The patient weighing 147 pounds with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 30, temperature 104° F, and blood glucose 391 mg/dL. Which intervention red by the health care provider should the nurse implement first?
Give a 2000mL normal saline bolus
Start insulin drip to maintain blood glucose at 110 to 150 mg/dL.
Give acetaminophen (Tylenol) 650 mg rectally.
Give prescribed Antibiotics
Start norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg.
The Correct Answer is D
In septic shock, prompt administration of antibiotics is crucial in order to target the underlying infection and prevent further progression of the septic process. Antibiotics help to eradicate the causative organisms and reduce the bacterial load, which can help improve patient outcomes.
While all the options mentioned are important interventions in the management of septic shock, initiating antibiotic therapy is considered a priority in order to address the underlying infection and prevent sepsis-related complications.
A. Giving a 2000 mL normal saline bolus in (option A) is incorrect because: Fluid resuscitation is important in septic shock to restore intravascular volume, but antibiotic therapy takes precedence as it directly targets the underlying infection.
B. Starting an insulin drip to maintain blood glucose at 110 to 150 mg/dL in (option B) is incorrect because Glycemic control is important in septic shock, but it is not the first priority compared to addressing the infection.
C. Giving acetaminophen (Tylenol) 650 mg rectally in (option C) is incorrect because Antipyretic medications can help reduce fever, but they do not address the underlying infection or stabilize the patient's condition.
E. Starting norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg in (option E) is incorrect because: Vasopressor support may be necessary in septic shock to maintain adequate blood pressure, but initiating antibiotics takes priority in order to address the underlying infection.
Therefore, in a patient with septic shock presenting with the given signs and symptoms, the nurse should first implement the intervention of giving the prescribed antibiotics to target the underlying infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Beck's triad consists of three classic clinical manifestations that are suggestive of cardiac tamponade, which is the compression of the heart by accumulated fluid or blood within the pericardial sac. The three components of Beck's triad include:
A. Muffled heart tones in (option A) are incorrect because Cardiac tamponade can dampen or muffle heart sounds due to the presence of fluid or blood around the heart, which can impair sound transmission.
B. Marked hypotension in (option B) is incorrect because Cardiac tamponade can cause decreased cardiac output, leading to hypotension, which is characterized by low blood pressure.
C. Distended jugular veins in (option C) is incorrect because Elevated venous pressure resulting from impaired filling and elevated right-sided heart pressures can lead to jugular vein distension, which is commonly seen in cardiac tamponade.
However, widening pulse pressure (the difference between systolic and diastolic blood pressure) is not typically part of Beck's triad. Widening pulse pressure is associated with her conditions such as aortic regurgitation, hyperthyroidism, or conditions involving increased stroke volume, rather than cardiac tamponade specifically.
Correct Answer is ["9"]
Explanation
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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
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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
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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
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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.
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