Health Variations 4: Case Study Analysis of Mr. Kirkman's Condition

This nursing assignment presents a detailed analysis of Mr. Kirkman, a 72-year-old patient presenting with symptoms of a urinary tract infection (UTI). The assignment explores the pathophysiology of UTI, including the lymphatic, haematogenous, and ascending steps of bacterial colonization, as well as the progression from peri-urethral colonization to bladder and kidney involvement. The analysis links the patient's symptoms, such as burning sensation during urination and abdominal pain, to the inflammatory response caused by bacterial infection. Furthermore, the assignment discusses the potential progression to urosepsis, considering the patient's elevated heart rate, low blood pressure, and respiratory complications. It also covers the interpretation of arterial blood gas (ABG) results, highlighting metabolic acidosis and hypoxemia. The assignment also proposes nursing interventions, including medication administration, fluid intake monitoring, and vitamin C supplementation, to manage the UTI and its complications. The provided references support the analysis with research from various sources.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT (CASE STUDY OF KIRKMAN)
Name of the student
Name of the university
Author note

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While analysing the care situation of the 72 year old patient Mr. Kirkman it was seen
that his primary concern is the burning sensation that he suffered from while urinating that
increased his distress. Further, the patient also mentioned of pain in his lower abdomen that
in spreading to his right shaft. In the case study, it was mentioned that Mr. Kirkman has been
diagnosed with urinary tract infection and hence these above-mentioned condition could be a
result of the UTI he suffered from.
While discussing the pathophysiology of the UTI affecting Mr. Kirkman, the three
steps of the occurrence of pathophysiology of patient should be mentioned. As per O’Brien et
al. (2016), the steps of pathophysiology associated with UTI is based on the lymphatic step,
haematogenous step and the ascending step and all these steps occurred after the UTI
associated bacteria starts colonising within the patient’s body. According to researchers
DiPiro et al. (2014), the primary spot of colonisation of pathogenic bacteria is associated with
the peri-urethral region and consequently with time starts spreading up to the urinary bladder
after complete colonising the urethra. It was seen through the research that the UTI pathogens
replicates and multiplies in the urethra and then through fimbria. It spreads in the epithelial
cells. Hence, these severe multiplication and replication of the pathogenic bacteria in the
human body leads to the urinary tract infection (Tikkanen et al., 2015). Similarly, the
symptoms that were provided in the patient’s case study are associated with the onset of UTI
as it was seen in the research of Wagenlehner et al. (2014) that frequent urge of ruination is
among the primary symptom of UTI and the painful sensation is associated with the
immunological inflammation that occurs due to the bacterial colonisation. It was seen
through research of Mody and Juthani-Mehta (2014) that Dysuria is the condition, due to
which such inflammation is faced by the patient. Hence the occurrence of such condition
increased the healthcare complication of the patient and lead to severe pain and discomfort.
Besides this, it was mentioned in a research of Rowe and Juthani-Mehta (2014) that patients

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that are suffering from UTI has the infection up to their kidney and hence the pain and
increased inflammation in the lower abdomen region was suffered by the patient. Though the
colonisation of bacteria in kidney is not common but as per Mody and Juthani-Mehta (2014)
in severe case of UTI, through fimbria, the infection spreads in kidney and subsequently, the
infection spreads in the parenchyma leading to a critical condition such as pyelonephritis
(Tikkanen et al., 2015). Due to such healthcare complication, as per Flores-Mireles et al.
(2015), patients develop critical healthcare condition associated with tubular damage and
ultimately through physiological complication, leads to interstitial oedema. Hence, these
pathophysiological explanation determined the fact that due to severe healthcare
complications bacteria colonisation and severe spread of bacterial infection leads to the
urinary tract infection and similar symptoms and complication were seen in case of Mr.
Kirkman.
After complete analysis of the patient condition of Mr. Kirkman, it could be said that
due to his increasing healthcare complication, his healthcare complications are increasing. As
per Spencer et al. (2014), due to the condition namely polynephritis, and if this healthcare
complication is left without any healthcare intervention, it could lead to urosepsis condition.
Urosepsis is the condition in which bacterial infection travels from the urinary tract and
spreads into the blood stream and hence leads to systematic infection in the patient’s body
that ultimately leads to sepsis. As per Tikkanen et al. (2015), while suffering from sepsis, the
blood pressure of patient’s decreases and to compensate that the heart rate of patient
increases. Therefore, this is the reason it was observed the patient developed high heart rate
(135 beats per minute) and suffered from sepsis induced UTI. Further, lower blood pressure
80/42 was also noted and this indicated towards the occurrence of tubular damage. As per
Stein et al. (2015), in case of tubular damage, patients suffer from critical condition
pyelonephritis due to which the condition related to urosepsis triggered. This cascade

