Western Sydney University: Urosepsis Case Study Analysis, 401211

This case study analyzes a 75-year-old male, Mr. Kirkman, presenting with urosepsis. The assignment begins with an analysis of the pathogenesis of urosepsis, detailing the role of the urinary system, bacterial infections, and the body's immune response leading to sepsis, including the role of endotoxins and the activation of the immune system. The document then focuses on a nursing strategy, specifically oxygen therapy, to address the patient's breathing difficulties, explaining the rationale, procedure, and monitoring techniques. Following this, the assignment provides an analysis of Mr. Kirkman's arterial blood gas results, interpreting the deviations from normal ranges and relating them to the underlying pathogenesis of sepsis, including the impact on pH, lactate, PaO2, PaCO2, bicarbonate, and base excess. The case study emphasizes the critical nature of sepsis and its effects on respiratory function, tissue perfusion, and acid-base balance. The assignment highlights the importance of timely intervention and evidence-based nursing practices in managing acute life-threatening conditions.

Running head: UROSEPSIS 1
Urosepsis
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UROSEPSIS 2
1. Pathogenesis
The urinary system is made up of two kidneys, two ureters, bladder, two sphincter muscles,
nerves in the bladder and the urethra. Each of the part has a unique role to ensure that the body
gets rid of its waste products. The urethra for example, is a tube that allows urine flow outside
the body. The sphincter muscles on the other hand prevent leakage of urine (Dreger, Degener,
Ahmad-Nejad, Wöbker, & Roth, 2015). The bladder is a triangle shaped organ below the
abdomen. It is used to store urine and expands to expel urine. The ureters convey urine from the
kidneys to the bladder. Finally, the two kidneys are used to filter waste products from the blood.
Under normal circumstances, the urinary system is very sterile. However, unprotected sexual
intercourse and insertion of an indwelling catheter under unhygienic conditions, bacteria,
especially of the gram negative genre, can access the urinary system (Peach, Garvan, Garvan, &
Cimiotti, 2016). The favorable conditions inside the urinary system allows for multiplication of
the bacteria. They normally begin colonizing the lower parts of the urinary system and this leads
to abdominal discomforts and a burning while urinating.
It is easier to treat a urinary tract infection. Studies recommend the use of antibiotics to clear the
rapidly replicating bacteria. This is done after carrying out culture tests to establish the genre of
bacteria responsible for the urinary tract infection. Once the bacteria has been identified, a
sensitivity test is then conducted to establish the best antibiotic to be used.
In case the UTI is not treated well, it progresses and leads to sepsis. Sepsis is the response of the
body to the UTI. According to studies, the gram negative bacteria responsible for urinary tract
infections like E.coli, Hemophilus influenza and Neisseria Possess endotoxins in their entire cell
walls (Schneeberger, Holleman, & Geerlings, 2016). Lipopolysaccharide is one of the

UROSEPSIS 3
endotoxins that can stimulate the immune response. Randomized controlled trials indicate that
the lipopolysaccharide activate the immune system that is comprised of coagulation,
inflammatory cells, complement system and immune cells. Furthermore, the immune cells such
as dendritic cells and neutrophils activate production of Interlukin-1 that mediate sepsis.
The immune response (sepsis) exhibited through inflammation as well as damage to vital organs
of the body leads to the clinical manifestations of the condition. Damage to the lungs and hearts
impairs gaseous exchange leading to tissue perfusion. Tissue perfusion destabilizes the acid base
balance of the body and this can be seen through the results of the arterial blood gases.
Furthermore, respiratory failure leads to increased heart and breathing rate as evidenced in
Mr.Kirkmann. Inflammation also leads to increased body temperature and it can be severe
through severe fever in the patient.
2. Nursing strategy
After conducting the ABCDE assessment framework, difficulty in breathing is the nursing health
problem that should be addressed. The best evidence based nursing intervention/strategy in this
case is oxygen therapy. Oxygen therapy is simply the administration of oxygen to the body to
supplement the few oxygen. The basic objective or aim of this approach is to provide more
oxygen for the patient to breathe well (Wagenlehner, Pilatz, Weidner, & Naber, 2015).
According to studies, the basic signs and symptoms of difficulty in breathing include a high
breathing and heart rate. This approach can therefore be utilized to alleviate such signs and
symptoms.
Oxygen therapy is a very sensitive approach. Several studies note that it should only be carried
out by a very experienced nurse or staff. The initial step is to determine oxygen saturation. This

