A 67 year old woman is admitted to the intensive care unit from a nursing home for a 24-hour onset of new altered mental status that has been progressively worsening. On a arrival to the ICU, she was disoriented, febrile with a temperature 101 F, HR 115 beats/min and was hypotensive with a blood pressure of 80/40 mm Hg. A check radiograph showed a right lower lobe infiltrate. Central venous access was obtained and she was started on broad spectrum antibiotics. A 20 ml/kg normal saline fluid challenge was administered over 30 minutes. Blood pressure is now 85/45 mm hg. HR is 110 beats/min. Her urine output has been 10mL/h since arrival. Laboratory studies are Hemoglobin 11g/dl normal range is 13.5 – 17.5 g/dl. Leukocyte count 33,000/uL normal range 4,500-11,000 uL, urine dipstick positive nitrites and leukocyte esterase normal range negative nitrites and leukocyte esterase
Questions:
1. What is the next step in addressing this patient’s blood pressure?
2. What are your most important nursing interventions for this patient?
3. What is your first line vasopressor in this situation? Explain your choice and brief pharmacodynamics.
