A nurse is working with an interdisciplinary disaster committee to develop a community-wide emergency response plan in the event of a nonbiological or chemical incident. The nurse should include which of the following agencies to be notified immediately after calling 911?

Choice A: Type and match for 2 units of packed RBCs

This option is not typically part of the initial management of sepsis. Typing and matching for blood transfusion is generally reserved for patients who are experiencing significant blood loss or severe anemia. In this case, the patient’s hemoglobin and hematocrit levels are within normal ranges, indicating that a blood transfusion is not immediately necessary. The primary focus in the first hour of sepsis management is to stabilize the patient through fluid resuscitation, infection control, and monitoring vital signs.

Choice B: Rapidly administer 30 mL/kg of normal saline

Rapid fluid resuscitation is a critical component of sepsis management. Administering 30 mL/kg of normal saline helps to restore intravascular volume, improve tissue perfusion, and prevent organ failure. This intervention is particularly important in patients with hypotension or elevated lactate levels, as it helps to maintain adequate blood pressure and oxygen delivery to tissues. The Surviving Sepsis Campaign guidelines recommend this approach to stabilize patients and prevent further complications.

Choice C: Measure lactate level

Measuring lactate levels is essential in the early management of sepsis. Elevated lactate levels indicate tissue hypoperfusion and anaerobic metabolism, which are hallmarks of sepsis and septic shock. Monitoring lactate levels helps to assess the severity of the condition and guide further treatment decisions. The Surviving Sepsis Campaign guidelines emphasize the importance of measuring lactate levels within the first hour of sepsis recognition. If the initial lactate level is elevated, it should be remeasured to evaluate the effectiveness of the interventions.

Choice D: Obtain blood cultures

Obtaining blood cultures before administering antibiotics is crucial for identifying the causative pathogen and tailoring antibiotic therapy. Blood cultures help to determine the source of infection and guide appropriate antimicrobial treatment. Early identification and targeted therapy are essential for improving patient outcomes in sepsis. The Surviving Sepsis Campaign guidelines recommend obtaining blood cultures as part of the initial management of sepsis.

Choice E: Obtain a wound culture

Obtaining a wound culture is important in this case because the patient has a wound with purulent drainage, which could be a potential source of infection. Identifying the specific pathogen responsible for the wound infection allows for targeted antibiotic therapy, which is more effective than broad-spectrum antibiotics. This intervention helps to control the source of infection and prevent further complications. The Surviving Sepsis Campaign guidelines support source control measures, including obtaining wound cultures, as part of the initial management of sepsis.

Choice A reason:

Reduced chest width: Aging does not typically result in a reduced chest width. Instead, changes in posture and the curvature of the spine can make the chest appear less prominent. The primary musculoskeletal changes with aging involve bone density, muscle mass, and joint flexibility

Choice B reason:

Increased force of isometric contraction: This is incorrect. Aging is associated with a decrease in muscle strength and mass, not an increase. The force of muscle contractions generally diminishes with age due to the loss of muscle fibers and changes in muscle composition.

Choice C reason:

Decreased muscle mass: This is correct. One of the most significant age-related musculoskeletal changes is sarcopenia, which is the loss of muscle mass and strength. This process begins around the age of 30 and accelerates with age, leading to decreased physical strength and increased risk of falls and fractures.

Choice D reason:

Thickened vertebral discs: Aging typically leads to the thinning and dehydration of intervertebral discs, not thickening. This can result in a reduction in height and increased susceptibility to spinal issues such as herniated discs and spinal stenosis.