An older patient who had knee replacement surgery 2 days ago can only tolerate being out of bed with physical therapy once a day. Which problem should the nurse identify as a priority for this patient?

The initial bundle of care in sepsis includes the following:

• Obtain blood cultures: Blood cultures help identify the specific microorganism causing the infection, which is important for guiding appropriate antibiotic therapy.
• Administer broad-spectrum antibiotics: Early administration of antibiotics is crucial in sepsis to target the suspected or likely infectious organisms. Broad-spectrum antibiotics cover a wide range of potential pathogens until more specific information from culture results is available.
• Obtain lactate levels: Measuring lactate levels helps assess tissue perfusion and can be used as an indicator of the severity of sepsis. Elevated lactate levels are associated with tissue hypoperfusion and increased mortality.
• Administer IV fluid bolus: Early aggressive fluid resuscitation is an essential component of sepsis management. Administering intravenous fluids helps restore intravascular volume and improve tissue perfusion.
• Administration of vasopressors: Especially in the setting of hypotension and to maintain MAP above 65mmHg.

Acute adrenal insufficiency, also known as adrenal crisis, is characterized by low levels of adrenal hormones, particularly cortisol. One of the primary manifestations of adrenal insufficiency is electrolyte imbalance, specifically hyponatremia (low sodium) and hyperkalemia (high potassium). Inadequate cortisol levels can lead to impaired sodium reabsorption in the kidneys, resulting in sodium loss and low serum sodium levels.

When the patient receives appropriate therapies for acute adrenal insufficiency, such as administration of glucocorticoids (e.g., hydrocortisone), the cortisol levels begin to normalize. As a result, the impaired sodium reabsorption improves, leading to an increase in serum sodium levels.