Question

A client is experiencing septic shock and the attending physician wants to titrate medications to be regulated so that a mean arterial pressure (MAP) between 75 and 85 mmHg is maintained. When evaluating the response of the drug, which of the blood pressure readings meet the goal? A. 135/90 B. 125/80 C. 115/70 D. 110/60

Short answer

Blood pressure readings B (95 mmHg), C (85 mmHg), and D (77 mmHg) meet the goal; reading A (105 mmHg) does not.

Step-by-step solution

Understanding Mean Arterial Pressure

Mean Arterial Pressure (MAP) is the average pressure in a patient's arteries during one cardiac cycle. It is important for ensuring adequate tissue perfusion and oxygenation. MAP can be estimated using the formula: MAP = (Systolic BP + 2(Diastolic BP)) / 3.

Calculate MAP for Option A

For the blood pressure reading 135/90 mmHg, use the MAP estimation formula: MAP = (135 + 2(90)) / 3 = (135 + 180) / 3 = 315 / 3 = 105 mmHg.

Calculate MAP for Option B

For the blood pressure reading 125/80 mmHg, use the MAP estimation formula: MAP = (125 + 2(80)) / 3 = (125 + 160) / 3 = 285 / 3 = 95 mmHg.

Calculate MAP for Option C

For the blood pressure reading 115/70 mmHg, use the MAP estimation formula: MAP = (115 + 2(70)) / 3 = (115 + 140) / 3 = 255 / 3 = 85 mmHg.

Calculate MAP for Option D

For the blood pressure reading 110/60 mmHg, use the MAP estimation formula: MAP = (110 + 2(60)) / 3 = (110 + 120) / 3 = 230 / 3 = 76.66, approximately 77 mmHg.

Determine Which Readings Meet the Goal

Compare each calculated MAP to the goal range of 75-85 mmHg. Options B, C, and D fall within that range. Option A exceeds it with a MAP of 105 mmHg.

Key concepts

Septic Shock Management

When managing septic shock in a clinical setting, it's essential to maintain systemic mean arterial pressure (MAP) to ensure tissue perfusion and organ function. Septic shock is a severe and potentially fatal condition where an infection leads to dangerous drops in blood pressure, requiring immediate intervention.

Key intervention steps include rapidly administering intravenous fluids to increase blood volume, followed by vasopressors if the patient's blood pressure remains low after fluid resuscitation. It's crucial to administer broad-spectrum antibiotics promptly to treat the underlying infection. Additionally, monitoring MAP is vital to guide therapy effectiveness; maintaining a MAP of at least 65 mmHg is generally recommended for septic shock patients, with some protocols suggesting an upper range of 85 mmHg, as noted in the exercise.

Monitoring other vital signs, such as heart rate, oxygen saturation, and urine output, is also critical in managing septic shock along with regular laboratory assessments to monitor the patient's response to treatment. Early recognition and comprehensive management are the keys to improving outcomes for septic shock patients.

NCLEX-RN Cardiovascular Disorders

Cardiovascular disorders are a significant component of the NCLEX-RN exam, and as a potential nurse, it is paramount to understand how to manage various cardiac conditions. This includes knowledge of the physiological mechanisms, such as mean arterial pressure and its implications on systemic perfusion.

For the NCLEX-RN exam, expect scenarios involving acute and chronic conditions such as hypertension, heart failure, arrhythmias, and shock states, including septic shock. A deep understanding of hemodynamic principles alongside the ability to interpret vital signs and laboratory data is essential. Nurses must be skilled in recognizing signs of decompensation in cardiac patients, knowing when to respond with appropriate interventions or escalate care.

Pharmacology for Nurses

Pharmacology is a cornerstone of nursing practice, especially in managing cardiovascular disorders. Nurses must understand the various classes of drugs, their mechanisms of action, therapeutic uses, and potential side effects.

In the context of septic shock, vasopressors such as norepinephrine and dopamine are often used to raise MAP to target levels. Balance is crucial, as overcorrection can lead to excessive vasoconstriction and compromised tissue perfusion. Therefore, titrating medications to maintain MAP within a specific range, as depicted in the exercise, is a fundamental skill.

Nurses should also be familiar with antibiotics, diuretics, antihypertensives, antiarrhythmics, and other cardiovascular drugs to manage patients effectively. Understanding these pharmacologic principles is critical for contributing to positive patient outcomes and is a substantial part of NCLEX-RN preparation.