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Difficulty: HardPhysiological Adaptation

A nurse is evaluating a client who is being treated for acute peritonitis. Which of the following assessment findings indicate the client is experiencing the early, hyperdynamic phase of septic shock? Select all that apply.

  1. Bounding peripheral pulsesAnswer
  2. B
    Cool, clammy, and mottled extremities
  3. Arterial blood gas results indicating respiratory alkalosisAnswer
  4. D
    Narrowed pulse pressure
  5. Heart rate of 124 beats/minuteAnswer
  6. F
    Arterial blood gas results indicating metabolic acidosis

Answer

The correct findings are bounding peripheral pulses, arterial blood gas results indicating respiratory alkalosis, and a heart rate of 124 beats/minute.
In the early, hyperdynamic (warm) phase of septic shock, the body's systemic inflammatory response causes massive peripheral vasodilation. To compensate for decreased systemic vascular resistance, cardiac output temporarily increases, leading to tachycardia and bounding peripheral pulses. Additionally, the client hyperventilates as an early compensatory mechanism, blowing off excess carbon dioxide and resulting in respiratory alkalosis.

Step-by-Step Solution

1
Analyze the pathophysiology of the early (warm) phase of septic shock.
The early phase is characterized by a systemic inflammatory response leading to massive peripheral vasodilation and a hyperdynamic circulatory state.
Understanding the underlying vascular changes is necessary to accurately predict the physical assessment findings.
2
Evaluate the cardiovascular findings against the pathophysiology.
A heart rate of 124 beats/minute and bounding peripheral pulses are expected. A narrowed pulse pressure is incorrect.
To compensate for profound vasodilation (decreased systemic vascular resistance), the heart pumps harder and faster, thereby increasing cardiac output and widening the pulse pressure.
3
Evaluate the skin and respiratory findings against the pathophysiology.
Respiratory alkalosis is expected. Cool, clammy skin and metabolic acidosis are incorrect.
Tachypnea is an early compensatory mechanism that causes excessive carbon dioxide elimination (respiratory alkalosis). Skin is initially warm and flushed due to vasodilation, whereas cool/clammy skin and lactic (metabolic) acidosis occur in the late, decompensated phase.

Key Concept

The early (hyperdynamic) phase of septic shock is characterized by massive peripheral vasodilation, a compensatory increase in cardiac output, and hyperventilation, which present clinically as warm skin, bounding pulses, tachycardia, and respiratory alkalosis.
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Physiological Adaptation

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