Health Variations 4: Nursing Report on UTI and Sepsis Case Study

This nursing report analyzes a case study of a 72-year-old patient, Mr. Kirkman, presenting with a urinary tract infection (UTI) and subsequent sepsis. The report details the patient's symptoms, including burning sensation during urination and lower abdominal pain, and the progression of the infection through ascending, lymphatic, and hematogenous routes. It explores the pathophysiology, clinical manifestations such as frequent urination and dysuria, and the development of pyelonephritis and urosepsis. The report also examines the patient's deteriorating physical condition, including elevated heart and respiratory rates, low blood pressure, and fever. The arterial blood gas (ABG) analysis reveals metabolic acidosis and hypoxemia. The nursing strategies discussed involve symptom assessment, pharmacological interventions like Vitamin C administration, and fluid intake encouragement. The report emphasizes the need for immediate medical attention due to the patient's critical state and outlines the importance of addressing underlying risk factors to prevent further complications. The patient's condition required urgent care to prevent further complications like urosepsis.

Running head: NURSING
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In close association to the provided case scenario, it can be mentioned that the 72 year
old client, Mr. Kirkman had presented with the complaint of burning sensation experienced
while urinating. His complaint also included a sensation of pain within the lower abdominal
region which was gradually spreading towards his right. The case study further reports that
Mr. kirkman was diagnosed with the problem of UTI (Urinary Tract Infection). Research
Studies mention that the pathophysiology of the urinary tract infection is directed by means
of three pathways which include the lymphatic, haematogenous as well as the ascending route
(Barber et al., 2013). It should be noted in this context that the clinical manifestation of the
infection is initiated once the pathogenic bacteria invades the human body. Typically the
pathogenic bacteria has been reported to colonise within the periuretharal region and invades
its way up to the urinary bladder advancing from the urethra (Flores-Mireles et al., 2015).
The pathogenic bacteria replicates, multiplies and produces biofilms within the epithelial
cells where it reaches through the fimbria (Hall, McGillicuddy & Kaplan, 2014). The
multiplication of the bacteria ultimately causes the infection. The manifestation of the urinary
tract infection is characterized by a multitude of symptoms that comprise of the frequent urge
to urinate (Barber et al., 2013). On account of the infection, the affected patients often
experience a burning sensation while urinating. The pain complaint is due to the
inflammation of the urinary bladder which happens on account of bacterial manifestation. It
should be noted in this context, that the inflammation of the urinary bladder typically
constricts the urinary bladder which results in intense pain and a condition known as dysuria
(Rosen & Klumpp, 2014). Inflammation of the urinary bladder significantly reduces the
ability of the bladder to void normally and causes discomfort and pain. Further, research
studies report that the pathogenic bacteria actively colonize within the ureter which
subsequently invades the kidney and causes pain within the lower abdominal region (DiPiro
et al., 2014). The human physiology suggests that the localization of the bacterial pathogen

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within the kidney is directed by the fimbria. This subsequently results in transmission of the
infection to the parenchyma and causes inflammation within the adjacent area giving rise to a
condition known as pyelonephritis (Wagenlehner et al., 2014). The condition of
pyelonephritis causes tubular damage that further causes a condition known as interstitial
oedema (Welk et al., 2017). Therefore, to summarize the findings of the case study, it can be
mentioned that the characteristic symptoms of pain and burning sensation experienced by the
patient can be attributed to bacterial colonization, transmission of infection and inflammation
caused within the urinary tract of the patient.
On the basis of the clinical evaluation presented, it can be said that the physical health
condition of the patient is deteriorating at a rapid pace. The heart rate of the patient was
reported to be 135 beats per minute which was higher than the standard range of about 60 to
100 beats per minute. Research studies suggest that once the pathogen invades the
parenchymal region it elicits an inflammatory reaction which gives rise to a condition known
as polynephritis (Hall et al., 2014; Wagenlehner et al., 2014). Further, research studies
mention that the condition, if left untreated could lead to urosepsis (DiPiro et al., 2014; Hall
et al., 2014). Urosepsis can be defined as a condition where the urinary tract infection
advances from the urinary tract and enters into the blood stream that generates systematic
infection (Ratzinger et al., 2013). The systematic infection typically circulates through the
blood stream inside the body and leads to the development of sepsis. The condition of sepsis
leads to problems that comprise of lower blood pressure, problem with breathing, augmented
heart rate as well as abnormal urine output. Therefore, it can be clearly explained on the
basis of the information discussed above that the patient was suffering from urinary tract
infection in combination with sepsis. In addition to this, on the basis of the clinical
observation data, it was also found that the patient had low blood pressure, equivalent to
80/42 against the normal range 120/80 mm HG. Research studies mention that tubular

