While monitoring a client 6 hours after an open cholecystectomy, the nurse notes several subtle physiological changes and suspects the development of early (compensatory) hypovolemic shock due to internal bleeding. Which of the following assessment findings support this physiological adaptation? (Select all that apply)
- Blood pressure changing from 124/76 mm Hg to 118/84 mm HgCevap
- Sudden onset of restlessness and apprehensionCevap
- CArterial blood gas analysis revealing a PaCO2 of 54 mm Hg
- DBounding radial and pedal pulses
- Respiratory rate increasing from 14 to 26 breaths per minuteCevap
- FUrine output totaling 110 mL over the past two hours
Cevap
The correct findings are a narrowing pulse pressure (blood pressure changing to 118/84 mm Hg), a sudden onset of restlessness and apprehension, and an increased respiratory rate (from 14 to 26 breaths per minute).
In the early (compensatory) stage of hypovolemic shock, the body activates the sympathetic nervous system and endocrine pathways to maintain cardiac output and vital organ perfusion. This physiologic adaptation leads to peripheral vasoconstriction, which increases diastolic blood pressure and narrows the pulse pressure before the systolic pressure definitively falls. Additionally, mild hypoxia to the brain presents initially as behavioral changes, such as restlessness, anxiety, or apprehension. The respiratory rate also increases (tachypnea) as a compensatory attempt to improve oxygen saturation and correct developing tissue hypoxia.
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Clinical Indicators of Compensatory Shock