A patient has MODS secondary to severe sepsis. The nurse would prioritize interventions to address which finding in this patient?
1. WBC count of 28,000 cell/cubic mm
2. Blood glucose of 245 mg/dL
3. pO2 of 54 mmHg
4. Serum lactate level of 2.1 mmol/L
3
Rationale 1: A WBC count of 28,000 cells indicates infection; antibiotics are begun within the first hour of identifying severe sepsis, but not before other findings are addressed.
Rationale 2: Interventions to address the blood glucose level should be implemented, but not before other, more urgent findings are addressed.
Rationale 3: The nurse follows the ABCs for priority; a pO2 of 54 mmHg reflects hypoxemia and is the priority.
Rationale 4: A serum lactate level of 2.1 mmol/L is barely above the normal range and is not the priority in this situation.
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