Question

A patient who has just been admitted with septic shock has a BP of 70/46, pulse 136, respirations 32, temperature 104.0° F, and blood glucose 246 mg/dl. Which order will the nurse accomplish first?

a. Start insulin drip to maintain blood glucose at 110 to 150 mg/dl.
b. Give normal saline IV at 500 ml/hr.
c. Titrate norepinephrine (Levophed) to keep MAP at 65 to 70 mm Hg.
d. Infuse drotrecogin- (Xigris) 24 mcg/kg.

Answer 1

The nurse should prioritize giving normal saline IV at 500 ml/hr to the septic shock patient, aimed at increasing intravascular volume and raising blood pressure to tackle the immediate risk of organ failure due to hypovolemic shock.

Step-by-step explanation:

A patient admitted with septic shock and presenting with a blood pressure of 70/46, pulse 136, respirations 32, temperature 104.0° F, and blood glucose 246 mg/dl requires immediate intervention to stabilize vital signs and address the underlying condition. Among the listed orders, the most critical to accomplish first is b. Give normal saline IV at 500 ml/hr. This rapidly administers fluids to increase the intravascular volume, thereby helping to raise the blood pressure and addressing the immediate life-threatening symptoms of hypotension and potential organ failure. This addresses the circulatory shock due to sepsis, which can quickly lead to multi-organ failure if not corrected. The normalization of blood pressure is crucial as the patient is in a state of hypovolemic shock, which is common in sepsis due to the increased vascular permeability and fluid loss into tissues. While maintaining blood glucose levels and administering medication to help increase blood pressure, such as norepinephrine, are vital parts of treatment, the initial focus should be on fluid resuscitation.