Built around Surviving Sepsis Campaign 2021, this MN650 titration plan moves norepinephrine toward a pressure goal, adds vasopressin and hydrocortisone at named thresholds and writes the weaning order down. Searches like "mn 650 unit 2 assignment example", "mn650 unit 2 sample" and "mn650 unit 2 example" land here.
Vasoactive Titration Plan for Septic Shock From a Urinary Source: One Target, Four Rungs and a Way Back Down
[Student Name]
Purdue University Global
MN650: Specialized Pharmacology for the AGACNP Acute Care NP
Unit 2 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Rates and thresholds are bracketed placeholders reflecting common practice; nothing here is a prescribing instruction.
Patient Summary
A composite 66-year-old retired electrician, 74 kg, admitted with fever, confusion and flank pain; urinalysis and imaging point to obstructive pyelonephritis. After 30 mL/kg of balanced crystalloid over three hours, his mean arterial pressure is 58 mmHg and lactate is 4.6 mmol/L. Blood and urine cultures were drawn and [empiric antibiotics] started within the first hour. A peripheral line is running in a large forearm vein; a central line is planned for hour two. Urology has been called about decompression. He takes [an ACE inhibitor] and [a beta-blocker] at home; both are held on admission, since they would blunt his response to vasopressors and fluids. His baseline blood pressure, from clinic notes, runs about 140/80, which is one reason the team will watch his urine output and mental status closely at a mean pressure of 65.
Target
Mean arterial pressure of 65 mmHg, the initial target the Surviving Sepsis Campaign guideline recommends for adults with septic shock on vasopressors (Evans et al., 2021).
Titration Table
Rung 1: norepinephrine. Start at [0.05] mcg/kg/min and increase by [0.02] mcg/kg/min every [5 to 10] minutes to reach the target. The guideline recommends norepinephrine as the first-line vasopressor.
Rung 2: vasopressin. Add at a fixed [0.03] units/min when norepinephrine reaches [0.25] mcg/kg/min without reaching the target. The guideline suggests adding vasopressin rather than escalating norepinephrine further, usually in the range of 0.25 to 0.5 mcg/kg/min (Evans et al., 2021). Vasopressin is not titrated. In VASST, adding vasopressin to norepinephrine did not lower overall mortality, but it allowed lower norepinephrine doses (Russell et al., 2008).
Rung 3: hydrocortisone. Start [200] mg a day, given as [50] mg every six hours, when norepinephrine at [0.25] mcg/kg/min or more has persisted for at least four hours after it was started, as the guideline suggests (Evans et al., 2021). In one large trial, hydrocortisone with fludrocortisone lowered 90-day mortality in septic shock (Annane et al., 2018).
Rung 4: epinephrine. Add at [0.05] mcg/kg/min if the target is still not reached, or if a bedside echocardiogram shows poor cardiac function with persistent low perfusion.
Perfusion Endpoints Beside the Pressure
A mean arterial pressure at goal with rising lactate and cold extremities means the number is met while perfusion is not. The plan therefore tracks three endpoints alongside pressure:
Capillary refill time, checked every [30] minutes during titration, target 3 seconds or less. In ANDROMEDA-SHOCK, resuscitation guided by capillary refill was at least as good as resuscitation guided by lactate, which supports it as a usable bedside measure (Hernández et al., 2019).
Urine output, measured hourly, target at least 0.5 mL/kg/h.
Lactate, repeated every [two] hours until falling, then every [six] hours.
If pressure is at goal but these worsen, the team reassesses fluid responsiveness, cardiac function and source control rather than simply raising the vasopressor.
What Else Runs Alongside
Source control. The most important step after antibiotics is relieving the obstruction. The plan notes the time urology was called and asks for decompression within [six] hours, because vasopressors cannot fix a pressure problem whose cause is an undrained infected kidney.
Fluids after the first 30 mL/kg. Further boluses are given only if a test of fluid responsiveness, such as a passive leg raise with a change in stroke volume, suggests they will help. Fluids given without that check risk pulmonary edema without raising pressure.
Arterial line. An arterial line is placed with the central line, because titrating every five to ten minutes on cuff pressures is imprecise and cuff readings can be unreliable in shock.
Communication. The nurse titrating the infusions calls the provider when norepinephrine reaches each rung's threshold, when the target is not met after [30] minutes at a rung, or when any endpoint worsens for [two] consecutive checks. Each rung change is written in the order set with the time it was reached, so the next shift can see where the patient sits on the ladder.
