urosepsis nursing case study

Urosepsis Nursing Diagnosis and Nursing Care Plan

Last updated on December 31st, 2022 at 11:52 am

Urosepsis Nursing Care Plans Diagnosis and Interventions

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.

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:

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.

Risks Factors to Urosepsis

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:

Diagnosis of Urosepsis

Treatment for urosepsis, urosepsis nursing diagnosis, nursing care plan for urosepsis 1.

Deficient Knowledge

Nursing Care Plan for Urosepsis 2

Hyperthermia

Nursing Care Plan for Urosepsis 3

Risk For Infection

Nursing Care Plan for Urosepsis 4

Risk For Impaired Gas Exchange

Nursing Care Plan for Urosepsis 5

Risk For 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

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

Disclaimer:

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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Urosepsis: Nursing Diagnoses & Care Plans

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.

In this article:

• Signs and Symptoms
• Nursing Process
• Deficient Knowledge
• Hyperthermia
• Impaired Gas Exchange
• Risk for Deficient Fluid Volume
• Risk for Shock

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:

• Frequent urination
• Urinary urgency
• 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.

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 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.

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.

Urosepsis symptoms include fever, chills, respiratory distress, abnormal heart function, and mental status changes.

Nursing Diagnosis: Hyperthermia

• Dehydration
• Inflammatory process
• Urinary tract infection
• Flushed skin
• Skin warm to touch
• Diaphoresis
• Restlessness
• Tachycardia
• Patient will maintain a core body temperature within normal limits. 
• Patient will not experience complications from hyperthermia.

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.

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.

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

• Disease process
• Ventilation-perfusion mismatch
• Abnormal ABG levels
• Altered breathing pattern
• Irritability
• Nasal flaring
• 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.

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.

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.

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

• Systemic inflammatory response
• Systemic infection
• Interstitial fluid shifts

A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.

• 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.

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.

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.

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

• Infection 
• Hypothermia 
• Unstable vital signs
• Hypoperfusion
• 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.

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.

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.

• Lewis’s Medical-Surgical Nursing. 11th Edition, Mariann M. Harding, RN, Ph.D., FAADN, CNE. 2020. Elsevier, Inc.
• 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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15 July 2017, Volume :42 Number 7 , page 53 - 54 [Free]

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• Goveas, Blaizie MS, CCRN, AGACNP-BC

Article Content

Mr. H, 70, presented to the ED with complaints of low back pain, painful urination, fever, and chills that began earlier in the day. He underwent a lithotripsy 1 week earlier and had a medical history significant for diabetes mellitus and liver transplant 5 years earlier. On initial presentation, Mr. H was awake, alert, and ambulatory; his vital signs were: temperature, 102 [degrees] F (38.9 [degrees] C); heart rate, 120 beats/minute; respiratory rate, 22 breaths/minute; and BP, 110/70 mm Hg .

Forty-five minutes later, Mr. H's vitals were: temperature, 103.2 [degrees] F (39.6 [degrees] C); heart rate, 132 beats/minute; respiratory rate, 28 breaths/minute; and BP, 80/50 mm Hg. His physical exam was significant for lethargy, dry mucous membranes, costovertebral angle tenderness, and mottling bilaterally up to his knees. His lab tests included a white blood cell count of 1,000/mm3 and lactic acid of 4.3 mmol/L. Mr. H was diagnosed with urosepsis and needed prompt interventions to avoid further hemodynamic compromise .

Introduction

Sepsis is a life-threatening condition that has an associated mortality of up to 41.1%. 1 Specifically, sepsis secondary to a urinary tract infection (UTI) accounts for nearly 25% of all sepsis cases. 2 The urinary tract is the second most common infection site, accounting for approximately 20% to 40% of all severe cases of sepsis in patients. 2 Given the high incidence and severity of sepsis, early recognition and appropriate management of UTIs play a vital role in preventing the disease progression to urosepsis.

