When an 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.
Signs and Symptoms
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 Assessment
It is a life-threatening condition that requires prompt recognition, assessment, and intervention to prevent complications and improve patient outcomes. Effective nursing care is pivotal in managing urosepsis, ensuring rapid diagnosis, and initiating appropriate treatments.
Initial Evaluation
The initial evaluation of a patient with suspected urosepsis involves a detailed medical history, physical examination, and diagnostic tests to identify the source of infection and assess the severity of the condition.
Medical History
- Review the patient’s medical history for risk factors such as recurrent urinary tract infections (UTIs), recent surgeries, catheters or other invasive procedures, and underlying chronic conditions such as diabetes or immunosuppression.
- Inquire about symptoms such as fever, chills, flank pain, dysuria, urinary frequency, and hematuria, which are common in urosepsis.
Physical Examination
- Perform a comprehensive physical examination focusing on signs of systemic infection and sepsis, including:
- Elevated body temperature or hypothermia
- Tachycardia and tachypnea
- Hypotension
- Altered mental status
- Signs of localized infection, such as costovertebral angle tenderness
Laboratory Tests
- Obtain baseline laboratory tests, including:
- Complete blood count (CBC) to check for leukocytosis or leukopenia
- Blood cultures to identify the causative organism
- Urine culture and sensitivity to determine the source of infection and appropriate antibiotics
- Serum lactate levels to assess the severity of sepsis
- Renal function tests to monitor for acute kidney injury
Nursing Intervention
Nurses play a vital role in improving patient outcomes and preventing the progression of sepsis. Ongoing vigilance and adherence to evidence-based practices are essential in delivering high-quality, safe, and effective care for patients with urosepsis.
Timely Administration of Antibiotics
– Administer broad-spectrum antibiotics as soon as possible, ideally within the first hour of recognizing sepsis.
– Adjust antibiotic therapy based on culture results and sensitivity reports to ensure targeted treatment.
Fluid Resuscitation
– Initiate aggressive fluid resuscitation with crystalloids to maintain adequate tissue perfusion and prevent septic shock.
– Monitor the patient’s response to fluid therapy, including blood pressure, urine output, and signs of fluid overload.
Hemodynamic Monitoring
– Continuously monitor vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation.
– Use invasive or non-invasive hemodynamic monitoring as needed to guide fluid and vasopressor therapy.
Supportive Care
– Provide supplemental oxygen to maintain adequate oxygenation and prevent hypoxia.
– Administer vasopressors if necessary to maintain mean arterial pressure (MAP) and ensure organ perfusion.
– Monitor and manage potential complications, such as acute kidney injury, acute respiratory distress syndrome (ARDS), and disseminated intravascular coagulation (DIC).
Patient and Family Education
– Educate patients and their families about the signs and symptoms of urosepsis, the importance of early recognition, and the need for prompt medical attention.
– Provide information on preventive measures, such as proper hygiene, catheter care, and timely treatment of urinary tract infections.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for urosepsis, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for urosepsis.
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.
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.
Impaired Gas Exchange
Urosepsis is a form of sepsis that originates from an infection of the urogenital tract and can cause physiologic, biologic, and biochemical abnormalities resulting in multiple organ dysfunction, impaired gas exchange, respiratory distress, and even death.
Nursing Diagnosis: Impaired Gas Exchange
Related to:
- Disease process
- Sepsis
- Ventilation-perfusion mismatch
As evidenced by:
- Abnormal ABG levels
- Altered breathing pattern
- Bradypnea
- Tachycardia
- Diaphoresis
- Confusion
- Irritability
- Restlessness
- Hypoxemia
- Hypoxia
- Nasal flaring
Expected outcomes:
- Patient will demonstrate improved ventilation and adequate oxygenation with blood gas levels within normal range.
- Patient will remain free from any signs of respiratory distress.
Assessment:
1. Assess and monitor the patient’s respiratory rate, depth, and rhythm.
Urosepsis is associated with systemic inflammation and will increase respiratory rate and rhythm. With shallow and rapid breathing and hypoventilation, gas exchange is impaired.