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damage caused due to pyelonephritis causes interstitial nephritis that could potentially trigger
the condition of urosepsis (Wu, Zhang & Kang, 2013). The condition of urosepsis leads to the
development of septic shock that triggers a cascade of biological reactions which activates
the immune system to release cytokine so as to fight against the infection. The discharge of
the cytokines lead to vasodilation or dilation of the blood vessels so as to ensure blood flow
in the area affected by sepsis (Wu, Zhang & Kang, 2013). The dilation of the blood vessels
leads to lowering of the blood pressure which is evident in case of the patient.
Further, it can also be mentioned that the clinical observation data reveals that the
patient experiences higher respiratory rate. The higher respiratory rate can be correlated with
the condition of tachypnea. It should be noted in this context that sepsis typically weakens the
immune system of the body to fight against the infection and reduces the blood flow rate
within the body (Shigemura et al., 2013). The bacterial pathogen invades the vital organs of
the body and reduces the supply of oxygenated blood which leads to higher respiratory rate
(Ratzinger et al., 2013). Further, the vital assessment also suggests that the temperature of the
patient is raised to 39 degree Celsius which is higher than the normal range of 36.1-37.2
degree Celsius. Research studies mention that when the body is affected is by UTI in
combination with sepsis, the body temperature is raised as the infection elicits an immune
response that elevates the normal body temperature of the body (Welk et al., 2017). Hence, it
can be mentioned that on account of UTI and acute sepsis the patient’s physical condition is
serious and requires immediate medical attention.
The primary nursing strategy that would be used for the patient would include,
assessment of the clinical symptoms and identify the underlying risk factors that are
associated with the progression of UTI. The primary symptoms comprise of chills, fever and
burning sensation while urinating. The identification of the risk factors would enable the
nurse to adapt a suitable intervention to minimise the risk factors so as to prevent worsening

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of the symptoms (Flores-Mireles et al., 2015). The second strategy would comprise of
administering pharmacological supplement medication such as Vitamin C which would help
in neutralizing the acidic environment within the urinary bladder. It should be noted that
Vitamin C is widely used as an antiseptic agent in the treatment of UTI (Hall et al., 2014).
The administration of Vitamin C would help in suppressing bacterial development. The third
intervention would comprise of encouraging fluid intake so as to facilitate hydration.
Research studies mention that hydration helps in eliminating excess toxins and bacteria which
assists recovery (Rosen & Klumpp, 2014).
Arterial blood gas result refers to the measure of total oxygen and carbon dioxide
within the blood which helps in formulating calculation about the level of pH and estimation
of kidney functioning. On the basis of evaluation of the ABG data of the patient, it can be
said that the pH is lower than the standard level, which suggests a condition of metabolic
acidosis (DiPiro et al., 2014). The PaO2 level is also lower than normal which suggests a
condition of hypoxemia, which means the patient is inhaling lower oxygen than
recommended (Barber et al., 2013). Also, the PaCO2 level as well as the HCO3 level is lower
than the standard range which suggests that patient is susceptible to suffer from metabolic
illnesses such as acute diarrhoea and renal dysfunction, conditions marked by lower CO2
content in the blood (Rosen & Klumpp, 2014). On account of higher presence of metabolic
acids, it can be commented that the acid balance equilibrium within the body is disturbed
leading to a condition of ketoacidosis or shock (Hall et al., 2014). Also, as mentioned by Wu
et al. (2013),
the amount of lactate present within the body is high which suggests that there is lactate
accumulation within the patient’s body which is a characteristic symptoms of urinary tract
infections.

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References:
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:
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infections: epidemiology, mechanisms of infection and treatment options. Nature
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and bacterial prostatitis in men. Current opinion in infectious diseases, 27(1), 97-101.

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Welk, B., Liu, K., Winick‐Ng, J., & Shariff, S. Z. (2017). Urinary tract infections, urologic
surgery, and renal dysfunction in a contemporary cohort of traumatic spinal cord
injured patients. Neurourology and urodynamics, 36(3), 640-647.
Wu, T. J., Zhang, L. N., & Kang, C. C. (2013). The effect of ulinastatin on disbalance of
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