A patient in the intensive care unit with a spinal cord injury is receiving intravenous fluid therapy for hypotension. The nurse is monitoring the infusion of fluids in order to achieve which of the following?
1. systolic blood pressure of 120 mm Hg
2. diastolic blood pressure of 90 mm Hg
3. mean arterial pressure of 85 to 90 mm Hg
4. urine output of > 40 cc per hour
3
Rationale: Judicious use of intravenous fluids is required when treating hypotension because too much fluid can precipitate pulmonary edema. However medications might be needed to maintain adequate cardiac output and tissue perfusion. In patients with spinal cord injury, it may be difficult to keep the systolic blood pressure over 90 mm Hg. A systolic blood pressure less than 90 mm Hg is detrimental because it causes hypoperfusion to the cord and, therefore, current guidelines recommend that the mean arterial pressure be maintained 85 to 90 mm Hg for the first 7 days post-spinal cord injury. It is difficult to achieve a systolic blood pressure greater than 90 mm Hg so the goal of the infusion is not to achieve a systolic blood pressure of 120 mm Hg. The diastolic blood pressure needs to be sufficient so that the patient's mean arterial pressure is between 85 to 90 mm Hg. The fluids are not being administered to improve the patient's urine output.
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