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After completing this case study, the reader should be able to:

  • Recognize the signs and symptoms of sepsis and septic shock.

  • State patient variables used to diagnose sepsis and septic shock.

  • Identify the initial treatment goals for patients after the diagnosis of sepsis.

  • Formulate a comprehensive treatment plan for the initial management of patients with sepsis.

  • Recommend appropriate supportive care therapies for patients with sepsis.


Chief Complaint

The patient presents from her nursing home with altered mental status and lethargy that has progressively worsened over the past 24 hours.


Ruth Carter is an 80-year-old woman who resides in a nursing home with a past medical history that includes hypertension, advanced dementia, chronic kidney disease, depression, and GERD. She was discharged last week from another hospital after being treated for 5 days for a urinary tract infection. She did well through the first 2 days after discharge but has become increasingly lethargic and drowsy in the past 24 hours. She is barely responsive at the time of assessment. She has had no reports of fever, nausea, vomiting, or pain.



Advanced dementia

CKD, stage II






No HTN, DM, CAD, cancer, or vascular disease


Lives in a nursing home due to dementia

No tobacco, alcohol, or illicit drug use


Clonidine 0.2 mg/24 H transdermal patch every week

Acetaminophen 500 mg PO Q 6 H as needed for pain/fever

Lorazepam 0.5 mg PO Q HS

Hydralazine 50 mg PO TID

Omeprazole 20 mg PO QAM

Rivastigmine 4.6 mg/24 H transdermal patch Q HS

Levofloxacin 500 mg PO Q 24 H for 3 days (received 5 days of inpatient therapy; completed total course 2 days ago)



Review of Systems

Unable to obtain due to patient’s mental status

Physical Exam


Unresponsive, thin appearing woman in acute distress

Vital Signs

BP 86/42 mm Hg, P 118–142 bpm, RR 14–35 breaths/min, T 35.6°C; SpO2: 94% on 8L NC, Ht 5′3″, Wt 50.8 kg


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