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Nursing 272: Final Semester > Unit 2: Cardiogenic Shock > Flashcards

Unit 2: Cardiogenic Shock Flashcards

1
Q

Cardiogenic Shock

A

a state of hypoperfusion at the tissue level resulting from severe impairment of ventricular contraction in the presence of adequate vascular volume
-independent of fluid volume the heart muscle cannot adequately pump causing decreased CO and poor perfusion

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2
Q

Components of Cardiogenic Shock

A
  • reduction of contractility b/c of damaged myocardium; reduces ejection fraction (EF)
  • increased left and right filling pressures but decreased CO
  • venous oxygen saturation decreases w/ increased oxygen extraction at the tissue level b/c of low cardiac output
  • leads to univentricular or biventricular failure, profound hypotension, and pulmonary edema
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3
Q

Risk Factors for Cardiogenic Shock

A
  • any disorder that results in acute deterioration of myocardial mechanical contraction
  • end-stage congestive HF
  • cardiomyopathy
  • hypertension
  • diabetes
  • multiple-vessel coronary artery disease
  • acute vascular disease
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4
Q

Vicious Cycle of Cardiogenic Shock

A

a cycle of increased oxygen demand w/ inadequate perfusion worsens ischemia ending in death if not broken
>the decreased CO leads to stimulation of compensatory mechanisms
-the SNC stimulation that increases HR, contractility, myocardial workload and oxygen demand, worsens ischemia
-systemic vasoconstriction increases the workload of an already stressed heart by increasing afterload
-fluid retention induced by the renin-angiotensin-aldosterone system increases filling pressures; contributes to development of pulmonary edema and hypoxemia

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5
Q

Clinical Manifestations of Cardiogenic Shock

A

Initial: chest pain, diaphoresis, nausea + vomiting

  • decreased LOC
  • decreased urine output
  • poor pulses
  • pale, cool skin
  • decreased bowel sounds
  • SOB, crackles on auscultation, decreased SpO2 d/t pulmonary edema
  • increased lactate levels
  • metabolic acidosis
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6
Q

Late Manifestations of Shock

A
  • become more pronounced
  • profound hypotension and bradycardia
  • organ systems begin to fail
  • increases in Creatinine and liver enzymes
  • coma
  • cyanotic; mottled skin
  • absent bowel sounds
  • hypoglycemia
  • anuria
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7
Q

What the Hemodynamic Parameters would look like in Cardiogenic Shock

A
  • Increased central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP)
  • High systemic vascular resistance (SVR)
  • Low cardiac output (CO)
  • Decreased venous oxygen saturation (SvO2)
  • Hypotension and Tachycardia
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8
Q

Lab and Diagnostic Tests

A

> 12-lead electrocardiogram
Cardiac enzymes
Chest Radiograph

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9
Q

Why 12-Lead ECG?

A

to r/o or rule in MI as a cause of shock

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10
Q

Why Cardiac Enzymes?

A

> Troponin, CK, CK-MB

-help confirm presence or absence of acute MI

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11
Q

Why Chest Radiograph?

A
  • to r/o other causes of hypotension and shock (pneumothorax or cardiac tamponade)
  • can confirm presence of pulmonary edema
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12
Q

Treatment Priorities for Cardiogenic Shock

A
  • Stabilizing oxygenation
  • Initiating drug therapy to increased BP and CO
  • Emergency revascularization, an attempt to restore blood flow through percutaneous coronary intervention (PCI)
  • Intra-aortic balloon pump (IABP) therapy to increase myocardial oxygen supply and decrease myocardial oxygen demand
  • if tx not successful, use of VAD
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13
Q

Stabilizing Oxygenation

A
  • 100% oxygen through a non-rebreather

- Intubation and mechanical ventilation to support ventilation and maximize oxygenation

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14
Q

Medications for Cardiogenic Shock

A
  • Vasopressors
  • Inotropic Support
  • Nitroglycerin
  • Diuretics
  • Morphine Sulfate
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15
Q

Vasopressors/ Vasoactive meds

A

> Dopamine
Norepinephrine

-support BP through vasoconstriction
-to sustain BP and help maintain mean arterial pressure
>care should be taken when taken b/c the meds will increase systemic vascular resistance increasing myocardial workload

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16
Q

Inotropic Support

A

> Dobutamine

  • increase myocardial contractility
  • increases CO
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17
Q

Nitroglycerin

A

to decrease preload and afterload

  • vasodilation
  • can decrease BP
18
Q

Diuretics

A

used w/ caution

  • attempt to decrease filling volumes
  • decrease vascular volume if filling pressures are extremely elevated
19
Q

Morphine Sulfate

A
  • help relieve pain d/t MI

- vasodilator that decreases venous return and preload

20
Q

Emergency Revascularization

A

through percutaneous coronary intervention (PCI)

  • insertion of a catheter through an artery up into the involved coronary artery and inflation of a balloon to break up the plaque causing the obstruction of flow
  • stent is placed to maintain patency of the vessel
21
Q

Intra-aortic Balloon Pump Therapy (IABP)

