The nurse is caring for a patient with MODS secondary to septic shock whose urine output was 10 mL for the last 2 hours. Temperature is 97 degrees, pulse is 124 and thready, and BP is 88/48. Which order is the current priority?

Question

1. Place the patient on a warming blanket.
2. Administer isotonic fluids at 20 mL/kg/hr.
3. Draw blood for BUN and creatinine.
4. Place the patient in a kinetic bed.

Answer 1

2
Rationale 1: The patient in septic shock who is hypothermic is in an advanced stage of sepsis. Warming may be indicated but should be done so very carefully. This is not the current priority.
Rationale 2: Fluids are indicated to improve blood pressure and blood flow through the kidney. Fluid administration should be monitored carefully, but this is the current priority intervention.
Rationale 3: BUN and creatinine may be evaluated to determine the consequence of renal blood flow, but this would be done after the ABCs have been addressed.
Rationale 4: A kinetic bed will decrease pressure on the skin and prevent breakdown secondary to decreased tissue perfusion, but this would be done after the ABCs have been addressed.