Critical Analysis of a Urinary Tract Infection Case Study: Mr. Kirkman

This case study analyzes the clinical presentation of Mr. Kirkman, a 75-year-old male admitted with a urinary tract infection (UTI). The analysis delves into the pathogenesis, focusing on the bacterial invasion, primarily by E. coli, and the subsequent inflammatory responses leading to symptoms like dysuria and flank pain. The study examines the progression of the infection to sepsis, including the impact on vital signs like heart rate, blood pressure, and temperature. It explores risk factors such as previous UTIs and chronic conditions. The analysis also highlights the importance of increased fluid intake as a key nursing strategy to combat the infection. Finally, it critically examines the arterial blood gas (ABG) results, correlating them with the underlying pathophysiology and the body's compensatory mechanisms.

Clinical case of urinary tract infection 1
CLINICAL CASE OF URINARY TRACT INFECTION
Student’s Name
Institutional Affiliation

Clinical case of urinary tract infection 2
Urinary tract infection refers to a bacterial infection of any part of the urinary system.
The urinary system comprises of various organs such as the urethra, bladder, ureters and kidneys.
Bacteria may invade any of these parts causing a urinary tract infection. So as to invade the
urinary tract, bacteria may enter through the urethra and invade the bladder where they multiply
(Williams & Craig, 2019). The body is designed to offer self-defense against the invasion of
bacterial infections. However the immune system may be compromised and the bacteria may
multiply in the system leading to a serious urinary tract infection. Mr. Kirk man is an example of
a patient suffering from a urinary tract infection. The aim of this discussion is to critically
analyze Mr. Kirkman’s case study and explain the pathogenesis behind his clinical manifestation,
nursing strategies as well as analyze some of his diagnostic results.
Mr. Kirkman’s clinical manifestations are common symptoms related to urinary tract
infections. He experiences a burning sensation while urinating that radiates to the right flank.
Other classical characteristics and symptoms associated with urinary tract infections include
increased urge to urinate, urinary hesitancy, cloudy urinary output and pelvic pain. The
pathophysiology of the condition involves an interplay of several factors that negatively impact
the urinary system. E.coli forms the main type of bacteria that causes urinary tract infections. It
accounts for about 80% of the community acquired infections (Flores-Mireles et al, 2015).
Urinary tract infections can also be hospital acquired. This is mainly caused by use of
catheterization equipment that carries the bacteria. E.coli accounts for about 50% of hospital
acquired urinary tract infections. Other bacteria involved in the pathophysiology of urinary tract
infections include klebsiella, proteus and enterococcus faecalis. The bacteria invade the urinary
tract through two main routes, ascending and descending routes.

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The ascending route is the most common form of Urinary tract infections and occurs
when bacteria ascend through the urethra to the bladder and then to the ureters into the kidneys
leading to pyelonephritis (Saint et al, 2016). The descending form occurs when septicemia leads
to kidney infections and is not dependent on the urethral uptake of bacteria. Once the bacteria
invade the urinary system, they multiply and it becomes difficult for the immune system to
defeat them and this leads to complications (Tandogdu & Wagenlehner, 2016). Mr. Kirkman’s
clinical presentation of a burning sensation during urination may be explained by the fact that the
bacterial infections in the urinary system provoke an immune response hence leading to
inflammation in the epithelial linings of the bladder and the urethra. Urinary tract infections
causes inflammatory responses as a result of the immune system combating the threat of
infection. The classical signs of inflammation include pain and therefore the dysuria experienced
is as a result of increased bacteria invasion in the epithelial linings of the urinary system.
The severity of urinary tract infections ranges from mild levels to very severe conditions
that require immediate management. There are therefore two types of the infection.
Uncomplicated urinary tract infections that results from low bacterial count and complicated
urinary tract infections that may be unresponsive to treatment (Grabe et al, 2015). Mr. Kirkman
has a severe form of urinary tract infection. This can be well indicated by the fact that his
condition was deteriorating even after efforts to manage him. His condition has progressed to
such an extent that he has developed sepsis.
Sepsis results when blood is infected by bacteria and the bacteria spreads to other body
organs (Keren et al, 2015). This can be fatal as it may lead to multiple organ failure. The current
situation of Mr. Kirkman shows that his blood pressure levels have significantly dropped to low
levels and a significant increase in the heart rate above normal ranges. This could be attributed to

