When a urinary tract infection is left untreated, it can spread systemically, leading to urosepsis, causing organ failure and death. Urosepsis is sepsis due to an infection of the urinary tract, bladder, or kidneys. Nearly a quarter of sepsis cases occur from a urogenital infection.
Symptoms of urosepsis depend on the infected part of the urinary tract, how far the infection has spread, and its progression. It will usually include symptoms of UTI, including:
- Dysuria
- Frequent urination
- Hematuria
- Urinary urgency
- Fever
- Dysuria
- Flank pain
- Chills
- Costovertebral angle pain and tenderness
Symptoms of sepsis include the following:
- Respiratory distress
- Hypotension
- Abnormal WBC count
- Organ failure
- Low platelet count
- Positive blood cultures
- Alterations in mental status
Urosepsis is diagnosed through a complete blood count, lactate level, urinalysis and culture, CT scan of the abdomen and pelvis, and ultrasound.
Nursing Process
Management of urosepsis is complex and requires the stabilization of vital signs and treatment of the underlying infection. Early detection and intervention enhance the rate of survival.
Nurses support patients with urosepsis through close monitoring, administering antibiotic therapy, and preventing complications like septic shock, coma, and death.
Nursing Care Plans Related to Urosepsis
Hyperthermia
Urosepsis symptoms include fever, chills, respiratory distress, abnormal heart function, and mental status changes.
Nursing Diagnosis: Hyperthermia
Related to:
- Dehydration
- Infection
- Inflammatory process
- Urinary tract infection
As evidenced by:
- Flushed skin
- Skin warm to touch
- Diaphoresis
- Restlessness
- Tachypnea
- Tachycardia
- Stupor
Expected outcomes:
- Patient will maintain a core body temperature within normal limits.
- Patient will not experience complications from hyperthermia.
Assessment:
1. Assess changes in temperature and other vital signs.
Hyperthermia in patients with urosepsis can be a life-threatening symptom and must be monitored frequently. Monitor in conjunction with blood pressure and heart rate.
2. Assess and review laboratory results.
Alterations in laboratory values, such as leukocytosis, can indicate an infection that causes hyperthermia.
3. Obtain cultures.
The nurse should obtain blood and urine samples to culture and assess the presence of bacteria. This must be completed prior to administering antibiotics.
Interventions:
1. Administer antipyretics as indicated.
Antipyretics can help regulate body temperature and lower it within normal parameters.
2. Provide a tepid sponge bath.
A tepid sponge bath can help lower body temperature that is caused by urosepsis.
3. Institute cooling measures.
Cooling measures like removing extra clothing and linen and maintaining a cool environment can help reduce body temperature.
4. Increase fluid intake if not contraindicated.
Hyperthermia can cause rapid dehydration. Offer oral fluids if the client is alert. Cooled saline can also be administered IV to reduce the core temperature.
5. Monitor for seizure activity.
Hyperthermia can result in fever-induced seizures. Monitor for symptoms like nystagmus, eye fluttering, and changes in mental status.
Risk for Shock
Severe cases of urosepsis can progress to septic shock. Septic shock is a medical emergency that causes blood pressure to drop dangerously low and multiple organs to shut down. ICU nurses are vital in treating patients with septic shock.
Nursing Diagnosis: Risk for Shock
Related to:
- Infection
- Hyperthermia
- Hypothermia
- Infection
- Unstable vital signs
- Hypoperfusion
- Disease process
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms.
Expected outcomes:
- Restore central venous pressure (CVP) to 8 mmHg to 12 mmHg.
- Restore mean arterial pressure (MAP) greater than 65 mmHg.
- Patient will maintain a urine output of 30 mL/hour.
- Patient will remain alert and oriented to person and place.
Assessment:
1. Assess lab values for developing shock.
Hyperglycemia above 120 mg/dL, WBC above 12,000/mm3 or below 4,000/mm3, azotemia, platelets below 100,000/mm3, and lactic acidosis above 2 mmol/L are laboratory findings in sepsis and septic shock.
