For which of the following patients would the RN anticipate an order for sodium bicarbonate IVP?

Choice A rationale:

Dopamine was once considered a first-line vasopressor for cardiogenic shock. However, recent studies have shown that it is associated with increased mortality compared to norepinephrine.

Dopamine has dose-dependent effects on dopamine receptors, beta receptors, and alpha receptors. At low doses (1-5 mcg/kg/min), it primarily stimulates dopamine receptors, leading to renal vasodilation and increased urine output. At moderate doses (5-10 mcg/kg/min), it stimulates beta receptors, resulting in increased heart rate and contractility. At high doses (>10 mcg/kg/min), it stimulates alpha receptors, causing vasoconstriction.

The main concern with dopamine is its potential to cause arrhythmias, particularly at higher doses. This is due to its effects on beta receptors, which can increase heart rate and myocardial oxygen demand.

Additionally, dopamine can cause tachyphylaxis, meaning that its effects can diminish over time, requiring higher doses to achieve the same effect.

Choice B rationale:

Norepinephrine is a potent alpha-adrenergic agonist that causes vasoconstriction, leading to an increase in blood pressure. It has minimal effects on beta receptors, so it is less likely to cause tachycardia and arrhythmias compared to dopamine.

Norepinephrine also has some inotropic effects, meaning that it can increase the strength of contraction of the heart muscle.

Studies have shown that norepinephrine is associated with improved survival rates in patients with cardiogenic shock compared to dopamine.

It is generally well-tolerated, with the most common side effects being hypertension and peripheral vasoconstriction.

Choice C rationale:

Epinephrine is a potent alpha- and beta-adrenergic agonist that causes vasoconstriction, increased heart rate, and increased contractility.

It is typically used as a second-line agent in cardiogenic shock, after norepinephrine has failed to achieve adequate blood pressure.

Epinephrine can cause significant tachycardia and arrhythmias, so it should be used with caution in patients with underlying heart disease.

Choice D rationale:

Vasopressin is a hormone that causes vasoconstriction by acting on V1 receptors in vascular smooth muscle. It is sometimes used as an adjunct to norepinephrine in patients with refractory cardiogenic shock.

Vasopressin has the potential to cause coronary vasoconstriction, so it should be used with caution in patients with coronary artery disease.

Choice A rationale:

Prednisolone is a corticosteroid that has anti-inflammatory and immunosuppressant effects. It does not have a direct effect on urine output.

While it may be used in some cases of head trauma to reduce inflammation, it would not be the first-line choice to address excessive urine output.

Prolonged use of prednisolone can have adverse effects such as fluid retention, weight gain, hypertension, and hyperglycemia.

Choice B rationale:

Corticotropin (ACTH) is a hormone that stimulates the adrenal glands to produce cortisol. Cortisol has a variety of effects, including increasing blood pressure and blood sugar levels.

It does not have a direct effect on urine output and would not be used to address this issue.

ACTH can have significant side effects, including fluid retention, electrolyte imbalances, and mood changes.

Choice C rationale:

Vasopressin is a hormone that regulates fluid balance in the body. It works by increasing water reabsorption in the kidneys, which can help to reduce urine output.

It is the most appropriate medication to administer to a client with excessive urine output following head trauma.

Vasopressin can be administered intravenously or subcutaneously. It is important to monitor the client's fluid intake and output closely when administering vasopressin, as it can lead to fluid overload if not used carefully.

Choice D rationale:

Calciferol is a form of vitamin D that helps to regulate calcium and phosphorus levels in the body. It does not have a direct effect on urine output.

It would not be used to address excessive urine output in a client with head trauma.

Excessive doses of calciferol can lead to hypercalcemia, which can cause kidney stones, bone pain, and other serious problems.