This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
Case
The patient is illustrative. Mr. P., 69, has diabetes and is on day 3 after bowel surgery. At 1400 he is confused, his temperature is 38.9 °C, heart rate 124, respiratory rate 26 and blood pressure 84/48 (mean arterial pressure 60). His abdomen is tender and his urine output has been 15 mL an hour for 3 hours. His lactate comes back at 4.6 mmol/L.
Defining sepsis and septic shock
The Third International Consensus Definitions (Sepsis-3) define sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be identified as an increase of 2 or more points in the Sequential Organ Failure Assessment (SOFA) score, which is associated with in-hospital mortality greater than 10%. Septic shock is a subset of sepsis in which circulatory and cellular changes are severe enough to raise mortality substantially. It can be identified by the need for vasopressors to keep the mean arterial pressure at 65 mm Hg or higher, together with a lactate above 2 mmol/L, despite adequate fluid resuscitation (Singer et al., 2016).
Mr. P. has a likely infection (an abdominal source after surgery), new organ dysfunction (confusion, low urine output) and hypotension with a high lactate. He is at high risk of septic shock.
Screening
The 2021 Surviving Sepsis Campaign guidelines recommend against using qSOFA alone as a single screening tool, compared with tools such as SIRS criteria or early warning scores, because qSOFA misses too many patients (Evans et al., 2021). Hospitals should have a screening and response process, and nurses are often the first to see the pattern.
The first hour
| Action | Guidance | Nursing role |
|---|---|---|
| Recognize and escalate | Hospital sepsis screening and response | Call the rapid response team using SBAR |
| Measure lactate | Measure lactate when sepsis is suspected, and remeasure if raised | Draw labs as ordered; report results promptly |
| Blood cultures | Obtain before antibiotics if it doesn't substantially delay them | Draw two sets from different sites |
| Antibiotics | Within 1 hour for possible septic shock or a high likelihood of sepsis | Give the first dose as soon as it's available; don't wait for imaging |
| Fluids | For sepsis-induced hypoperfusion or shock, at least 30 mL/kg of IV crystalloid within the first 3 hours is suggested, with balanced crystalloids preferred | Give boluses as ordered; reassess lung sounds, breathing and blood pressure after each |
| Vasopressors | Norepinephrine is first line, with an initial target mean arterial pressure of 65 mm Hg | Prepare for transfer to the ICU; vasopressors may be started peripherally while central access is placed |
(Evans et al., 2021)
Ongoing assessment
The nurse reassesses mental status, capillary refill, skin, urine output and vital signs frequently. The guidelines suggest using capillary refill time as an adjunct to other measures of perfusion. The surgical team is also involved early, because an abdominal source may need drainage or surgery to control the infection.
Evaluation
Within the hour, Mr. P. receives blood cultures, broad-spectrum antibiotics and a 30 mL/kg fluid bolus. His mean arterial pressure stays below 65, so norepinephrine is started and he moves to the ICU, where a CT scan shows an anastomotic leak. His repeat lactate 2 hours later has fallen to 2.8 mmol/L.
Learning point
In sepsis, recognizing a pattern quickly and acting on several fronts at once saves time and tissue. The bedside nurse's assessment and escalation start that chain.
References
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., . . . Levy, M. (2021). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Critical Care Medicine, 49(11), e1063–e1143. https://doi.org/10.1097/CCM.0000000000005337
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J.-D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J.-L., & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 315(8), 801–810. https://doi.org/10.1001/jama.2016.0287
