Urosepsis Nursing Diagnosis and Nursing Care Plan

Urosepsis Nursing Care Plans Diagnosis and Interventions

Urosepsis NCLEX Review and Nursing Care Plans

Urosepsis emerges when an infection spreads from the urinary tract to the bloodstream. The bacteria can multiply from the urethra into the bladder, resulting in an infection. If a urinary tract infection is left untreated, it may result in complications, such as urosepsis.

UTIs can occur when bacteria in the bladder multiply to an alarming degree. Thus, urosepsis occurs when sepsis affects the urinary tract structures.

As the body tries to stop the infection, it can cause a drastic heartbeat, pyrexia, chills, confusion, organ damage, or even death. Recognizing the possible risks and clinical manifestations can be beneficial.

Signs and Symptoms of Urosepsis

Urosepsis develops as a result of a UTI. Hence, urinary tract infections are typically infections that affect only the bladder, and symptoms include:

  • intense, drastic, and recurring urge to urinate
  • while urinating, the patient may experience a burning or irritating sensation.
  • having the feeling that the bladder has not been wholly emptied
  • discomfort in the lower back or abdomen
  • urine that is thick or cloudy and might or might not contain blood

The infection in the bladder can sometimes spread to the upper urinary system, including the ureters (the tubes that affix the bladder to the kidneys) and the kidneys. Urosepsis can become a complication if these parts of the urinary system become infected.

If the patient manifests any of the following urosepsis symptoms, advise them to seek immediate medical attention:

  • fever
  • pain on the lower sides of the back, near the kidneys
  • vomiting and nausea
  • extreme exhaustion
  • reduced urine output
  • failure to think clearly
  • breathing difficulties
  • changes in cardiac function
  • stomachache
  • elevated heart rate
  • abnormal body temperature (hyperthermia or hypothermia)
  • rapid breathing

Causes of Urosepsis

The urogenital tract is the initial infectious focus in 20% to 30% of all septic patients. Obstructive urinary tract diseases, such as ureteral stones, anomalies, stenosis, or tumor, are the most common causes of urosepsis.

If a UTI is not managed, it can lead to urosepsis. People who are predisposed to urosepsis include:

  • women
  • children
  • elderly people
  • people with a weakened immune system
  • people who already have wounds or injuries
  • people who use invasive devices like catheters or breathing tubes

Risks Factors to Urosepsis

A variety of factors increase the likelihood of developing urosepsis. Urosepsis risk factors include:

  • Old age. Urosepsis becomes more common with age, peaking in individuals over 80, and is associated with remarkably high mortality rates.
  • Immunocompromised patients. Patients with compromised immune systems are more likely to contract infections, increasing their likelihood of urosepsis.
  • Diabetes. Diabetes mellitus patients are at an increased risk of developing infections and urosepsis, accounting for 20.1-22.7% of all sepsis patients. Infection remains the leading cause of death in people with diabetes.
  • Usage of catheters to drain urine. Patients who utilize medical devices, such as catheters, may be more susceptible to infections and UTIs, raising the chances of urosepsis.
  • Gender. Since women’s urethras are shorter than men’s, they are more susceptible to UTIs. The bacteria can be transmitted from the urethra into the bladder and multiply, resulting in urosepsis.
  • Gestation. Many changes occur in the body throughout pregnancy, raising the likelihood of getting a UTI. As the baby grows, so does the pressure on the bladder, which can decrease the urine flow and result in infection.
  • Incontinence of feces
  • Polycystic kidney disease (PKD)
  • Procedures or surgeries affecting the urinary tract system
  • Obstruction of the urinary tract caused by stones, an augmented prostate, urethral scarring, or other factors
  • Lack of mobility
  • Urinary retention or inadequate bladder emptying

Complications of Urosepsis

Age and general health influences the chance of having potential complications. Complications of untreated urosepsis can be severe, even fatal, in some individuals, particularly older adults, people with chronic illnesses, and those with a compromised immune system. Urosepsis complications include:

