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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Correct Answer is B
Explanation
Systemic vascular resistance represents the resistance to blood flow in the systemic circulation. It is an important indicator of afterload, which is the force against which the left ventricle must pump to eject blood into the systemic circulation. By monitoring the changes in SVR, the nurse can assess the impact of medications aimed at reducing left ventricular afterload.
A. Pulmonary artery wedge pressure (PAWP) in (option A) is incorrect because: PAWP is a measure of left ventricular preload and reflects the pressure within the left atrium and left ventricle at end-diastole. It is not specifically related to afterload reduction.
C. Pulmonary vascular resistance (PVR) in (option C) is incorrect because: PVR represents the resistance to blood flow in the pulmonary circulation. It is not directly related to left ventricular afterload.
D. Central venous pressure (CVP) in (option D) is incorrect because: CVP reflects the pressure in the right atrium and is an indicator of right-sided cardiac function. It is not specifically related to left ventricular afterload reduction.
Therefore, to assess the effectiveness of medications in reducing left ventricular afterload, the nurse should monitor the systemic vascular resistance (SVR).
Correct Answer is C
Explanation
Septic shock is a life-threatening condition characterized by severe infection, systemic inflammation, and inadequate tissue perfusion. In this critical situation, one of the initial priorities is to restore intravascular volume and improve tissue perfusion. Initiation of an intravenous line allows for the administration of fluids and other necessary medications to support the patient's hemodynamic stability.
While the other interventions mentioned are also important components of septic shock management, the immediate priority is to address hypotension and tissue hypoperfusion through fluid resuscitation:
A. Obtaining wound and blood cultures in (option A) is incorrect because: Cultures are important to identify the source and causative organisms of the infection. However, fluid resuscitation should take priority over obtaining cultures, as it is necessary to stabilize the patient's hemodynamics.
B. Removing or controlling potentially infected sources in (option B) is incorrect because: Identifying and controlling the source of infection is crucial in septic shock management to prevent further progression. However, initiating fluid resuscitation is more time-sensitive and should be prioritized.
D. Drawing blood for hematology and chemistry studies in (option D) is incorrect because Laboratory studies are important for evaluating organ function and guiding treatment. However, the immediate focus should be on fluid resuscitation to address the underlying hypoperfusion and stabilize the patient's condition.
Therefore, the intervention considered a priority when treating a patient who presents with septic shock is the initiation of an intravenous line and fluid administration to restore intravascular volume and improve tissue perfusion.
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