Sepsis is a life-threatening medical emergency caused by the body’s extreme response to infection. In hospital settings, nurses are often the first healthcare professionals to recognise the early signs of sepsis through routine patient observations and clinical assessments.
Recognising sepsis early allows nurses to escalate deterioration quickly and initiate urgent treatment, which can significantly improve patient outcomes. If you want to understand how vital signs reveal deterioration over time, I discussed this in my post on NEWS2 monitoring in clinical practice.
What Are the Early Signs of Sepsis Nurses Should Recognise?
The early signs of sepsis nurses should recognise include tachycardia, tachypnoea, fever or hypothermia, confusion, reduced urine output, and low blood pressure. These symptoms often develop gradually and may first appear as small changes in routine nursing observations. Early recognition of sepsis allows nurses to perform a timely sepsis nursing assessment and escalate care immediately.
1. Increased Heart Rate (Tachycardia)
Tachycardia is one of the most common early warning signs of sepsis. A heart rate above 90–100 beats per minute may indicate the body is compensating for infection and inflammation. Patients with developing sepsis may show a gradual increase in heart rate during a shift, even if other observations initially appear stable.
This increase in heart rate may occur as the body attempts to maintain circulation and oxygen delivery to vital organs during infection. In some patients, tachycardia may precede other abnormal findings, such as fever or hypotension. For this reason, nurses should always review trends in vital signs rather than relying on a single set of observations when assessing for possible deterioration.
💡Quick Tip:
Always compare the patient’s current heart rate with previous observation trends. A slowly rising heart rate across several hours can indicate early deterioration even before the NEWS2 score becomes critical. For more insight into recognising observation trends, read my article on NEWS2 monitoring during busy ward shifts.
2. Rapid Breathing (Tachypnoea)
A respiratory rate above 20 breaths per minute is one of the most important early signs of sepsis that nurses should recognise. Respiratory rate often increases before oxygen saturation drops, making it a sensitive early indicator of infection and deterioration.
Patients may present with:
- Rapid breathing
- Increased work of breathing
- Feeling short of breath
An increasing respiratory rate may also indicate that the body is trying to compensate for metabolic changes caused by infection. Careful monitoring of respiratory rate during routine observations can help nurses detect early deterioration and promptly escalate concerns.
💡Quick Tip:
If a patient appears unwell, always count the respiratory rate manually for a full 60 seconds rather than relying on automated monitors.
3. Fever or Low Body Temperature
Changes in temperature are another common early sign of sepsis.
Patients may develop:
- Fever above 38°C
- Hypothermia below 36°C
- Shivering or chills
Some patients — particularly older adults — may develop low temperature rather than fever. Temperature abnormalities may occur as the body responds to infection and systemic inflammation. Nurses should always interpret temperature changes alongside other observations such as heart rate, respiratory rate, and blood pressure. Monitoring temperature trends over time can help identify early deterioration and prompt timely escalation.
💡Quick Tip:
If abnormal temperature occurs alongside tachycardia or tachypnoea, repeat a full set of observations within 30–60 minutes and reassess the patient.
4. New Confusion or Altered Mental State
Sudden confusion or reduced alertness can be an early indicator of systemic infection and sepsis.
Patients may show:
• New confusion
• Reduced alertness
• Agitation or restlessness
These changes are particularly common in older patients with infection. Altered mental status may occur when an infection affects brain function or when poor circulation impairs oxygen delivery to vital organs. Nurses should always compare the patient’s current level of consciousness with their usual baseline behaviour. Any sudden change in cognition or responsiveness should prompt reassessment and possible escalation to the medical team.
💡Quick Tip:
Assess and document the patient’s AVPU score (Alert, Voice, Pain, Unresponsive) and compare it with previous neurological assessments.
5. Reduced Urine Output
Reduced urine output may indicate early organ dysfunction, particularly affecting kidney function.
