Posted: August 16th, 2017

When the nurse observes that the patient’s systolic blood pressure is less than 80–90 mm Hg, respirations are rapid and shallow, heart rate is over 150 beats per minute, and urine output is less than 30 cc per hour, the nurse recognizes that the patient is demonstrating which stage of shock?

When the nurse observes that the patient’s systolic blood pressure is less than 80–90 mm Hg, respirations are rapid and shallow, heart rate is over 150 beats per minute, and urine output is less than 30 cc per hour, the nurse recognizes that the patient is demonstrating which stage of shock?
a) Compensatory
In compensatory shock, the patient’s blood pressure is normal, respirations are above 20, and heart rate is above 100 but below 150.
b) Progressive
In progressive shock, the patient’s skin appears mottled and mentation demonstrates lethargy.
c) Refractory
In refractory or irreversible shock, the patient requires complete mechanical and pharmacologic support.
d) Irreversible
In refractory or irreversible shock, the patient requires complete mechanical and pharmacologic support.