  • Disseminated intravascular coagulation. Disseminated intravascular coagulation, or DIC, is a complex condition that can occur in patients suffering from severe urosepsis or septic shock. Blood clotting difficulties may occur, resulting in a vicious cycle.
  • Kidney Damage. One of the most common causes of acute kidney injury is urosepsis. For most people, temporary dialysis in the ICU is sufficient to help their bodies heal, and their kidneys resume functioning. However, the damage is too severe for some patients, and their kidneys stop working correctly.
  • Organ Failure. When the body’s infection-fighting processes activate, organs function poorly and abnormally. Urosepsis can lead to septic shock. Septic shock is a significant drop in blood pressure that can cause extensive organ damage and death.
  • Perirenal or Renal abscesses. A renal abscess is most commonly a complication of a urinary tract infection (UTI) or urosepsis, which is often complicated by some obstruction of urine flow.
  • Prostatic abscesses. A prostate abscess is a potential complication of urosepsis. Prevalent symptoms include excessive urination, pain, difficulty urinating, and urine retention.
  • Septic Shock. In severe cases, urosepsis can lead to a condition known as septic shock. When a patient experiences septic shock, their blood pressure drops to unsafe levels, and their organs start to deteriorate.
  • Scarring of the urinary tract.

Diagnosis of Urosepsis

The doctor can verify the presence of a UTI by running a test on a urine sample. However, if the doctor believes that the infection might have spread and progressed into urosepsis, they will suggest further laboratory examinations. These laboratory examinations include:

  • Blood and Laboratory Tests
    • Blood Culture. Blood cultures are utilized to confirm the presence of bacteria in the blood, define the type of bacteria present, and help choose the proper treatment. A blood culture is used to diagnose a urinary tract infection, which can lead to urosepsis, a severe and potentially fatal complication.
    • Blood gas analysis. This procedure tests arterial blood’s pH, oxygen, and carbon dioxide levels.
    • Complete blood count. A CBC will show elevated white cells if urosepsis is present. When this happens, the lab will proceed to incubate the patient’s blood, and if bacteria are still present after five days, the patient is considered septic.
    • Clotting tests like prothrombin time (PT) and partial thromboplastin time (PTT). These lab tests assess a patient’s blood clotting. Urosepsis can disrupt the production of clotting factors, resulting in hemorrhage.
    • Culture of cerebrospinal fluid (CSF). A needle is used in this test to obtain some of the fluid that moves around the spinal cord. The lab tests the CSF for bacteria, fungi, and viruses.
    • Platelet count. A low platelet count can indicate a potentially fatal urosepsis complication known as disseminated intravascular coagulation.
    • Urine Culture. A urine sample is taken and tested for bacteria.
  • Imaging Tests
    • CT Scan and MRI. CT scans and MRIs are efficient imaging tests in urosepsis patients. These procedures are the most accurate methods for recognizing bacterial interstitial nephritis and micro-abscesses within the kidney, emphysematous pyelonephritis, renal papillary necrosis, and perinephric abscesses.
    • Ultrasound. An ultrasound scan is beneficial for emergency imaging in patients with severe loin pain, fever, and suspected urosepsis.

Treatment for Urosepsis

  • Early goal-directed therapy (EGDT) The following are the treatment guidelines:
  • Antibiotics are administered to the patient as soon as possible to eliminate the source of the suspected infection.
    • Supportive care, such as lungs and blood flow stabilization,
    • Additional rehabilitative therapies
  • Supportive care, such as lungs and blood flow stabilization,
    • Additional rehabilitative therapies
  • Oral Antibiotics
    • Beta-lactamase inhibitor. This type of antibiotic is one of the best options for the treatment of UTIs and urosepsis.
    • Third Generation Cephalosporin. The 3rd generation cephalosporin is commonly used in the treatment of uncomplicated UTIs.
    • Fluoroquinolones. Fluoroquinolones have been linked to better clinical outcomes in women with uncomplicated UTIs and urosepsis.
  • Management of urosepsis that leads to septic shock

