A 61-year-old female patient with hypovolemic shock has these vital signs: temperature 97.9°F (36.6°C): pulse 123 beats/min: blood pressure 85/48 mamite respirations 24 breaths/min; urine output 20 mL for last 2 hours: skin cool and clammy. Which prescription order for this patient does the nurse question?

Central venous pressure (CVP) is a measurement of the pressure in the central veins, which reflects the blood volume and right-sided cardiac function. High CVP readings may indicate fluid overload or impaired cardiac function, and intervention is necessary to address the underlying cause.
Administering IV diuretic medications can help reduce fluid volume by increasing urine output and promoting fluid elimination. By removing excess fluid, the diuretic medications can help lower the CVP and alleviate the high pressures.
The other options mentioned are not the anticipated actions for addressing high CVP:
A. Increasing the IV fluid infusion rate in (option A) is incorrect because: If the CVP is already indicating high pressures, increasing the IV fluid infusion rate would further contribute to fluid overload and exacerbate the problem. This action would not be appropriate for high CVP readings.
C. Elevating the head of the patient's bed to 45 degrees in (option C) is incorrect because Positioning the patient with the head of the bed elevated is commonly done to prevent complications such as aspiration or improve respiratory function. While it may have other benefits, it does not directly address the high CVP.
D. Documenting the CVP and continuing to monitor in (option D) is incorrect because Documenting the CVP and continuing to monitor is important for ongoing assessment and evaluation. However, in the presence of high CVP readings, intervention is necessary to address the underlying issue rather than solely documenting and monitoring.
Therefore, when a patient's CVP monitor indicates high pressures following surgery, the nurse would anticipate administering IV diuretic medications to help reduce fluid volume and lower the CVP.

Norepinephrine is a potent vasoconstrictor and inotropic agent commonly used to increase blood pressure in cases of hypotension or shock. However, if the infusion rate is too high, it can lead to excessive vasoconstriction and potentially compromise organ perfusion.
A heart rate of 58 beats/min suggests bradycardia, which can be an indication of excessive vasoconstriction caused by a high dose or rate of norepinephrine infusion. Excessive vasoconstriction can reduce cardiac output and worsen tissue perfusion.
A. Mean arterial pressure is 55 mm Hg in (option A) is incorrect because A mean arterial pressure of 55 mm Hg may be within an acceptable range for a patient receiving norepinephrine infusion, depending on the patient's baseline blood pressure and clinical condition.
B. Systemic vascular resistance (SVR) is elevated in (option B) is incorrect because An elevated SVR indicates increased peripheral vascular resistance and can be a desired effect of norepinephrine infusion to improve blood pressure and perfusion.
C. Pulmonary artery wedge pressure (PAWP) is low in (option C) which is incorrect because A low PAWP may indicate decreased left ventricular preload, which can be a desired effect of norepinephrine infusion to reduce fluid overload in certain clinical conditions.
It is important for the nurse to carefully monitor the patient's hemodynamic parameters, including blood pressure, heart rate, and organ perfusion when titrating norepinephrine infusion to ensure optimal dosing and minimize potential adverse effects. If concerns arise regarding the infusion rate, the healthcare provider should be promptly notified for further evaluation and adjustment of the treatment plan.