Diagnosing sepsis

New definitions for sepsis and septic shock (Sepsis-3) were published in 2016. Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. 3 Septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality. 3 Patients with septic shock can be identified with the clinical criteria of hypotension, requiring vasopressor therapy to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L in the absence of hypovolemia. 3

Risk factors for urosepsis

Urosepsis is an infection arising from the urinary or genital organs that manifests with systemic signs and symptoms. Common causes of urosepsis include obstructive etiologies, such as urethral stones, tumors, urethral strictures, phimosis, ureterocele, polycystic kidney disease, and pregnancy. 4 Patients with indwelling urethral catheters, ureteric stents, nephrostomy tubes, neurogenic bladder, cystocele, and vesicoureteral reflux are at a higher risk for developing urosepsis. 4 Hospitalized patients and those in long-term-care facilities are at a higher risk to develop infections with drug-resistant organisms. 4

Even though microbial pathogens are the primary culprit in any infection, the host defense mechanism also plays a role in urosepsis. Patients with a weakened immune system, such as older adults and patients with chronic metabolic disorders (diabetes mellitus and chronic kidney disease), AIDS, immunosuppression due to transplantation, neutropenia resulting from chemotherapy, or chronic corticosteroid use, are also at a higher risk to develop urosepsis. 4 When these high-risk patients develop a UTI, it is considered to be a complicated UTI, which is the most common precursor to urosepsis. 4

Clinical signs and symptoms

Clinical signs of UTIs include fever, nausea, vomiting, flank pain, costovertebral angle tenderness, dysuria, hematuria, malodorous urine, urinary retention, urinary frequency, and prostatic/scrotal pain in men. 2 In the early stages of urosepsis, the patient will have an increase in cardiac output, systemic vasodilation, and a significant decrease in systemic vascular resistance, resulting in a dramatic intravascular volume loss. 4 The patient will also have hyperdynamic circulation with warm skin, bounding pulses, tachycardia, tachypnea, and a febrile flushed appearance.

To compensate for the low intravascular volume, catecholamines are released to increase cardiac output and myocardial contractility. However, given the low intravascular volume, these compensatory mechanisms are not adequate enough to maintain BP. This progresses to hypotension and hypoperfusion to the tissues, resulting in cellular energy loss and lactic acid production. 4 This is seen as severe lactic acidosis and septic shock. This state of septic shock is usually irreversible with severe tissue hypoperfusion and systemic vasoconstriction. The two ominous signs of septic shock include hypothermia and leukopenia. 5

Other signs and symptoms of tissue hypoperfusion include cold extremities, mottled skin far above the knees, flank pain, renal angle tenderness, ureteric or renal colic, and dysuria. This toxic sequela further leads to hypoperfusion in other organs clinically seen with multiple organ failure, such as respiratory failure with acute respiratory distress syndrome, acute kidney failure, hepatic failure, and disseminated intravascular coagulation. 3

Antimicrobial management

Appropriate antimicrobial management is essential in preventing UTIs from progressing to urosepsis. Previous antimicrobial regimens that have failed patients presenting with urosepsis should be avoided. Urosepsis is most frequently caused by Gram-negative bacilli organisms, with Escherichia coli (50%) being the most common organism in urosepsis. 4 Proteus spp . (15%), Enterobacter and Klebsiella (15%), and Pseudomonas aeruginosa (5%) are the other common organisms isolated in urosepsis. 4

Gram-positive organisms are less frequently seen in urosepsis. 4 Antibiotic therapy should be individualized for each patient based on local pathogen susceptibility and resistant pathogens. 6 According to local susceptibility patterns, a third-generation cephalosporin, piperacillin in combination with beta-lactamase inhibitor (BLI), or a fluoroquinolone (without history of fluoroquinolone therapy in the past 6 months) may be appropriate antibiotic choices. 2

Candida and Pseudomonas are more frequently seen in patients with an impaired host defense; therefore, an antifungal and antipseudomonal drug, such as third-generation cephalosporin, piperacillin in combination with BLI, or a carbapenem, should be considered in this high-risk patient population. 2 Institutions with a high incidence of enterobacteriaceae with extended-spectrum beta-lactamase or fluoroquinolone-resistant E. coli should initiate empirical therapy with a carbapenem. 2