Urosepsis can lead to septic shock. If the patient exhibits symptoms of this complication, such as confusion or organ failure, he or she may need to be admitted to the Intensive Care Unit. Treatment may include the following:

  • Intravenous antibiotics
    • Blood pressure management
  • Other Treatment and Procedures
    • Blood transfusions. Packed red blood cell (pRBC) transfusion has been included in the suggested treatment regimen for urosepsis patients.
    • Lithotripsy. This procedure is used to break up kidney or bladder stones if they are present.
    • Vasopressors. A vasopressor is a medication used by healthcare providers to constrict or narrow blood vessels in people with low blood pressure. This medication is frequently used for septic shock patients who cannot get enough blood to their vital organs. The organs cannot function without oxygen-rich blood, which can be life-threatening.
    • Mechanical ventilation. Mechanical ventilation if the patient is already in a life-threatening situation due to urosepsis.
    • Drainage of any abscesses that may exist
    • Intravenous fluids for blood volume maintenance and blood pressure support
    • Maintaining blood oxygenation with oxygen therapy.
    • Removal of any contaminated catheters or other devices

Urosepsis Nursing Diagnosis

Nursing Care Plan for Urosepsis 1

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to lack of awareness of the condition, cognitive limitations, lack of treatment understanding, emergence of apparently preventable complications, and misunderstanding of essential details about the illness secondary to urosepsis as evidenced by verbalizing incorrect information, failing to follow through on instruction, and denying the need to learn.

Desired Outcomes:

  • The patient will verbally express his or her understanding of the disease process, prognosis, and possible complications.
  • The patient will verbalize his or her comprehension of the treatment options.
  • The patient will take part in the medication regimen.
  • The patient will make the necessary lifestyle changes.
Urosepsis Nursing InterventionsRationale
Identify each patient’s urosepsis risk factors, transmission mode, and infection entry portals.  Knowing the methods of infection transmission allows the healthcare team to plan for and implement preventive measures for the patient.
Provide information on therapeutic interventions, interactions, adverse effects, and the relevance of adhering to the urosepsis medication regimen.Adequate and appropriate information promotes comprehension and adherence to treatment or prophylaxis, lowering the risk of relapse and complications of urosepsis.
Recognize signs and symptoms of urosepsis that require medical attention, such as persistently elevated fever, a rapid heart rate, loss of consciousness, skin irritation of uncertain origin, unexplained exhaustion, anorexia, extreme thirst, and bladder function changes.  Early detection of developing infection allows for timely intervention and decreases the likelihood of life-threatening urosepsis complications.
Discuss with the patient the importance of a healthy nutritional intake or a well-balanced diet.  Good nutrition is essential for optimal healing, immune system enhancement, and overall health.  
Examine the importance of personal hygiene, environmental cleanliness, proper cooking techniques, and food storage.  Personal hygiene and environmental cleanliness reduce pathogen exposure.  
Explain to the patient the disease process and possible complications of urosepsis.  Discussing urosepsis and clinical expectations with the patient provides knowledge and understanding from which the patient can make well-informed choices.

Nursing Care Plan for Urosepsis 2

Hyperthermia

Nursing Diagnosis: Hyperthermia related to dehydration, the direct impact of circulating endotoxins on the hypothalamus, temperature regulation alteration, high metabolic rate, or infection secondary to urosepsis as evidenced by flushed skin that is hot to the touch, higher-than-normal body temperature, increased respiration rate, and palpitations.

