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CARDIOGENIC SHOCK

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CARDIOGENIC SHOCK

What is Cardiogenic Shock?
- The inabiliy to pump blood out of the heart.
- The inability to maintain cardiac output, even though there is adequate blood volume.
- The inability to meet the bodies blood circulation needs.
- A life threatening state
- Due to heart attack
Causes of Cardiogenic Shock
- Systolic Dysfunction
  - inability to pump blood forward, commonly caused from myocardial infarction
- Diastolic Dysfunction
  - impairment of either ventricle to fill during diastole
- Arrhythmias
  - irregular heart beat or rhythm
- Structural Problems
  - tension pneumothorax
  - stenosis and regurgitation
  - ventricular septal rupture
Clinical Manifestations
- Cardiac
  - tachycardia
  - decreased cardiac output
  - decreased blood pressure
  - narrowing pulse pressure
  - edema
  - weak pulse
- Pulmonary
  - dyspnea
  - pulmonary congestion
  - crackles and wheezing
  - tachypnea
- Neurological
  - anxiety, confusion, and agitation
  - delirium
  - loss of consciousness
- Integumentary
  - dusky or pale skin colour
  - cool and clammy
- Gastrointestinal and Genitourinary
  - oliguria
  - decrease bowel sounds
Diagnostics
- decreased capillary refill time
- increased levels of blood urea nitrogen (BUN)
- increase blood glucose
- decreased cerebral perfusion
- increase sodium and water retention
Treatments
- Oxygenation
  - provide oxygen supplementation through most appropriate device
  - possible intubation required
- Circulation
  - restore blood flow
    - thombolytics
    - implant of stent
    - angioplasty
    - coronary artery bypass grafting (CABP)
  - circulatory assist devices
    - intra-aortic balloon pump (IABP)
    - ventricular assistive device
- Pharmacotherapy
  - nitrates
  - inotropes
  - diuretics
  - beta blockers
Manifestations of the Stages of Shock
- Compensatory
  - pale and cool or warm and flushed
  - increase blood glucose
  - increase pH
  - decrease PaO2 and PaCO2
- Progressive
  - hypothermia
  - cold and clamm skin
  - increase bleeding times
  - increase liver enzymes
- Refractory
  - hypothermia
  - discolouration and cyanosis of skin
  - decrease blood glucose
  - metabolic acidosis
  - increase lactate levels
- Initial
  - increased blood pressure
  - decreased heart rate
  - decrease cardiac output
Nursing Interventions
- Shock Menegment
  - Monitor vital Signs
  - Monitor orthostatic blood pressure
  - Monitor neurological status
  - Monitor Oxygen delivery
  - Monitor for respiratory failure
  - Monitor fluid intake and output
  - Listen to bowel sounds
- Cardiac Management
  - Monitor ECG
  - Monitor central venous pressure
  - monitor pulmonary artery pressure
  - Asses PAOP
  - Listen to heart sounds
  - Administer prescribed therapy
- Respiratory Management
  - Listen to breath sounds
  - Asses rate, rhythm and depth of respirations
  - Asses levels of ABG's
- Personal Hygiene
  - Mouth care
  - Skin care to prevent breakdown and infection
  - Passive range of motion
- Emotional Support and Comfort
  - Explain procedures
  - Address anxiety and fear
  - Talk to patient even if intubated
  - Provide support to patient and family