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Difficulty: HardPhysiological Adaptation

While conducting a comprehensive assessment on a client with a systemic infection, the nurse notes several physiological shifts. The nurse suspects the client is entering the early, hyperdynamic phase of septic shock. Which assessment findings indicate this specific stage of clinical deterioration? Select all that apply.

  1. Bounding peripheral pulsesAnswer
  2. Widening pulse pressureAnswer
  3. Laboratory results showing a serum pH of 7.487.48 and a PaCO2PaCO_2 of 2929 mm HgAnswer
  4. D
    Cool, mottled extremities with sluggish capillary refill
  5. E
    Laboratory results showing a serum pH of 7.307.30 and an HCO3−HCO_3^- level of 1515 mEq/L
  6. F
    Narrowing pulse pressure

Answer

The findings indicating early (hyperdynamic) septic shock are a widening pulse pressure, bounding peripheral pulses, and laboratory results demonstrating respiratory alkalosis.
Early (hyperdynamic) septic shock is characterized by profound systemic vasodilation caused by inflammatory mediators. This vasodilation leads to a decreased diastolic blood pressure, which widens the pulse pressure. Cardiac output initially increases to compensate, resulting in bounding peripheral pulses. Additionally, the client hyperventilates in response to early hypoxia and systemic inflammation, causing respiratory alkalosis (elevated pH, decreased PaCO2).

Step-by-Step Solution

1
Analyze the pathophysiology of early septic shock.
Early septic shock is characterized by a hyperdynamic state caused by massive systemic vasodilation in response to inflammatory mediators.
Understanding the underlying vasodilation helps differentiate this initial phase from other types of shock or the late stages of septic shock.
2
Evaluate the hemodynamic and peripheral assessment options based on vasodilation.
Profound vasodilation leads to a decreased diastolic blood pressure (causing a widened pulse pressure) and an initial increase in cardiac output (presenting as bounding pulses and warm skin).
This eliminates options describing a narrowing pulse pressure and cool, mottled extremities, which are signs of vasoconstriction and decreased cardiac output seen in late shock.
3
Assess the arterial blood gas (ABG) options in the context of early shock compensation.
Early in shock, the client hyperventilates to increase oxygen delivery, leading to 'blowing off' carbon dioxide and resulting in respiratory alkalosis.
Metabolic acidosis occurs later when prolonged tissue hypoxia forces anaerobic metabolism, leading to lactic acid accumulation.

Key Concept

Differentiation between the early (hyperdynamic) and late (hypodynamic) phases of septic shock.
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Physiological Adaptation

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