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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Introduction
In a particular case, a 75 year old patient called Kirkmann presented at the Emergency
and was admitted to the ward after the diagnosis of urinary tract infection. 24 hours later, he was
diagnosed with urinary tract infection with sepsis. Sepsis is a condition brought about as the
immune response fights back and in return the body injures its organs and cells (Bery, 2017). It
contributes to significant mortality rates globally. Within the framework of this essay, there will
be a discussion on pathogenesis of urosepsis, the appropriate nursing strategy for the condition
and an analysis of arterial blood gases. Finally, there will be a conclusion to summarize
important information.
Pathogenesis
The urinary system is made up of the bladder, ureter and urethra. Normally, urine flows
form the kidney after undergoing glomerular filtration through the ureters up to the bladder.
From the bladder, the urine moves out through a duct known as urethra held in position by the
sphincter muscles. The urinary system is sterile and it is very hard for a foreign body or pathogen
to invade the same (Levy, 2016). In the event of unprotected sex, insertion of catheter under
unhygienic conditions and other conditions, gram negative bacteria such proteus, klebsiella,
staphylococcus aureus and Enterobacter colonize the urinary system and replicate rapidly. In
such a scenario, the patient will start feeling a burning sensation while urinating. Furthermore,
the patient also experiences abdominal pain that radiates from the right flank. This signs and
symptoms are common when the bacteria reach the bladder. However, studies note that it is very
easy to manage such urinary tract infections by the use of antibiotics (Wagenlehner, Tandogdu,

URINARY TRACT INFECTION WITH SEPSIS
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& Bjerklund Johansen, 2017). A recent survey in fact stated that 90% of the urinary tract
infections completely subside after the use of recommended antibiotics.
Not all urinary tract infections subside after treatment. A study by Fleischmann et al in
2015, argues that 20-30% of the Urinary Tract Infections progress and lead to a condition known
as sepsis (Fleischmann et al., 2015). The study explain sepsis as a shock brought about as the
immune system respond to the bacteria infection. Randomized controlled trials have found out
that the gram negative bacteria that cause urinary tract infections have endotoxins such as
lipopolysaccharide in their cell walls. The lipopolysaccharide normally stimulate the activity of
cells of the immune system such as monocytes, dendritic cells, macrophages and neutrophils
(Qiang, Yu, Li, & Zhou, 2016). They are the monocytes that mediate sepsis. Furthermore,
studies also argue that they produce tumor necrosis factor alpha as well as interleukin
1.Furthermore, research show that they directly bind receptors that are found in the endothelial
cell membranes and this also promote pro-inflammatory mediators. Once the toxins are in the
bloodstream, sepsis of varying severity is produced depending on the rate at which they are
released. Eventually, the patient starts experiencing a rapid heart and respiratory rate, elevated
neutrophils and low blood pressure. The patient also experience difficulties while breathing.
Appropriate nursing strategy
Vasopressor therapy is one of the best nursing strategy that can be used in management
of Mr. Kirkmann. Sepsis according to studies, leads to the disruption of endothelial walls. This in
return leads to vasodilation and randomized controlled trials show that arterial constrictors are
the best. The rationale of this nursing strategy therefore is to treat vasodilation (Tandogdu,
Bjerklund Johansen, Bartoletti, & Wagenlehner, 2016). The nurse should therefore ensure that
Mr.Kirkmann adheres to arterial constrictors prescribed to him. However, contrasting studies