Week 4 - Cardiogenic Shock Flashcards
what is cardiogenic shock (2)
- 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!!!
what are precipitating factors for cardiogenic shock (7)
any heart problems
- MI
- cardiomyopathies
- cardiac injury
- systolic dysfunction
- diastolic dysfunction
- arrythmias
- structural problems
what are CVS signs of cardiogenic shock (6)
- tachycardia
- hypotension
- narrowed pulse pressure
- chest pain
- increased preload
- decreased CO
what are resp signs of cardiogenic shock (4)
- tachypneic
- pulmonary congestion
- crackles
- dyspnea
what are peripheral signs of cardiogenic shock (5)
signs of hypoperfusion
- cyanosis
- pallor
- dusky skin
- cool, clammy skim
- decreased cap refill
what are neuro signs of cardiogenic shock (4)
- decreased LOC
- confusion
- anxiety
- agitation
what are renal signs of cardiogenic shock (3)
- oliguria
- sodium retention
- water retention
what can be used to diagnose cardiogenic shock (4)
- ECG
- chest xray
- echo
- lab findings
what are GI signs of cardiogenic shock (3)
- decreased BS
- NV
what lab findings are present in cardiogenic shock (5)
- increased cardic markers
- increased BG
- increased BUN
- cardiac enzymes
- troponin lvls
what is the goal of treatment for cardiogenic shock
- restore blood flow to myocardium and allow for perfusion
- restore balance between O2 demand and O2 supply
what are definitive measures to restore blood flow (4)
- thrombolytic therapy
- angioplasty w stent implantation
- emergency revascularizatio
- valve replacement
what should be performed as soon as possible after the initial insult (2)
- cardiac catheterization
- PCI (coronary angioplasty) w or without stent implantation
what should be done until cardiac catheterization and PCI can be performed
- SV and CO must be optimized to facilitate optimal perfusion
what are other treatment measures are used for cardiogenic shock (6)
- O2
- cardiac drugs (dependent on cause & complications)
- mechanical interventions
- reperfusion
- meds
- cardiac monitoring (ECG)
what are 3 options of treatment to get reperfusion (3)
- PCI
- CABG
- fibrinolytic therapy
what meds can be used in treatment of cardiogenic shock (5)
- inotropes
- vasopressors
- diuretics (if pulm. edema)
- aspirin (if acute MI)
- antiarhythmics
what meds should be avoided in the acute stage of cardiogenic shock (2)
- beta blockers
- nitrates
what mechanical interventions can be used in treatment of cardiogenic shock (2)
- ventricular assist device
- intra-aortic balloon pump
what is the biggest difference between cardiac shock and other types of shock?
- cannot be treated with rapid fluid replacement bc the heart cannot handle the extra fluid
what are some nursing diagnosis r/t cardiogenic shock (8)
- 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
what are some nursing interventions for shock mngmt (8)
- 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
what cardiac nursing interventions can be done for shock mngmt (6)
- 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
what vasogenic interventions can be done for shock mngmt (4)
- 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
what nursing interventions r/t volume can be done for shock mngmt (6)
- 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
a nursing diagnosis r/t shock is anxiety. what nursing interventions can be done for this (8)
- 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
