The medical-surgical nurse is caring for a 55-year-old female patient after surgery. The patient's respiratory rate has increased from 12 to 22 breaths/min, and the pulse rate has increased from 86 to 110 beats/min since the patient was last assessed 4 hours ago. What action by the nurse is best?

The stages of shock are commonly described as the initial, compensatory, progressive, and refractory stages. Here is an explanation of each stage and why the patient's assessment findings correspond to the progressive stage:
B. The compensatory stage in (option B) is incorrect because, In the compensatory stage, the body continues to activate compensatory mechanisms to maintain perfusion. This includes increased heart rate, peripheral vasoconstriction, and shunting of blood to vital organs. The patient's assessment findings of decreasing cardiac output, decreased peripheral perfusion, and increased capillary permeability suggest that the body's compensatory mechanisms are no longer sufficient to maintain perfusion adequately. Therefore, the patient has progressed beyond the compensatory stage.
C. The initial stage in (option C) is incorrect because, In the initial stage, there is an initial insult or injury that triggers the shock state. The body's compensatory mechanisms are activated, such as increased heart rate and vasoconstriction, to maintain blood pressure and perfusion. However, the patient's assessment findings indicate that they have progressed beyond the initial stage.
D. The refractory stage in (option D) is incorrect because The refractory stage represents a severe and irreversible state of shock where vital organs fail, and despite interventions, the patient's condition does not improve. The patient's assessment findings do not suggest the refractory stage, as there is still potential for intervention and management.

Septic shock is characterized by inadequate tissue perfusion and hypotension, which can lead to organ dysfunction and failure. The administration of intravenous fluids, such as a normal saline bolus, is the initial priority in the management of septic shock to restore intravascular volume and improve perfusion.
A. Draw an arterial blood gas (ABG) in (option A) is incorrect because: ABG may be ordered to assess the patient's acid-base status and oxygenation, but addressing hypotension and restoring perfusion through fluid administration takes priority.
B. Start insulin drip to maintain blood glucose at 150 mg/dl or lower in (option B) is incorrect because: Hyperglycaemia is commonly observed in critically ill patients, including those with septic shock. While controlling blood glucose is important, it is not the immediate priority compared to addressing hypotension and restoring intravascular volume.
D. Titrate norepinephrine (Levophed) to keep mean arterial pressure (MAP) greater than 65 mm Hg in (option D) is incorrect because: Norepinephrine is a vasopressor medication used to increase blood pressure and perfusion in septic shock. While it may be necessary for the management of septic shock, fluid resuscitation should be initiated first to optimize intravascular volume before starting vasopressors.
Therefore, the first order that the nurse should accomplish in this scenario is to give a normal saline bolus IV of 30 mL/kg to address the hypotension and restore intravascular volume.