An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate?
Increase the rate for the dopamine infusion.
Increase the rate for the sodium nitroprusside infusion.
Decrease the rate for the nitroglycerin infusion.
Decrease the rate for the 5% dextrose in normal saline infusion.
The Correct Answer is B
B. Sodium nitroprusside is a potent vasodilator used to reduce systemic vascular resistance and afterload, thereby improving cardiac output and tissue perfusion in cardiogenic shock. In this scenario, where the patient has cool and clammy skin with high SVR, indicating peripheral vasoconstriction,
increasing the rate of sodium nitroprusside infusion can help vasodilate peripheral vessels, reduce afterload, and improve tissue perfusion
A. Dopamine is a medication commonly used in the management of cardiogenic shock to increase cardiac output and systemic blood pressure. However, in this scenario where the patient is cool and clammy with high SVR, indicating vasoconstriction and potential peripheral hypoperfusion, increasing the rate of dopamine infusion may further increase systemic vascular resistance and exacerbate peripheral vasoconstriction. This can worsen tissue perfusion and exacerbate the patient's condition.
.
C. Nitroglycerin is another vasodilator commonly used in the management of cardiogenic shock to reduce preload and afterload, thereby improving cardiac output and tissue perfusion. However, decreasing the rate of nitroglycerin infusion may further exacerbate vasoconstriction and increase SVR, worsening tissue perfusion in this scenario. Therefore, decreasing the rate of nitroglycerin infusion is not indicated.
D. Intravenous fluids such as 5% dextrose in normal saline are typically administered to maintain adequate intravascular volume and perfusion pressure in shock states. However, decreasing the rate of intravenous fluid infusion may further decrease intravascular volume and preload, potentially exacerbating hypoperfusion and worsening the patient's condition. Therefore, decreasing the rate of intravenous fluid infusion is not indicated in this scenario.
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Related Questions
Correct Answer is B
Explanation
B. Administering furosemide, a loop diuretic, to a patient in septic shock with low urine output could exacerbate hypovolemia and worsen organ perfusion. It could further reduce preload, exacerbating hypotension, and impairing cardiac output. Loop diuretics are typically contraindicated in hypovolemic shock.
A. Corticosteroids such as hydrocortisone can help improve vascular tone and responsiveness to vasopressors. Given the patient's clinical presentation and lack of response to initial fluid resuscitation, administering hydrocortisone is appropriate.
C. Increasing the fluid infusion rate can help restore intravascular volume and improve organ perfusion. However, caution should be exercised to avoid fluid overload and pulmonary edema.
D .Norepinephrine is a vasopressor commonly used to increase systemic vascular resistance and improve blood pressure in septic shock. It helps maintain perfusion pressure to vital organs, thereby supporting organ function.
Correct Answer is ["B","C","D","E","F"]
Explanation
B. Continuous monitoring of vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation, is essential for assessing the patient's hemodynamic status and response to treatment.
Additionally, continuous electrocardiographic (ECG) monitoring allows for real-time assessment of cardiac rhythm and conduction abnormalities.
C. This is an important nursing action to provide comfort and reduce anxiety for the patient. Transcutaneous pacing is often used as a temporary measure to stabilize heart rate and cardiac output until more definitive treatment, such as insertion of a permanent pacemaker, can be performed.
D. Atropine is another medication commonly used in ACLS protocols for symptomatic bradycardia and heart block. It acts to increase heart rate by blocking vagal tone. However, its effectiveness in third- degree heart block may be limited, and transcutaneous pacing is often the preferred intervention in this situation.
E. Correct placement of transcutaneous pacemaker pads is crucial for effective pacing. The pads should be placed on the chest over the heart to deliver electrical impulses and stimulate myocardial contraction. Proper placement ensures optimal pacing effectiveness and patient safety.
F. This nursing action addresses the patient's comfort and pain management following the placement of the transcutaneous pacemaker. The procedure may cause discomfort or pain, and appropriate analgesia should be provided to alleviate any discomfort and promote patient comfort.
A. Epinephrine is a medication commonly used in advanced cardiac life support (ACLS) protocols for bradycardia and heart block. In this scenario, the patient's heart rate has decreased to 40 beats/minute, indicating symptomatic bradycardia and potential hemodynamic instability. Epinephrine may be administered to increase heart rate and improve cardiac output.
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