A 27-year-old male patient who has been involved in a motor vehicle crash is admitted to the emergency department with cool, clammy skin, tachypnoea, tachycardia, and hypotension. All of these orders are written. Which one will the nurse act on first?

The stages of shock are commonly described as the initial, compensatory, progressive, and refractory stages. Here is an explanation of each stage and why the patient's assessment findings correspond to the progressive stage:
B. The compensatory stage in (option B) is incorrect because, In the compensatory stage, the body continues to activate compensatory mechanisms to maintain perfusion. This includes increased heart rate, peripheral vasoconstriction, and shunting of blood to vital organs. The patient's assessment findings of decreasing cardiac output, decreased peripheral perfusion, and increased capillary permeability suggest that the body's compensatory mechanisms are no longer sufficient to maintain perfusion adequately. Therefore, the patient has progressed beyond the compensatory stage.
C. The initial stage in (option C) is incorrect because, In the initial stage, there is an initial insult or injury that triggers the shock state. The body's compensatory mechanisms are activated, such as increased heart rate and vasoconstriction, to maintain blood pressure and perfusion. However, the patient's assessment findings indicate that they have progressed beyond the initial stage.
D. The refractory stage in (option D) is incorrect because The refractory stage represents a severe and irreversible state of shock where vital organs fail, and despite interventions, the patient's condition does not improve. The patient's assessment findings do not suggest the refractory stage, as there is still potential for intervention and management.

In septic shock, prompt administration of antibiotics is crucial in order to target the underlying infection and prevent further progression of the septic process. Antibiotics help to eradicate the causative organisms and reduce the bacterial load, which can help improve patient outcomes.
While all the options mentioned are important interventions in the management of septic shock, initiating antibiotic therapy is considered a priority in order to address the underlying infection and prevent sepsis-related complications.
A. Giving a 2000 mL normal saline bolus in (option A) is incorrect because: Fluid resuscitation is important in septic shock to restore intravascular volume, but antibiotic therapy takes precedence as it directly targets the underlying infection.
B. Starting an insulin drip to maintain blood glucose at 110 to 150 mg/dL in (option B) is incorrect because Glycemic control is important in septic shock, but it is not the first priority compared to addressing the infection.
C. Giving acetaminophen (Tylenol) 650 mg rectally in (option C) is incorrect because Antipyretic medications can help reduce fever, but they do not address the underlying infection or stabilize the patient's condition.
E. Starting norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg in (option E) is incorrect because: Vasopressor support may be necessary in septic shock to maintain adequate blood pressure, but initiating antibiotics takes priority in order to address the underlying infection.
Therefore, in a patient with septic shock presenting with the given signs and symptoms, the nurse should first implement the intervention of giving the prescribed antibiotics to target the underlying infection.