The nurse is caring for a client 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 of the following orders is the priority at this time? 1. Administer isotonic fluids at 20 ml/kg/hr.
2. Draw blood for BUN and creatinine.
3. Place the client in a kinetic bed.
4. Place the client on a warming blanket.
Administer isotonic fluids at 20 ml/kg/hr.
Rationale: The client has entered the cold or hypodynamic phase of shock characterized by vasodilation and profound hypotension. Fluids are indicated to improve blood pressure and blood flow through the kidney. BUN and creatinine may be evaluated to determine the consequence of renal blood flow, but this is done after the ABCs have been addressed. A kinetic bed will decrease pressure on the skin and prevent breakdown secondary to decreased tissue perfusion, but is performed after the ABCs are addressed. A low body temperature in the cold or hypodynamic phase is expected; warming may cause vasodilation and lowered blood pressure. Treating the underlying cause of hypoperfusion to the kidneys is indicated.
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Of the following client statements made by an older adult client which best reflects an under-standing the educational materials on nutrition presented by the nurse?
1. "I'll keep this literature and read it again later." 2. "I love rye bread. It's good to know its high in fiber." 3. "Nutrition and cooking has always been passions of mine." 4. "Now I can see the connection between food and my health."
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1. The same staging system is used for lymphoma and Hodgkin disease. 2. Aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. 3. All children with lymphoma need a bone marrow transplant for a good prognosis. 4. Despite high-dose chemotherapy, the prognosis is very poor for most children.