Surviving Sepsis Campaign

The Surviving Sepsis Campaign (SSC) aims to reduce sepsis mortality, and along with new definitions, the guidelines for management of sepsis and septic shock were updated in 2016. Upon initial clinical suspicion of sepsis, SSC guidelines recommend initial fluid resuscitation with at least 30 mL/kg of I.V. crystalloid fluid given within the first 3 hours. 1 Ongoing reevaluation including clinical exam of physiologic variables (such as temperature, heart rate, respiratory rate, BP, arterial oxygen saturation, and urine output) remains key in assessing response to therapy. 1

Aggressive fluid resuscitation can help restore hemodynamics and increase oxygen delivery to tissues in patients with sepsis. Empiric broad-spectrum antimicrobials should be initiated as soon as possible and within 1 hour of diagnosis. 1 Microbiologic cultures including blood and urine should be collected prior to antimicrobial administration; however, antimicrobial administration should not be delayed. 1 Delay in antimicrobial administration is associated with an increase in mortality. 1 De-escalation of antimicrobials should be done once culture data results in pathogen identification and sensitivities are obtained. 1

Norepinephrine, the first vasopressor of choice, should be given to patients with septic shock to maintain a mean arterial pressure greater than 65 mm Hg. 1 SSC guidelines recommend additional intensive care strategies to manage sepsis and septic shock, with the emphasis on early antimicrobial therapy, and initial aggressive fluid resuscitation. 1

Case study revisited

Mr. H received antimicrobials within the hour, was adequately fluid resuscitated, and was transferred to ICU where he recovered from urosepsis .

Achieving optimal outcomes

Urosepsis has a high mortality, and the main focus still remains on prevention with a proactive approach. High-risk patients should always be carefully monitored and assessed for any signs and symptoms of developing UTIs. Patients with diagnosed UTIs should be closely monitored for worsening infection and developing sepsis or septic shock. Screening tools can aid in identifying sepsis early in acutely ill hospitalized patients, leading to lower mortality. 1 Early detection of urosepsis allows for early intervention, which can hinder the progression of the disease process and optimize outcomes.

1. Rhodes A, Evans LE, Alhazzani W, et al Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med . 2017;43(3):304-377. [Context Link]

2. Wagenlehner FM, Lichtenstern C, Rolfes C, et al Diagnosis and management for urosepsis. Int J Urol . 2013;20(10):963-970. [Context Link]

3. Singer M, Deutschman CS, Seymour CW, et al The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA . 2016;315(8):801-810. [Context Link]

4. Kalra OP, Raizada A. Approach to a patient with urosepsis. J Glob Infect Dis . 2009;1(1):57-63. [Context Link]

5. Dellinger RP, Levy MM, Rhodes A, et al Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med . 2013;41(2):580-637. [Context Link]

6. Wagenlehner FM, Tandogdu Z, Bjerklund Johansen TE. An update on classification and management of urosepsis. Curr Opin Urol . 2017;27(2):133-137. [Context Link]

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Urosepsis Case Study

Epidemiology of urosepsis.

• Urosepsis accounts for approximately 25% of cases of sepsis and has a mortality rate between 30-40%
• The most common pathogens involved in urosepsis are Escherichia coli (50%), followed by Proteus (15%), Enterobacter (15%), Klebsiella (15%), Pseudomonas aeruginosa  (5%), and gram-positive bacteria (15%).
• Urosepsis is more common in females than males, with women being at higher risk due to anatomical differences that make them more susceptible to UTIs.
• Older adults are also at increased risk for developing urosepsis due to factors such as weakened immune systems and underlying medical conditions.
• Patients with catheters or other urinary tract interventions are at heightened risk of developing urosepsis.
• Individuals with conditions like diabetes or kidney stones may be predisposed to recurrent UTIs, which can increase the likelihood of urosepsis.
• Proper hygiene practices, timely diagnosis and treatment of UTIs, and management of underlying health conditions are essential in reducing the burden of urosepsis.

