32) A patient with shock of unknown etiology whose hemodynamic monitoring indicatesa BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure has thefollowing collaborative interventions prescribed. Which intervention will the nursequestion?(a) Infuse normal saline at 250ml/hr(b) Keep head of bed elevated to 30 degrees(c) Give nitroprusside unless systolic BP is less than 90 mmHg(d) Administer dobutamine to keep systolic BP greater than 90 mmHg
Question
- A patient with shock of unknown etiology whose hemodynamic monitoring indicatesa BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure has thefollowing collaborative interventions prescribed. Which intervention will the nursequestion?(a) Infuse normal saline at 250ml/hr(b) Keep head of bed elevated to 30 degrees(c) Give nitroprusside unless systolic BP is less than 90 mmHg(d) Administer dobutamine to keep systolic BP greater than 90 mmHg
Solution
The nurse should question the intervention (a) "Infuse normal saline at 250ml/hr". This is because the patient's hemodynamic monitoring indicates an elevated pulmonary artery wedge pressure, which suggests that the patient may have fluid overload or heart failure. Infusing more fluid at such a high rate could potentially exacerbate the patient's condition. The other interventions are appropriate: keeping the head of the bed elevated can help with breathing; nitroprusside can help lower blood pressure and dobutamine can help increase blood pressure if it drops too low.
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