A patient with a history of heroin and alcohol abuse has right arm cellulitis with a puncture wound. Vitals show tachycardia, fever, hypotension. Which intervention should the nurse implement first?

• A. Administer antibiotics
• B. Place in Trendelenburg
• C. Increase IV fluids to 150 mL/min
• D. Withhold fluids

Answer: (C)

When infection triggers systemic inflammation, the top priority is restoring circulation to improve tissue perfusion. The patient’s tachycardia and hypotension signal decreased effective blood flow, likely from septic processes after the puncture wound. Giving a rapid intravenous fluid bolus with isotonic saline increases intravascular volume, boosts blood pressure, and improves perfusion to organs. This immediate step lays the groundwork for the body to respond to treatment, including antibiotics, which are essential but most effective once perfusion is stabilized. Placing the patient in Trendelenburg isn’t a recommended shock management strategy, and withholding fluids would worsen hypotension. Thus, initiating aggressive IV fluid resuscitation is the first priority.