A nurse’s knowledge leads to immediate intervention.
- Sepsis is a life-threatening condition resulting from a dysregulated immune response to infection that can rapidly progress to septic shock and organ failure.
- For each hour of delayed treatment, mortality rates increase.
- Signs and symptoms include altered mental status, decreased urine output, elevated blood cell count, fever or hypothermia, hypotension, tachycardia, and tachypnea.
EMMA CRAIG*, A 68-YEAR-OLD, alert, and oriented woman with a past medical history of type 2 diabetes, hypertension, and arthritis, is admitted for an elective right total hip arthroplasty. Postoperatively, she remains on the med–surg unit while awaiting transfer to inpatient rehab. She receives a single dose of broad-spectrum antibiotics in the operating room per surgical protocol.
On postoperative Day 0, Hudson, Ms. Craig’s bedside nurse, notes stable vital signs: BP 128/68 mmHg with a MAP of 88 mmHg, HR 72 bpm, RR 15 breaths per minute, O2 saturation 98% on room air, and temperature of 36.6° C (97.8° F).
Early recognition
On post-op Day 3, Ms. Craig becomes lethargic and disoriented to time and place. Vital signs reveal clinical deterioration: BP 88/44 mmHg, MAP 59 mmHg, HR 116 bpm, RR 20 breaths per minute, O2 saturation 88% on room air, and temperature 37.9° C (100.2° F). Morning lab results reveal an elevated white blood cell count of 18,000/uL.
Hudson recognizes the acute change in mental status and abnormal vital signs as indications of organ dysfunction, meeting the definition of two or more abnormalities concerning for sepsis. He initiates a rapid response, in accordance with the hospital’s protocol and guidelines described by King and colleagues.
On the scene
To identify the pathogen, the rapid response team draws two sets of blood cultures from two peripheral sites before administering antibiotics. A CBC and a serum lactate level are obtained.
Per Surviving Sepsis Campaign guidelines, the team initiates weight-based fluid resuscitation to address sepsis-induced hypovolemia, improve tissue perfusion, and achieve a MAP of ≥65. Broad-spectrum antibiotics are administered promptly to reduce mortality associated with delayed antimicrobial therapy, while supplemental oxygen is provided to maintain adequate oxygenation and support increased metabolic demands during the systemic inflammatory response.
Ms. Craig is transferred to the ICU for monitoring and potential escalation of care, including vasopressor therapy and airway support if needed.
Outcomes
Ms. Craig receives a diagnosis of sepsis secondary to a postoperative surgical site infection. The provider prescribes targeted I.V. antibiotics and fluid resuscitation.
Ongoing interprofessional collaboration among nursing, medical, pharmacy, and critical care teams supports rapid treatment adjustments and close monitoring, leading to hemodynamic stabilization. Ms. Craig is safely discharged to an inpatient rehabilitation facility with scheduled follow-up appointments with her surgeon and primary care provider for postsurgical and postsepsis care.
Hudson’s recognition of the signs and symptoms of sepsis facilitated timely diagnostic evaluation and initiation of evidence-based interventions, preventing Ms. Craig’s further deterioration.
Education
The World Health Organization defines sepsis as a life-threatening condition resulting from a dysregulated immune response to infection that can rapidly progress to septic shock and organ failure. In Ms. Craig’s case, a postevent debriefing with the rapid response team reinforces the importance of early sepsis recognition, strict adherence to evidence-based guidelines, and identification of early signs and symptoms. (See Sepsis: Signs and symptoms)
Sepsis: Signs and symptoms
Signs and symptoms of sepsis include the following:
- Altered mental status
- Decreased urine output
- Elevated white blood cell count
- Fever or hypothermia
- Hypotension
- Tachycardia
- Tachypnea
Delays in antibiotic administration and fluid resuscitation significantly increase the risk of progression to septic shock and mortality.
According to the Sepsis Alliance, for each hour of delayed treatment, mortality rates increase, underscoring the critical role of timely intervention. Patient and family education includes recognition of signs of infection and the importance of immediate medical care. Nurses can empower patients and families to reduce care delays and improve outcomes.
*Names are fictitious.
Sarah Pridemore is a clinical nurse educator at University Hospitals in Cleveland, Ohio.
American Nurse Journal. 2026; 21(10). Doi: 10.51256/ANJ102652
References
King J, Chenoweth CE, England PC, et al. Clinical Care Guidelines: Early Recognition and Initial Management of Sepsis in Adult Patients. Michigan Medicine, University of Michigan; 2023. ncbi.nlm.nih.gov/books/NBK598311/
Oczkowski S, Alshamsi F, Belley-Cote E, et al. Surviving Sepsis Campaign Guidelines 2021: Highlights for the practicing clinician. Pol Arch Intern Med. 2022;132(7-8):16290. doi:10.20452/pamw.16290
Sepsis Alliance. Sepsis and Septic Shock. July 17, 2026. sepsis.org/sepsisand/septic-shock
World Health Organization. Sepsis. May 3, 2024. who.int/news-room/fact-sheets/detail/sepsis
Key words: acute sepsis, postoperative infection, fluid resuscitation
