Quick Answer
Sepsis is time-critical. Hour-1 Bundle: lactate + cultures before antibiotics, broad-spectrum antibiotics within 1 h, 30 mL/kg crystalloid for hypotension or lactate ≥ 4, norepinephrine to MAP ≥ 65 if fluid-refractory. Every hour of antibiotic delay raises mortality ~7%. Priority diagnoses: ineffective tissue perfusion, hyperthermia, risk for shock, deficient fluid volume, acute confusion.
Assessment
Subjective: chills, malaise, confusion, decreased urine output.
Objective: temp > 38 or < 36 °C, HR > 90, RR > 22, altered mentation, MAP < 65, SpO₂ ↓, lactate > 2, WBC > 12 or < 4, positive cultures, mottled skin, cap refill > 3 s.
Priority NANDA-I diagnoses
- Ineffective tissue perfusion AEB MAP 58, lactate 4.2, mottling.
- Hyperthermia AEB temp 39.2 °C.
- Risk for shock.
- Deficient fluid volume.
- Acute confusion.
NOC outcomes
- MAP ≥ 65 mmHg within 3 h.
- Lactate cleared (≥ 10% reduction) within 6 h.
- Urine output ≥ 0.5 mL/kg/h.
- Afebrile within 24 h.
- Mentation returns to baseline.
Hour-1 Bundle (Surviving Sepsis 2021)
- Lactate + blood cultures × 2 BEFORE antibiotics — antibiotics reduce culture yield within minutes.
- Broad-spectrum antibiotics within 1 h — every hour of delay ↑ mortality ~7%.
- 30 mL/kg crystalloid for hypotension or lactate ≥ 4.
- Norepinephrine to MAP ≥ 65 if fluid-refractory — first-line vasopressor.
- Reassess volume + perfusion after resuscitation (passive leg raise, cap refill).
- Source control: remove infected lines, drain abscesses.
- VTE + stress-ulcer prophylaxis, HOB 30°, glucose 140–180.
Evaluation
By hour 6: MAP 72 on weaning norepinephrine, lactate 1.6, UO 0.7 mL/kg/h, mentation clearing. Bundle compliant.