Epidemilogy of Hoarding

Hoarding disorder is a complex and often misunderstood condition characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value. Understanding the epidemiology of hoarding can provide valuable insights into its prevalence, risk factors, and impact on individuals and communities.

Prevalence:

• Community Samples: Estimates suggest that hoarding behaviors affect approximately 2% to 6% of the general population.
• Clinical Samples: Hoarding disorder is more prevalent among individuals seeking mental health treatment, with rates ranging from 15% to 30%.

Demographics:

• Age: Hoarding symptoms often begin in childhood or adolescence and tend to worsen with age.
• Gender: Hoarding disorder appears to be equally common among men and women.
• Socioeconomic Status: Hoarding behaviors can occur across all socioeconomic levels, but individuals with lower socioeconomic status may be at increased risk due to limited resources and access to treatment.

Comorbidities:

• Obsessive-Compulsive Disorder (OCD)
• Anxiety Disorders
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Personality Disorders

Risk Factors:

• Genetic Factors: Family studies suggest a genetic predisposition to hoarding disorder.
• Environmental Factors: Early life experiences, traumatic events, and learned behaviors can contribute to the development of hoarding behaviors.
• Psychological Factors: Perfectionism, indecisiveness, and cognitive deficits in information processing may contribute to hoarding symptoms.
• Quality of Life: Hoarding disorder can significantly impair an individual’s quality of life, affecting relationships, social functioning, and daily activities.
• Safety Risks: Accumulation of possessions can lead to safety hazards, such as fire hazards, falls, and infestations.
• Health Risks: Hoarding can be associated with poor physical health outcomes due to unsanitary living conditions and neglect of personal hygiene.

Treatment Seeking:

• Despite the significant impact of hoarding disorder, many individuals do not seek treatment due to stigma, shame, or lack of awareness about available interventions.

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A case of urosepsis with atypical presentation

Björk Ólafsdóttir.

1 Department of Emergency Medicine, Landspítali University Hospital, Reykjavík, Iceland

Sigrún Ásgeirsdóttir

Jón magnús kristjánsson.

2 University of Iceland, Department of Medicine, Iceland

A 39 year old woman with a history of ovarian cysts and pyelonephritis presented to our emergency department with the chief complaint of right sided flank pain of 22 hours duration. The pain had been slowly increasing and was severe at presentation. The pain was constant, centered in the right upper quadrant with radiation to the epigastrium, back and lower right quadrant. She had vomited three times prior to presentation. There was no urinary frequency or dysuria and normal bowel movements. No vaginal bleeding or discharge.

Case report

The vital signs on presentation were: pulse 88, BP 85/47, RR 12, sat 100 on room air, GCS 15 and T 36.9°C. On examination her skin was cold and clammy and she appeared in some distress. Auscultation of her heart and lungs was normal. She was tender in her upper right quadrant and on percussion over her right kidney without referred or rebound tenderness. While waiting for the results of the blood test the fever increased to 39.2°C and the blood pressure dropped further despite aggressive fluid therapy. Blood cultures were drawn and she received a plasma expander, ceftriaxone 1 g IV and pressors after which she was intubated. A CT was performed that showed inflammation around the right kidney with dilatation of the right urethra and a 6 mm concrement at the vesicourethral junction.

Urinary tract infections range from uncomplicated cystitis to urosepsis and are relatively common presentations at most emergency departments. Urosepsis classically presents with fever, confusion, generalized weakness, tachycardia and dehydration and eventually hypotension and severe sepsis with organ dysfunction. It is most likely to occur in patients with urinary obstruction or indwelling catheters and in immunosuppressed patients, those of advanced age or with serious underlying medical problems. In all patients with suspected urosepsis it is of paramount importance to rule out an obstructive calculus as infection in the presence of high grade obstruction from a stone is a urologic emergency that necessitates not only admission, but also immediate urologic intervention in combination with early antibiotic treatment. Delay in drainage can lead to significant morbidity and death.