The charge nurse in an intensive care unit is rounding and reviewing hemodynamic data for clients in the unit. Which client requires immediate intervention?

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11ecbb05_cbe8_44c7_b433_45e768806b18_MD0009_00 Mean arterial pressure (MAP) is the average pressure within the arteries. Compared to blood pressure alone, MAP is a more precise measurement of the body's ability to perfuse organs and tissues. MAP of at least 60 mm Hg is required to adequately perfuse vital organs, but MAP ≥70 mm Hg is optimal. Without intervention, MAP <60 mm Hg may progress to ischemia, organ damage, and death (Option C). Common causes of low MAP include hypovolemia (eg, hemorrhage, severe dehydration), sepsis, and heart failure. Typical interventions include replacing intravascular volume (eg, IV fluids, albumin, blood products) and administering IV medications such as vasopressors (eg, norepinephrine, vasopressin) to induce peripheral vasoconstriction and inotropes (eg, dobutamine) to increase cardiac contractility. MAP is calculated automatically by intra-arterial blood pressure monitors and some noninvasive blood pressure machines. MAP can also be calculated manually using the systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings and the following formula: MAP = (SBP + [2 × DBP])/3. (Options A and B) Central venous pressure of 6 mm Hg and cardiac output of 5 L/min are within normal limits. (Option D) Blood pressure of 168/95 mm Hg is an elevated reading requiring further assessment. However, low MAP is the highest priority due to risk for tissue ischemia. Educational objective: Mean arterial pressure (MAP) of at least 60 mm Hg is required to adequately perfuse vital organs; however, MAP ≥70 mm Hg is optimal. Without intervention, MAP <60 mm Hg may progress to tissue ischemia, organ damage, and death.

The Charge Nurse in an Intensive Care Unit Is Rounding