Urinary Tract Infection with Sepsis

Running head: URINARY TRACT INFECTION WITH SEPSIS
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Urinary tract infection with sepsis
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URINARY TRACT INFECTION WITH SEPSIS
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1. Analyze the pathogenesis in relation to the clinical manifestations in the case study.
Normally, the urinary system is made up of the bladder, urethra, ureter and kidneys. The
urinary system under normal conditions is sterile. However, bacteria can access the urinary
system when for example an individual engages in a sexual activity or when an indwelling
catheter is inserted under unhygienic conditions (Dreger, Degener, Ahmad-Nejad, Wöbker, &
Roth, 2015). The bacteria then colonize mostly the lower urinary system and this leads to
abdominal discomforts and burning/itching sensation while urinating as was the case with Mr.
Kirkmann.
Normally, urinary tract infections are easily treated by antibiotics. If they are not treated
on time, they progress and lead to further complications like sepsis. Sepsis is just an immune
response to an underlying infection. Studies indicate that bacteria responsible of urinary tract
infections are gram negative (Peach, Garvan, Garvan, & Cimiotti, 2016). This bacteria have
endotoxins in their cell walls. Examples of the gram negative bacteria include E .Coli,
Pseudomonas aeruginosa, Klebsiella pneumonia, Hemophilus influenza and Neisseria. They are
the same type of bacteria that are associated with Urinary Tract infections. A good example of
the endotoxin from their cell walls is lipopolysaccharides. Further studies elaborate that the
endotoxin produced by the bacteria activate both the inflammatory, coagulation and complement
systems which stimulate production of monocytes or immune cells (Schneeberger, Holleman, &
Geerlings, 2016). The immune cells like dendritic cells, macrophages and neutrophils together
stimulate production of interlukin-1 as well as tissue necrosis factor alpha that mediate sepsis.
Since sepsis is an immune response to the endotoxin, there is inflammation and injury to
vital organs such as lungs and the heart. This eventually leads to respiratory failure that leads to

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tissue perfusion. Tissue perfusion leads to metabolic acidosis and this is the reason why the
arterial blood gases parameters in Mr.Kirkmann were abnormal. Furthermore, respiratory failure
means the patient cannot breathe well and the body responds by increasing the heart and breath
rates to above 90 and 20 per minute as was seen in the case study. Inflammation on the other
hand leads to high temperature and that is why Mr.Kirkmann had a temperature of 38 degrees
Celsius.
2. Select one appropriate nursing strategy and explain the underpinning evidence base for
this rational.
Oxygen therapy in this case, is the best nursing strategy. Difficulty in breathing according to
the ABCDE nursing framework is the priority nursing problem that has to be addressed
instantly. The signs and symptoms of difficulty in breathing can be seen through the high
breathing and heart rate. This means the patient is struggling to compensate for the
respiratory failure brought about by sepsis. The rationale or rather the objective of this
nursing intervention is to provide additional oxygen so that the patient can breathe effectively
(Wagenlehner, Pilatz, Weidner, & Naber, 2015). According to studies however, this nursing
intervention is supposed to be conducted by a very experienced staff or nurse. After checking
the oxygen saturation which is the fifth vital sign by using a pulse oximeter, the nurse can
determine the quantity of oxygen to be administered. The nurse should also monitor blood
pressure, temperature and the respiratory rate. Oxygen is normally administered through an
appropriate device which is either a cannula or gas mask. The nurse should administer
oxygen until it reaches the normal level of between 94 and 98%. Finally, the nurse should
cross off the drug chart so that there is double administration of oxygen.