Question

L.V. is a 68-year-old male admitted to the coronary care unit 24 hours ago with an anteroseptal myocardial infarction (MI). His past medical history includes two other MIs within the last 5 years, obesity, hypertension, hyperlipidemia, and sleep apnea. L.V. had chest pain at home for 12 hours before seeking medical treatment. Lab results note troponin I at 5.2 mcg/L. L.V. is currently pain free with stable VS. The heart monitor shows sinus rhythm with occasional, unifocal premature ventricular contractions and a heart rate (HR) in the 90s. His blood pressure (BP) is 130/70, respiratory rate (RR) is 24 breaths/minute and O2 saturation is 93% on O2 via nasal cannula at 2 L/min. He has a heparin drip infusing at 1200 U/hr and IV nitroglycerin infusing at 20 mcg/min. You are assigned to care for L.V. as part of a two-patient assignment. Question 3: During assessment of L.V., you find him to be apprehensive and slightly restless but oriented to person, place, and time. Vital signs are as follows: BP 110/60, HR 110 beats/minute, RR 28 breaths/minute, temperature 36.4° C. Lung sounds reveal fine bibasilar crackles. His abdomen is soft with hypoactive bowel sounds. He has not voided since midnight. His skin is pale and cool. Knowing that he is at risk for cardiogenic shock, you realize that these assessment findings may correlate with which stage of shock?

Compensatory

Progressive

Refractory

Answer 1

Here the patient is in progressive stage of shock. That is the third stage. The progressive stage characterized by low blood pressure, increased heart rate , O Liguria. In this patient BP is low,heart rate is high, then pale and cool skin shows decreased blood supply due to vasoconstriction.

Compensatory stage characterized by low cardiac output and normal BP. Irreversible stage characterized by decreasing BP, and normal blood volume changes.