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Complex DMR > Cardiogenic shock > Flashcards

Cardiogenic shock Flashcards

1
Q

What can lead to cardiogenic shock

A 
►Myocardial infarction
►Dysrhythmias
►End-stage congestive heart failure
►Cardiomyopathy
►Myocarditis / Endocarditis
►Valvular diseases / structural disorders
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2
Q

What happens to Filling pressures and BP in cardiogenic shock

A

Persistent hypotension (systolic blood pressure <80 to 90
mmHg or mean arterial pressure 30 mmHg lower than
baseline)
• Severe reduction in the Cardiac Output (Cardiac Index
<1.8 L/min without support or <2 to 2.2 L/min with
support)
• Adequate or elevated filling pressures

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3
Q

How is oxygen delivery affected in cardiac shock

A 
Oxygen delivery (DO2) is affected by changes in any of its 3
components (Hb, Oxygenation, and CO) and by changes in
VO2 (O2 consumption).
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4
Q

What happens in acute anemia/acute hypoxia

A

In the case of acute anemia or acute hypoxia, the CO increases to maintain normal DO2

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5
Q

Is there compensatory mechanism for acute reduction in CO

A

there is no compensatory mechanism for acute

reduction in CO.

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6
Q

What happens if there is a drop in CO

A 
Acute reduction in DO2 due to a drop in CO (from AMI)
when VO2 is unchanged is ‘‘compensated’’ by greater
oxygen extraction (ER), resulting in a drop in mixed venous
oxygen saturation (SvO2)
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7
Q

Hemodynamics in cardiogentic shock
CO/EF
CVP/PAOP
SVO2

A 
• CO/EF decreased
• Preload (CVP, PAOP)
increased
• SvO2 decreased
hypotension
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8
Q

What happens with the SNS in cardiogenic shock

A

SNS stimulation= tachycardia

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9
Q

RASS Stimulation in cardiogenic shock

A

•Increased SVR
• Further difficulty with
ventricular ejection

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10
Q

Cardiac symptoms in cardiogenic shock

A
  • Chest pain
  • Tachycardia
  • Hypotension
  • Decreased peripheral pulses
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11
Q

Respiratory symptoms cardiogenic shock

A
  • SOB
  • Dyspnea
  • Crackles
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12
Q

Neurological symptoms cardiogenic shock

A
  • Restlessness

* Confusion

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13
Q

GI symptoms in cardiogenic shock

A

Nausea, Vomiting

Decreased bowel sounds

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14
Q

GU symptoms in cardiogenic shock

A

Inadequate urinary output

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15
Q

Skin symptoms in cardiogenic shock

A
  • Cool and clammy skin

* Diaphoresis

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16
Q

What happens when Compensatory Mechanisms Fail

A 
-Worsening inadequate organ perfusion
• Hypotension
• Tachycardia with weak pulses
• Tachypnea
• Cold, cyanotic, and mottled skin
• Decreased or absent urine output
• Severely decreased level of consciousness
• Severely decreased or absent bowel sounds
17
Q

Clinical manifestations of cardiogenic shock in late stage

Body systems

A

Multiple Organ Dysfunction Syndrome
• Cardiac: Severe hypotension, bradycardia
• Respiratory: Hypoxia
• GI: Liver and pancreas failure leading to hypoglycemia*
• GU: Decreased or absent urine output*
• Hematological: Emboli, DIC, Severe coagulopathy

18
Q

Complications of cardiogenic shock

A 
Cardiopulmonary arrest
Dysrhythmias
Multisystem organ failure
Stroke
Thromboembolism
19
Q

Diagnostic tests for Cardiogenic shock ECG what do you look for

A

►ECG
• ST elevation
• Q wave

• Metabolic profile – indicators of
systems failure (LFTs, RFTs)*
20
Q

Diagnostic tests for Cardiogenic shock Lab what do you look for

A 
►Laboratory analysis
• Increased troponin, CK-MB
• Arterial and venous blood gas
analysis - hypoxemia with
metabolic acidosis (Elevated
lactic acid*), and decreased
SvO2
• Metabolic profile – indicators of
systems failure (LFTs, RFTs)*
21
Q

Pulmonary artery catheterization/values Cardiogenic shock

A
  • CO decreased

* CVP, PAOP, SVR increased

22
Q

Echocardiogram

Cardiogenic shock

A
  • Ejection fraction decreased

* Wall motion abnormalities

23
Q

Emergency medical management of cardiogenic shock

A

Stabilizing oxygenation
• Oxygen via 100% non-rebreather or Intubation and Mechanical Ventilation
• Hemodynamic monitoring
• BP, CO, preload, afterload, stroke volume, and SVO2
• Vasoactive medication therapy
• to support blood pressure and increase cardiac output
►Pain control

24
Q

Medication Therapy cardiogenic shock

A 
►Increase contractility – Inotropic drugs
• Dobutamine, Milrinone
►Decrease preload and afterload
• Nitroglycerine, Nitroprusside, Intravenous Morphine
►Support blood pressure – Vasopressors
• Dopamine, Norepinephrine
►Decrease O2 demand and workload
• Nitrates, b Blockers
►Diuretics
25
Q

Medical Management: Procedures & Assistive Devices Cardiogenic shock

A

►Restore Blood Flow/Emergency Revascularization
• PTCA with stenting
►Intra-Aortic Balloon Pump
• Reduces afterload, improves coronary artery perfusion, improves
perfusion to vital organs
►Ventricular assist device
• External pump that assists the pumping of the left ventricle
►Extracorporeal Membrane Oxygenation (ECMO)

26
Q

Nursing Management: Care of IABP

A

►Ensure IABP catheter securement
►HOB < 30 degrees, and the affected leg is kept straight at all times
• Helps avoid catheter migration
►Assess catheter tubing for brown flecks or blood
• Brown flecks may indicate balloon rupture
►Assess lower extremity perfusion such as color, temperature, and
pulses

27
Q

Surgical Management of cardiogenic shock

A

►Coronary Artery Bypass Graft
►Replacement of faulty valves
►Artificial heart replacement
►Heart Transplantation

28
Q

Nursing management of cariogenic shock labs

A 
ABG
• Hemoglobin and Hematocrit
• Metabolic profile
• Lactate
• SvO2
29
Q

Nursing interventions for Cardiac shock

A 
Stabilize oxygenation
• 100% NRB
• Prepare for intubation
►Monitor hemodynamic status
• VS
• Arterial line
• CVP
• PA catheter
• Continuous ECG monitoring
►Administer medications and IV fluids
►Prepare for procedures

Complex DMR (12 decks)

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