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Difficulty: MediumPhysiological Adaptation

A nurse is assessing a client admitted with severe pyelonephritis who is suspected of developing early (hyperdynamic) septic shock. Which of the following clinical manifestations should the nurse expect to find during this initial compensatory stage? Select all that apply.

  1. Heart rate of 118 beats/minAnswer
  2. Respiratory rate of 28 breaths/minAnswer
  3. Warm, flushed skinAnswer
  4. D
    Cool, pale extremities
  5. E
    Narrowing pulse pressure
  6. F
    Arterial blood gas indicating uncompensated respiratory acidosis

Answer

The correct findings include a heart rate of 118 beats/min, a respiratory rate of 28 breaths/min, and warm, flushed skin.
In early septic shock, endotoxins trigger a systemic inflammatory response leading to profound peripheral vasodilation. This hyperdynamic state causes the skin to be warm and flushed. To compensate for the decreased systemic vascular resistance and maintain oxygen delivery, the heart rate and respiratory rate increase.

Step-by-Step Solution

1
Analyze the client's condition and the stage of shock presented in the scenario.
The client is in the early (hyperdynamic or 'warm') stage of septic shock.
Identifying the specific type and stage of shock is essential for predicting the physiological manifestations.
2
Evaluate the hemodynamic and respiratory changes typical of early septic shock.
Inflammatory mediators cause massive vasodilation (warm, flushed skin), leading to a compensatory increase in heart rate (tachycardia) and respiratory rate (tachypnea).
The body attempts to maintain oxygen delivery and cardiac output despite decreased systemic vascular resistance.
3
Differentiate these early signs from late septic shock or other types of shock.
Cool extremities, narrowing pulse pressure, and respiratory acidosis are eliminated as they represent late septic shock or hypovolemic/cardiogenic shock.
Applying the correct physiological adaptation principles prevents confusing different shock etiologies and stages.

Key Concept

In the early (hyperdynamic) stage of septic shock, inflammatory mediators cause massive systemic vasodilation resulting in warm, flushed skin, bounding pulses, tachycardia, and tachypnea.
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Topics

Physiological Adaptation

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