| Course | N420 Adult Health IV |
|---|---|
| Module | Module 4 |
| Paper type | Sepsis case paper |
| Length | About 1,051 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Pre-licensure BSN |
| Updated | September 2026 |
Free sample paper for N420 Module 4
Not Himself, No Fever: Following the Sepsis Continuum in an 86-Year-Old Man From Assisted Living
Student Name
Pre-licensure BSN Program, Aspen University
N420: Adult Health IV
Instructor Name
Month Day, Year
Not Himself, No Fever: Following the Sepsis Continuum in an 86-Year-Old Man From Assisted Living
Older adults with sepsis often arrive without the signs students learn to expect. Mr. G., a composite 86-year-old retired carpenter, was sent to the emergency department from assisted living because staff said he was not himself: he had fallen twice in two days, was eating little and did not recognize a regular aide. His temperature was 36.1 degrees Celsius. This paper follows him along the sepsis continuum, from infection to sepsis to septic shock, and explains the nursing care at each point. Mr. G. is an illustrative composite.
Definitions
Under the current consensus, sepsis means organ failure, dangerous to life, produced by a disordered host reaction to infection, identified by an acute rise of two points or more in the Sequential Organ Failure Assessment score. Septic shock is the subset whose mean arterial pressure cannot be held at 65 without vasopressors and whose lactate stays above 2 mmol/L despite adequate fluid (Singer et al., 2016). The definitions describe a continuum, and a patient can move along it in hours.
Why the Signs Are Different in Older Adults
Fever may be absent or blunted in 20% to 30% of older adults with infection, which can delay diagnosis (Norman, 2000). Instead, sepsis may show as confusion, falls, loss of appetite or a sudden decline in function. Blood pressure must be read against the person's usual values. Mr. G.'s pressure of 102/60 looked acceptable, but his assisted living records showed readings in the 150s, so he had lost about 50 points. His heart rate of 104 was limited by a beta-blocker, which can mask the expected rise.
The Continuum in Mr. G.'s Case
The table follows his course over the first six hours.
| Point on the continuum | Mr. G.'s findings | Nursing focus |
|---|---|---|
| Infection | Cough for four days, crackles at the right base, oxygen saturation 91% on room air | Recognize infection as the likely cause of his change |
| Sepsis | New confusion, breathing rate 24, relative hypotension, creatinine 2.0 from a baseline of 1.1, lactate 3.2 | Screen, alert the provider, start hour-one care |
| Septic shock | At hour four, mean pressure 58 after fluids, lactate 4.0 | Vasopressor per order, close monitoring, escalation to intensive care |
Screening and Recognition
The 2021 international guidelines advise against relying on the quick Sequential Organ Failure Assessment (qSOFA) as the only screening tool in place of systemic inflammatory response criteria or early warning scores, because it misses many patients (Evans et al., 2021). For Mr. G., the triage nurse's decision to screen him for sepsis despite a normal temperature was the most important action of the day. A structured report to the provider named the likely source, the drop in blood pressure from baseline, the new confusion and the kidney changes.
Hour-One Care
When septic shock is possible or sepsis is likely, the guidelines recommend giving antimicrobials immediately, ideally within an hour of recognition, after obtaining blood cultures where this does not delay treatment. They also recommend measuring lactate and suggest a crystalloid volume of 30 mL per kilogram over the first three hours for sepsis-induced hypoperfusion (Evans et al., 2021). For Mr. G., the nurse drew two sets of blood cultures and a lactate, started the ordered antibiotics within 50 minutes of triage and began fluids. At 68 kilograms, his full volume would be about 2 liters. Because older adults can develop fluid overload, the nurse gave the fluid in portions and reassessed breathing, crackles, oxygen saturation and blood pressure after each.
Finding the Source and Using Antibiotics Well
A chest radiograph confirmed a right lower lobe pneumonia, and a sputum sample was sent before the second antibiotic dose. Broad coverage was chosen at first because he had been in a residential setting and recently in hospital. The guidelines recommend reassessing antibiotic therapy each day for narrowing (Evans et al., 2021), so the nurse's handoff noted when cultures would result. Good stewardship protects older adults in particular from resistant organisms and from infections such as Clostridioides difficile.
Moving to Septic Shock
By hour four, after 1.5 liters, his mean arterial pressure was 58 and his lactate had risen to 4.0. He now met the definition of septic shock. Norepinephrine was started through a peripheral line as a bridge while a central line was placed, with the nurse checking the site every hour for infiltration. He was transferred to intensive care. The nurse's handoff included the time of antibiotics, total fluid given, the lactate trend and his usual blood pressure, because the receiving team would otherwise not know his baseline.
Preventing Harm During Resuscitation
Resuscitation brings its own risks for an 86-year-old. Mr. G. had fallen twice, so his bed was kept low with the alarm on, and a staff member stayed with him while he was confused. Because his swallowing may be weaker when he is delirious, oral intake was held until a bedside screen was done. His skin was inspected on arrival, since a long lie after a fall and poor perfusion both raise the risk of pressure injury, and his heels were offloaded. His home medicines were reviewed, and his blood pressure tablets were held while he was hypotensive.
