Urosepsis is a life-threatening condition that occurs when a urinary tract infection (UTI) spreads to the bloodstream, potentially leading to organ failure and death. Understanding proper nursing diagnoses and interventions is crucial for optimal patient outcomes. This comprehensive guide explores the essential nursing care plans and interventions for managing patients with urosepsis.
Understanding Urosepsis
Urosepsis accounts for approximately 25% of all sepsis cases, making it a significant concern in healthcare settings. This condition typically develops when bacteria from a urinary tract infection enter the bloodstream, triggering a systemic inflammatory response that can rapidly progress to septic shock if left untreated.
Clinical Manifestations
Patients with urosepsis typically present with a combination of UTI symptoms and systemic signs of infection:
Primary UTI Symptoms:
- Burning during urination (dysuria)
- Increased urinary frequency
- Blood in urine (hematuria)
- Urinary urgency
- Lower abdominal pain
- Flank pain
- Costovertebral angle tenderness
Systemic Symptoms:
- High fever or hypothermia
- Rapid breathing (tachypnea)
- Elevated heart rate (tachycardia)
- Low blood pressure (hypotension)
- Mental status changes
- Decreased urine output
- Severe weakness
Diagnostic Assessments
Healthcare providers diagnose urosepsis through various diagnostic tests:
- Complete blood count (CBC)
- Blood cultures
- Urinalysis and urine culture
- Serum lactate levels
- Comprehensive metabolic panel
- Imaging studies (CT scan or ultrasound)
Nursing Care Plans for Urosepsis
The following nursing care plans address the most critical aspects of urosepsis management:
1. Risk for Septic Shock
Nursing Diagnosis: Risk for Septic Shock related to systemic infection and inflammatory response.
Related Factors:
- Severe infection
- Systemic inflammatory response
- Compromised immune system
- Delayed treatment
- Advanced age
- Underlying health conditions
Nursing Interventions and Rationales:
Monitor vital signs every 1-2 hours
- Rationale: Early detection of deterioration allows prompt intervention
Assess peripheral perfusion hourly
- Rationale: Indicates effectiveness of tissue perfusion and cardiac output
Implement early goal-directed therapy
- Rationale: Improves survival rates through targeted interventions
Administer prescribed antibiotics within one hour of diagnosis
- Rationale: Early antibiotic administration improves patient outcomes
Desired Outcomes:
- The patient maintains stable vital signs
- Mean arterial pressure remains >65 mmHg
- Urine output maintains at >0.5 mL/kg/hour
- The patient shows no signs of organ dysfunction
2. Hyperthermia
Nursing Diagnosis: Hyperthermia related to systemic inflammatory response syndrome (SIRS) and infection.
Related Factors:
- Infectious process
- Dehydration
- Increased metabolic rate
- Inflammatory mediators
Nursing Interventions and Rationales:
Monitor body temperature every 2-4 hours
- Rationale: Allows early detection of temperature changes
Administer antipyretics as prescribed
- Rationale: Helps reduce fever and associated metabolic demands
Provide cooling measures
- Rationale: External cooling helps reduce core body temperature
Monitor for signs of seizure activity
- Rationale: High temperatures can trigger seizures
Desired Outcomes:
- Body temperature returns to normal range (36.5-37.5°C)
- The patient remains free of complications from hyperthermia
- The patient maintains an adequate hydration status
3. Acute Pain
Nursing Diagnosis: Acute Pain related to the inflammatory process and tissue damage.
Related Factors:
- Inflammation of the urinary tract
- Tissue damage
- Pressure from edema
- Muscle tension
Nursing Interventions and Rationales:
Assess pain characteristics regularly using a standardized scale
- Rationale: Enables proper pain management and evaluation of interventions
Administer prescribed analgesics
- Rationale: Provides pain relief and comfort
Assist with position changes
- Rationale: Reduces pressure and promotes comfort
Document pain patterns and response to interventions
- Rationale: Helps evaluate the effectiveness of pain management strategy
Desired Outcomes:
- The patient reports decreased pain levels
- The patient demonstrates improved comfort
- The patient maintains optimal activity level despite the pain
4. Deficient Fluid Volume
Nursing Diagnosis: Deficient Fluid Volume related to increased fluid loss and decreased intake.
Related Factors:
- Fever
- Increased metabolic rate
- Decreased oral intake
- Vascular permeability changes
- Diaphoresis
Nursing Interventions and Rationales:
Monitor fluid intake and output hourly
- Rationale: Ensures accurate fluid balance assessment
Administer IV fluids as prescribed
- Rationale: Maintains adequate circulation and perfusion
Assess skin turgor and mucous membranes
- Rationale: Indicates hydration status
Monitor laboratory values
- Rationale: Reflects fluid and electrolyte balance
Desired Outcomes:
- The patient maintains adequate hydration
- Vital signs remain within normal limits
- Urine output remains >30 mL/hour
- Laboratory values return to the normal range
5. Impaired Gas Exchange
Nursing Diagnosis: Impaired Gas Exchange related to inflammatory response and altered oxygen delivery.
Related Factors:
- Inflammatory response
- Ventilation-perfusion mismatch
- Changes in membrane permeability
- Increased metabolic demands
Nursing Interventions and Rationales:
Monitor respiratory rate, depth, and pattern
- Rationale: Indicates respiratory status and oxygenation
Assess oxygen saturation continuously
- Rationale: Enables early detection of deterioration
Position patient appropriately
- Rationale: Optimizes ventilation and perfusion
Administer oxygen therapy as prescribed
- Rationale: Maintains adequate oxygenation
Desired Outcomes:
- Patient maintains oxygen saturation >92%
- The patient demonstrates normal respiratory pattern
- The patient remains free from signs of respiratory distress
Prevention Strategies
Education plays a crucial role in preventing urosepsis. Key prevention strategies include:
- Proper hygiene practices
- Adequate hydration
- Prompt treatment of UTIs
- Regular bladder emptying
- Management of underlying conditions
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Guliciuc M, Maier AC, Maier IM, Kraft A, Cucuruzac RR, Marinescu M, Şerban C, Rebegea L, Constantin GB, Firescu D. The Urosepsis-A Literature Review. Medicina (Kaunas). 2021 Aug 25;57(9):872. doi: 10.3390/medicina57090872. PMID: 34577795; PMCID: PMC8468212.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Kalra OP, Raizada A. Approach to a patient with urosepsis. J Glob Infect Dis. 2009 Jan;1(1):57-63. doi: 10.4103/0974-777X.52984. PMID: 20300389; PMCID: PMC2840933.
- Kim HI, Park S. Sepsis: Early Recognition and Optimized Treatment. Tuberc Respir Dis (Seoul). 2019 Jan;82(1):6-14. doi: 10.4046/trd.2018.0041. Epub 2018 Sep 28. PMID: 30302954; PMCID: PMC6304323.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
