What would the critical care nurse expect to find if administering a fluid challenge to an 80-year-old patient had the intended effect?
1. A systolic blood pressure of 120 mm Hg or less
2. Heart rate remaining steady at 60 to 70 beats per minute
3. Skin turgor showing improvement within 24 hours
4. A MAP of 70 mm Hg or higher
4
Rationale 1: The blood pressure would likely be higher following a fluid bolus. With a rapid increase of intravascular volume, an older patient's vascular system would respond with increased resistance so the blood pressure would rise.
Rationale 2: As the result of increased volume from the bolus, an older patient's heart would have to pump faster to accommodate for the increase in intravascular volume.
Rationale 3: Skin turgor in an older patient is not a reliable clinical sign for improved renal perfusion.
Rationale 4: A MAP of 70 mm Hg is correct and the intended outcome for an older adult. Adults over the age of 70 may require a higher MAP, perhaps as high as 100 mm Hg, to maintain adequate renal perfusion.
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