One week following a total hysterectomy, a patient presents to the emergency department with a temperature of 104° F, heart rate 118, blood pressure 100/68 mmHg, new onset confusion and delirium, and flushed, warm skin. On assessment, the patient has positive bowel sounds, the patient’s abdomen is soft and non-tender, she has mild to moderate subcostal and intercostal retractions, and her breath sounds are clear and equal bilaterally. The nurse anticipates which diagnosis?

Question

One week following a total hysterectomy, a patient presents to the emergency department with a temperature of 104&deg; F, heart rate 118, blood pressure 100/68 mmHg, new onset confusion and delirium, and flushed, warm skin. On assessment, the patient has positive bowel sounds, the patient&rsquo;s abdomen is soft and non-tender, she has mild to moderate subcostal and intercostal retractions, and her breath sounds are clear and equal bilaterally. The nurse anticipates which diagnosis?

Accepted Answer

Sepsis. The patient&rsquo;s fever, tachycardia, hypotension, decreased level of consciousness, and flushed, warm skin indicate infection. The patient&rsquo;s breath sounds are clear, which tends to rule out pneumonia. The findings are not consistent with pulmonary embolism, which would present with severe shortness of breath. The patient has positive bowel sounds with a soft, non-tender abdomen, which tends to rule out peritonitis. Therefore, the likely diagnosis is sepsis, which can occur following abdominal surgery.

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