A 61-year-old female patient with hypovolemic shock has these vital signs: temperature 97.9°F (36.6°C): pulse 123 beats/min: blood pressure 85/48 mamite respirations 24 breaths/min; urine output 20 mL for last 2 hours: skin cool and clammy. Which prescription order for this patient does the nurse question?
A.
Doasive Nitrogen 12m mi
B.
Dobutamine Doubters) 5 mcg/kg/min
C.
Plasmanate 1 unit
D.
Bumetanide (Bumex) 1 mg IV
The Correct Answer and Explanation is:
Correct Answer: A. Nitroglycerin 12 mcg/min
Explanation:
Hypovolemic shock occurs when there is a significant loss of blood or fluids, leading to decreased circulating blood volume and, consequently, inadequate tissue perfusion. This condition is often characterized by low blood pressure, increased heart rate, rapid breathing, and reduced urine output, as seen in this 61-year-old female patient. The priority in managing hypovolemic shock is to restore the circulating volume, maintain adequate tissue perfusion, and support the cardiovascular system.
Let’s break down each prescription:
A. Nitroglycerin 12 mcg/min:
Nitroglycerin is a vasodilator, primarily used to manage conditions like angina or heart failure by dilating blood vessels to reduce the workload on the heart. In hypovolemic shock, however, nitroglycerin could exacerbate the situation by further lowering blood pressure through vasodilation, which can reduce perfusion to vital organs. Given the patient’s already low blood pressure (85/48 mm Hg), administering nitroglycerin could be detrimental, leading to a further drop in blood pressure and worsening the shock. Therefore, this is the prescription that the nurse should question.
B. Dobutamine (Dobutrex) 5 mcg/kg/min:
Dobutamine is an inotropic agent that increases cardiac output by strengthening heart contractions without significantly affecting blood pressure. In hypovolemic shock, dobutamine can help improve cardiac output and tissue perfusion, making it a suitable option to support the cardiovascular system.
C. Plasmanate 1 unit:
Plasmanate is a plasma volume expander used to increase blood volume. Administering Plasmanate would help restore the circulating blood volume in a patient with hypovolemic shock, making it an appropriate intervention in this scenario.
D. Bumetanide (Bumex) 1 mg IV:
Bumetanide is a loop diuretic, used to remove excess fluid from the body. However, in the context of hypovolemic shock, it would be counterproductive as the patient is already experiencing low blood volume. Although this prescription might be questioned, it is less critical than nitroglycerin because the diuretic effect could worsen the volume status if used inappropriately but might be considered under certain circumstances.
Conclusion:
In this patient’s case, nitroglycerin (A) is the most inappropriate prescription because it can exacerbate hypotension in hypovolemic shock, potentially leading to a life-threatening situation. The focus should be on fluid resuscitation and supporting cardiac output, making the other options more appropriate for this patient’s condition.