Medical Surgical Labs Priority Labs #5

Question

A nurse is two hours into her shift and is caring for her ICU client. She receives these critical labs: PCO2 30 mmHg, PTT 100 sec, creatinine 1.3 mg/dL, and WBC 13,000. The cardiac monitor shows the client’s blood pressure is 89/63. The nurse notes there has been a significant decrease in urine, a mental status change, and patches of discoloration to the skin. What do these findings suggest?

Answers

  1. Sepsis
    • Rationale:

      This answer is not correct because the client’s blood pressure is so low. This is the marked difference between sepsis and septic shock.

  2. Severe sepsis
    • Rationale:

      This answer is not correct because the client’s blood pressure is too low. The client with septic shock will have all the symptoms of severe sepsis; patchy discoloration of skin, decreased output, mental status changes, difficulty breathing, but the blood pressure will not be this low.

  3. Septic shock
    • Rationale:

      This answer is correct because of the client’s critical labs values and very low blood pressure. The client’s low PCO2 indicates respiratory alkalosis, which is seen in sepsis. Platelets will be less than 100,000, creatinine over 1.3 mg/dL, and WBC will be very low. The client with septic shock will have a very low blood pressure and a high heart rate, in addition to all the signs of severe sepsis. These include patchy discoloration of skin, decreased output, mental status changes, difficulty breathing, and cool clammy skin.

  4. Nosocomial infection
    • Rationale:

      This answer is not correct because although a nosocomial infection is very possible and can lead to septic shock, the client’s temperature is not mentioned in this question. The labs reveal the client is in septic shock.

Overview

Septic shock is a severe case of sepsis that can lead to organ failure. Signs of septic shock include decrease in urine output, mental status changes, difficulty breathing, patchy skin discoloration, and an extremely low blood pressure.

Explanation

Learning Outcomes

Septic shock is a severe case of sepsis that can lead to organ failure. Signs of septic shock include decrease in urine output, mental status changes, difficulty breathing, patchy skin discoloration, and an extremely low blood pressure. The client’s low PCO2 indicates respiratory alkalosis, which is seen in sepsis. Platelets will be less than 100,000, creatinine over 1.3 mg/dL, and WBC will be very low. The client with septic shock will have a very low blood pressure and a high heart rate, in addition to all the signs of severe sepsis. These include patchy discoloration of skin, decreased output, mental status changes, difficulty breathing, and cool clammy skin.

Test Taking Tip

Know the criteria for sepsis and the three stages of sepsis. Always remember the difference between severe sepsis and septic shock is the severe hypotension that accompanies septic shock.

Video Rationale