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low cardiac output as a result of septic shock whereby the bacterial infection has spread
throughout the body and is no longer limited to the urinary system. The increased heartrate is
therefore a compensatory mechanism of the body to ensure that the limited blood can be supplied
to the body organs. The patient increase in body temperature is also of significance as it indicates
fever that is as a result of a high inoculum of the bacteria.
There are several risk factors associated with urinary tract infections. One of the major
factors as in Mr. Kirkman’s case is a previous history of a urinary tract infection. A high
bacterial count during urinary tract infection can be hard to clear even after adequate medication
(Shaikh et al, 2016). This is because bacteria become resistant over time and develop new
mechanism to evade clearance. Bacteria can be suppressed for quite a long time in the body.
However, once the body’s immunity is compromised they can be reactivated and continue to
multiply thus causing reinfection as in Mr. Kirkman’s clinical case. Other risk factors associated
with the condition include catheter use and urinary invasive procedures, blockages in the urinary
tract and congenital urinary tract abnormalities.
One of the important nursing strategies in Mr. Kirkman’s clinical case would be to
encourage increased fluid intake by the patient. In addition to an isotonic fluid infusion, there is
need to increase fluid intake in order to raise the blood volume of the patient. Since the urinary
tract infection has significantly spread predisposing the patient to septic shock, there is a low
blood volume as indicated by the low blood pressure levels. Fluid intake helps reverse the
severity of the condition by raising back the blood volume to normal ranges (Gágyor et al, 2015).
In addition to this, the rationale for this would be the fact that it encourages increased urinary
output. This is of significance when it comes to urinary tract infection as it enables the flushing
out of bacteria that had invaded the urinary tract linings from the body hence reducing the

Clinical case of urinary tract infection 5
bacterial count. This helps ensure that new bacteria do not invade the renal system and
exacerbate the condition. Increased fluid intake also increases renal blood flow hence improving
circulation and assisting in combating the infection (Stein et al, 2015).
Diagnostic testing forms an important part of monitoring a patient and improving their
outcome. Urinary tests and other were performed on Mr. Kirkman. The arterial blood gases
testing revealed a significantly lower than normal pH of 7.25. The partial oxygen and carbon
(IV) oxide levels were also significantly lower than normal. This could be attributable to an
imbalance caused by respiratory gaseous exchange changes. The severe urinary tract infection
invaded blood and the circulatory system causing a fall in the oxygen levels. This caused the
body to respond by increasing the respiratory rate to levels sufficient for oxygenation of tissues.
As a result of increased respiratory rate, carbon (IV) oxide levels significantly decreased leading
to a lower than normal carbon (IV) oxide levels.
A low bicarbonate level is also observed in the ABGs. Several bacteria including E. coli
that lead to urinary tract infections utilize bicarbonate in their metabolic processes to release
carbon (IV) oxide. E. coli contain the enzyme cyanase that catalyzes the reaction of cyanate with
bicarbonate (Leung et al, 2018). Low levels of bicarbonate which is alkaline in nature lead to low
pH levels as indicated by the results. There was a significant increase in the levels of lactate
above normal range. This is an indication of anaerobic respiration within tissues as a result of
low levels of oxygen. Since the patient was experiencing sepsis, the low blood volume was not
sufficient to perfuse all tissues hence the low oxygen levels in some peripheral tissues including
muscles prompted anaerobic respiration leading to increased lactate accumulation.

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