Desired Outcomes:

  • The patient will not experience severe complications related to urosepsis.
  • The patient’s temperature will be within normal range and free of chills.
Urosepsis Nursing InterventionsRationale
Keep an eye on the temperature of the surrounding environment. Bed linens should be limited or added as indicated.  Keeping the patient’s body temperature near normal requires adjusting the room temperature and linens.  
As needed, give the patient a cooling blanket or hypothermia therapy.  This intervention aims to reduce Fever, mainly when it is higher than 104°F to 105°F (39.9°C-40°C) and when severe urosepsis complications are likely to occur.  
As needed, administer antipyretics to the patient.  Antipyretics reduce Fever by acting centrally on the hypothalamus; Fever should be controlled in urosepsis patients. On the other hand, Fever may be advantageous in restricting organism growth and increasing the auto-destruction of infected cells.  
Give the patient tepid sponge baths. Avoid drinking alcohol.  Tepid sponge baths may aid in the reduction of Fever caused by infection or urosepsis. Alcohol consumption can cause chills, Fever, and skin dehydration.  
Thoroughly observe the patient’s temperature. Take note of any shaking chills or occasional excessive sweating.  Temperatures ranging from 102°F to 106°F (38.9°C to 41.1°C) indicate UTI that has progressed to urosepsis. Fever patterns could aid in diagnosis.    

Nursing Care Plan for Urosepsis 3

Risk For Infection

Nursing Diagnosis: Risk for Infection related to the inability to detect or treat infection, failure to take proper precautions, invasive procedures, exposure to environmental factors (nosocomial), and compromised immune system secondary to urosepsis.

Desired Outcomes:

  • The patient will recover promptly.
  • The patient will have no purulent secretions, drainage, or erythema.
  • The patient will be afebrile.
Urosepsis Nursing InterventionsRationale
Examine the patient for a potential source of contamination. Take note of possible manifestations and factors of urosepsis, such as burning urination, localized abdominal pain, burns, and the presence of invasive catheters or lines.Urinary tract infection is the most common cause of urosepsis, followed by abdominal and surrounding tissue infections. The use of invasive catheters or devices is another cause of hospital-acquired urosepsis.  
Keep track of the patient’s laboratory results, such as the WBC count with neutrophils and band counts.  The standard neutrophil-to-total WBC ratio is at least 50%; however, calculating the absolute neutrophil count is more pertinent to assessing immune status when the WBC count is significantly reduced. Similarly, an increase in band cells indicates the body’s attempt to mount a reaction to urosepsis, whereas a decrease indicates decompensation.
Keep an eye on the patient for signs of clinical deterioration or failure to improve with therapy.  The deterioration of a clinical condition or failure to improve with therapeutic interventions may be caused by improper or insufficient antibiotic therapy or by uncontrolled growth of resistant or opportunistic pathogens.
When possible, avoid using invasive devices and procedures in the urinary tract. When infection is present, remove lines and devices and replace them as needed.  This intervention aims to reduce the number of potential entry points for opportunistic organisms that can cause urosepsis.  
Inspect the urine catheter of the patient regularly.      CAUTIs (catheter-associated urinary tract infections) are prevalent because urethral catheters inoculate organisms into the bladder and enhance colonization by providing a surface for bacterial attachment and resulting in mucosal irritation.  
Use sterile techniques when changing dressings, suctioning, and providing site care, such as an invasive line or a urinary catheter.Medical asepsis prevents the spreading of bacteria and lowers the risk of nosocomial infection.
Examine any patient’s reports of vaginal or perineal itching or burning.  For women, vaginal itching may indicate UTI. UTIs can be prevented from progressing to urosepsis if detected early.  
Teach the patient how to properly wash their hands with antibacterial soap before and after each care activity.  Cross-contamination is reduced by hand washing and hand hygiene. It should be noted that Methicillin-resistant Staphylococcus aureus (MRSA) is the most frequently transmitted bacteria through direct contact with health care professionals who cannot wash their hands between patient contacts.  

Nursing Care Plan for Urosepsis 4

Risk For Impaired Gas Exchange

Nursing Diagnosis: Risk for Impaired Gas Exchange related to respiratory alkalosis disrupted oxygen supply and utilization in tissues secondary to urosepsis.

