This case study discusses the pathogenesis, appropriate nursing strategy, and arterial blood gases in relation to urinary tract infection with sepsis. It provides insights into the condition and offers recommendations for effective nursing interventions. Find expert study material and assignments on Desklib.
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Running head: URINARY TRACT INFECTION WITH SEPSIS1 Urinary tract infection with sepsis Name: Institution: Tutor: Date:
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URINARY TRACT INFECTIONS WITH SEPSIS2 Introduction In this case study, Kirkmann a 75 year old man presented at the ED and was admitted later after diagnosis with urinary tract infection that got worse after 24 hours to sepsis. Sepsis according to the World Health Organization is the overall effect as the immune system fight back against an infection like UTIs. Since urinary tract infection with sepsis is lethal, it is important to comprehend the pathogenesis of the condition in order to come up with effective nursing strategies. Within this essay, there will a discussion on pathogenesis, appropriate nursing strategy and arterial blood gases in relation to urinary tract infection with sepsis of Mr. Kirkmann. Pathogenesis Studies indicate that the genitourinary tract is responsible for 20-30% of sepsis. The World Health Organization and the Centre for Disease Control define a urinary tract infection as any medical condition that affects the urinary system which is comprised of the bladder, kidneys and ureters. However, the body or rather the urinary system is made in a manner that makes it hard for any bacteria to colonize the urinary system (Abraham, 2016). It only happens in extreme conditions such as after sexual intercourse or unhygienic insertion of catheters. Once the bacteria attack the bladder and start replicating, the patient will experience burning sensation during urinating and abdominal pain that radiate from the right flank (Sprung & Reinhart, 2016). If the Urinary tract infection is not treated on time and effectively by antibiotics, it leads to sepsis like the case of Mr.Kirkmann. Sepsis is a condition in which the body responds to an infection and in the end injures its own tissues and organs and might to death or significant morbidity. In the case study, Mr.Kirkmann was diagnosed with Urinary Tract Infection with sepsis.
URINARY TRACT INFECTIONS WITH SEPSIS3 Gram negative bacteria that are responsible for urinary tract infections have endotoxins in their cell walls. The most common bacteria responsible includeE.coli, proteus spp, Klebsiella spp, Enterobacter, P aeruginosaand finallystaphylococcus aureus. A good example of the endotoxin is Lipopolysaccharides (Tandogdu, Bjerklund Johansen, Bartoletti, & Wagenlehner, 2016). They are the lipopolysaccharides that mediate the manifestation of urinary tract infection with sepsis. Randomized controlled trials from different studies have established that the endotoxins normally activates the different components of the immune system such as the inflammatory, coagulation and complement systems. Furthermore, the endotoxins have also shown to stimulate the actions of monocytes, macrophages, neutrophils and dendritic cells (Deutschman & Singer, 2016). The monocytes mediate clinical sepsis besides the production of tumor necrosis alpha as well as the interleukin 1.Studies indicate that they are normally produced at the concentration of between 25 and 50 pg and Ml. Further studies have also found out that the endotoxins normally bind receptors in the endothelial cell membranes and this has also shown to enhance pro-inflammatory mediators (Singer et al., 2016). It is the rate at which the endotoxins are released into blood stream that determines the severity of the sepsis. The sepsis leads to respiratory failure thus the patient experience variations in blood arterial gases as well as low blood pressure, high heart and respiratory rate and low blood pressure like in the case of Mr.Kirkmann. Appropriate Nursing strategy According to the ABCDE framework of nursing survey, Mr.Kirkmann is experiencing difficulties in breathing due to sepsis that causes venodilation thus he experiences hypovolemia. The appropriate nursing strategy according to studies in this case is fluid therapy. The rationale of this nursing strategy is to increase the volume of fluids that will in return facilitate the delivery
