UROSEPSIS

SECONDARY TO
COMPLICATED
UTI
ESPLANADA, JAMIE JOHN Q.
Patient’s
profile
Name: Rolito Lagaras
Birthday: September 24, 1975
Age: 45
Occupation: Fisherman
Diagnosis: UROSEPSIS SECONDARY TO
COMPLICATED UTI; S/P PERCUTANEOUS
NEPHROLITHOTOMY LEFT AND INSERTION OF DJ
STENT
 History of
present illness
1-week PTA, patient complained of right lower
quadrant pain. Pain upon urination was also
noted.

1-day PTA, the patient had fever. Still

complained pain upon urination. Medication
taken but provided no relief hence admission.
Past health
history
No birth defects or ill conditions at birth. The
patient can only recall cough, colds, and fever as
his childhood illnesses. The patient had complete
immunization when he was still a child. Last May
14, the patient undergone surgery for the removal
of kidney stones on his left kidneys. No specific
allergies noted.
FAMILY
HEALTH
HISTORY
Patient mother’s name is Evelyn Lagaras who is 60 years
old. His father is Artemio Lagaras, deceased. Has family
history of hypertension on mother side.
Psychosocial
lifestyle and
practices
“An akon typical nga adlaw kay makadto
ak ha dagat mangingisda kay amo man an
akon pakabuhi. Danaygihapon ako iton
nagluluto hit mga karaonon” as verbalized.
urosepsis
Urosepsis is when an untreated UTI spreads
through your urinary tract to your kidney
(pyelonephritis) and causes sepsis. It can also be
caused by a bladder infection (cystitis), although
cystitis rarely causes sepsis by itself.
• A UTI is when your urinary tract is infected. This can be
caused by bacterial or fungal infections and is typically
easy to treat. You can get a UTI through sexual activity,
unsanitary conditions, or wiping after going to the
washroom.
• Sepsis is an often dangerous condition that happens when
your body damages its own tissues while responding to
infection. In some cases, sepsis may develop into septic
shock, which is a dramatic drop in blood pressure that can
lead to organ dysfunction and death.

• Even though most people recover from mild sepsis, the

mortality rate for septic shock is around 40%. Having severe
sepsis will also make you more likely to develop infections in
the future.
SIGNS AND
SYMPTOMS
Once it's confirmed you have a UTI and sepsis, it
likely means you have urosepsis.
If you have the following symptoms, you may
have sepsis:

• Respiratory (breathing) rate is equal to 22

breaths per minute or higher
• Systolic blood pressure is equal to or less than
100 millimeters of mercury (mm Hg)
• Abnormal white blood cell count (either too high
or too low)
Severe sepsis symptoms include:

• Organ failure, such as kidney (renal)

dysfunction resulting in less urine
• Low platelet count
• Changes in mental status
In some cases, sepsis may turn into septic shock,
which is a drastic drop in blood pressure that can
increase the risk of death. Signs of septic shock
include:

• Needing medication to maintain systolic blood

pressure equal to or greater than 65 mm Hg.
• High levels of lactic acid in your blood, which
means your cells aren’t using oxygen in the right
way
treatment
Early goal-directed therapy (EGDT) can reduce
the mortality rate of sepsis. The treatment
guidelines include:

• Rapidly giving you antibiotics to get rid of

the suspected infection source
• Supportive care, such as stabilizing your
lungs and flow of blood
• Additional supportive therapies
● The doctor will give you the antibiotics within one
hour of a confirmed diagnosis after blood and
urine cultures have been collected. The goal is to
decrease the mortality rate of sepsis. Your
survival rate will decrease by 8% each hour
antibiotics are delayed after the first six hours.
Antibiotics used to treat sepsis often include:

● Piperacillin with a beta-lactamase inhibitor

● Third-generation cephalosporin
● Fluoroquinolone
Other ways to treat sepsis include intravenous
(IV) fluids at a minimum of 30 milliliters per
kilogram.

Your doctor may also give you vasopressors

such as norepinephrine, which keep your
blood pressure from dropping.
If you have another condition affecting
your urinary tract, it needs to be treated
as soon as possible. For instance, if you
have a ureteral stone (calculus) that’s
causing urosepsis, your doctor will put in
a stent.
PERCUTANEOUS
NEPHROLITHOT
OMY LEFT AND
INSERTION OF
DJ STENT
Percutaneous nephrolithotomy is a procedure
used to remove kidney stones from the body when
they can't pass on their own. A scope is inserted
through a small incision in your back to remove the
kidney stones.

Percutaneous nephrolithotomy is used most often for

larger stones or when other procedures, such as
extracorporeal shock wave lithotripsy or uteroscopy,
are unsuccessful or not possible.
PCNL is performed under general anesthesia with the
patient lying face down on their abdomen. Once
anesthesia is administered, your surgeon will perform
cystoscopy (telescopic examination of your bladder)
and instill xray dye or carbon dioxide into your kidney
through a small catheter placed up through the ureter
or drainage tube of the affected kidney to “map” the
branches of the collecting system. This allows your
surgeon to precisely locate the stone within the kidney
and place a small needle through the skin under xray
guidance to directly access the stone.
This needle tract is dilated to approximately 1-
cm to allow placement of a plastic sheath and
telescope to directly visualize the stone. Using
an ultrasonic, mechanical or laser lithotripsy
device, the stone is fragmented into small
pieces and extracted out of the body through
the sheath. On occasions, more than one tract
may be required to access and attempts
removal of all stones.
A small ureteral stent may be left draining
the kidney to the bladder in addition to a
nephrostomy tube draining the kidney to an
external drainage bag at the end of the
operation. The length of the surgery is
generally 3-4 hours.
Post-operative
care
Diet

The patient may return to normal diet after surgery

as ordered. Mild nausea and possibly vomiting
may occur in the first 6-8 hours following surgery.
This is usually due to the side effects of anesthesia
and will resolve soon. We suggest clear liquids and
a light meal the first evening following surgery.
Activity

Advise the patient and significant other that after

discharge, no strenuous activity for 2 weeks.
Otherwise, do not lift more than 15 lbs. and do not
swim for 3 weeks after surgery.
Stent

If the patient will be sent home with a ureteral

stent, it may cause UTI-like symptoms including
burning with urination, flank pain that is worse with
voiding, frequency, urgency, and rust-colored
urine. This is normal and all symptoms will resolve
within a few days of stent removal.
Problems to Report
• Fever of 38 degrees Celcius or higher.
• Pain not managed with prescription pain medication despite using it
as directed on bottle.
• Clots in the urine that are the size of a quarter or larger
• Redness around incision site that is spreading or getting larger
• Discolored or foul-smelling discharge (pus) from wound site
• Difficulty urinating after surgery.
• Drug reactions such as a rash or vomiting. If difficulty with breathing
occurs, go directly to the ER.