2. Assess and monitor the patient’s mental status.
Impaired gas exchange in patients with urosepsis can initially manifest with irritability, confusion, and restlessness. Late signs of impaired gas exchange include lethargy and somnolence.
Interventions:
1. Continuously monitor the patient’s oxygen saturation.
Continuous monitoring of the patient’s oxygen saturation can help determine worsening gas exchange in patients with urosepsis. An oxygen saturation measuring less than 88% indicates a significant oxygenation problem.
2. Administer supplemental oxygen as indicated.
Supplemental oxygenation is essential in preventing hypoxemia in patients with impaired gas exchange. Oxygen therapy must be titrated accordingly to improve hypoxemia and promote an increase in oxygen saturation of at least 90%.
3. Monitor ABGs frequently.
After administering oxygen, check ABG results every 30-60 minutes to monitor for acidosis.
4. Administer antibiotic therapy as indicated.
Aggressive antibiotic therapy is essential in resolving urosepsis and reversing its systemic effects and symptoms.
5. Intervene if respiratory distress develops.
If acute respiratory distress occurs, prevent deterioration to respiratory failure by alerting the emergency response system and preparing the patient for intubation.
Risk for Deficient Fluid Volume
Patients with urosepsis and other forms of sepsis are at risk for developing deficient fluid volume due to fluid loss and shifts from intravascular space into the intracellular and interstitial spaces caused by hypovolemia, fever, vasodilation, diaphoresis, and increased respiratory rate.
Nursing Diagnosis: Risk for Deficient Fluid Volume
Related to:
- Systemic inflammatory response
- Disease process
- Systemic infection
- Fever
- Diaphoresis
- Fluid loss
- Interstitial fluid shifts
- Hypotension
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will maintain normal vital signs and urine output of 0.5 ml/kg/hr.
- Patient will be free from signs of hypovolemia and dehydration, such as hypotension, tachycardia, poor skin turgor, or concentrated urine.
Assessment:
1. Assess for early signs of hypovolemia.
Early detection of hypovolemia can help initiate prompt interventions to prevent further complications in patients with urosepsis. Early signs of hypovolemia include thirst, headaches, irritability, and restlessness. Late symptoms of hypovolemia include cold, clammy skin, cyanosis, weak thready pulse, oliguria, and confusion.
2. Assess and monitor the patient’s vital signs.
Deficient fluid volume can signal further deterioration in patients with urosepsis. Vital sign changes associated with deficient fluid volume include tachypnea, tachycardia, decreased pulse rate, and an increase or decrease in temperature.
3. Assess laboratory values.
Electrolyte levels, BUN, and creatinine must be monitored to assess for alterations that signal imbalances in fluid volume.
Interventions:
1. Initiate fluid resuscitation with crystalloid solutions.
Fluid resuscitation with crystalloid solutions is indicated for patients with urosepsis. Prompt initiation and correction of fluid problems can prevent further deterioration of the patient’s condition and reduce the risk of dehydration and hypovolemia.
2. Monitor urine output and characteristics.
Decreasing urine volume, along with concentrated urine, signals potential renal injury from hypovolemia.
3. Encourage increased fluid intake as tolerated.
Adequate fluid intake can help correct and prevent complications in fluid volume deficits in patients with systemic inflammation and infection due to urosepsis.
4. Initiate interventions to resolve the patient’s hyperthermia.
Patients with urosepsis initially experience hyperthermia due to systemic infection and may experience fluid loss due to heat exhaustion, diaphoresis, and excessive sweating. It is vital to provide supportive care to resolve hyperthermia by providing antipyretic medications, removing excess clothing, providing a tepid sponge bath, and keeping the environment cool.
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 yet occurred. Nursing interventions are aimed at prevention.
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.
Nursing Diagnoses and Rationales for Urosepsis
1. Risk for Infection
Rationale: Urosepsis originates from a urinary tract infection (UTI) that has spread into the bloodstream. Monitoring for signs of infection, such as fever, chills, and elevated white blood cell count, is essential. Administering prescribed antibiotics promptly and ensuring proper hygiene practices can help control the spread of infection. Educating the patient on the importance of completing the full course of antibiotics and recognizing early signs of infection can prevent recurrence.