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ultimately increases the level of cytokines and hence the vasodilation of blood vessels are
observed. Hence, in case of Mr. Kirkman, due to this condition, the blood pressure of the
patient was noted as severely low (Tikkanen et al., 2015).
Besides these, the case study mentioned that the patient suffered from respiratory
complications and the rate of respiration was higher than the normal range. As the patient
suffered from sepsis, it leads to weakening the immune system and eventually the body
becomes weaker to fight the bacteria infection that continuously spreads within the body.
Further, the increasing bacterial infection could lead to higher respiratory rate by decreasing
the capacity of lungs to absorb oxygenated blood. Hence, due to the severe UTI infection, the
patient developed the higher respiratory rate. Therefore, all these critical condition indicated
that immediate and effective healthcare interventions need to be applied in the healthcare of
patients so that effective intervention could be applied.
Therefore, in such condition, the primary aim would be developing an assessment of
his health condition and understanding the prognosis of the UTI and associated infections so
that the patient could be provided with effective interventions (Tikkanen et al., 2015). All the
symptoms associated with UTI such as low BP, increased heart arte, increased body
temperature and pain and burning sensation associated with it. Further, with this intervention,
the patient would be provided with intervention associated with administration of medication
and supplementation such as vitamin C as Montorsi et al. (2016) mentioned that application
of vitamins in healthcare treatment of UTI helps to manage the UTI infection and supress the
growth of bacteria. Further, the patient would be observed for his fluid intake so that all the
infection could be eliminated and burning sensation of the patient could be cured.
Further, the provided arterial blood gas results indicated to the measurement and
calculation of oxygen and carbon dioxide condition so that the level of pH and the level of

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kidney functionality could be assessed. Metabolic acidosis was observed in the patient
condition and through the provided ABG assessment, it was also noted that the blood pH of
the patient was lower than the normal range (Wang et al., 2014). Further, it was seen that
PaO2 level is also lower than the actual level and hence, it was indicated that the patient is
suffering from the condition related to hypoxemia. As per Herzog et al. (2014), due to such
metabolic conditions, the patient suffered from critical healthcare conditions such as acute
diarrhoea and renal dysfunction. Further, in such condition, it was noted that the patient
suffered from critical condition and the acid balance equilibrium within the body is disturbed
and therefore, the healthcare complication associated with acidosis, ketosis and shock was
determined. Further, it was also seen that the patient developed lactate in his body due to
lactate accumulation and as per Armbruster et al. (2017), it was the sign of UTI which was
observed in the case study of Kirkman.

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References
Armbruster, C. E., Smith, S. N., Johnson, A. O., DeOrnellas, V., Eaton, K. A., Yep, A., ... &
Mobley, H. L. (2017). The pathogenic potential of Proteus mirabilis is enhanced by
other uropathogens during polymicrobial urinary tract infection. Infection and
immunity, 85(2), e00808-16.
DiPiro, J. T., Talbert, R. L., Yee, G. C., Matzke, G. R., Wells, B. G., & Posey, L. M. (Eds.).
(2014). Pharmacotherapy: a pathophysiologic approach (Vol. 6). New York:
McGraw-Hill Education.
Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract
infections: epidemiology, mechanisms of infection and treatment options. Nature
reviews microbiology, 13(5), 269.
Herzog, K., Dusel, J. E., Hugentobler, M., Beutin, L., Sägesser, G., Stephan, R., ... &
Nüesch-Inderbinen, M. (2014). Diarrheagenic enteroaggregative Escherichia coli
causing urinary tract infection and bacteremia leading to sepsis. Infection, 42(2), 441-
444.
Mody, L., & Juthani-Mehta, M. (2014). Urinary tract infections in older women: a clinical
review. Jama, 311(8), 844-854.
Montorsi, F., Gandaglia, G., Salonia, A., Briganti, A., & Mirone, V. (2016). Effectiveness of
a combination of cranberries, Lactobacillus rhamnosus, and vitamin C for the
management of recurrent urinary tract infections in women: results of a pilot
study. European urology, 70(6), 912-915.

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O’Brien, V. P., Hannan, T. J., Nielsen, H. V., & Hultgren, S. J. (2016). Drug and vaccine
development for the treatment and prevention of urinary tract
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