Case Study: Urinary Tract Infection with Sepsis Analysis-WSU

This case study comprehensively analyzes a 75-year-old male patient, Mr. Kirkmann, presenting with a urinary tract infection that progressed to sepsis. It delves into the pathogenesis of the condition, explaining how bacteria colonize the urinary system, leading to local discomfort and potentially escalating to sepsis, an immune response causing inflammation and organ injury. The analysis links the pathogenesis to clinical manifestations such as increased heart and breath rates, elevated temperature, and abnormal arterial blood gas parameters. It also discusses the significance of arterial blood gas results, interpreting deviations from normal values in relation to sepsis-induced hemodynamic and respiratory changes. Furthermore, the study selects oxygen therapy as an appropriate nursing strategy, justifying its use with evidence-based rationale, emphasizing the importance of experienced staff monitoring oxygen saturation and vital signs during administration. Desklib provides students with access to a wealth of academic resources, including solved assignments and past papers.

Running head: URINARY TRACT INFECTION WITH SEPSIS 1
Urinary tract infection with sepsis
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URINARY TRACT INFECTION WITH SEPSIS 2
1. Analyze the pathogenesis in relation to the clinical manifestations in the case study.
Normally, the urinary system is made up of the bladder, urethra, ureter and kidneys. The
urinary system under normal conditions is sterile. However, bacteria can access the urinary
system when for example an individual engages in a sexual activity or when an indwelling
catheter is inserted under unhygienic conditions (Dreger, Degener, Ahmad-Nejad, Wöbker, &
Roth, 2015). The bacteria then colonize mostly the lower urinary system and this leads to
abdominal discomforts and burning/itching sensation while urinating as was the case with Mr.
Kirkmann.
Normally, urinary tract infections are easily treated by antibiotics. If they are not treated
on time, they progress and lead to further complications like sepsis. Sepsis is just an immune
response to an underlying infection. Studies indicate that bacteria responsible of urinary tract
infections are gram negative (Peach, Garvan, Garvan, & Cimiotti, 2016). This bacteria have
endotoxins in their cell walls. Examples of the gram negative bacteria include E .Coli,
Pseudomonas aeruginosa, Klebsiella pneumonia, Hemophilus influenza and Neisseria. They are
the same type of bacteria that are associated with Urinary Tract infections. A good example of
the endotoxin from their cell walls is lipopolysaccharides. Further studies elaborate that the
endotoxin produced by the bacteria activate both the inflammatory, coagulation and complement
systems which stimulate production of monocytes or immune cells (Schneeberger, Holleman, &
Geerlings, 2016). The immune cells like dendritic cells, macrophages and neutrophils together
stimulate production of interlukin-1 as well as tissue necrosis factor alpha that mediate sepsis.
Since sepsis is an immune response to the endotoxin, there is inflammation and injury to
vital organs such as lungs and the heart. This eventually leads to respiratory failure that leads to
tissue perfusion. Tissue perfusion leads to metabolic acidosis and this is the reason why the

URINARY TRACT INFECTION WITH SEPSIS 3
arterial blood gases parameters in Mr.Kirkmann were abnormal. Furthermore, respiratory failure
means the patient cannot breathe well and the body responds by increasing the heart and breath
rates to above 90 and 20 per minute as was seen in the case study. Inflammation on the other
hand leads to high temperature and that is why Mr.Kirkmann had a temperature of 38 degrees
Celsius.
2. Select one appropriate nursing strategy and explain the underpinning evidence base for
this rational.
Oxygen therapy in this case, is the best nursing strategy. Difficulty in breathing according to
the ABCDE nursing framework is the priority nursing problem that has to be addressed
instantly. The signs and symptoms of difficulty in breathing can be seen through the high
breathing and heart rate. This means the patient is struggling to compensate for the
respiratory failure brought about by sepsis. The rationale or rather the objective of this
nursing intervention is to provide additional oxygen so that the patient can breathe effectively
(Wagenlehner, Pilatz, Weidner, & Naber, 2015). According to studies however, this nursing
intervention is supposed to be conducted by a very experienced staff or nurse. After checking
the oxygen saturation which is the fifth vital sign by using a pulse oximeter, the nurse can
determine the quantity of oxygen to be administered. The nurse should also monitor blood
pressure, temperature and the respiratory rate. Oxygen is normally administered through an
appropriate device which is either a cannula or gas mask. The nurse should administer
oxygen until it reaches the normal level of between 94 and 98%. Finally, the nurse should
cross off the drug chart so that there is double administration of oxygen.
3. Critically analyze the Arterial blood gas results and relate them to the underlying
pathogenesis.

