Cardiogenic Shock

Assessment
1. Risk Factors
  1. Stress
  2. Smoker
  3. Obesity
  4. Cardiac/family history of MI
2. Clinical Manifestations
  1. Cardiovascular
    1. Tachycardia
      1. By: Paige Keller 214197420
    2. Weak pulse
    3. Decreased capillary refill time
    4. Chest pain may or may not be present
  2. Pulmonary
    1. Tachypnea
    2. Cyanosis
    3. Crackles and Wheezes in lung sounds
    4. Severe shortness of breath
  3. Renal
    1. Decreased urine output
    2. Increased Na+ and H20 retention
    3. Decreased renal blood flow
  4. Skin
    1. Pallor
    2. Cool, clammy
    3. Diaphoresis (sweating)
  5. Neurologiccal
    1. Anxiety, confusion, agitation
    2. Los of consiousness
  6. Gastrointestinal
    1. Decreased bowel sounds
    2. Nausea and vomiting
Treatment
1. Drug Therapy
  1. Diuretics
    1. Used to decrease plasma volume and peripheral edema.
  2. Inotropic Agents
    1. Dopamine
      1. Produces cardiac stimulation to improve heart funtion
    2. Dobutamine
      1. Produces systemic vasodilation, causing an increase in strength and force of the heart causing more blood to circulate throughout the body
    3. Norepinephrine
      1. Norepinephrine increases blood pressure and afterload. Increased afterload may result in decreased cardiac output, increased myocardial oxygen demand, and cardiac ischemia.
  3. Vasodilators
    1. Nitroglycerine
      1. Causes a decrease in preload and blood pressure
  4. Opioid Analgesics
    1. Morphine
2. Nursing Intervention/ Collaborative Care
  1. Prevention/ Health Teaching/ Discharge Planning
    1. Smoking cessation
    2. Importance of proper diet and exercise
      1. Lower cholesterol and saturated fats from diet
    3. Control hypertension
  2. Involve family in the comfort and care of the patient
  3. Monitor urine output, lab values i.e. BUN and serum creatinine
  4. Monitor vital signs: blood pressure, pulse, respiratory rate, every 1-5 minutes until patient is stable
  5. Correction of underlying cause
  6. Monitor ABG's, CBC's, Lytes
  7. Maintain patent arterial line
  8. Fluid/IV Therapy
  9. Effective pain management
  10. Oxygen therapy
3. Surgical Management
  1. Percutaneous Coronary Intervention (PCI)
    1. Should be initiated within 90 minutes of presentation
  2. Coronary Artery Bypass Surgery (CABG)
Diagnosis
1. Pathophysiology
  1. Primary ventricular ischemia
    1. Systolic dysfunction causing ineffective blood perfusion
      1. Decreased cardiac output, Decreased stroke volume
        SNS stimulation resulting in increased heart rate and systemic vascular resistance.
        Further cardiac damage and progressive decline of cardiac output due to increase workload and oxygen demand.
  2. Structural problems
  3. Dysryhmias
2. Etiology
  1. Myocardial infarction resulting in significant dysfunction or loss of left ventricular myocardium (greater than 40%)
    1. Right ventricular myocardial infarction
      1. End-stage cardiomyopathy
        Papillary muscle dysfunction
        Free wall rupture
        Congenital heart defects
3. Labs/Diagnostic Studies
  1. ECG
    1. Detects and records the hearts electrical activity, measuring rate and rhythm
      1. ST elevation indicative of an MI
  2. Cardiac Enzyme Test
    1. Creatine kinase and CK-MB will be elevated
    2. Myoglobin
    3. Troponins present are indicative of damaged cardiac muscle
    4. LDH will be elevated approx. 10 hours after onset of MI
  3. Coronary Angiography
    1. Dye is injected into the bloodstream allowing an x-ray of the heart and blood vessels to identify areas with blockages
  4. Echocardiogram
    1. Identifies damaged areas of the heart due to poor blood flow
  5. Blood Tests
    1. ABG's
    2. Biochemical profile
    3. CBC
  6. Pulmonary Artery Catheterization
    1. Catheter is used to check blood pressure in the pulmonary artery
Expected Outcomes
1. Positive outcomes are possible with a rapid diagnosis,, prompt medical interventions and supportive therapies,
What is it?
1. Occurs primarily when there is a severe dysfunction of the left, right, or both ventricles that result in inadequate pumping of blood.
2. Frequently associated with multisystem organ failure and is a medical emergency if not treated right away

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	Created by Paige Keller over 8 years ago