The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis: P wave not apparent, ventricular rate 196, R-R interval regular, P-R interval not measurable, QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as;

The patient's symptoms of fever and elevated white blood cell count suggest a potential infection and sepsis. Broad-spectrum antibiotics should be initiated promptly to cover a wide range of possible pathogens until further diagnostic tests and identification of the specific causative agent are obtained. Early administration of appropriate antibiotics is crucial in sepsis management to target the suspected infection and improve patient outcomes.
A. Cooling baths in (option A) is incorrect because: Cooling baths are typically used in the management of hyperthermia or specific conditions like heatstroke. While the patient has an elevated temperature, it is likely due to the systemic inflammatory response rather than solely hyperthermia.
C. Blood transfusion in (option C) is incorrect because Blood transfusion may be required in certain cases of sepsis if there is evidence of significant anemia or active bleeding. However, based on the information provided, there is no immediate indication of a blood transfusion.
D. NPO status in (option D) is incorrect because NPO status (nothing by mouth) is a general precautionary measure used in various situations, such as prior to surgery or to manage gastrointestinal complications. It is not a specific intervention in the sepsis resuscitation bundle.
Therefore, the nurse should initiate the intervention of administering broad-spectrum antibiotics in this scenario.

Step 1: Convert the patient's weight from pounds to kilograms. 130 pounds ÷ 2.205 (1 pound = 0.453592 kilograms) ≈ 58.97 kilograms

Step 2: Calculate the total dosage of Dobutamine required per hour based on the weight-specific dose. 2.5 mcg/kg/min × 58.97 kg = 147.425 mcg/min

Step 3: Calculate the infusion rate (mL/hr) using the concentration of Dobutamine in the prepared solution. The solution contains 250 mg of Dobutamine in 500 mL, which means there are 250,000 mcg of Dobutamine in 500 mL. To determine the mL/hr, divide the required dosage (147.425 mcg/min) by the amount of Dobutamine in 500 mL (250,000 mcg) and multiply by 500 mL (volume of the solution).

(147.425 mcg/min ÷ 250,000 mcg) × 500 mL ≈ 0.295 mL/min

To get the mL/hr, we convert the rate from minutes to hours (60 minutes = 1 hour):

0.295 mL/min × 60 min/hr ≈ 17.7 mL/hr

Round the answer to the nearest whole number:

Approximately 18 mL/hr of Dobutamine should be administered to the patient.