Desired Outcomes:

  • The patient’s ABGs and respiratory rate will be within normal limits, with clear respirations and a concise or improving chest x-ray.
  • The patient will have no dyspnea or cyanosis.
Urosepsis Nursing InterventionsRationale
Thoroughly monitor the patient’s respiratory rate and depth. Take note of the use of a respiratory muscle or the breathing process.          Hypoxemia, stress, and circulating endotoxins all cause rapid, shallow breathing. Hypoventilation and dyspnea are symptoms of ineffective compensatory mechanisms and indicate the need for ventilatory support.  
Examine the patient’s breath sounds. Look for crackles, stridor, wheezes, and areas with poor or no ventilation.  The presence of adventitious sounds and respiratory distress could indicate a severe complication of urosepsis.  
Examine the sensorium for changes such as confusion, extreme fatigue, mood changes, stupor, delirium, and coma.  The cerebral function is susceptible to changes in oxygen supply, such as hypoxemia or decreased perfusion.
Take note of the presence of circumoral cyanosis in the patient.  Circumoral cyanosis is a sign of insufficient central oxygenation and hypoxemia caused by urosepsis.
Supplemental oxygen should be administered through an appropriate route, such as a nasal cannula, mask, or high-flow rebreathing mask.  Supplemental oxygen is required to rectify hypoxemia caused by failing respirations or progressing acidosis.

Nursing Care Plan for Urosepsis 5

Risk For Shock

Nursing Diagnosis: Risk for Shock related to diminished arterial venous blood flow, partial vasoconstriction, unstable vital signs, relative or actual hypovolemia, and organ damage secondary to urosepsis.

Desired Outcome: The patient will have sufficient perfusion as demonstrated by stable vital signs, palpable peripheral pulses, dry and warm skin, an average level of mentation, independently appropriate urine output, and active bowel sounds.

Urosepsis Nursing InterventionsRationale
Thoroughly monitor the patient’s blood pressure (BP) trends, exceptionally gradual hypotension, and widening pulse pressure.              As circulating microorganisms stimulate the release and activation of chemical and hormonal substances, hypotension develops. Initially, these endotoxins cause peripheral vasodilation, reduced systemic vascular resistance (SVR), and relative hypovolemia. As the shock progresses, cardiac output is severely reduced due to significant changes in contractility, preload, or afterload, resulting in tremendous hypotension.  
Monitor the patient if he or she experiences dyspnea.  In severe cases, urosepsis can progress to severe sepsis, septic shock, or multi-organ failure. Severe sepsis causes little to no urine production. They may have breathing difficulties, as well as heart problems.  
Look for changes in skin color, temperature, and moisture.    If untreated, urosepsis can lead to shock. In the hyperdynamic phase of early septic shock, vasodilation results in the warm, dry, pink skin characteristic of hyperperfusion. As the shock state worsens, compensatory vasoconstriction occurs, directing blood to vital organs while decreasing peripheral blood flow and producing cool, clammy, pale, and dusky skin.
Record the specific gravity of the patient’s urine and hourly urine output.  Reduced renal perfusion due to fluid shifts and selective vasoconstriction is indicated by decreasing urinary output with high specific gravity. This condition could be a sign of a severe urosepsis complication.
Advise the patient to stay in bed and ask for assistance with care activities, especially if the urosepsis is severe.    Preventing overexertion reduces myocardial workload and oxygen consumption, optimizing tissue perfusion efficiency.
Keep an eye on the patient’s heart rate and rhythm. Dysrhythmias should be noted.      Patients with urosepsis frequently experience changes in heart rate, resulting in palpitations and rapid heartbeat. The bacterial toxins caused by urosepsis, together with the increased work of pumping, inevitably weaken the heart. As a result, the heart pumps less blood, and vital organs get even less, resulting in shock.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Nursing Stat Facts
Nursing Stat Facts

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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