A 48-year-old female patient with septic shock presents with a BP of 70/46, pulse 136, respirations 32, temperature 104.0° F, and blood glucose of 246 mg/dl. The following have been ordered. Which order will the nurse accomplish first?
Draw an arterial blood gas (ABG).
Start insulin drip to maintain blood glucose at 150 mg/dl or lower.
Give a normal saline bolus IV of 30mL/kg.
Titrate norepinephrine (Levophed) to keep MAP greater than 65 mm Hg.
The Correct Answer is C
Septic shock is characterized by inadequate tissue perfusion and hypotension, which can lead to organ dysfunction and failure. The administration of intravenous fluids, such as a normal saline bolus, is the initial priority in the management of septic shock to restore intravascular volume and improve perfusion.
A. Draw an arterial blood gas (ABG) in (option A) is incorrect because: ABG may be ordered to assess the patient's acid-base status and oxygenation, but addressing hypotension and restoring perfusion through fluid administration takes priority.
B. Start insulin drip to maintain blood glucose at 150 mg/dl or lower in (option B) is incorrect because: Hyperglycaemia is commonly observed in critically ill patients, including those with septic shock. While controlling blood glucose is important, it is not the immediate priority compared to addressing hypotension and restoring intravascular volume.
D. Titrate norepinephrine (Levophed) to keep mean arterial pressure (MAP) greater than 65 mm Hg in (option D) is incorrect because: Norepinephrine is a vasopressor medication used to increase blood pressure and perfusion in septic shock. While it may be necessary for the management of septic shock, fluid resuscitation should be initiated first to optimize intravascular volume before starting vasopressors.
Therefore, the first order that the nurse should accomplish in this scenario is to give a normal saline bolus IV of 30 mL/kg to address the hypotension and restore intravascular volume.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The ABG results show a pH of 7.50, PaCO2 of 29 mmHg, and HCO3 of 23 mEq/L, indicating respiratory alkalosis. In respiratory alkalosis, there is a decrease in PaCO2 (hypocapnia), which can be caused by excessive ventilation.
To address the respiratory alkalosis, the nurse should decrease the respiratory rate. This would help reduce the amount of ventilation provided and allow the patient to retain more carbon dioxide (CO2), thereby increasing the PaCO2 levels and restoring acid-base balance.
B. Leaving the ventilator at the current settings in (option B) is incorrect because it may exacerbate respiratory alkalosis as it would maintain the same level of ventilation.
C. Increasing the tidal volume (VT) in (option C) is incorrect because it would not address the respiratory alkalosis. Tidal volume refers to the volume of air delivered with each breath, while the issue in this case is excessive ventilation leading to hypocapnia.
D. Increasing the FiO2 (fraction of inspired oxygen) in (option D) is incorrect because it is not indicated based on the given ABG results. The oxygenation (PaO2) level is within normal limits (80 mmHg), suggesting adequate oxygenation.
It is important to consult with the healthcare provider or respiratory therapist for further guidance on adjusting the ventilator settings based on the patient's condition and response to therapy.
Correct Answer is B
Explanation
The patient's symptoms of fever and elevated white blood cell count suggest a potential infection and sepsis. Broad-spectrum antibiotics should be initiated promptly to cover a wide range of possible pathogens until further diagnostic tests and identification of the specific causative agent are obtained. Early administration of appropriate antibiotics is crucial in sepsis management to target the suspected infection and improve patient outcomes.
A. Cooling baths in (option A) is incorrect because: Cooling baths are typically used in the management of hyperthermia or specific conditions like heatstroke. While the patient has an elevated temperature, it is likely due to the systemic inflammatory response rather than solely hyperthermia.
C. Blood transfusion in (option C) is incorrect because Blood transfusion may be required in certain cases of sepsis if there is evidence of significant anemia or active bleeding. However, based on the information provided, there is no immediate indication of a blood transfusion.
D. NPO status in (option D) is incorrect because NPO status (nothing by mouth) is a general precautionary measure used in various situations, such as prior to surgery or to manage gastrointestinal complications. It is not a specific intervention in the sepsis resuscitation bundle.
Therefore, the nurse should initiate the intervention of administering broad-spectrum antibiotics in this scenario.
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