An adult client with bacterial pneumonia becomes increasingly disoriented and somnolent. Which assessment findings indicate that the client may be in septic shock? Select all that apply.

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Sepsis is an overwhelming response to infection that causes impaired organ function. Septic shock occurs when sepsis causes cardiovascular collapse and/or impairs the body's ability to maintain normal metabolic and cellular processes. Manifestations of septic shock include: Fever or hypothermia (>100.4 F [38 C]; <96.8 F [36 C]) - Either fever or low body temperature is found in sepsis and septic shock. Fever occurs in response to infection, whereas low body temperature can occur as shock worsens due to metabolic alterations and inadequate tissue perfusion (Option C). Hypotension - Systolic blood pressure <90 mm Hg or mean arterial pressure <65 mm Hg in a client with infection may indicate septic shock. Altered perfusion from hypotension may cause lactic acid accumulation and metabolic acidosis (Option A). Prolonged capillary refill - A refill time >3-4 seconds in adults indicates inadequate tissue perfusion as a result of altered peripheral circulation and hypotension (Option B). Tachycardia - A resting heart rate >90/min is common in septic shock to compensate for decreased systemic vascular tone and hypotension. WBC count >12,000/mm³ (12 x 10⁹/L) or immature neutrophils (bands) of >10% - An increased WBC count, especially with bands, indicates severe infection (Option E). (Option D) Clients with septic shock typically develop decreased urine output (ie, <0.5 mL/kg/hr) due to inadequate organ perfusion. Educational objective: Septic shock is a life-threatening systemic response to infection that causes impaired organ function, cardiovascular collapse, and/or impairment of normal metabolic and cellular processes. Signs of septic shock include fever or hypothermia, hypotension, tachycardia, and leukocytosis.

An Adult Client with Bacterial Pneumonia Becomes Increasingly Disoriented and Somnolent