URINARY TRACT INFECTIONS WITH SEPSIS4 of oxygen to tissues and prevent tissue perfusion. Several studies have established that using crystalloids like isotonic sodium chloride or the lactated Ringers solution can assist patients with urosepsis (Gerlach, 2018). This therapy has also in recent studies show that it can be used to resuscitate the patient. However, it is recommended that fluid therapy should be combined with other nursing strategies there is increased permeability in veins and therefore fluids alone would leak continuously. Analysis of arterial blood gases An arterial blood gas test also known as blood gas analysis, is a test conducted on patients to estimate the levels of oxygen and carbon dioxide in the blood. Furthermore, the test also reveals blood PH, Bicarbonates, Base excess, lactate and how the lung function. Normally, it is conducted during emergency situations to assist in diagnosing the underlying cause of difficulty in breathing. The normal values for the arterial blood gases vary from one laboratory to another. The variation according to results is as a result of the difference in altitude or sea level. However, the recommended normal values should be as follows: For partial pressure for oxygen and carbon dioxide, the values should be between 75 to 100 mmHg and 35 to 45 mmHg respectively (Shankar-Hari et al., 2016). That of oxygen saturation should be between 94 and 100% while the normal levels of bicarbonates and base excess should be 22 to 26 mEq/L and -6mmol/L respectively. Finally, the normal PH for blood should be between 7.35 and 7.45. All the results in the case of Mr.Kirkmann for the arterial blood gases were not within the normal range. The results for PH was 7.25 while those of the partial pressure for oxygen and carbon dioxide were 75mmHg and 32 mmHg respectively. The results for Bicarbonates and base
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URINARY TRACT INFECTIONS WITH SEPSIS5 excess were 15mmol/L and -6 mmol/L respectively. The results for lactate were 3.2 mmol/l. Despite the abnormal results for an arterial blood gas test, it should not be diagnostic. Further results and exams should be combined with arterial blood gas to evaluate the patient. Abnormal results may indicate certain issues. According to a study by Rather & Kasana in 2015, abnormal arterial blood gases results may either mean the patient is not getting enough oxygen or is not excreting enough carbon dioxide (Rather & Kasana, 2015). For Mr.Kirkmann, the results for partial pressure of oxygen were 75 mmHg and this is below the normal or recommended level. What this means is that Mr.Kirkmann is not getting enough oxygen. This is due to urosepsis. Studies link urosepsis to tissue perfusion and this means less oxygen is available to the cells and tissues as exhibited by the low partial pressure for oxygen. Studies define sepsis as a clinical condition characterized by circulatory failure. This implies that less oxygen is delivered and utilized at tissue and cell level (Seymour et al., 2016). This means that cells have to breakdown carbohydrates, amino acids and fats in the absence of oxygen otherwise known as anaerobic metabolism. During this process, lactate dehydrogenase breakdown pyruvate to form lactate. The increased lactate or lactic acid in blood leads to a state known as metabolic acidosis which is exhibited by a PH below 7.35 and a partial pressure for carbon dioxide of below 42mmHg.This was the typical state in the case of Mr.Kirkmann. The low partial pressure for oxygen on the other hand was as a result of respiratory failure thus less oxygen is supplied to the cells or blood. Conclusion Urinary tract infection with sepsis leads to mortality. It is therefore imperative that necessary stakeholders understands the pathogenesis of the condition which is basically a lethal immune response in order to formulate the best nursing interventions. Fluid therapy has been
URINARY TRACT INFECTIONS WITH SEPSIS6 used in the past but it does not combat tissue perfusion. Research should therefore be conducted to come up with the best nursing strategy.
URINARY TRACT INFECTIONS WITH SEPSIS7 References Abraham,E. (2016). New Definitions for Sepsis and Septic Shock.JAMA,315(8), 757. doi:10.1001/jama.2016.0290 Deutschman,C.S., & Singer,M. (2016). Definitions for Sepsis and Septic Shock—Reply. JAMA,316(4), 458. doi:10.1001/jama.2016.6389 Gerlach,H. (2018). Faculty of 1000 evaluation for Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).F1000 - Post-publication peer review of the biomedical literature. doi:10.3410/f.726165855.793550942 Rather,A.R., & Kasana,B. (2015). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).JMS SKIMS,18(2), 162-164. doi:10.33883/jms.v18i2.269 Seymour,C.W., Liu,V.X., Iwashyna,T.J., Brunkhorst,F.M., Rea,T.D., Scherag,A., … Angus,D.C. (2016). Assessment of Clinical Criteria for Sepsis.JAMA,315(8), 762. doi:10.1001/jama.2016.0288 Shankar-Hari,M., Phillips,G.S., Levy,M.L., Seymour,C.W., Liu,V.X., & Deutschman,C.S. (2016). Developing a New Definition and Assessing New Clinical Criteria for Septic Shock.JAMA,315(8), 775. doi:10.1001/jama.2016.0289 Singer M, Deutschman CS, Seymour C. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):801-810. Sprung,C.L., & Reinhart,K. (2016). Definitions for Sepsis and Septic Shock.JAMA, 316(4), 456. doi:10.1001/jama.2016.6377
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