The emergency department nurse provides care for a 50-year-old male patient with septic shock. The nurse recalls that the renin- angiotensin system is activated during which stage of shock?

In the initial 24 hours after burn injury, fluid resuscitation is a critical priority in the management of burn patients. Burn injuries can lead to significant fluid loss, both locally at the burn site and systemically due to increased capillary permeability. Fluid resuscitation aims to restore and maintain adequate intravascular volume, ensuring sufficient tissue perfusion and organ function.
The Parkland Formula is commonly used to guide fluid resuscitation in burn patients. It involves calculating the total volume of fluid needed in the first 24 hours, with a portion given in the initial hours after injury and the remainder given over the remaining hours.
A. Sterile dressing changes (option A) are incorrect because they are important in wound care management for burn patients to prevent infection. However, fluid resuscitation takes precedence within the first 24 hours.
B. Emotional support (option B) is incorrect because it is an essential aspect of burn care, as burn injuries can have a significant psychological impact. While emotional support is crucial for the patient's overall well-being, it may not be the highest priority within the first 24 hours compared to addressing the physiological needs of fluid resuscitation.
D. Range-of-motion exercises (option D) are incorrect because they are important for preventing contractures and maintaining joint mobility in burn patients. However, they are typically initiated after the initial fluid resuscitation phase and wound stabilization.
Therefore, the priority the nurse anticipates within the first 24 hours for a 31-year-old male patient with burn injuries is fluid resuscitation.

A. Narrowed pulse pressure: In cardiogenic shock, the cardiac output is compromised, resulting in reduced stroke volume and subsequent narrowed pulse pressure. The pulse pressure is the difference between systolic and diastolic blood pressure.
B. Tachycardia: Tachycardia is a compensatory response in cardiogenic shock, as the body attempts to increase cardiac output to maintain tissue perfusion despite decreased stroke volume. Increased heart rate is a common finding in this condition.
D. Pulmonary congestion: Cardiogenic shock is often associated with impaired left ventricular function, leading to an inadequate pump mechanism. This can result in fluid accumulation and congestion in the pulmonary circulation, leading to pulmonary edema and congestion. Patients may experience symptoms such as dyspnea, crackles on lung auscultation, and increased work of breathing.
E. Elevated pulmonary artery wedge pressure (PAWP): PAWP is a measurement obtained during invasive hemodynamic monitoring. In cardiogenic shock, the impaired left ventricular function leads to increased left atrial pressure, which is reflected by an elevated PAWP. Elevated PAWP indicates increased fluid volume and congestion in the left side of the heart.
C. Elevated SBP in (option C) is incorrect because Elevated systolic blood pressure (SBP) is not a typical finding in cardiogenic shock. Instead, hypotension or decreased blood pressure is commonly observed due to reduced cardiac output.