Sentinel U: Medical Surgical Early Recognition/Failure to
Respond
Hermeaner Riviere-Fingal
Miami Dade College
Transforming Practice Through Innovation and Leadership Capstone NUR4945L-2263
Professor: Kassandra Greci
May 22, 2026
, Pathophysiology of Patient Deterioration
Scenario 1 focuses on Jamie, whose symptoms of right lower quadrant pain, vomiting,
and low-grade fever are strongly associated with acute appendicitis. The obstruction of
the appendix increases intraluminal pressure, resulting in inflammation, ischemia, and
bacterial overgrowth. The elevated white blood cell count with a left shift demonstrates
the body’s inflammatory response to infection. Jamie’s tachycardia and tachypnea are
compensatory mechanisms that occur as the body attempts to maintain oxygenation and
tissue perfusion during systemic inflammation. As a transplant nurse at Jackson
Memorial Hospital, I understand the importance of recognizing these subtle early
warning signs before a patient rapidly deteriorates.
Scenario 2: Harold (Sepsis and Septic Shock)
Harold’s condition demonstrates the progression from a urinary tract infection to sepsis
and septic shock. Sepsis occurs when the body develops a dysregulated inflammatory
response to infection, causing widespread endothelial injury, vasodilation, and capillary
leakage. Harold’s confusion and decreased responsiveness indicate cerebral
hypoperfusion, while his hypotension and elevated lactate levels suggest distributive
shock and impaired tissue oxygenation. Elevated lactate is an important marker of
anaerobic metabolism and poor organ perfusion. Working on a transplant unit, I
frequently care for immunocompromised patients who are at high risk for sepsis, which
has strengthened my ability to recognize early signs of deterioration and respond quickly.
Clinical Assessment and Nursing Management
Early recognition is essential in both scenarios. Jamie’s pale and diaphoretic appearance
indicates severe pain and autonomic stress, while Harold’s altered mental status and
Respond
Hermeaner Riviere-Fingal
Miami Dade College
Transforming Practice Through Innovation and Leadership Capstone NUR4945L-2263
Professor: Kassandra Greci
May 22, 2026
, Pathophysiology of Patient Deterioration
Scenario 1 focuses on Jamie, whose symptoms of right lower quadrant pain, vomiting,
and low-grade fever are strongly associated with acute appendicitis. The obstruction of
the appendix increases intraluminal pressure, resulting in inflammation, ischemia, and
bacterial overgrowth. The elevated white blood cell count with a left shift demonstrates
the body’s inflammatory response to infection. Jamie’s tachycardia and tachypnea are
compensatory mechanisms that occur as the body attempts to maintain oxygenation and
tissue perfusion during systemic inflammation. As a transplant nurse at Jackson
Memorial Hospital, I understand the importance of recognizing these subtle early
warning signs before a patient rapidly deteriorates.
Scenario 2: Harold (Sepsis and Septic Shock)
Harold’s condition demonstrates the progression from a urinary tract infection to sepsis
and septic shock. Sepsis occurs when the body develops a dysregulated inflammatory
response to infection, causing widespread endothelial injury, vasodilation, and capillary
leakage. Harold’s confusion and decreased responsiveness indicate cerebral
hypoperfusion, while his hypotension and elevated lactate levels suggest distributive
shock and impaired tissue oxygenation. Elevated lactate is an important marker of
anaerobic metabolism and poor organ perfusion. Working on a transplant unit, I
frequently care for immunocompromised patients who are at high risk for sepsis, which
has strengthened my ability to recognize early signs of deterioration and respond quickly.
Clinical Assessment and Nursing Management
Early recognition is essential in both scenarios. Jamie’s pale and diaphoretic appearance
indicates severe pain and autonomic stress, while Harold’s altered mental status and
