Examkin

Question

Difficulty: HardPhysiological Adaptation

A client is admitted to the progressive care unit with suspected bowel perforation and peritonitis. The nurse assesses the client and notes a Glasgow Coma Scale score of 12, cool and mottled extremities, and a capillary refill time of 5 seconds. Vital signs include a heart rate of 132 beats/min, a respiratory rate of 28 breaths/min, and a blood pressure of 82/40 mm Hg. Arterial blood gas (ABG) results reveal a pH of 7.26, PaCO2 of 30 mm Hg, PaO2 of 74 mm Hg, and HCO3 of 14 mEq/L. Based on these physiological findings, which intervention should the nurse prioritize?

  1. Initiate a rapid intravenous bolus of 0.9% sodium chloride.Answer
  2. B
    Administer intravenous sodium bicarbonate to directly neutralize the acidic blood pH.
  3. C
    Coach the client to perform controlled, shallow breathing to prevent further loss of carbon dioxide.
  4. D
    Initiate a prescribed continuous infusion of norepinephrine before additional fluid administration.

Answer

The priority intervention is to initiate a rapid intravenous bolus of 0.9% sodium chloride.
The client is exhibiting classical signs of septic shock with profound tissue hypoperfusion (hypotension, mottled skin, delayed capillary refill). This lack of oxygenated blood flow forces cells into anaerobic metabolism, producing lactic acid and causing the metabolic acidosis seen on the ABG. The immediate physiological priority is to rapidly expand the intravascular volume with isotonic crystalloids. This increases cardiac output, restores tissue perfusion, allows cells to return to aerobic metabolism, and helps clear the accumulated lactate.

Step-by-Step Solution

1
Analyze the client's vital signs and physical assessment findings.
Hypotension, tachycardia, tachypnea, altered mental status, and mottled extremities indicate profound hypoperfusion and late-stage shock.
Recognizing the signs of shock is essential for determining the underlying physiological crisis.
2
Interpret the arterial blood gas (ABG) values.
The ABG shows a primary metabolic acidosis (pH 7.26, HCO3 14 mEq/L) with partial respiratory compensation (PaCO2 30 mm Hg).
Understanding the acid-base imbalance helps identify the systemic impact of the client's condition.
3
Synthesize the assessment and ABG findings to identify the root cause.
The metabolic acidosis is lactic acidosis driven by anaerobic metabolism due to severe tissue hypoxia and hypoperfusion.
Connecting the shock state to the metabolic acidosis dictates the required treatment approach.
4
Select the intervention that addresses the root physiological cause.
Rapid administration of isotonic crystalloids (0.9% sodium chloride) expands intravascular volume, increasing cardiac output and tissue perfusion.
Restoring perfusion is the definitive treatment for lactic acidosis in a shock state; other measures are secondary or contraindicated.

Key Concept

Management of Septic Shock and Lactic Acidosis
Rate this question

Topics

Physiological Adaptation

More questions from this topic