A critical care nurse is managing a client with severe sepsis. The client is receiving a c… — NCLEX-RN

A critical care nurse is managing a client with severe sepsis. The client is receiving a continuous intravenous infusion of norepinephrine.

Client Data:
- Weight: $220$ lb
- Current mean arterial pressure (MAP): $54$ mm Hg
- Current infusion pump rate: $18$ mL/hr
- Medication concentration: Norepinephrine $8$ mg in $250$ mL $5\%$ Dextrose in Water (D5W)
- Provider titration protocol: "Increase norepinephrine by $0.04$ mcg/kg/min every $5$ minutes until MAP is $\geq 65$ mm Hg."

The nurse determines the need to increase the infusion rate according to the protocol. What should be the newly programmed infusion pump rate in mL/hr?

*Round the final answer to the nearest tenth.*

Cevap: 25.5 mL/hr

Cevap

The new infusion pump rate should be set to 25.5 mL/hr.

To find the new pump rate, the nurse must first determine how much extra volume per hour is needed to satisfy the

0.04

mcg/kg/min increase. By converting the client's weight to

100

kg, the required dose increase is

4

mcg/min, which equals

240

mcg/hr. Using the bag concentration of

32

mcg/mL, the required volume increase is

7.5

mL/hr. Adding this to the baseline rate of

18

mL/hr yields the final correct rate of

25.5

mL/hr.

Adım Adım Çözüm

Convert weight to kilograms.

220

lb /

2.2

100

kg.

Weight-based dosing requires the client's weight in kg.

Calculate the dose increment per minute.

0.04

mcg/kg/min *

100

kg =

4

mcg/min.

This determines how much additional medication the client needs every minute based on the protocol.

Convert the dose increment to an hourly rate.

4

mcg/min *

60

min/hr =

240

mcg/hr.

Infusion pumps are programmed in mL/hr, so the dose must be expressed per hour.

Determine the concentration of the IV bag in mcg/mL.

8

mg =

8000

mcg.

8000

mcg /

250

mL =

32

mcg/mL.

Medication is ordered in mcg, but supplied in mg. Both units must match to find the volume.

Calculate the volume increment in mL/hr.

240

mcg/hr /

32

mcg/mL =

7.5

mL/hr.

This isolates the exact amount of fluid needed to deliver the required increase in medication.

Add the volume increment to the current infusion rate.

18

mL/hr +

7.5

mL/hr =

25.5

mL/hr.

The protocol requires increasing the current rate, not replacing it with only the increment.

Anahtar Kavram

Advanced medication titration requires calculating the incremental dose increase based on weight and concentration, then accurately adding that newly calculated volume rate to the baseline continuous infusion rate.

Soru

Cevap

Adım Adım Çözüm

Anahtar Kavram

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