401211 Health Variations 4: Urinary Tract Infection with Sepsis

This report analyzes a case of a 75-year-old patient, Mr. Kirkmann, who presented with a urinary tract infection and later developed sepsis. The report delves into the pathogenesis of urosepsis, discussing how bacterial infections in the urinary system can lead to a systemic inflammatory response. It examines the role of endotoxins, the immune system's reaction, and the resulting clinical manifestations. Furthermore, the report identifies and justifies an appropriate nursing strategy for managing the patient's condition, specifically focusing on vasopressor therapy, and provides the rationale behind this choice. The report then critically analyzes Mr. Kirkmann's arterial blood gas results, interpreting the abnormal values in relation to the underlying pathogenesis and the physiological changes associated with sepsis, such as tissue perfusion and acid-base imbalances. The conclusion summarizes the key findings and emphasizes the need for further research to improve treatment outcomes for urosepsis.

Running head: URINARY TRACT INFECTION WITH SEPSIS 1
Urinary tract infection with sepsis
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URINARY TRACT INFECTION WITH SEPSIS 2
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,
& Bjerklund Johansen, 2017). A recent survey in fact stated that 90% of the urinary tract
infections completely subside after the use of recommended antibiotics.

URINARY TRACT INFECTION WITH SEPSIS 3
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
state that vasopressors do not improve tissue perfusion since constriction does not improve on

URINARY TRACT INFECTION WITH SEPSIS 4
the obstruction of capillaries at the cellular level. This is the reason why some studies have
reported failed response among some patients to vasopressors.
Analysis of arterial blood gases
An arterial blood gas profile is normally conducted to find out the level of PH, the partial
pressure for oxygen and carbon dioxide, lactic acid, base excess and bicarbonates. The aim of
this test is to establish if the lungs of the particular patient are in normal condition or not.
Normally, the test is recommended in the ICU but can also be conducted under certain medical
conditions like urinary tract infection with sepsis like in the case of Mr.Kirkmann. According to
the National Institute of Health and the Quality Assurance departments, The normal values for
the different parameters in the arterial blood gas profile are as follows: A normal PH should be
between 7.35 and 7.45.The normal partial pressure for carbon dioxide should range between 35
and 45 mmHg while that of oxygen should be between 75 and 100 mmHg. Furthermore, the
levels of bicarbonates should range from 22 to 26 mEq/L while the oxygen saturation should be
between 94 to 100% (Wagenlehner et al., 2013). Finally, the normal base excess should be -
6mmol/L. Therefore, in case a nurse conducts an assessment and results are contrary to the
normal levels, there should be a concern and necessary nursing interventions should be put in
place to prevent complications associated with variations in normal arterial blood gases.
In the case of Mr. Kirkman, all the parameters of the arterial blood gases were not
normal. The PH was lower than the normal range at 7.35. The reason for the low PH is according
to studies related to urosepsis. Studies indicate that during shock or urosepsis, there is tissue
perfusion. This implies that less oxygen can reach to cells of the body. Normally, the cells carry
out aerobic respiration to produce energy in the presence of oxygen. Tissue perfusion means less
oxygen is able to reach to the cells. As a result, they metabolize carbohydrates, amino acids and

