Case Study of an Acute Life-Threatening Condition

Question 1: Pathophysiology Causing All the Clinical Manifestations With Which Mrs Smith Presents

The patient in the given clinical case study has been diagnosed with urosepsis. The clinical findings are also resonating with the defined clinical diagnosis of the patient. The condition of urosepsis is mainly caused by the active infection of the urinary tract. The condition tends to impact the urinary tract and causes a bladder infection. It can further impact the normal functioning of the kidneys and thus, leading to poor filtration of the kidneys. The lab report generated for the patient indicates a high neutrophil and lymphocyte count. The neutrophil-lymphocyte ratio can be considered as a direct reflection of the inflammatory marker (Selim et al., 2023). The result of the ratio on the higher side is a direct indication of the active presence of an acute inflammatory response. This can also result in an overall poor physiological status of well-being and poor prognosis, which can be observed for Casey Smith. The marked inflammatory response can also be validated with a higher level of c-reactive protein which shows considerably higher levels than normal.

The patient is als struggling with a presence of active infection. This can be considred prmarily due to the febrile status of the patient. The core body temperature for the patient is noted to be 38.9. This is indicates presence of a high grade fever, which is also a direct presentation of active infection. The arterial blood gas analysis for the patient is indicative of a state of metabolic acidosis. Urosepsis has been found to be develop an underlying state of metabolic acidosis (Dragic et al., 2021). Metabolic acidosis is also found to rather common with patients who are severely septic, as noted for the patient in our clinical case study. This condition rather further contributes to the progression to state of sepsis. Due to the state of urospesis the patient is having the clinical complication of urinary tract infection. This type of infection can result in the inhibition of hydrogen ion secretion and resulting in low pH and impaired urine output. This can also collectively result in state metabolic acidosis as noted for the patient.

The patient is also struggling with right flank pain since past few days. This can also be associated wih acute kidney problems. The concern for poor kidney function is also obsrveed amongst patients with urosepsis. This can be true for Casey Smith as her lab findings are indicative of high creatinine and urea levels. This is also caused secondary to an acute kidney infection and poor urine output. The situation can become life-threatening for the patient, as noted for Casey Smith. Due to acute infection and compromised state of spesis, there is a decreased peripheral perfusion (Joffre et al., 2021). Due to this there is a marked circulatory deficit and the same can be a sign of shock. This can also be proved right for Casey with the clinical parameter of prolonged capillary refill time.

Apart from these primary relatable clinical findings, the patient can be observed to have other secondary complications. Some of these complications are noted for patients with urospesis include fluctuations in heart rate, a state of anxiety and even a state of confusion (Thompson et al., 2019). However, the patient is altert and oriented, her GCS reading can be observed to be reflected as a mild traumatic brain injury. A state of sepsis can cause a pattern of cerberal dysfunction which can further induce distruption of blood-brain barrier and hypoperfusion. This can also alter with the circulation in the cerebra region and thereby, impacting the overall glasgow coma scale reading (Guo et al., 2019). Change in heart rate and anxious state of mind can also be due to febrile condition, caused secondary to the state of sepsis.

Question 2: Mrs. Smith Prescribed Interventions

The vitals of the patient are nted to be rather abnormal as compared to the normal ranges. The patient must be transfered to an intensive care unit for effective care managment. This type of care management will enable immediate and prompt response for the patients as per her clinically deteriorating status. Intensive care managment will also assist in noting the vitals of the patient on an hourly basis. This will assist in noting for abnormal signs and managing care through a constructive manner. In case, the patient is not provided effective care on timely basis, the condition of urosepsis can become life-threatening for the patient. This can also result in multiple organ faliure and can increase the length of stay along with increased cost incurred in treatment managment.

It is also vital to keep a close vigil on the urine and blood culture of the patient. Casey has an established diagnosis of urosepsis with an active state of infection. She is also having kidney related concerns and low urine output. Casey blood culture is also positive for presence of blood and increased creatinine levels. Due to this there is a possibility of poor flushing out of toxins from urine (Ishihara et al., 2020). Noting for urine culture will help in keepng a close vigil on these abnormal signs and enabling most appropriate care for the patient.

The medication of Ceftriaxone has been noted to have positive effect in patients with acute sepsis. It is antibacterial in its mechanism of action which helps in acting as an empiric antibiotic and reduces the overall risk of mortality for the patients (Heffernan et al., 2021). It also works by reducing the sensitivity of the causaative pathogen and thereby, significantly reducing the infectious spred caused by sepsis. Normal saline on the other hand helps in contributing the increased risk of development of metabolic acidosis (Balamuth et al., 2019). This can further help in preventing the risk of developing acute kidney injury for the patient.

Reference

Balamuth, F., Kittick, M., McBride, P., Woodford, A. L., Vestal, N., Casper, T. C., ... & Weiss, S. L. (2019). Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis: The PR o MPT BOLUS Randomized Controlled Trial Pilot Feasibility Study. Academic Emergency Medicine, 26(12), 1346-1356.

Dragic, S., Momcicevic, D., Zlojutro, B., Jandric, M., Kovacevic, T., Djajic, V., ... & Kovacevic, P. (2021). Successful outcomes of critically ill patients with extreme metabolic acidosis treated with structured approach: case series. Clinical Medicine Insights: Case Reports, 14, 11795476211025138.

Guo, J., Cheng, Y., Wang, Q., Su, J., Cui, L., & Jin, Z. (2019). Changes of rScO2 and ScvO2 in childrenwith sepsis‑related encephalopathywith different prognoses and clinical features. Experimental and Therapeutic Medicine, 17(5), 3943-3948.

Heffernan, A. J., Curran, R. A., Denny, K. J., Sime, F. B., Stanford, C. L., McWhinney, B., ... & Lipman, J. (2021). Ceftriaxone dosing in patients admitted from the emergency department with sepsis. European Journal of Clinical Pharmacology, 77, 207-214.

Ishihara, T., Watanabe, N., Inoue, S., Aoki, H., Tsuji, T., Yamamoto, B., ... & Imanishi, T. (2020). Usefulness of next-generation DNA sequencing for the diagnosis of urinary tract infection. Drug Discoveries & Therapeutics, 14(1), 42-49.

Joffre, J., & Hellman, J. (2021). Oxidative stress and endothelial dysfunction in sepsis and acute inflammation. Antioxidants & redox signaling, 35(15), 1291-1307.

Selim, Z. I., Mostafa, N. M., Ismael, E. O., & Kamal, D. (2023). Platelet lymphocyte ratio, lymphocyte monocyte ratio, mean platelet volume, and neutrophil lymphocyte ratio in Behcet’s disease and their relation to disease activity. Egyptian Rheumatology and Rehabilitation, 50(1), 1.

Thompson, K., Venkatesh, B., & Finfer, S. (2019). Sepsis and septic shock: current approaches to management. Internal Medicine Journal, 49(2), 160-170.

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