Delirium, Family and Goals of Care
Mr. G.'s confusion was delirium, a sign of brain dysfunction from sepsis. The nurse reoriented him, kept his glasses and hearing aids on, and called his daughter to sit with him. His daughter also mentioned that he had told his doctor he would not want long-term life support. The nurse made sure this reached the team so a goals-of-care conversation could happen early, before decisions were forced by a crisis.
Evaluation
Over the next day, success would mean a falling lactate, a mean pressure at 65 or higher with a decreasing vasopressor dose, urine flowing at 0.5 mL per kilogram an hour or more, clearing confusion and a plan of care that matches his wishes.
Conclusion
Mr. G. had no fever, a blood pressure that looked normal and a heart rate held down by medication. What revealed his sepsis was a change from his own baseline, noticed by staff who knew him and taken seriously by a nurse who screened anyway. Hour-one care, careful fluids, early escalation and attention to his wishes followed from that first act of recognition.
References
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., ... Levy, M. (2021). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Critical Care Medicine, 49(11), e1063-e1143. https://doi.org/10.1097/CCM.0000000000005337
Norman, D. C. (2000). Fever in the elderly. Clinical Infectious Diseases, 31(1), 148-151. https://doi.org/10.1086/313896
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J.-D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J.-L., & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 315(8), 801-810. https://doi.org/10.1001/jama.2016.0287
Reading the N420 Module 4 assignment instructions
The sepsis continuum is named in Aspen's N420 catalog description, and with the module's own wording hidden from the public, that listing shaped this sample. A sepsis assignment usually asks you to define the stages, describe how a patient moves between them, and set out nursing assessment and interventions at each point, often with a case. This module adds an atypical presentation in an older adult, so the paper must explain what makes older patients different. Check whether your instructor expects the current international guideline, whether a specific screening tool is required, and whether the case should come from your clinical experience with identifying details removed. Ask whether a table is expected.
How the N420 Module 4 example is put together
Roughly 1,050 words sit under twelve headings, with one continuum table. The introduction describes how the patient arrived. Definitions follow the current consensus. A section explains atypical presentation and relative hypotension. The table tracks his findings across infection, sepsis and septic shock. Screening and recognition discuss why the triage nurse's decision mattered. Hour-one care covers cultures, antibiotics, lactate and fluids adapted to his age. A section on finding the source addresses stewardship. The move to septic shock and a section on preventing harm during resuscitation follow, and delirium, family, goals of care, evaluation and a conclusion complete the paper. Every section refers back to his own baseline values.
Where the marks sit in the N420 Module 4 rubric
Sepsis papers tend to be graded on accurate definitions, early recognition, timely interventions and individualized care. Definitions are current and precise. Recognition earns the most marks because the paper reads each vital sign against his baseline, which a margin note calls the core skill for older adults. Interventions follow the 2021 guidelines with times recorded, and the fluid section shows adaptation rather than copying, which instructors credit. Individualized care appears in delirium management, fall and skin prevention and early attention to his wishes. Evaluation criteria are measurable. The last points depend on a legible continuum table and correct APA entries for the 2021 guideline, the consensus definitions and the review of fever in older people. Recording the antibiotic time within the hour also shows the guideline was followed, not just cited.
Common N420 Module 4 mistakes, and how to avoid them
The most common mistake is waiting for fever before suspecting sepsis in an older adult. Look for confusion, falls, weakness and poor intake. Students also judge blood pressure against normal ranges instead of the patient's baseline, and beta-blockers can hide a rising heart rate. Another frequent error is giving the full fluid volume at once to a frail patient without reassessment. Give it in portions and listen to the lungs. Some papers forget the handoff details the next team needs, such as antibiotic time and fluid totals. Finally, raise goals of care early. Families often know the patient's wishes, and hearing them before a crisis changes decisions. Record exactly when the first dose went in.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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- N420 Module 5: Traumatic Brain Injury: The First 24 Hours
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N420 Module 4 questions, answered
What does N420 Module 4 usually ask for?
Aspen's N420 description includes the sepsis continuum, so a paper following a patient from infection to sepsis to septic shock is a typical assignment. Check your classroom for the prompt.
Why do older adults with sepsis often lack a fever?
Aging blunts the fever response, so up to about a third of older adults with infection have no fever. Confusion, falls, weakness and poor intake may be the first signs.
What is the difference between sepsis and septic shock?
Sepsis is organ dysfunction caused by the body's response to infection. Septic shock adds a need for vasopressors to keep the mean pressure at 65 or higher and a lactate above 2 despite fluids.
Where can I find a free N420 Module 4 sample paper?
The complete sepsis continuum paper, continuum table and notes included, is on this page and free to open. It sits fourth among the N420 samples, between the cardiogenic shock and brain injury papers.
What makes sepsis different in older adults in N420 Module 4?
Older adults often lack fever, may present with confusion, falls or poor intake, and can have relative hypotension that looks normal. Comparing findings with their baseline is essential.