Health Variations 4: Case Study of Acute Life Threatening Conditions

This assignment analyzes a case study of a 75-year-old male, Mr. Kirkman, who presents to the emergency department with a urinary tract infection (UTI) that progresses to severe sepsis. The assignment delves into the pathogenesis of sepsis, examining the inflammatory reactions, blood pressure changes, and alterations in respiratory and heart rates. It further analyzes the patient's Glasgow Coma Scale (GCS) and other clinical manifestations, such as dark urine and fever. The assignment then prioritizes oxygen therapy as a nursing strategy, providing a rationale based on evidence. Finally, it critically analyzes Mr. Kirkman's arterial blood gas (ABG) results, including pH, partial pressure of oxygen and carbon dioxide, bicarbonate levels, and lactate levels, relating them to the underlying pathogenesis of the patient's condition.

Running head: HEALTH VARIATIONS 4 1
Health Variations 4 – Acute Life Threatening Conditions
Student’s Name
Institutional Affiliation

HEALTH VARIATIONS 4 2
Health Variations 4 – Acute Life Threatening Conditions
Q. 1 Bacteria and fungi cause urinary tract infections (UTIs) that affect the upper and lower
urinary tracts. There are higher incidences of UTIs among the elderly often necessitating the use
of indwelling catheters. In this case, Mr. Kirkman reports to the emergency department
complaining of a burning sensation when passing urine and abdominal pain. His diagnosis
indicates that he has a urinary tract infection. His history shows that he had UTI previously. Mr.
Kirkman is put on medication and an indwelling catheter inserted. However, after twenty-four
hours, his condition exacerbates and diagnosed with UTI with severe sepsis. His blood pressure
reduces, heart rate, temperature, and respiratory rate increase.
Sepsis and severe sepsis refers to the life-threatening events that arise due to
inflammatory reactions in relation to infections (Gotts & Matthay, 2016). Sepsis causes death in
patients of all age because of immune and organ dysfunction. Under severe septic conditions,
urinary tract infections trigger localized inflammatory reactions that release cytokines,
interleukins, and tumor necrosis factors from protective white blood cells. The release of
numerous inflammatory mediators increases the permeability and dilation of blood vessels
(Liang, 2016). Subsequently, the blood pressure decreases as seen from Mr. Kirkman’s value of
80/42.
Alterations on a patient’s ventilation and oxygenation condition indicate UTI with severe
sepsis in relation to the fight against infections. Respiratory rates increase as compensatory
mechanisms for inadequate supply of oxygen to the heart and peripheral tissues just as in Mr.
Kirkman’s 35 bpm case. Breathing rates increase to help expel the high amounts of carbon (IV)
oxide present while bringing the low pH to an optimum (Patel & Cooper, 2018). Additionally,
the extent of sepsis in patients with UTIs impacts the sinus rhythm. The standard range of a

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person’s heartbeat is between 10-100 bpm. However, these values are higher under Mr.
Kirkman’s septic conditions as his ventricular trunks contract to pump blood to the sinus node
and peripheral organs. The primary survey results show that he is using accessory muscles to aid
his cardiac output. Also, SPO2 ought to be between 94- 100% as it denotes the amount of
oxygen bound to haemoglobin. Mr. Kirkman’s 82% results show that he is under hypoxia; there
is an insufficient supply of oxygen to his tissues.
The examination shows that Mr. Kirkman speaks in single words, which is evident from
GCS reading: E4, V4, M5. His verbal response on the GCS is 4, denoting that Mr. Kirkman has
disoriented communication. According to Alalawi et al. (2017), a GCS is essential in
determining the extent of neurological dysfunction after injuries. The overall GCS values are
equal to 13, and this shows that Mr. Kirkman has minor damage due to urinary tract infections.
Besides, his motor response is 5 meaning that he localizes to pain (Alalawi et al., 2017). Usually,
the advancement of UTIs to the lower urinary tract triggers lower abdominal pain that radiates
into the right flank. The infiltration of inflammatory mediators to the sites of infection trigger
pain. Also, the immune system produces pyrogens to fight the urinary tract infections, which
often trigger fever. It is evident from Mr. Kirkman’s survey where his temperature is recorded as
39°C. Mr. Kirkman’s dark urine is an indicator of urinary tract infections or damage to his
bladder.
Q 2. Prioritizing the use of oxygen therapy to improve Mr. Kirkman’s deteriorating septic
condition (Roberts, Disselkamp, & Yataco, 2015)
Rationale: Mr. Kirkman’s state of UTI with severe sepsis demands for an appropriate nursing
strategy that will help prevent the development of acute life-threatening events, which may cause
sheer organ failure or death. Nurses ought to consider appropriate ventilation measures, such as

