A critical care nurse is monitoring a client admitted with severe acute necrotizing pancreatitis. The client's central venous pressure (CVP) has decreased from 8 mm Hg to 2 mm Hg over the last four hours. Which of the following assessment findings indicate the client is developing hypovolemic shock secondary to massive third-spacing of fluids? Select all that apply.
- Narrowing of the arterial pulse pressureCevap
- BArterial blood gas pH of 7.46
- Capillary refill time of 5 secondsCevap
- DJugular venous distention with the head of the bed elevated 45 degrees
- EWarm, flushed skin in the distal extremities
- Urine output of 30 mL over the previous 2 hoursCevap
Cevap
The clinical indicators of developing hypovolemic shock in this client are a narrowing of the arterial pulse pressure, a capillary refill time of 5 seconds, and a urine output of 30 mL over the previous 2 hours.
In severe acute pancreatitis, increased capillary permeability leads to a massive shift of intravascular fluid into the third space (retroperitoneal cavity). This fluid loss reduces circulating blood volume, lowering the central venous pressure. As the body enters hypovolemic shock, compensatory mechanisms engage: peripheral vasoconstriction causes a narrowed arterial pulse pressure and a prolonged capillary refill time (> 3 seconds), while decreased renal perfusion leads to oliguria (urine output < 30 mL/hr).
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Anahtar Kavram
Hypovolemic Shock and Third-Spacing in Acute Pancreatitis