The emergency department nurse reviews the medical record of a 41-year-old male patient with hemorrhagic shock, which contains the following information.

Physical Assessment Findings Pulse 140 beats/min and thready
Diagnostic Findings ABG respiratory acidosis
Blood pressure 60/40 mm Hg Respirations 40/min and shallow
Lactate level 7 mmol/L

All of these provider prescriptions are ordered for the patient. Which does the nurse carry out first?

1. Doseinmcg/min=2mcg/kg/min×60kg=120mcg/min

   Convert this to mg/min since the concentration is in mg:

   120mcg/min=0.12mg/min120 \text{ mcg/min} = 0.12 \text{ mg/min}120mcg/min=0.12mg/min

2. Determine the concentration of Dopamine:

   • Total amount of Dopamine: 200 mg in 250 mL of saline
   • Concentration:

   Concentration=200mg250mL=0.8mg/mL\text{Concentration} = \frac{200 \text{ mg}}{250 \text{ mL}} = 0.8 \text{ mg/mL}Concentration=250mL200mg​=0.8mg/mL

3. Calculate the pump rate in mL/min:

   To find the rate in mL/min needed to deliver 0.12 mg/min:

   Pumprate=Desireddose(mg/min)Concentration(mg/mL)\text{Pump rate} = \frac{\text{Desired dose (mg/min)}}{\text{Concentration (mg/mL)}}Pumprate=Concentration(mg/mL)Desireddose(mg/min)​

   Pumprate=0.12mg/min0.8mg/mL=0.15mL/min\text{Pump rate} = \frac{0.12 \text{ mg/min}}{0.8 \text{ mg/mL}} = 0.15 \text{ mL/min}Pumprate=0.8mg/mL0.12mg/min​=0.15mL/min

4. Convert the pump rate to mL/hour:

   Multiply by 60 to convert from mL/min to mL/hour:

   Pumprate=0.15mL/min×60min/hour=9mL/hour\text{Pump rate} = 0.15 \text{ mL/min} \times 60 \text{ min/hour} = 9 \text{ mL/hour}Pumprate=0.15mL/min×60min/hour=9mL/hour

So, you should set the pump to deliver Dopamine at a rate of 9 mL/hour.

These manifestations occur as compensatory mechanisms in response to decreased blood volume and compromised tissue perfusion. The body attempts to compensate for the inadequate circulating volume by increasing heart rate (A) and respiratory rate (B) to enhance oxygen delivery.
D. The decreased systolic blood pressure (D) is a result of decreased cardiac output and vasoconstriction in an attempt to maintain perfusion to vital organs.
E. The decreased urine output (E) is a result of decreased renal perfusion due to decreased blood volume.
C. Decreased pulse rate in (option C) is incorrect because it is not typically seen in the compensatory stage of hypovolemic shock. The body tries to increase heart rate to maintain cardiac output and compensate for the decreased blood volume.
F. Bilateral crackles in (option F) is incorrect because the lung bases are more commonly associated with conditions such as pulmonary edema or fluid overload, rather than the compensatory stage of hypovolemic shock.
It's important to note that the manifestations of shock can vary depending on individual patient factors and the underlying cause of shock. Therefore, a comprehensive assessment and clinical judgment are necessary to fully evaluate the patient's condition.