URINARY TRACT INFECTION WITH SEPSIS 4
An arterial blood gas test is normally done to determine the level of acidity, PH, oxygen, lactate,
base and carbon dioxide in arteries. The objective is to determine if the lungs are working well or
not. Normally, it is conducted in the Intensive Care Unit as well as the ER setting (Terpstra &
Geerlings, 2016). However, the test can also be done depending on the diagnosis of the patient
like in the case of Mr. Kirkmann. The test can also be done in the case of potential shock, kidney
failure and abnormalities of the lungs. A complete arterial blood gas profile includes the PH,
base excess (BE), partial pressure for both oxygen and carbon dioxide, Bicarbonates and finally
lactate (Roberts et al., 2018). According to the Quality Assurance standards, the normal values of
the above parameters as follows: PH should be between 7.35 and 7.45.The normal partial
pressure for oxygen and carbon dioxide should be between 75 and 100 mmHg and 35 to 45
mmHg respectively. The normal values for bicarbonates should be between 22 and 26 mEq/L.
Finally, the normal values for base excess and lactate should be between -2 and +2 mmol/L and
0.3 to 0.8 mmol/L respectively (Fernández Sarmiento et al., 2016). In case a blood test is
conducted and one of the parameters is not within the normal ranges, then indicates certain
physiological abnormalities within the body.
In the case study, all the parameters were outside the normal ranges. The PH was 7.25
and this is below the normal range of 7.35.This signifies acidity within the body. For lactate, the
results indicated 3.2 mmol/L. The Base excess was -6 mmol/L while the readings for
Bicarbonates was 15mmol/L. Finally, the partial pressure for oxygen and carbon dioxide were 75
mmHg and 32mmHg respectively. The deviations from the normal values is as a result of urinary
tract infection with sepsis.
Sepsis according to the World Health Organization, is an immune response to an
underlying condition which in this case, is a urinary tract infection. The response by the immune

URINARY TRACT INFECTION WITH SEPSIS 5
system brings about hemodynamic changes and respiratory failure (Datta, Grahamslaw, Gray,
Graham, & Walker, 2016). A partial pressure oxygen indicates how well oxygen moves from the
lungs to other organs in the body. With hemodynamic changes and respiratory changes however,
less oxygen is availed to the arteries and organs. This is the reason why the partial pressure for
oxygen in Mr. Kirkmann was below the normal values. Different studies show that the amount of
carbon dioxide produced in the body is directly proportional to the amount of oxygen used
(Boulain et al., 2016). Since sepsis leads to tissue perfusion as previously explained, less oxygen
reach the tissues and this subsequently leads to low production of carbon dioxide. This is the
reason why the partial pressure for carbon dioxide was lower than the normal ranges in the case
of Mr. Kirkmann.
Impaired tissue perfusion due to sepsis affects lactate and the acid base balance within the
body. Studies indicate that in such cases of tissue perfusion, carbohydrates, fats and amino acids
are broken down through anaerobic metabolism. In this process, lactate dehydrogenase breaks
down pyruvate to form lactate (Kreü, Jazrawi, Miller, Baigi, & Chew, 2017). The lactate then
leaves cells and travels through blood to the liver. In such cases, an arterial blood gas would
indicate high levels of lactate like in the case of Mr. Kirkmann. A high concentration of lactic
acid according to studies tips the acid base balance leading to acidity exhibited by a low PH of
7.35,low bicarbonates and base excess as seen in the case of Mr. Kirkmann. It is therefore
important that nurses act quickly to restore the normal arterial blood gases before the situation
gets worse.
References

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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.
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Fernández Sarmiento, J., Araque, P., Yepes, M., Mulett, H., Tovar, X., & Rodriguez, F.
(2016). Correlation between Arterial Lactate and Central Venous Lactate in Children
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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.
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Peach, B. C., Garvan, G. J., Garvan, C. S., & Cimiotti, J. P. (2016). Risk Factors for
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