[Solved]: patient on 100% oxygen via a nonrebreathing mask…

patient on 100% oxygen via a nonrebreathing mask and get a set of baseline vital signs while you begin to question her regarding her current illness and past medical history. The patient tells you that she has end-stage renal disease and requires dialysis every other day. She was unable to make it to her last appointment because she did not feel well and had no way to get there. She did not call her physician, stating that she thought she could “shake off this bug.” She had been taking acetaminophen (Tylenol) every 4 hours for the fever and the pain in her forearm. Her past medical history is significant for hypertension, a myocardial infarction in 2003, and heart failure. Daily medications include Captopril, low-dose aspirin, and nitroglycerin as needed. Assessment of the patient shows a RR of 32, HR of 116, and BP of 84/40. The ECG monitor shows sinus tachycardia with occasional premature beats and tall, pointed T waves. The oxygen saturation with the patient on the nonrebreathing mask is 94%. You perform a physical exam on the patient while your partner prepares an IV setup. Your physical exam reveals the following findings: jugular venous distention, accessory muscle use, pitting edema of both lower extremities, and an area surrounding the shunt site on the right arm approximately 4 cm in diameter that is red, swollen, and hot to the touch. As you are completing your assessment, the patient begins to complain of feeling light-headed. You lower the head of the dialysis chair to a 60°angle, initiate an IV using a 18-gauge catheter in the left antecubital space, and begin a fluid bolus of 200 mL, after checking for pulmonary edema. Is the patient going into shock? If so, what type? Is a fluid bolus appropriate here? Why or why not?