Examkin

Question

Difficulty: MediumPhysiological Adaptation

While conducting a physiological assessment on a client who experienced an anterior wall myocardial infarction the previous day, the nurse suspects the onset of hemodynamic compromise. Which clinical manifestations indicate the early development of cardiogenic shock? Select all that apply.

  1. Restlessness and new-onset confusionAnswer
  2. Apical heart rate of 122 beats per minuteAnswer
  3. Urine output of 15 mL over the past hourAnswer
  4. D
    Progressively widening pulse pressure
  5. E
    Warm, flushed extremities

Answer

The correct indicators of early cardiogenic shock are restlessness and new-onset confusion, an apical heart rate of 122 beats per minute, and a urine output of 15 mL over the past hour.
In early cardiogenic shock, decreased cardiac output triggers the sympathetic nervous system. This compensatory response causes tachycardia to increase cardiac output and shunts blood away from non-vital organs (causing oliguria, such as 15 mL/hr) and the skin. Furthermore, the brain is highly sensitive to slight drops in oxygenation, making restlessness and confusion very early indicators of compromised systemic perfusion.

Step-by-Step Solution

1
Analyze the pathophysiology of the condition.
Cardiogenic shock results from severe impairment of ventricular pumping action, leading to decreased cardiac output and systemic hypoperfusion.
Understanding the core mechanism explains the body's compensatory responses.
2
Identify early compensatory mechanisms.
The sympathetic nervous system activates, causing tachycardia to increase cardiac output and peripheral vasoconstriction to maintain blood pressure and shunt blood to vital organs.
These early physiological mechanisms produce specific clinical signs before profound hypotension occurs.
3
Evaluate the given options against known shock indicators.
Tachycardia, oliguria, and altered mental status are early signs of poor perfusion. Widening pulse pressure and warm skin contradict the sympathetic vasoconstrictive response seen in cardiogenic shock.
Differentiating between true cardiogenic shock signs and those of other shock types is essential for prompt, accurate intervention.

Key Concept

Early recognition of cardiogenic shock
Rate this question

Topics

Physiological Adaptation

More questions from this topic