Week 4 - Cardiogenic Shock

Question 1

what is cardiogenic shock (2)

Answer 1

• occurs when systolic or diastolic dysfunction of the pumping action of the heart results in compromised CO
• heart has been damaged so much that it is unable to supply enough blood to the organs & the body

emergency!!!

Question 2

what are precipitating factors for cardiogenic shock (7)

Answer 2

any heart problems

• MI
• cardiomyopathies
• cardiac injury
• systolic dysfunction
• diastolic dysfunction
• arrythmias
• structural problems

Question 3

what are CVS signs of cardiogenic shock (6)

Answer 3

• tachycardia
• hypotension
• narrowed pulse pressure
• chest pain
• increased preload
• decreased CO

Question 4

what are resp signs of cardiogenic shock (4)

Answer 4

• tachypneic
• pulmonary congestion
• crackles
• dyspnea

Question 5

what are peripheral signs of cardiogenic shock (5)

Answer 5

signs of hypoperfusion

• cyanosis
• pallor
• dusky skin
• cool, clammy skim
• decreased cap refill

Question 6

what are neuro signs of cardiogenic shock (4)

Answer 6

• decreased LOC
• confusion
• anxiety
• agitation

Question 7

what are renal signs of cardiogenic shock (3)

Answer 7

• oliguria
• sodium retention
• water retention

Question 8

what can be used to diagnose cardiogenic shock (4)

Answer 8

• ECG
• chest xray
• echo
• lab findings

Question 9

what are GI signs of cardiogenic shock (3)

Answer 9

• decreased BS

- NV

Question 10

what lab findings are present in cardiogenic shock (5)

Answer 10

• increased cardic markers
• increased BG
• increased BUN
• cardiac enzymes
• troponin lvls

Question 11

what is the goal of treatment for cardiogenic shock

Answer 11

• restore blood flow to myocardium and allow for perfusion

- restore balance between O2 demand and O2 supply

Question 12

what are definitive measures to restore blood flow (4)

Answer 12

• thrombolytic therapy
• angioplasty w stent implantation
• emergency revascularizatio
• valve replacement

Question 13

what should be performed as soon as possible after the initial insult (2)

Answer 13

• cardiac catheterization

- PCI (coronary angioplasty) w or without stent implantation

Question 14

what should be done until cardiac catheterization and PCI can be performed

Answer 14

• SV and CO must be optimized to facilitate optimal perfusion

Question 15

what are other treatment measures are used for cardiogenic shock (6)

Answer 15

• O2
• cardiac drugs (dependent on cause & complications)
• mechanical interventions
• reperfusion
• meds
• cardiac monitoring (ECG)

Question 16

what are 3 options of treatment to get reperfusion (3)

Answer 16

• PCI
• CABG
• fibrinolytic therapy

Question 17

what meds can be used in treatment of cardiogenic shock (5)

Answer 17

• inotropes
• vasopressors
• diuretics (if pulm. edema)
• aspirin (if acute MI)
• antiarhythmics

Question 18

what meds should be avoided in the acute stage of cardiogenic shock (2)

Answer 18

• beta blockers

- nitrates

Question 19

what mechanical interventions can be used in treatment of cardiogenic shock (2)

Answer 19

• ventricular assist device

- intra-aortic balloon pump

Question 20

what is the biggest difference between cardiac shock and other types of shock?

Answer 20

• cannot be treated with rapid fluid replacement bc the heart cannot handle the extra fluid

Question 21

what are some nursing diagnosis r/t cardiogenic shock (8)

Answer 21

• decreased CO
• ineffective tissue perfusion
• impaired gas exchange
• risk for unstable BP
• acute confusion
• deficient or imbalanced fluid volume
• risk for ineffective thermoregulation
• risk for electrolyte imbalance

Question 22

what are some nursing interventions for shock mngmt (8)

Answer 22

• monitor VS
• monitor mental status
• monitor uo
• monitor trends in hemodynamic parameters
• monitor labs
• monitor determinants of tissue O2 delivery
• monitor for signs of resp failure
• monitor fluid status, weights, I&O
• monitor renal function
• admin O2
• monitor BG
• admin DVT and stress ulcer prophylaxis
• admin antimicrobial agents (to prevent septic shock)
• admin vasopressors, antidysrhythmias, anti-inflamm, diuretics, thrombolytics, inotropes, blood products, venodilators

Question 23

what cardiac nursing interventions can be done for shock mngmt (6)

Answer 23

• monitor adequate coronary perfusion
• monitor ECG, cardiac enzymes
• monitor for angina
• promote adequate organ system perfusion w vasopressors
• promote afterload reduction
• promote optimal preload while minimizing afterload

Question 24

what vasogenic interventions can be done for shock mngmt (4)

Answer 24

• monitor for physiological changes r/t loss of vascular tone
• place pt in supine position w legs elevated
• maintain 2 large bore IV
• admin antibiotics, antihistamines, epi, vasopressors, anti-inflamm

Question 25

what nursing interventions r/t volume can be done for shock mngmt (6)

Answer 25

• monitor for sudden loss of blood
• monitor dehydration
• check secretions for signs of bleeding
• monitor for S&S of hypovolemic shock
• admin blood products if needed
• monitor hgb

Question 26

a nursing diagnosis r/t shock is anxiety. what nursing interventions can be done for this (8)

Answer 26

• seek to understand pts perspective of stressful situation
• use calm, reassuring approach
• listen attentively
• admin meds if appropriate
• stay w pt to promote safety & reduce fear
• control stimuli for pts needs
• provide factual info
• encourage fam to stay w pt