While at M.M.’s bedside, the nurse notices he is moredrowsy. He is now only oriented to person. The nurse takes anotherset of vital signs.
Vital signs:
BP: 84/48
HR: 110 bpm
RR: 34 bpm
SpO2: 88% on 2L nasal cannula
Temperature: 39.2 degrees Celsius
The nurse titrates the oxygen flow meter to 4L andupdates the ED physician. The ED physician places an arterial lineand a central line to initiate vasopressors. He orders anorepinephrine infusion to be titrated to keep the MAP > 65mmHg. He also tells the nurse to prepare to the patient fortransfer to the intensive care unit (ICU).
NOTE: Mean Arterial Pressure (MAP) is measured directlywith an arterial line; however, to calculate the MAP, the formulais MAP = (systolic BP = 2 x diastolic BP)/3. The MAP should be 60or over in order to adequately perfuse the coronary arteries,brain, and kidneys.
- Fill-in-the-Blank. The nurse sets up the norepinephrineinfusion and a second nurse independently confirms the medication.The patient now has two peripheral intravenous (IV) sites and atriple-lumen subclavian central venous line.
- Which IV access site(s) would be best to use for the IVadministration of norepinephrine?
- Which IV access site(s) would not be appropriate for IVadministration of norepinephrine?
Explain your rationale.
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- Multiple-choice: Ten minutes after the norepinephrineinfusion is initiated, M.M.’s blood pressure (BP) is 82/48 mmHg andthe mean arterial pressure (MAP) is 58 mmHg. Which action by thenurse is most appropriate?
- Notify the physician about the BP.
- Stop the norepinephrine infusion and request a change inmedication.
- Increase the norepinephrine infusion.
- Continue the infusion at the same rate.
