CARDIOGENIC SHOCK

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

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CARDIOGENIC SHOCK

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	Created by Kelsey Ball about 7 years ago