A 68-year-old client with septic shock has received 30 mL/kg of crystalloid (a total of 2.4 L) over the first 3 hours. The most recent vital signs are BP 84/52, mean arterial pressure (MAP) 58, HR 116, lactate 4.6 mmol/L, urine output 15 mL/h. The provider is at the bedside. Which intervention does the nurse anticipate next, consistent with current sepsis guidelines?

• 1 Initiate norepinephrine through a central venous catheter (or temporarily through a large proximal IV until central access is obtained), and titrate to a MAP of 65 mmHg or greater while continuing source control and antibiotics. ✓ Correct answer
• 2 Initiate a continuous infusion of dopamine at 2 mcg/kg/min through a peripheral intravenous line, with the expectation that it will increase renal perfusion as a first-line agent and raise the mean arterial pressure to at least 65 mmHg.
• 3 Administer 100 mL of 5% albumin intravenously to expand the intravascular volume more effectively than crystalloid, and then reassess the mean arterial pressure and urine output before deciding on vasopressor therapy.
• 4 Defer the initiation of vasopressors and administer a second crystalloid bolus of 30 mL/kg to achieve a total of 60 mL/kg, then reevaluate the mean arterial pressure and urine output to determine if pressors are needed.

For study reference only. Always follow current clinical guidelines and your institution’s protocols.