UROSEPSIS 4
can be done with the help of a pulse oximeter. Furthermore, the partial pressure for oxygen can
be used to determine if the amount of oxygen in blood is sufficient or not. The amount of oxygen
saturation provides the basis of prescribing the quantity of oxygen to be administered.
There are different methods that the nurse can administer oxygen. The most commonly used
devices however include a cannula or the gas mask. The method chosen depends on the health
condition and the preferences of the patient. The costs and availability of the device also
determine the method to be used. Since the normal oxygen saturation is between 94 and 98%, the
nurse should monitor the patient until enough of the oxygen has been administered (Boulain et
al., 2016). Low and high quantities of oxygen are both harmful and the nurse should therefore be
very keen. After attaining the desired quantity of oxygen, the nurse should cross over the chart so
that another nurse does not mistakenly administer extra oxygen (Kreü, Jazrawi, Miller, Baigi, &
Chew, 2017). Of the patients treated with oxygen therapy, 93% have reported signs of relief.
Nurses should therefore utilize oxygen therapy whenever handling a patient experiencing
difficulties with breathing.
3. Analysis of the arterial blood gases
This test is carried out routinely at the ICU and upon request by a doctor. It is done to determine
the PH, lactate, PaO 2 and PaCO 2, Bicarbonates and the Base excess. In the case study, all the
parameters were outside normal ranges. The PH was 7.25 yet the normal range is 7.35 and
7.45.Lactate was 3.2 mmol/L and the normal ranges are between 0.3 and 0.8mmol/L (Terpstra &
Geerlings, 2016). The partial pressure for oxygen was 75 mmHg while for carbon dioxide, it was
32mmHg.The normal values for the two are 75-100 for oxygen and 35-45 mmHg for carbon
dioxide. The Base excess was -6 mmol/L and finally, the Bicarbonates was 15 mmol/L yet the
normal values should be 22 to 26 mEq/L.

UROSEPSIS 5
Sepsis is the reaction of the body against an underlying medical condition. The immune response
brings about hemodynamic variations and in severe cases, it causes respiratory failure. The
partial pressure for oxygen is a measure of how oxygen travels to different organs and tissues in
the body from the lungs. As previously explained, sepsis causes respiratory failure and that
means inadequate oxygen reach other organs and tissues. This is the reason Mr.Kirkmann
experienced less partial pressure for oxygen (Roberts et al., 2018). Similarly, the PaC02 is
defined as the portion of total blood gas pressure exerted by carbon dioxide. Partial pressure for
carbon dioxide directly correlates with the PaO 2. If more oxygen is available, then the partial
PaCO2 also increases (Datta, Grahamslaw, Gray, Graham, & Walker, 2016). Respiratory failure,
brought about by sepsis means less oxygen reach the tissues and this also means less carbon
dioxide is produced. This eventually leads to low partial pressure of carbon dioxide as seen in
Mr. Kirkmann.
Tissue perfusion as a consequence of sepsis affects the PH, bicarbonates and the base excess. In
a normal individual, oxygen is used as a fuel in cellular metabolism. In an individual with sepsis
like Kirkmann, tissue perfusion means oxygen is inadequate for metabolism. Carbohydrates,
amino acids and proteins are therefore broken down through anaerobic respiration (Fernández
Sarmiento et al., 2016).In this process, lactate dehydrogenase metabolize pyruvate to form
lactate. The lactic acid produced travels to liver. This creates a high concentration of lactic acid
in blood and that is why lactate in Mr.Kirkmann was high. High lactic acid is the reason why the
PH was low as well as the bicarbonates and the base excess.

UROSEPSIS 6
References
Boulain, T., Garot, D., Vignon, P., Lascarrou, J., Benzekri-Lefevre, D., & Dequin, P. (2016).
Predicting arterial blood gas and lactate from central venous blood analysis in
critically ill patients: a multicentre, prospective, diagnostic accuracy study. British
Journal of Anaesthesia, 117(3), 341-349. doi:10.1093/bja/aew261
Datta, D., Grahamslaw, J., Gray, A. J., Graham, C., & Walker, C. A. (2016). Lactate -
Arterial and Venous Agreement in Sepsis. European Journal of Emergency Medicine,
1. doi:10.1097/mej.0000000000000437
Dreger, N. M., Degener, S., Ahmad-Nejad, P., Wöbker, G., & Roth, S. (2015). Urosepsis—
Etiology, Diagnosis, and Treatment. Deutsches Aerzteblatt Online.
doi:10.3238/arztebl.2015.0837
Fernández Sarmiento, J., Araque, P., Yepes, M., Mulett, H., Tovar, X., & Rodriguez, F.
(2016). Correlation between Arterial Lactate and Central Venous Lactate in Children
with Sepsis. Critical Care Research and Practice, 2016, 1-5.
doi:10.1155/2016/7839739
Kreü, S., Jazrawi, A., Miller, J., Baigi, A., & Chew, M. (2017). Alkalosis in Critically Ill
Patients with Severe Sepsis and Septic Shock. PLOS ONE, 12(1), e0168563.
doi:10.1371/journal.pone.0168563
Peach, B. C., Garvan, G. J., Garvan, C. S., & Cimiotti, J. P. (2016). Risk Factors for
Urosepsis in Older Adults. Gerontology and Geriatric Medicine, 2,
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Roberts, B. W., Mohr, N. M., Ablordeppey, E., Drewry, A. M., Ferguson, I. T., Trzeciak, S.,
… Fuller, B. M. (2018). Association Between Partial Pressure of Arterial Carbon
Dioxide and Survival to Hospital Discharge Among Patients Diagnosed With Sepsis

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in the Emergency Department. Critical Care Medicine, 46(3), e213-e220.
doi:10.1097/ccm.0000000000002918
Schneeberger, C., Holleman, F., & Geerlings, S. E. (2016). Febrile urinary tract infections.
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Terpstra, M. L., & Geerlings, S. E. (2016). Urinary tract infections. Current Opinion in
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Wagenlehner, F. M., Pilatz, A., Weidner, W., & Naber, K. G. (2015). Urosepsis: Overview
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