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oxygen therapies to prevent help improve the patient’s deteriorating septic state (Roberts,
Disselkamp, & Yataco, 2015). It is essential to maintain standard tissue oxygenation status to
prevent the progression of Mr. Kirkman’s sepsis to septic shock. According to Roberts,
Disselkamp, and Yataco (2015), sepsis occurs due to activation of various immune and
coagulation systems by infections, for instance, urinary tract infections.
Consequently, severe sepsis ensues as a result of metabolic acidosis or organ failure.
Common symptoms include hypotension, increased heart rate, and fever. Oxygen therapy will
help Mr. Kirkman attain aerobic respiration rate, which will reduce his respiration rate and
increase his blood pressure to standard levels (Ganghi et al., 2018). Besides, proper ventilation
ought to prevent the release of inflammatory mediators. Notably, oxygen therapy inhibits the
release of pro-inflammatory mediators that under septic conditions cause hyper-inflammation.
More also, proper oxygen supply to tissues enhances bactericidal activities of most
microorganisms, which will help eliminate UTI causing microbes (Ganghi et al., 2018). Also, the
supply of oxygen under pressure results in the natural healing of wounds in the upper and lower
urinary tracts. Decisively, treatment with oxygen at the emergency rooms ought to be a nurse’
priority on the diagnosis of UTI with severe sepsis; it will aid in preventing organ failure and
death.
Q 3. Arterial blood (ABG) analysis is crucial in the diagnosis and management of a patient’s
oxygenation and ventilation status, as well as their acid-base balance (Pompey & Abraham-
Settles, 2019). The primary components for this analysis include pH, partial pressure of oxygen
and carbon (IV) oxide, bicarbonate concentration, and oxygen saturation within the arteries.
These measurements are crucial in evaluating Mr. Kirkman’s UTI with severe sepsis condition.
Mr. Kirkman’s ABG results show that his pH is at 7.25, which slightly lower than the minimum

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standard value. Conventionally, a human’s metabolic and respiratory systems work to maintain
hydrogen ion concentration within the usual range of 7.35 to 7.45 (Burns, 2014).
Nonetheless, homeostatic imbalance in metabolic and respiratory processes results in
acidosis or alkalosis. An inadequate supply of oxygen characterizes Mr. Kirkman acidotic
condition. It dictates the presence of high amounts of carbon dioxide that when combined with
water results in carbonic acid, which lowers the pH.
The partial pressure of oxygen demotes the concentration of oxygen that dissolves in
arterial plasma (Castro & Keenagham, 2019). The standard ranges lie between 80 mmHg and
100 mmHg; however, Mr. Kirkman’s PaO2 levels are 75 mmHg. His value is low indicating that
he is under hypoxia. It is evident from his examination after twenty-four hours that show
increased heart rate and respiratory rate, a mechanism by his body tries to take in as much
oxygen to the tissues. Besides, Mr. Kirkman’s partial pressure of carbon (IV) oxide is 32 mmHg
which is lower than the standard range of 35 mmHg to 45 mmHg. His increased respiration rate
helps to decrease the amount of carbon (IV) oxide dissolved in blood as his body tries to attain
proper oxygenation status.
Bicarbonate (HCO3) values are critical in estimating the concentration of bicarbonate in
the serum. More significant amounts of hydrogen ions and low bicarbonate levels characterize
low pH. Equally, high pH relates to high bicarbonate levels. Burns (2014) states that low base
levels and high acidic conditions describe metabolic acidosis. Mr. Kirkman’s HCO3 values are
15 mmol/L which is lower than the standard range of 22 mmol/L to 32 mmol/L. His low pH
dictates the low bicarbonate levels in the serum. Proper ventilation, as evident from Mr.
Kirkman’s increased respiratory rate, seeks to achieve an average pH and HCO3 values. Notably,
his base excess (BE) levels are low: -6 mmol/L. Extreme low BE levels is an indicator of

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metabolic acidosis, and a compensation mechanism for the low pH (Larkin & Zimmanck, 2015).
Besides, Mr. Kirkman’s lactate levels are 3.2 mmol/L, values that are higher than the standard
reference range of 0.3 – 0.8 mmol/L. Poor oxygen status in Mr. Kirkman’s body channels
glucose into anaerobic respiration whose end product is lactic acid. Also, urinary tract infections
cause perforations of tissues that results in increased production of lactic acid.

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References
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Roberts, J. K., Disselkamp, M., & Yataco, A. C. (2015). Oxygen Delivery in Septic Shock.
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