A nurse is evaluating a client admitted with severe urosepsis. The client has already received a 30 mL/kg bolus of 0.9% sodium chloride and broad-spectrum intravenous antibiotics. Upon reassessment, which of the following clinical changes most strongly indicates that the client is experiencing progressive physiological decompensation and transitioning from the early (hyperdynamic) phase to the late (hypodynamic) phase of septic shock?
- Arterial blood gas analysis demonstrates a shift from a primary respiratory alkalosis to a primary metabolic acidosis.Answer
- BThe client's peripheral pulses become bounding and the pulse pressure significantly widens.
- CArterial blood gas analysis reveals an uncompensated respiratory alkalosis with a progressively decreasing PaCO2.
- DThe client's extremities remain warm and flushed with a capillary refill time of less than 2 seconds.
Answer
The transition from the early to late phase of septic shock is most strongly indicated by an arterial blood gas shift from primary respiratory alkalosis to primary metabolic acidosis.
The correct answer identifies the fundamental pathophysiological shift in late shock. In the early stages of septic shock, the client hyperventilates to meet oxygen demands, blowing off CO2 and causing respiratory alkalosis. As shock progresses to the late, hypodynamic phase, compensatory mechanisms fail. Profound tissue hypoperfusion forces cells into anaerobic metabolism, producing massive amounts of lactic acid. This results in a defining shift to metabolic acidosis, indicating severe and potentially irreversible physiological decompensation.
Step-by-Step Solution
Key Concept
The progression of septic shock involves a distinct transition from an early hyperdynamic state (respiratory alkalosis, vasodilation) to a late hypodynamic state characterized by anaerobic metabolism and lactic acidosis (metabolic acidosis).
Estimated Time:1m 30s