Cardiogenic Shock

Question 0

Mortality rates for patients with cardiogenic shock

Answer 0

50 to 85%

Question 1

Define shock

Answer 1

Syndrome characterized by decreased tissue perfusion and impaired cellular metabolism

Imbalance in supply/demand for O2 and nutrients

Question 2

Definition of low blood flow cardiogenic shock

Answer 2

Systolic or diastolic dysfunction and compromised cardiac output

Question 3

Precipitating causes of cardiogenic shock

Answer 3

MI, cardiomyopathy, blunt cardiac injury, severe systemic or pulmonary HTN, cardiac tamponade, myocardial depression from metabolic problems

Question 4

Early manifestations of cardiogenic shock

Answer 4

Tachycardia, hypotension, narrowed pulse pressure, increased myocardial oxygen consumption

Question 5

Presentation of cardiogenic shock is similar to

Answer 5

Acute decompensated heart failure

Question 6

The heart’s inability to pump blood forward will result in

Answer 6

Low CO: less than 4 L/min

Low cardiac index: less than 2.5 L/min/m2

Question 7

Physical examination of cardiogenic shock:

Answer 7

Tachypnea, pulmonary congestion, pallor, cool, clammy skin, decreased capillary refill time, anxiety, confusion, agitation

Increased PAWP

Decrease renal perfusion and UO

Question 8

Laboratory studies used in diagnosing cardiogenic shock

Answer 8

Troponin
Cardiac enzymes
BNP
ECG
Chest x ray
Echocardiogram

Question 9

What goes on in the Initial stage of shock

Answer 9

Usually not clinically apparent
Metabolism changes from aerobic to anaerobic
Lactic acid accumulates and must be removed by blood and broken down in the liver
Process requires unavailable O2 ( give o2)

Question 10

Describe the Compensatory stage of shock

Answer 10

Clinically apparent: neural, hormonal, biochemical compensatory mechanisms

Attempts are aimed at overcoming consequences of anerobic metabolism and maintaining homeostasis.

Question 11

Classic sign of shock

Answer 11

Drop in bp, which occurs because of a decrease in CO and narrowing of pulse pressure

Question 12

Progressive stage of shock

Answer 12

Compensatory mechanisms fail

Requires aggressive interventions to prevents multiple organ dysfunction syndrome

Question 13

Important changes in the progressive stages

Answer 13

Patients mental status

Question 14

Describe the irreversible stage of shock

Answer 14

Exacerbation of anaerobic metabolism, accumulation of lactic acid. Increased capillary permeability

Question 15

What does increased permeability allow?

Answer 15

Fluid and plasma to leave the vascular space and move to the interstitial space

Question 16

Decreased coronary blood flow leads to

Answer 16

Worsening myocardial depression and further decline in CO

Question 17

Loss of intravascular volume worsens

Answer 17

Hypotension and tachycardia and decreased coronary blood flow

Question 18

What happens in the irreversible stage of shock

Answer 18

Profound hypotension and hypoxemia, tachycardia worsens, failure of one organ system affects others, recovery is unlikely

Question 19

What does the failure of liver, lungs, and kidneys lead to?

Answer 19

Accumulation of waste products such as lactate, urea, ammonia, and carbon dioxide

Question 20

Important to remember about diagnosing shock

Answer 20

Through hx and physical examination. No single study to determine shock. Use blood studies, base deficit, elevation of lactate, 12 lead EKG, chest x ray, hemodynamic monitoring

Question 21

Lateral wall MI

Answer 21

Has no wall movement and is a huge risk for cardiogenic shock

Question 22

Collaborative care for shock

Answer 22

Ensure patent airway, maximize oxygen delivery.

May need a mechanical vent and a medical coma to preserve myocardial function

Question 23

What fluids are used for initial resuscitation of shock

Answer 23

Isotonic crystalloids- example normal saline

Question 24

Before initiating fluid resuscitation the nurse should

Answer 24

Insert 2 large bore (14-16 gauge) IV, preferably into the AC

Question 25

Vasodilator therapy includes

Answer 25

Nitroglycerin and nitroprusside

Question 26

Vasodilator agent used most often in cardiogenic shock is

Answer 26

Nitrogylcerin (Tridil)

Question 27

Goal of vasodilator therapy

Answer 27

Achieve and maintain a MAP of greater than 65

Question 28

When using thrombolytic therapy, make sure to assess

Answer 28

Level of consciousness.. Possible brain bleed