygen and carbon
dioxide incidence there are a number of contributory factors like the insufficiency of antioxidant
enzymes that should prevent the oxidative stress in the urinary tract resulting in low tension.
From the diagnostic results, the Base Excess is lower than the normal ranges of -2mmol/l-
2mmol/l. The decrease the Base Excess value is caused by hypoventilation in the lungs due to
bronchitis. Lactate level was 3.2mmol/liter, a value higher than the normal known range of 0.3-
0.8mmol/liter. Comparing to the normal ranges, this is a very high disparity. However, they are
correspondent to the oxygen and carbon dioxide levels which are low in the blood. An excess of
lactic acid indicates hypoxia resulting in incomplete oxidation of glucose and production of
lactic acid in large amounts in the muscles and their accumulation in the blood (Aitken,
Chaboyer & Marshall, 2015). Nurses should analyse the pathophysiology of the patients using
the best available evidence and their clinical judgment to assist in the selection of appropriate
treatment and relevant care measures and prioritize patients’ wellbeing. There is also an urgent
need for research on the effectiveness of the use of other means like the combination therapies in
the treatment of complicated urinary tract infections in patient care.

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References
Craft, J., Gordon, C., Heuther, S., McCance, K., Brashers, V., & Rote, N. (2015).
Understanding pathophysiology (2nd Ed.). Chatswood, NSW: Elsevier Australia.
Wagner, K. D., & Hardin-Pierce, M. G. (2014). High-acuity nursing (6th Ed.). Upper Saddle
River, NJ: Pearson.
Marie, E.N., & Hoehn, K. (2014) Human anatomy and physiology (9th international ed.).
San Francisco, CA: Pearson/Benjamin Cummings.
McLean, B. A. (2012). Acute respiratory failure and intensive measures. Critical Care Nursing
Clinics of North America, 24(3), 361-375.
Aitken, L., Chaboyer & Marshall, A., W. (Eds) (2015). ACCCN's Critical Care Nursing. (3rd
ed.). Chatswood, NSW: Elsevier.
Grossmann S. (2013). Porth's pathophysiology: Concepts of alteredhealth states (8th Ed.).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Burke, K. & Lemone, P., (2014). Medical-surgical nursing: Critical thinking in client care
(2nd Australian Ed.). French’s Forest, NSW: Pearson Australia.
Craft, J., Gordon, C., Heuther, S., McCance, K., Brashers, V., & Rote, N. (2015).
Understanding pathophysiology (2nd Ed.). Chats wood, NSW: Elsevier Australia.
Elliot, .D, Aitken, L., & Chaboyer, W. (Ends) (2015). ACCCN's Critical Care Nursing. (2nd
Ed.). Chatswood, NSW: Elsevier.
Grossmann S. (2013). Porth's pathophysiology: Concepts of altered health states (9th ed.).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Lemone, P., & Burke, K. (2014). Medical-surgical nursing: Critical thinking in client care (2nd
Australian ed.). Frenchs Forest, NSW: Pearson Australia.

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Marieb, E.N., & Hoehn, K. (2013) Human anatomy and physiology (9th ed.). San
Francisco, CA: Pearson/Benjamin Cummings.