A nurse is attending to a patient with a bowel obstruction who has been prescribed a nasogastric tube. What steps should the nurse take during the insertion of the nasogastric tube?

Choice A rationale:

Irreversible shock is the final stage of shock, where the body's compensatory mechanisms have failed, and damage to vital organs is irreversible. This stage is characterized by:

Profound hypotension (systolic blood pressure persistently below 60 mmHg) Severely altered mental status (unresponsiveness or coma)

Widespread organ failure (kidney failure, liver failure, respiratory failure) Lack of response to aggressive fluid resuscitation and vasopressor therapy

The patient in the question does not exhibit all of these signs and symptoms, particularly the profound hypotension and irreversible organ failure. Therefore, irreversible shock is not the most likely stage.

Choice B rationale:

End-organ dysfunction is a stage of shock where inadequate tissue perfusion has begun to cause damage to vital organs. This stage is characterized by:

Hypotension that may respond to fluid resuscitation

Signs of organ dysfunction, such as decreased urine output, altered mental status, or respiratory distress

The patient in the question does have some signs of organ dysfunction, such as confusion and crackles on lung auscultation. However, the hypotension is not as severe as typically seen in end-organ dysfunction shock, and there is no mention of other organ dysfunction like decreased urine output. Therefore, end-organ dysfunction is not the most likely stage.

Choice C rationale:

Early reversible shock is the initial stage of shock, where the body's compensatory mechanisms are still able to maintain blood pressure and organ perfusion. This stage is characterized by:

Mild to moderate hypotension Tachycardia

Cool, clammy skin Narrowed pulse pressure Restlessness or anxiety

The patient in the question presents with all of these signs and symptoms, making early reversible shock the most likely stage.

Choice D rationale:

Preshock is a state of impending shock, where the body's compensatory mechanisms are activated but not yet fully effective. This stage is characterized by:

Normal or slightly low blood pressure Tachycardia

Cool, clammy skin Restlessness or anxiety

The patient in the question has hypotension, which is not consistent with preshock. Therefore, preshock is not the correct stage.

Choice A rationale:

While explaining the importance and rationale of the new policy can be helpful, it may not address the underlying reasons for the nurse's resistance.

If the nurse does not understand or agree with the rationale, they may still be resistant to change.

Additionally, simply providing information may not create an open and trusting environment where the nurse feels comfortable expressing their concerns.

Choice B rationale:

Encouraging the nurse to verbalize their concerns allows the nurse manager to understand the specific reasons for the resistance.

This can help to identify any misconceptions or concerns that can be addressed directly.

It also gives the nurse an opportunity to feel heard and understood, which can help to build trust and rapport. When nurses feel that their concerns are being taken seriously, they are more likely to be open to change.

Choice C rationale:

Threatening disciplinary action is likely to create resentment and further resistance. It may also damage the relationship between the nurse manager and the nurse.

This approach should only be used as a last resort, after other attempts to address the resistance have failed.

Choice D rationale:

Ignoring the resistance is not an effective strategy.

It is likely to lead to continued noncompliance with the new policy,

It may also send the message that the nurse manager does not care about the nurse's concerns.

Peer pressure can sometimes be helpful in facilitating change, but it should not be relied upon as the sole strategy.