A 78-kg patient with septic shock has a urine output of 30 mL/hr for the past 3 hours. The pulse rate is 120/minute and the central venous pressure and pulmonary artery wed pressure are low. Which order by the health care provider will the nurse question?
Administer hydrocortisone (Solu-Cortef) 100 mg IV.
Give PRN furosemide (Lasix) 40 mg IV.
Increase normal saline infusion to 250 mL/hr.
Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg.
The Correct Answer is C
In septic shock, one of the key goals of management is to restore and maintain adequate intravascular volume. However, in this case, the patient's urine output is low (30 mL/hr for the past 3 hours), suggesting inadequate renal perfusion and potential fluid overload.
Administering additional normal saline at an increased rate (250 mL/hr) without addressing the low urine output could potentially exacerbate fluid overload and further compromise the patient's condition.
A. Administer hydrocortisone (Solu-Cortef) 100 mg IV in (option A) is incorrect because: Hydrocortisone is commonly used in septic shock to help stabilize blood pressure and modulate the inflammatory response.
B. Giving PRN furosemide (Lasix) 40 mg IV in (option B) is incorrect because Furosemide, a loop diuretic, can be administered as needed to address fluid overload or to increase urine output if there is evidence of volume overload.
D. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg in (option D) is incorrect because: Norepinephrine is a vasopressor commonly used in septic shock to increase systemic vascular resistance and maintain adequate blood pressure.
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Related Questions
Correct Answer is B
Explanation
Assessing tissue perfusion is crucial in evaluating the adequacy of oxygen and nutrient delivery to the body's tissues. While multiple factors contribute to tissue perfusion, the options provided in choice B are key indicators:
Level of consciousness: Altered mental status or changes in the patient's level of consciousness can be a sign of impaired cerebral perfusion, which reflects overall tissue perfusion.
Urine output: Monitoring urine output provides information about renal perfusion and kidney function. Decreased urine output can be indicative of inadequate tissue perfusion.
Lactate level: Lactate is a by-product of anaerobic metabolism that accumulates when there is insufficient oxygen delivery to tissues. Elevated lactate levels indicate tissue hypoperfusion and cellular oxygen debt.
A. Pupil response, pulse pressure, and urine output in (option A) are incorrect because While pupil response and pulse pressure may provide some information about perfusion, they do not encompass a comprehensive assessment of tissue perfusion. Additionally, assessing urine output is important, but it alone may not provide a complete picture of tissue perfusion status.
C. Blood pressure, pulse, and respirations in (option C) are incorrect because Blood pressure, pulse, and respirations are important vital signs to monitor, but they do not solely indicate tissue perfusion. Hypotension, for example, can be a late sign of inadequate tissue perfusion.
D. Breath sounds, heart rate, and pupil response in (option D) are incorrect because: Although breath sounds and heart rate can be affected by changes in tissue perfusion, they are not specific or comprehensive indicators of tissue perfusion status. Pupil response alone does not provide a complete assessment of tissue perfusion.
Therefore, the most accurate assessment of tissue perfusion in a patient in shock involves evaluating the level of consciousness, urine output, and lactate levels.
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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