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Difficulty: HardPhysiological Adaptation

A nurse is monitoring a client who is 48 hours post-operative following an emergency bowel resection for a perforated diverticulum. The client has become increasingly restless over the past two hours. Which of the following assessment findings should the nurse identify as early (hyperdynamic) indicators of septic shock? Select all that apply.

  1. Respiratory rate of 28 breaths/min with a PaCO2PaCO_2 of 30 mm HgAnswer
  2. B
    Narrowing pulse pressure with a delayed capillary refill
  3. Warm, flushed skin with bounding peripheral pulsesAnswer
  4. D
    Arterial blood gas demonstrating a pH of 7.28 and an HCO3−HCO_3^- of 15 mEq/L
  5. E
    Central venous pressure (CVP) reading of 14 mm Hg
  6. Core body temperature of 38.8°C (101.8°F)Answer

Answer

The early indicators of septic shock are a respiratory rate of 28 breaths/min with a low PaCO2PaCO_2, warm and flushed skin with bounding pulses, and an elevated core body temperature.
In the early (hyperdynamic or 'warm') phase of septic shock, endotoxins and inflammatory mediators cause massive systemic vasodilation. This leads to warm, flushed skin and bounding peripheral pulses as the heart compensates with an increased cardiac output. Hyperthermia is a hallmark of the systemic inflammatory response. Additionally, clients typically hyperventilate early in the process to meet increased metabolic demands, which blows off carbon dioxide, resulting in a low PaCO2PaCO_2 and a primary respiratory alkalosis.

Step-by-Step Solution

1
Analyze the pathophysiology of early septic shock.
Recognize that early septic shock (the warm phase) is characterized by massive systemic vasodilation and a compensatory hyperdynamic cardiovascular state.
This physiological adaptation differentiates early septic shock from other forms of shock (like cardiogenic or hypovolemic), which initially present with severe vasoconstriction.
2
Evaluate the respiratory and ABG parameters.
Identify that an elevated respiratory rate and a decreased PaCO2PaCO_2 (respiratory alkalosis) are early compensatory responses to systemic inflammation and fever.
Hyperventilation occurs early in the disease process before tissue hypoxemia is severe enough to cause anaerobic metabolism and lactic acidosis.
3
Evaluate the hemodynamic and peripheral assessment findings.
Identify that warm, flushed skin and bounding pulses result from profound vasodilation.
The body attempts to maintain cardiac output through decreased systemic vascular resistance, which is a hallmark of distributive shock.

Key Concept

Early (Hyperdynamic) Septic Shock Pathophysiology
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Topics

Physiological Adaptation

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