URINARY TRACT INFECTION WITH SEPSIS 5
fats without oxygen and this is known as anaerobic metabolism. During this cycle, lactate
dehydrogenase breaks down pyruvate to produce lactate. The lactate is then transported through
blood to the liver. This is why the level of lactate was high in Mr.Kirkmann.
High lactate production tips the acid balance of the body. Several studies have been
conducted and results indicate that anaerobic metabolism that leads to increased lactate impairs
the acid base balance of the body. Glander & Rooij in 2018,Note that lactate above 3mmol/L like
in the case of Mr.Kirkmann that was 3.2mmol/L tips the acid balance such that the blood
becomes amore acidic (Glander & Rooij, 2018). This now candidly explains why the results for
Mr.Kirkmann had low PH of 7.25 while the Base Excess and Bicarbonates were also low at -
6mmol/L and 15 mmol/L respectively.
Sepsis leads to tissue perfusion that alters the amount of oxygen reaching muscles and
cells. In the case study of Mr. Kirkmann, the partial pressure for oxygen was 75mmHg while that
of carbon dioxide was 32mmHg. All this vales were lower than the normal values. John in his
study conducted in 2015 explains that the amount of carbon dioxide produced is directly
proportional to the amount of oxygen used (John, 2015). Tissue perfusion as a result of sepsis
means less oxygen is available to the cells and the body. This therefore means less oxygen will
be used. Subsequently, less carbon dioxide is produced. This is the reason for both low partial
pressure for oxygen and carbon dioxide in the case study of Mr.Kirkmann. With all parameters
outside the normal ranges, nurses should initiate proper nursing intervention before the
conditions gets worse.

URINARY TRACT INFECTION WITH SEPSIS 6
Conclusion
Urosepsis is an immune response of the body that in return injures tissues or cells of the
body. It is a condition that contributes to significant mortality globally. Its pathophysiology lies
in an underlying untreated urinary tract infection. Endotoxins from the gram negative bacteria
mediate the immune response that is eventually manifested as sepsis in the patient. This can be
seen through difficulties in breathing and variations in arterial blood gases .However, the
condition can be treated through vasopressor therapy. More studies should however be
conducted to further comprehend the pathophysiology in order to develop better and effective
drugs to prevent mortalities associated with sepsis.

URINARY TRACT INFECTION WITH SEPSIS 7
References
Bery, A. (2017). Successful Management of Urosepsis with Ceftriaxone+Sulbactam+EDTA:
A Case Report of Penem Sparing Approach. JOURNAL OF CLINICAL AND
DIAGNOSTIC RESEARCH. doi:10.7860/jcdr/2017/29146.10661
Fleischmann, C., Scherag, A., Adhikari, N., Hartog, C., Tsaganos, T., Schlattmann, P., …
Reinhart, K. (2015). Global burden of sepsis: a systematic review. Critical Care,
19(Suppl 1), P21. doi:10.1186/cc14101
Glander, K., & Rooij, L. V. (2018). How much automation do we really need?
Fahrerassistenzsysteme 2016, 19-30. doi:10.1007/978-3-658-21444-9_2
John, E. (2015). Nephrology in Pediatric Critical Care. Journal of Pediatric Intensive Care,
05(02), 041-041. doi:10.1055/s-0035-1568154
Levy, M. M. (2016). Clarifying Sepsis Management. American Journal of Respiratory and
Critical Care Medicine, 193(11), 1195-1196. doi:10.1164/rccm.201601-0090ed
Qiang, X., Yu, T., Li, Y., & Zhou, L. (2016). Prognosis Risk of Urosepsis in Critical Care
Medicine: A Prospective Observational Study. BioMed Research International, 2016,
1-5. doi:10.1155/2016/9028924
Tandogdu, Z., Bjerklund Johansen, T. E., Bartoletti, R., & Wagenlehner, F. (2016).
Management of the Urologic Sepsis Syndrome. European Urology Supplements,
15(4), 102-111. doi:10.1016/j.eursup.2016.04.004
Wagenlehner, F. M., Lichtenstern, C., Rolfes, C., Mayer, K., Uhle, F., Weidner, W., &
Weigand, M. A. (2013). Diagnosis and management for urosepsis. International
Journal of Urology, n/a-n/a. doi:10.1111/iju.12200

URINARY TRACT INFECTION WITH SEPSIS 8
Wagenlehner, F. M., Tandogdu, Z., & Bjerklund Johansen, T. E. (2017). An update on
classification and management of urosepsis. Current Opinion in Urology, 27(2), 133-
137. doi:10.1097/mou.0000000000000364