A

used when drug therapy does not improve CO

  • increases myocardial oxygen supply
  • decreases myocardial oxygen demand
  • balloon at tip of catheter; it is timed to inflate at start of diastole (rest) and deflate before systole
  • when inflates, blood is displaced toward the coronary arteries and into systemic circulation, improving coronary and systemic perfusion
  • deflating the balloon decreases afterload, decreasing the workload of the left ventricle
22
Q

Ventricular Assist Device (VAD)

A

surgically inserted mechanical pump that assists the pumping of the left ventricle and decrease workload of the heart

23
Q

Nursing Management: Assessment and Analysis

A

clinical manifestations are r/t a decrease in CO and impaired tissue perfusion

  • chest pain
  • diaphoresis
  • nausea
  • hypotension
  • tachycardia
  • tachypnea
  • crackles, SOB, decreased SpO2 if edema present
  • decreased LOC
  • weak pulses
  • cold, cyanotic, mottled skin
  • decreased urine output
  • absent/decreased bowel sounds

> W/o successful intervention:

  • profound hypotension
  • bradycardia
  • hypoxia
24
Q

Nursing Assessments for Cardiogenic Shock

A
  • Neurological status
  • Vital Signs
  • Hemodynamic parameters
  • Breath sounds
  • Urine output
  • Skin Color + Temperature
  • Lab tests; ABGs, SvO2, Metabolic profile, Lactate/Base Deficit
25
Q

Assessments: Neurological Status

A

decreased LOC occurs as a result of decreased CO and carotid vasoconstriction that occurs as a result of hyperventilation and respiratory alkalosis

26
Q

Assessments: Vital Signs

A
  • hypotension and tachycardia b/c of decreased CO
  • respiratory rate increased in an effort to increase tissue oxygenation and remove CO2 to compensate for metabolic acidosis
  • oxygenation may be decreased d/t presence of pulmonary edema
27
Q

Assessments: Vital Signs

A
  • hypotension and tachycardia b/c of decreased CO
  • respiratory rate increased in an effort to increase tissue oxygenation and remove CO2 to compensate for metabolic acidosis
  • oxygenation may be decreased d/t presence of pulmonary edema
28
Q

Hemodynamic Parameters

A
  • both right and left preloads are increased b/c of impaired pumping ability of the heart, but CO is low
  • to compensate for low CO, vasoconstriction occurs, increasing systemic vascular resistance (SVR)
29
Q

Assessment: Breath Sounds

A

crackles d/t pulmonary edema

30
Q

Assessment: Urine Output

A
  • decreases as a result of decreased CO

- decreases as a result of stimulation of compensatory mechanisms that increase reabsorption of sodium and water

31
Q

Assessments: Skin Color and Temperature

A

cold and clammy skin = progressing shock

32
Q

Assessment: Lab Tests: ABGs

A

initially reflect respiratory alkalosis d/t tachypnea

-later stages = metabolic acidosis d/t anaerobic metabolism

33
Q

Assessment: Labs: Venous Oxygen Saturation (SvO2)

A

decreased SvO2/ScvO2 = inadequate oxygen delivery (DO2)

34
Q

Assessment: Labs: Metabolic Profile

A
  • Renal failure = increase in BUN + Creatinine

- Liver Failure = increase liver function test results b/c of decreased organ perfusion

35
Q

Assessment: Labs: Lactate (Lactic acid)/ Base Deficit

A

increase lactate level and negative (-) base deficit = poor perfusion at cellular level

36
Q

Nursing Actions for Cardiogenic Shock

A
  • Apply 100% non-rebreather oxygen mask
  • Prepare for intubation and mechanical ventilation
  • Administer medications as ordered: Vasoactive meds, Inotropic Meds, Diuretics, Morphine Sulfate
  • Administer fluids as prescribed
  • Restrict Activity
37
Q

Nursing Actions for Cardiogenic Shock

A
  • Apply 100% non-rebreather oxygen mask
  • Prepare for intubation and mechanical ventilation
  • Administer medications as ordered: Vasoactive meds, Inotropic Meds, Diuretics, Morphine Sulfate
  • Administer fluids as prescribed
  • Restrict Activity
38
Q

Why Administer fluids as prescribed?

A

used cautiously

-to increase CO if filling pressures are low and there is no signs of pulmonary edema

39
Q

Why Restrict Activity?

A

will decrease cardiac workload and oxygen consumption (VO2)

40
Q

Nursing Education/Teaching

A

> Instruct about rest periods
-increased activity or stress levels cause increased myocardial oxygen consumption (VO2) and can worsen progression of shock
Teach about causes of cardiogenic shock and MI

41
Q

Evaluating Care Outcomes

A
  • rapid recognition
  • inotropic and vasoactive support help maintain adequate CO and BP to ensure sufficient oxygen supply to the tissues
  • monitoring of clinical manifestations and hemodynamic status helps evaluate therapeutic interventions
42
Q

W/ Successful treatment

A
  • satisfactory BP level
  • satisfactory CO
  • adequate tissue perfusion

Nursing 272: Final Semester (79 decks)

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