Lesson 1Pathophysiology of sepsis and septic shock: host response, organ dysfunction, and progressionExplains the body's response to infection, covering inflammatory and immune pathways, microcirculatory failure, and cellular dysfunction. Connects these processes to organ failure, shock advancement, and clinical indicators that nurses track in real time in local hospitals.
Host immune response to infection in sepsisEndothelial injury and capillary leakMicrocirculatory and mitochondrial dysfunctionFrom sepsis to septic shock: key transitionsOrgan dysfunction patterns and SOFA conceptsClinical correlates of underlying pathophysiologyLesson 2Fluid therapy specifics: crystalloid selection, bolus strategies, and recognition of fluid overloadDiscusses crystalloid choices, bolus amounts, and rates for early sepsis resuscitation. Stresses dynamic evaluation of fluid responsiveness, spotting fluid overload at the bedside, and nursing approaches to balance perfusion while avoiding harm in resource-limited environments.
Balanced versus normal saline selectionInitial bolus strategies and reassessment timingStatic and dynamic fluid responsiveness toolsClinical signs of fluid overload at the bedsideDocumentation of fluid balance and net statusCollaboration on de-resuscitation strategiesLesson 3Patient safety and sepsis-related complications: acute kidney injury, coagulopathy, and need for organ supportCovers frequent sepsis complications like acute kidney injury, coagulopathy, respiratory failure, and organ support needs. Focuses on early detection, prevention methods, and nursing support for renal, respiratory, and blood-related care in ICU wards.
Recognition and staging of acute kidney injuryCoagulopathy, DIC, and bleeding riskRespiratory failure and ventilatory supportHaemodynamic support beyond vasopressorsNursing care for renal replacement therapyPrevention and early detection of complicationsLesson 4Documentation and communication: recording bundle elements, escalation triggers, and handover of sepsis careOutlines precise recording of sepsis bundles, vital trends, and interventions, plus effective communication of escalation points. Highlights structured handovers, closed-loop communication, and checklists to ensure seamless care continuity in multidisciplinary teams.
Recording sepsis bundle elements and timingDocumenting haemodynamics and lactate trendsEscalation triggers and rapid response criteriaStructured handover tools for sepsis patientsInterdisciplinary communication best practicesLegal and quality implications of documentationLesson 5Antimicrobial stewardship and timing: empirical therapy selection, de-escalation, and culture stewardshipEmphasises prompt empirical antimicrobial choices, dosing, and administration in sepsis. Covers culture collection, therapy review with new information, de-escalation plans, and nursing involvement in stewardship and toxicity monitoring in South African facilities.
Timing of first-dose antibiotics in sepsisEmpirical regimen selection and local antibiogramsObtaining cultures without delaying therapyDe-escalation and duration of therapyMonitoring for antimicrobial adverse effectsNursing contributions to stewardship roundsLesson 6Vasopressors and inotropes: indications, dosing targets, titration, adverse effects, and common nurse-driven protocols for norepinephrineExamines norepinephrine as the primary vasopressor in septic shock, covering indications, initial doses, titration methods, monitoring goals, side effects, and nurse-led protocols, including safety protocols and central line management.
Indications for norepinephrine in septic shockStarting doses, concentration, and titration stepsMAP targets and haemodynamic monitoringRecognition and management of adverse effectsCentral line use, patency, and extravasation careNurse-driven vasopressor titration protocolsLesson 7Current international sepsis guidelines and bundles (Surviving Sepsis Campaign): 1-hour and 3-hour elementsSummarises Surviving Sepsis Campaign guidelines and bundles, focusing on 1-hour and 3-hour components. Stresses time-critical nursing tasks, local protocol adjustments, and audit processes to enhance compliance and outcomes in South African ICUs.
Core principles of Surviving Sepsis CampaignOne-hour bundle elements and nurse actionsThree-hour bundle elements and sequencingIntegrating bundles into unit workflowsMeasuring compliance and feedback loopsAdapting guidelines to local resourcesLesson 8Haemodynamic goals in sepsis: MAP targets, lactate-guided resuscitation, and fluid responsiveness assessmentDefines haemodynamic targets in sepsis, such as MAP goals, lactate clearance, and perfusion indicators. Reviews bedside fluid responsiveness checks using dynamic measures, ultrasound, and clinical insight for resuscitation in critical care.
MAP targets and individualised blood pressure goalsLactate trends and perfusion-guided resuscitationCapillary refill and peripheral perfusion markersDynamic indices for fluid responsivenessRole of bedside ultrasound in volume assessmentBalancing fluids, vasopressors, and inotropesLesson 9Monitoring response to sepsis treatment: serial lactates, urine output, end-organ perfusion markers, and bedside clinical toolsDescribes tracking sepsis treatment response via serial lactates, urine output, mental state, and organ markers. Includes bedside tools, reassessment intervals, and recording to direct ongoing resuscitation and de-escalation efforts.
Serial lactate measurement and interpretationUrine output targets and renal perfusionNeurologic status and delirium screeningSkin, temperature, and perfusion assessmentFrequency and structure of reassessment roundsTrend-based documentation and care adjustmentsLesson 10Infection source control: principles, timelines, and nursing coordination for procedures and diagnosticsDetails infection source control principles, including timing, coordination of scans and procedures, and team communication. Emphasises nursing roles in preparation, transport, consent assistance, and monitoring after procedures in busy wards.
Identifying likely infection sources earlyTiming and urgency of source control actionsCoordinating imaging and bedside proceduresPreprocedure preparation and safety checksPostprocedure monitoring and complication signsNursing role in multidisciplinary planning
