# Select all assessments that the nurse should include to evaluate end-organ perfusion in an ICU client receiving vasopressors for shock.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375117&lang=en  
> language: en  
> subject: Management of Care  
> category: MOC

## Question

Select all assessments that the nurse should include to evaluate end-organ perfusion in an ICU client receiving vasopressors for shock.

1Trend mental status with an appropriate neurologic or sedation scale.
2Measure hourly urine output and review kidney-function trends.
3Trend serial lactate values and interpret them with the full clinical picture.
4Assess capillary refill, skin temperature, and mottling over time.
5Use achievement of the MAP target as the only evidence that organ perfusion is adequate.
6Trend central venous oxygen saturation when it is clinically indicated and available.
7Review renal and hepatic laboratory trends for evolving organ injury.
8Use daily body weight as the sole real-time indicator of tissue perfusion.

## Explanation

End-organ perfusion in shock requires trends from several systems: mental status for cerebral perfusion, hourly urine output and kidney function for renal perfusion, serial lactate interpreted in clinical context, and peripheral perfusion findings such as capillary refill, skin temperature, and mottling. When a central venous oxygen saturation is clinically indicated and available, its trend can add information about oxygen-delivery balance. Hepatic and renal laboratory trends may reveal organ injury. A target MAP is important but does not prove adequate tissue perfusion by itself, and daily weight is too slow to serve as the sole immediate perfusion measure.

## In-depth explanation

Mottling score (Ait-Oufella) on knee correlates with mortality. ScvO2 under 65 with adequate MAP suggests low cardiac output despite vasopressor.

## Clinical scenario

Septic shock on norepinephrine. MAP 68. Hour 6 of resuscitation.

## Key concepts

- **lactate clearance** — Percent decrease in lactate over 2-6 hours; over 10 percent suggests adequate resuscitation.
- **ScvO2** — Central venous oxygen saturation; surrogate for oxygen extraction balance.
- **mottling score** — Bedside skin marbling pattern over knees; predicts ICU mortality.

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