A 36-year-old man with lymphoma presents with signs of impending septic shock 9 days after chemotherapy. The nurse could expect which of the following to be present?

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

The patient is 9 days post-chemotherapy, the typical nadir period, leading to neutropenia and a very high risk of infection.
Impending septic shock signifies the transition from sepsis to a state of circulatory collapse and organ failure.
This state is characterized by persistent hypotension (low blood pressure) and signs of end-organ hypoperfusion.
Oliguria (urine output less than 0.5 mL/kg/hr) is a critical sign of acute kidney injury due to poor blood flow, a hallmark of developing shock.
The combination of fever (from infection), hypotension, and oliguria is a classic triad indicating progression to septic shock.

Option A: This option describes features of early 'warm' septic shock. However, oliguria (in the correct option) is a more specific and severe indicator of organ hypoperfusion and impending circulatory collapse.
Option B: Low-grade fever, chills, and tachycardia are classic signs of early sepsis or a systemic infection. They do not, by themselves, indicate the progression to organ dysfunction or the hypotension characteristic of impending shock.
Option D: The presence of a normal blood pressure rules out shock. While fever and increased respirations are signs of sepsis, the compensated blood pressure means the patient has not yet progressed to septic shock.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Clinical presentation of impending septic shock in an immunocompromised patient in acute care settings.
Recognizing the transition to septic shock is a critical nursing skill. Mortality increases by nearly 8% for every hour that treatment is delayed.
For neutropenic patients, a fever (temperature greater than 38.3°C or 101°F once, or greater than 38°C or 100.4°F for an hour) is a medical emergency requiring immediate evaluation and initiation of broad-spectrum antibiotics within one hour.
The 'Sepsis Six' or 'Hour-1 Bundle' are protocols that guide immediate nursing and medical actions: obtain lactate and blood cultures, administer antibiotics and fluids, and begin vasopressors if needed.

How to Approach the Question

First, identify the patient's core problem and risk factors. A patient with lymphoma, 9 days post-chemotherapy, is at an extremely high risk for neutropenic sepsis.
Next, analyze the key term in the question: 'impending septic shock.' This is a more severe condition than just sepsis and implies that organ dysfunction and hypotension are developing.
Recall the definitions of the sepsis continuum: Sepsis involves infection plus a systemic response (fever, tachycardia). Septic shock involves sepsis plus persistent hypotension and signs of organ hypoperfusion.
Evaluate each option against the definition of impending shock. Look for the option that includes both hypotension and a clear sign of organ damage (like oliguria).
Eliminate options that describe early sepsis (where blood pressure is still normal) or those that have less specific signs of organ failure.

Concept Tested & Keywords

Concept Tested: Clinical presentation of impending septic shock in an immunocompromised patient.
Stem keywords: lymphoma, septic shock, chemotherapy, 9 days after
Lead-in keywords: could expect
Clinical cues: 36-year-old man: Indicates an adult patient.
Clinical cues: Lymphoma: An underlying malignancy that often requires immunosuppressive chemotherapy.

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 38-40

E6 Medicine Harrison 22e Part 1 p. 621-623

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