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A nurse is caring for a 73-year-old client in the emergency department (ED)

Exhibits
It has been identified that the client is in sepsis. Select the 4 actions that the nurse should complete in the first hour to manage sepsis and prevent further complications?

Insert a nasogastric (NG) tube.

Type and cross-match for 2 units of packed RBCs.

Administer broad-spectrum antibiotics.

Measure lactate level.

Rapidly administer 30 ml/kg of normal saline.

Obtain blood cultures.

Obtain a urine specimen.

Obtain a wound culture.

Answer and Explanation

Correct Answer : C,D,E,F

A. Administering antibiotics helps target the suspected infection and prevent its spread. Broad-spectrum antibiotics are typically initiated until the specific pathogen is identified through cultures. This action should be completed as soon as possible within the first hour.

D. Lactate measurement is important in assessing tissue perfusion and the severity of sepsis. Elevated lactate levels indicate tissue hypoperfusion and can help identify patients at higher risk of mortality. Monitoring lactate levels guides resuscitation efforts and helps in assessing the response to treatment.

E. Fluid resuscitation is a cornerstone in the management of sepsis. Administering a large volume of intravenous fluids helps restore intravascular volume, improve tissue perfusion, and prevent further organ dysfunction. The recommended initial fluid bolus is 30 ml/kg of crystalloid solution, such as normal saline, administered rapidly within the first few hours of recognition of sepsis.

F. Blood cultures help identify the causative organism(s) responsible for the sepsis. This information is crucial for guiding antibiotic therapy, especially in cases of severe sepsis or septic shock. Blood cultures should be obtained before initiating antibiotic therapy to maximize their sensitivity and specificity.

B. Type and cross-match for packed red blood cells (PRBCs) are indicated in situations where blood transfusion may be required, such as severe anemia or active bleeding. While sepsis can lead to various complications, such as disseminated intravascular coagulation (DIC), the priority in the first hour is resuscitation and antibiotic administration.

G. Obtaining a urine specimen may be indicated to assess for urinary tract infection (UTI), which can be a potential source of sepsis. However, in the initial management of sepsis, obtaining blood cultures (option F) takes precedence as blood cultures provide more critical information for guiding antibiotic therapy.

H. Obtaining a wound culture may help identify the specific pathogens present in the wound and guide antibiotic therapy if the wound is suspected to be the source of sepsis. However, in the first hour of managing sepsis, the priority is to initiate broad-spectrum antibiotics and obtain blood cultures, as these interventions are more urgent in preventing further complications from sepsis.

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Correct Answer is A

Explanation

A Adequate fluid administration is essential before giving vasopressors to patients with hypovolemic shock. The patient’s low central venous pressure indicates a need for more volume replacement. The other patient data are not contraindications to norepinephrine administration.

B Low dose dopamine is not a contraindication to epinephrine administration.

C A sinus tachycardia is not a contraindication to epinephrine administration

D Lack of urine output is not a contraindication to epinephrine administration

Correct Answer is []

Explanation

In respiratory acidosis, there is an accumulation of carbon dioxide (CO2) in the blood due to inadequate ventilation, leading to an increase in the partial pressure of arterial carbon dioxide (PaCO2) and a decrease in pH.

This is often caused by conditions that impair ventilation, such as airway obstruction, respiratory muscle weakness, lung diseases (e.g., chronic obstructive pulmonary disease, pneumonia), or central nervous system depression (e.g., drug overdose, head injury).

Management of respiratory acidosis include bronchodilators, sodium bicarbonate, adequate ventilation, and treatment of underlying causes.

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A nurse is caring for a 73-year-old client in the emergency department (ED) Exhibits It has been identified that the client is in sepsis. Select the 4 actions that the nurse should complete in the first hour to manage sepsis and prevent further complications?

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Norepinephrine has been prescribed for a patient who was admitted with dehydration and hypotension. Which data indicate that the nurse should consult with the health care provider before starting the norepinephrine?

Correct Answer is A

Explanation

Correct Answer is []

Explanation

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A nurse is caring for a 73-year-old client in the emergency department (ED)

Exhibits
It has been identified that the client is in sepsis. Select the 4 actions that the nurse should complete in the first hour to manage sepsis and prevent further complications?