2. Assess the patient’s vital signs.
Shock can manifest with cold and moist skin, cyanotic extremities, weak and rapid pulse, alterations in blood pressure, and altered mental state. Tachypnea and altered cognition are predictors of poor outcomes.
Interventions:
1. Administer antibiotics immediately as ordered.
Antibiotics should be administered within 6 hours of diagnosis.
2. Provide continuous cardiopulmonary monitoring.
Continuous monitoring of vital signs and organ perfusion is necessary to monitor the effectiveness of treatment and the status of the patient.
3. Monitor the patient’s intake and output.
Urine production is evidence of how well the kidneys are perfusing. Strict intake and output documentation can determine the patient’s kidney function.
4. Monitor skin color, temperature, and pulses.
In early shock, when blood pressure is maintained, extremities may be warm with rapid capillary refill and bounding pulses as the body attempts to compensate. As septic shock worsens, hypotension occurs with cool extremities, sluggish capillary refill, and thready pulses.
5. Provide adequate fluid resuscitation.
IV fluids with normal saline are necessary to manage hypotension and support organ perfusion.
Deficient Knowledge
Patient education is a vital component of the management of urosepsis. Urosepsis stems from untreated urinary tract infections and can easily be prevented if accurate information is provided about the condition, symptoms, complications, and treatment interventions.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Inadequate access to resources
- Misinformation
- Inadequate knowledge of symptoms
- Poor health literacy
- Inadequate commitment to learning
- Unawareness of the severity of untreated infections
As evidenced by:
- Inaccurate statements about preventing UTIs
- Inappropriate adherence to antibiotic regimens
- Development of recurrent UTIs
- Development of sepsis
Expected outcomes:
- Patient will explain the symptoms of a UTI and when to call their provider.
- Patient will demonstrate completion of their antibiotic regimen.
Assessment:
1. Assess the risk factors for urosepsis.
Understanding the risk factors can help plan an appropriate treatment regimen for patients with urosepsis. Patients who are incontinent, use a catheter, are immunocompromised, have an enlarged prostate, or have urinary tract abnormalities, are at a higher risk of recurrent UTIs.
2. Assess the patient’s knowledge about the condition, its complications, and interventions.
Assessing what the patient knows about urosepsis will help determine appropriate teaching points and methods that support their learning style.
3. Consider education for older adults.
UTIs affect older adults differently. They may not present with usual dysuria symptoms but instead show signs of confusion and agitation. Ensure family members and friends are aware of this so they can help their loved one seek medical assistance.
Interventions:
1. Teach the patient about preventing UTIs.
Preventing UTIs and bladder infections in the first place will reduce incidences of urosepsis. Instruct the patient on the following:
- Wipe front to back after using the bathroom (in females)
- Drink plenty of water to flush the urinary system
- Empty the bladder when you feel the urge to prevent urine stasis
- Wear loose-fitting cotton underwear and clothing
2. Educate the patient about signs that require medical attention.
Fever, rapid heart rate, altered mental state, and dry mucous membranes can indicate a developing complication like septic shock.
3. Instruct always to complete a course of antibiotics.
The nurse can teach the patient about antibiotic resistance, which results from overuse and incorrect use of antibiotics, making treatment of infections more difficult. Antibiotics should always be completed, even if symptoms go away.
4. Instruct on a healthy lifestyle.
Maintaining good overall health through diet, physical activity, immunizations, handwashing, and managing chronic conditions will guard against sepsis and lead to better outcomes if sepsis occurs.
References
- Lewis’s Medical-Surgical Nursing. 11th Edition, Mariann M. Harding, RN, Ph.D., FAADN, CNE. 2020. Elsevier, Inc.
- Septic Shock (Nursing). Mahapatra S, Heffner AC, Atarthi-Dugan JM. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568698/
- Urosepsis. Porat A, Bhutta BS, Kesler S. [Updated 2022 Aug 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482344/
- What Is Urosepsis? Healthline. Updated: June 2, 2017. From: https://www.healthline.com/health/urosepsis
- What Is Urosepsis? WebMD. Reviewed: June 7, 2021. From: https://www.webmd.com/a-to-z-guides/what-is-urosepsis