Nurses should monitor for:
- Urine output less than 0.5 ml/kg/hr
- Dark or concentrated urine
- Reduced output despite fluid intake
Fluid balance monitoring is essential in recognising acute kidney injury related to infection. Reduced urine output may occur when an infection affects blood flow to the kidneys and impairs normal kidney function. Nurses should review the patient’s fluid balance chart regularly to identify any downward trends in urine output during the shift. Early recognition of reduced urine output allows nurses to escalate concerns promptly and support timely intervention.
💡Quick Tip:
Review the fluid balance chart and catheter output over the last 4–6 hours to identify downward trends in urine output.
You can read more about this in my Nursing Notes post discussing fluid balance monitoring and acute kidney injury in hospital patients.
6. Falling Blood Pressure
Hypotension can indicate worsening sepsis or septic shock, requiring urgent escalation.
Signs may include:
- Low systolic blood pressure
- Weak or thready pulse
- Cold or clammy skin
Low blood pressure may occur when an infection causes widespread inflammation, impairing the body’s ability to maintain adequate circulation. As perfusion decreases, vital organs such as the brain and kidneys may not receive enough oxygen and nutrients. Nurses should promptly repeat observations and immediately escalate concerns if hypotension occurs alongside other signs of deterioration. Patients may also appear pale, dizzy, or increasingly drowsy as blood pressure falls. Close monitoring and prompt communication with the medical team are essential to prevent further clinical deterioration.
💡Quick Tip:
If hypotension occurs alongside tachycardia or tachypnoea, repeat observations immediately and escalate using NEWS2 or the hospital sepsis pathway.
Sepsis Nursing Assessment: What Nurses Should Monitor
During a sepsis nursing assessment, nurses should closely monitor the following observations:
- Heart rate
- Respiratory rate
- Temperature
- Blood pressure
- Oxygen saturation
- Urine output
- Level of consciousness
These observations form an important part of routine patient assessment and can help nurses recognise early physiological changes associated with infection and deterioration. Careful monitoring of these parameters allows nurses to detect subtle changes in a patient’s condition before more severe complications develop. It is also important to review trends in observations over time, rather than relying on a single set of vital signs, as gradual changes may indicate a worsening infection. Monitoring these parameters helps nurses identify early patient deterioration and recognise sepsis symptoms quickly, enabling timely escalation and intervention.
When Nurses Should Escalate Possible Sepsis
If sepsis is suspected, nurses should escalate immediately according to hospital protocol. Early recognition and timely escalation are critical because delays in treatment can lead to rapid deterioration and organ dysfunction. Nurses play an important role in identifying abnormal observations, communicating concerns clearly, and activating the appropriate escalation pathway. Most NHS hospitals use:
• NEWS2 scoring systems
• Sepsis screening tools
• Rapid response or outreach teams
These systems help healthcare teams recognise patient deterioration quickly and ensure that appropriate clinical reviews are carried out without delay. Escalation may involve informing the nurse in charge, contacting the medical team, or activating the hospital’s sepsis or rapid response protocol. Early treatment interventions may include:
• Oxygen therapy
• Intravenous fluids
• Blood cultures
• Intravenous antibiotics
These interventions are often initiated as part of the early sepsis management bundle to treat infection and support circulation. Prompt administration of antibiotics and fluids is especially important in preventing the progression of sepsis to septic shock.
Early escalation is one of the most important responsibilities nurses have in preventing severe sepsis and septic shock. Acting quickly when warning signs appear can significantly improve patient outcomes and reduce the risk of life-threatening complications.
Final Reflection from the Ward
In clinical practice, sepsis rarely appears suddenly. Instead, it often begins with small clinical changes:
A respiratory rate slowly increasing.
A patient becoming slightly confused.
Urine output gradually decreasing.
Recognising these subtle changes early is one of the most important skills nurses develop in recognising patient deterioration in hospital settings. Trust your clinical judgement — and escalate concerns early when something does not feel right.
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