2. Impaired Urinary Elimination
Rationale: Urosepsis can cause dysuria, frequent urination, and urinary retention. Assessing the patient’s urinary patterns and bladder function regularly is crucial. Encouraging fluid intake and providing prompt assistance with toileting can help maintain normal urinary elimination. Educating the patient on the signs of urinary tract infection and the importance of maintaining good perineal hygiene can reduce the risk of further complications.
3. Acute Pain
Rationale: Urosepsis can cause significant discomfort and pain, particularly in the lower abdomen, back, and during urination. Assessing the patient’s pain level and providing appropriate pain management interventions, such as analgesics and non-pharmacological methods like heat application, can alleviate discomfort. Educating the patient on pain management strategies and encouraging them to report any changes in pain can enhance their comfort.
4. Risk for Fluid Volume Deficit
Rationale: Symptoms of urosepsis, such as fever, vomiting, and diarrhea, can lead to dehydration. Monitoring for signs of dehydration, such as dry mucous membranes, decreased urine output, and hypotension, is essential. Encouraging fluid intake and providing intravenous fluids if necessary can help maintain fluid balance. Educating the patient on the importance of staying hydrated, especially during illness, can prevent fluid volume deficit.
5. Ineffective Tissue Perfusion
Rationale: Urosepsis can cause hypotension and decreased tissue perfusion, leading to organ dysfunction. Monitoring vital signs, including blood pressure, heart rate, and oxygen saturation, is critical. Administering prescribed medications, such as vasopressors, to maintain adequate blood pressure and perfusion can prevent organ damage. Educating the patient on the importance of adhering to treatment and monitoring for signs of decreased perfusion, such as altered mental status and decreased urine output, can enhance outcomes.
6. Anxiety
Rationale: The diagnosis and treatment of urosepsis can be distressing for patients, leading to anxiety and fear. Assessing the patient’s anxiety level and providing emotional support is essential. Educating the patient on the condition, treatment plan, and expected outcomes can reduce anxiety. Encouraging the use of relaxation techniques, such as deep breathing and mindfulness, can help manage anxiety. Referral to counseling services or support groups can provide additional resources for coping with the emotional impact of urosepsis.
7. Knowledge Deficit
Rationale: Patients with urosepsis may have limited knowledge about the condition, its treatment, and prevention strategies. Assessing the patient’s understanding and providing education on the causes, symptoms, and treatment of urosepsis is crucial. Teaching the patient about the importance of completing the full course of antibiotics, recognizing early signs of infection, and maintaining good personal hygiene can empower them to manage their health effectively. Providing written materials and utilizing teach-back methods can reinforce understanding.
8. Risk for Imbalanced Nutrition: Less Than Body Requirements
Rationale: Urosepsis can cause anorexia, nausea, and vomiting, leading to inadequate nutritional intake. Assessing the patient’s nutritional status and providing dietary support, such as small frequent meals and nutritional supplements, can help meet their nutritional needs. Collaborating with a dietitian to develop a personalized nutrition plan and educating the patient on the importance of maintaining adequate nutrition during illness can improve outcomes.
9. Risk for Impaired Skin Integrity
Rationale: Urosepsis can lead to immobility, incontinence, and decreased tissue perfusion, increasing the risk of skin breakdown. Assessing the patient’s skin condition regularly and implementing preventive measures, such as frequent repositioning and using pressure-relieving devices, can protect skin integrity. Educating the patient and caregivers on the importance of skin care and early detection of skin changes can prevent complications.
10. Fatigue
Rationale: The physical and emotional demands of urosepsis can lead to significant fatigue. Assessing the patient’s energy levels and encouraging rest periods throughout the day can help manage fatigue. Promoting good sleep hygiene and providing a comfortable sleeping environment can improve the quality of sleep. Educating the patient on pacing activities and conserving energy can reduce the impact of fatigue on daily life.
REFERENCES
- Lewis’s Medical-Surgical Nursing. 11th Edition, Mariann M. Harding, RN, Ph.D., FAADN, CNE. 2020. Elsevier, Inc.
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- 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
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