# Sepsis Nursing Care Bundle > Sepsis nursing care bundle: qSOFA screening, the Hour-1 bundle elements, 30 mL per kg fluids, noradrenaline to MAP 65 and lactate clearance checks. - Canonical URL: https://prepelephant.com/topics/allied/nursing/sepsis-nursing-care-bundle - Exam / course: Allied Health · Subject: Nursing - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Sepsis Nursing Care Bundle", PrepElephant, https://prepelephant.com/topics/allied/nursing/sepsis-nursing-care-bundle ## Direct answer Septic shock kills within hours, and the bedside nurse controls the clock: the Surviving Sepsis Campaign's Hour-1 bundle exists because every element loses value with delay. Screening comes first — qSOFA flags risk with respiratory rate 22 or more, altered mentation and systolic pressure 100 or less — and once sepsis is recognised, the bundle runs as one movement: measure lactate (and remeasure if it is 2 mmol/L or more), draw blood cultures before antibiotics, deliver broad-spectrum antibiotics within the first hour, give 30 mL/kg of crystalloid for hypotension or lactate of 4 or more, and start vasopressors — noradrenaline first-line — to hold mean arterial pressure at 65 mmHg or above. Nursing owns the logistics of all five: access, culture bottles, timing documentation, the fluid that actually runs, and the observations showing whether lactate clears and urine flows. ## What you must remember - **qSOFA:** respiratory rate at least 22, altered mentation, systolic pressure 100 or less — two or more flags a high-risk patient; SIRS criteria remain the sensitive net that catches the others. - **The Hour-1 bundle:** lactate measured and remeasured within 2-4 hours if at least 2 mmol/L; two blood culture sets before antibiotics; broad-spectrum antibiotics within one hour; 30 mL/kg crystalloid for hypotension or lactate 4 or more; vasopressors to MAP 65 if hypotension persists. - **Culture craft:** two sets from separate sites, one from a fresh stick where possible, timed and labelled — but never delaying the antibiotic past the hour. - **Fluid reality:** 30 mL/kg is roughly 1.5-2 litres in an adult, started within the hour and assessed — pulse, pressure, capillary refill, urine output — because fluid without reassessment is just oedema. - **Noradrenaline, not adrenaline:** first-line vasopressor in septic shock, ideally via a central line, titrated to MAP 65 or above. - **End points that matter:** lactate clearance, urine output at least 0.5 mL/kg/hour, mentation and MAP. - **Source control is nursing too:** removing the culprit catheter, draining the abscess — an undrained source makes antibiotics spectators. - **Indian context:** puerperal sepsis remains a reviewed cause of maternal death in India, and febrile postpartum women deserve the same bundle, the same hour, as everyone else. ## The first sixty minutes of septic shock A 58-year-old with a urinary infection arrives confused, breathing at 26, pressure 86/50. The triage nurse recognises qSOFA three of three and says the word sepsis aloud, starting clocks that otherwise never start. Minute 5: monitor on, two large-bore cannulae, lactate drawn. Minute 10: two culture sets from separate sites. Minute 20: the first antibiotic running — no waiting for a bed, because the bundle belongs to recognition time. Minute 25: 30 mL/kg crystalloid wide open, capillary refill shortening, pulse falling from 122 to 104. By minute 55 the pressure has drifted to 82 despite a litre and a half; noradrenaline starts per protocol, titrated until the MAP reads 66. The one-hour note documents five timestamps — recognition, cultures, antibiotic, fluid, vasopressor. At hour four lactate has fallen from 4.2 to 2.4, urine runs 40 mL/hour and the confusion has cleared. Nothing heroic — five ordinary acts, none delayed. ## Where the marks are lost The classic losing answer is "transfer to intensive care and start the bundle there" — the bundle is ward work, and the transfer is what happens after it is running. The second is culturing after the antibiotic: one dose sterilises the bottle, and the susceptibility data that would later narrow therapy is gone; the correct sequencing, cultures then antibiotic, both inside the hour, is examinable in exactly that order. The third is unmeasured fluid: 30 mL/kg written but not run, or run into a failing heart without reassessment — strong answers pair every fluid order with response markers. For viva depth, know why noradrenaline: septic shock is vasoplegic, and its alpha activity restores vascular tone with fewer arrhythmias than adrenaline. And keep the obstetric addendum ready for Indian papers — puerperal sepsis. ## Frequently asked questions ### What are the qSOFA criteria? Respiratory rate of 22 or more, altered mentation and systolic blood pressure of 100 or less; two or more indicate higher risk of poor outcome in suspected infection. ### What are the five elements of the Hour-1 sepsis bundle? Measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics, give 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L or more, and start vasopressors to keep MAP at 65 mmHg or above. ### How fast should the fluid bolus be given? Started within the hour and infused rapidly with reassessment of pressure, perfusion and urine output — with caution and smaller aliquots in cardiac or renal failure. ### Why is noradrenaline the first-line vasopressor in septic shock? Because septic shock is vasoplegic: noradrenaline's alpha activity restores vascular tone and MAP with modest beta effects and fewer arrhythmias. ### Why must blood cultures precede the first antibiotic dose? One dose can sterilise cultures and lose the organism and its susceptibility pattern, removing the chance to de-escalate — without delaying the antibiotic beyond one hour.