Peripheral Administration
The guideline suggests starting vasopressors through a peripheral line rather than delaying until central access is placed (Evans et al., 2021). Norepinephrine runs through the forearm line with the site checked for extravasation every [hour]. Central access is expected by hour two; if it is delayed, the plan is revisited at hour six.
Coming Off
The ladder is reversed as the patient improves, with a stated condition for each step.
Norepinephrine is reduced first as the target is maintained, by [0.02] mcg/kg/min every [30] minutes.
Vasopressin is stopped when norepinephrine is below [0.1] mcg/kg/min and the target has held for [six] hours.
Hydrocortisone is stopped when all vasopressors have been off for [24] hours, with or without a short taper.
Epinephrine, if used, comes off before vasopressin.
This order follows unit practice. Published data point in different directions on whether vasopressin or norepinephrine should be weaned first, and the plan attributes its sequence to local protocol rather than to a trial.
References
Annane, D., Renault, A., Brun-Buisson, C., Megarbane, B., Quenot, J.-P., Siami, S., Cariou, A., Forceville, X., Schwebel, C., Martin, C., Timsit, J.-F., Misset, B., Ali Benali, M., Colin, G., Souweine, B., Asehnoune, K., Mercier, E., Chimot, L., Charpentier, C., ... Bellissant, E. (2018). Hydrocortisone plus fludrocortisone for adults with septic shock. New England Journal of Medicine, 378(9), 809-818. https://doi.org/10.1056/NEJMoa1705716
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., ... Levy, M. (2021). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Critical Care Medicine, 49(11), e1063-e1143. https://doi.org/10.1097/CCM.0000000000005337
Hernández, G., Ospina-Tascón, G. A., Damiani, L. P., Estenssoro, E., Dubin, A., Hurtado, J., Friedman, G., Castro, R., Alegría, L., Teboul, J.-L., Cecconi, M., Ferri, G., Jibaja, M., Pairumani, R., Fernández, P., Barahona, D., Granda-Luna, V., Cavalcanti, A. B., & Bakker, J. (2019). Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: The ANDROMEDA-SHOCK randomized clinical trial. JAMA, 321(7), 654-664. https://doi.org/10.1001/jama.2019.0071
Russell, J. A., Walley, K. R., Singer, J., Gordon, A. C., Hébert, P. C., Cooper, D. J., Holmes, C. L., Mehta, S., Granton, J. T., Storms, M. M., Cook, D. J., Presneill, J. J., & Ayers, D. (2008). Vasopressin versus norepinephrine infusion in patients with septic shock. New England Journal of Medicine, 358(9), 877-887. https://doi.org/10.1056/NEJMoa067373
How this MN650 Unit 2 example is structured
Decisions run top to bottom, each written as a condition and an action so that a bedside reader could follow it without interpretation. Pressure is the target but not the only one; the endpoint column exists because a mean arterial pressure at goal with rising lactate and cold extremities means the number is met while perfusion is not. ANDROMEDA-SHOCK (Hernandez and colleagues, JAMA 2019) is cited for capillary refill as a usable bedside measure. Peripheral administration takes two sentences: the guideline supports starting peripherally rather than delaying, and the plan names the extravasation check and the hour by which central access is expected. The final section reverses the ladder. Hydrocortisone and vasopressin each come off under a stated condition, and the sequence is attributed to unit practice because the published data point in different directions.
Get an MN650 Unit 2 example written to your instructions
Everything in your MN650 Unit 2 case matters to the sample: the weight, the pressures, the lactate and whichever titration template the rubric calls for. The finished plan returns within 24-48h, without charge the first time, every rung tied to a dose threshold and every drug given a condition for stopping. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN650 Unit 2 questions, answered
Should the plan use mcg/min or mcg/kg/min?
Whichever the case or the unit uses, applied consistently. Some hospitals order norepinephrine by weight and others by flat rate, and both appear in the literature. The sample states the convention once at the top of the table and converts any cited threshold into it, showing the arithmetic, so a reader never has to guess which unit a number belongs to.
Does the plan have to follow Surviving Sepsis Campaign exactly?
It should cite the 2021 guideline where it applies and say plainly where it departs. Several recommendations are weak or rest on low-certainty evidence, so a plan may reasonably argue a different target for a specific patient, as long as the argument names its evidence. Silent departures read as errors; reasoned ones read as judgment, and markers tend to reward that difference.
Is the titration table meant for use on a real unit?
No. It is a composite written for a course assignment, and every rate and threshold is bracketed for that reason. Real titration protocols belong to the hospital, its pharmacy and the treating team. What the sample demonstrates is a format a marker can audit: condition, action, endpoint and a stated interval for each row.