Cardiogenic Shock

Shock, medical surgical, med surg, Cardiac

Video Transcript 

The today's video, we're going to be talking about cardiogenic shock. And if you enjoy this video, make sure to subscribe to the channel and give it a thumbs up. We post all nursing content to help you guys get through nursing school and better understand the concepts that you will need to know for NCLEX and your nursing exam.

So this video is on cardiogenic shock. Let's get into it.

Okay. So what is cardiogenic shock? It is the condition of diminished cardiac output that severely impairs cardiac perfusion. It reflects severe left sided, heart failure.

The pathophysiology is the inability to contract. When the myocardium can't contract sufficiently to maintain adequate cardiac output, the stroke volume decreases and the heart can't eject an adequate volume of blood with each contraction. This can lead to pulmonary congestion. This is when the blood backs up behind the weekend, left ventricle and it includes preload and causes. Pulmonary congestion. Compensation is in addition to compensating for the drop of stroke volume the heart rate increases in an attempt to maintain cardiac output, which leads to and diminished stroke volume, which is the results of the diminished stroke volume, coronary artery perfusion and collateral blood flow is decreased, which increases the workload, all of the mechanisms, including the heart's workload and enhanced left sided heart failure.

So the end result is that the myocardial hypoxia, which further decreases cardiac output and triggers a conference, compensatory mechanism to prevent decompensation and death.

So classification there is coronary and non-coronary. So coronary is patients with acute MI's and non-coronary is conditions that stress the myocardium as a result of conditions that result in an ineffective myocardial functioning. So statistics and incidences. So cardiac shock occurs as a serious complication in five to 10% of patients who are hospitalized with acute myocardial infraction.

Historically mortality of cardiogenic shock has been 80 to 90%. That is so high, but recently studies have indicated that has dropped to between 56 and 67 due to advert thrombolytics improved interventional procedures and better therapies. Incidences of cardiogenic shock is more common in men and women because of their higher incidence of coronary artery disease.

So the causes of cardiogenic shock is myocardial infraction. So regardless of the underlying cause this is when the left ventricle dysfunction sets in motion, a series of compensatory mechanisms that attempt to increase cardiac output, but later on leads to deterioration, myocardial ischema, which the compensatory mechanism may initially stabilize the patient.

But later on would cause deterioration with the rising demands of oxygen on the already compromised myocardium. And end-stage cardiomyopathy the inability of the heart to pump enough blood for the system causes cardiogenic shock. So clinical manifestations, you may see clammy skin. The patient will have cool clammy skin as the blood cannot circulate properly to the peripheries. You may see a decreased systolic blood pressure, which can decrease to a 30 points below their normal baseline. You may see tachycardia because the heart is pumping faster than normal to compensate for the decreased output all over the. You may see rapid respirations. These will be rapid shallow respirations because there's not enough oxygen circulating in the bloody body.

You may see olguria. So this is when there's a decreased output of urine, which will be less than 20 MLS per hour. You may see mental confusion because of insufficient oxygen to the brain. And you may see cyanosis because again, insufficient oxygen is being distributed all over the body. So as the nurse, our assessment and diagnostic findings.

So we are going to use auscultation to detect Gallup rhythms, faint heart sounds. If the shock results from a rupture of the ventricular septum or papillary muscles, a wholly-owned systolic murmur may be present. Pulmonary artery pressure is something else that we're going to look at, which may show. If there is an increase in pulmonary artery pressure, it will reflect a rise in the left ventricle.

And diastolic pressure and an increased resistance to the afterload. We may also use arterial pressure monitoring. This is an invasive arterial pressure monitoring, which indicate, which can indicate hypotension due to impaired ventricular ejection. We may look at ABG analysis. So these are arterial blood gas analysis, which may show metabolic acidosis or hypoxic.

We may look at an electrocardiogram to show the evidence of an acute MI, ischemia or ventricular aneurism. We may look at an echocardiogram, which can determine left ventricular function and reveal valvular abnormalities. And we may look at enzyme levels, such as lactic, dehydrogenase, creatine, kinase, aspartame, aminotransferase, and alanine aminotransferase, which can all confirm an MI.

So the medical management of a patient dealing with cardiogenic shock is going to be oxygen to minimize damage to muscles and organs. They may have an angioplasty and stunting. So this is a catheter is inserted into the blocked artery to open it up. They may have a balloon pump, which is inserted into the aorta to help blood flow and reduce the workload of the heart.

They may be given some pain control. If they are experiencing chest pain, there may be some Ivy and morphine for pain relief. We may also do some hemodynamic monitoring through an arterial line which can help to give an accurate and continuous monitor of the blood pressure also provides a port for which can obtain frequent arterial blood samples in fluid management.

So we may administer some fluids but they must be monitored closely to detect signs of fluid overload.

So the pharmacological management for these patients may include IV dopamine, which is a vasopressure it increases cardiac output, blood pressure and renal blood flow. They may be given some IV dobutamine , which is an agent that may increase myocardial contractility. They may also be given some norepinephrine which is a more potent vasoconstrictor that is taken. That there'll be that they'll give when it's necessary. And IV nitroprusside which is a vasodilator that may be used with a vasopressor to further improve cardiac output by decreasing peripheral, vascular resistance and reducing preload. So the surgical management will include a mechanical assisted device that attempts to improve the coronary artery perfusion and decreased cardiac workload through an inflatable balloon pump, which is surgically inserted through the femoral artery, into the descending thoracic aorta. And this is called an intra aortic balloon pump. And as you can see during diastolic, the balloon inflates hindering systole, the balloon deflates. So our nursing assessment is going to include vital signs. We'll be assessing all of the vital signs, including blood pressure. It's mostly important.

There's also, we'll be looking at, in assessing fluid overload. So the ventricles of the heart cannot fully object the volume of blood at systole. So fluid may accumulate in the lungs and want to be watching for that.

So our nursing diagnoses could include things like decreased cardiac output related to changes in myocardial contractility, impaired gas exchange related to changes in aveolar and capillary membrane, excess fluid volume related to decrease in renal organ perfusion, increased sodium and water hydrostatic pressure increased or decreased plasma protein. Ineffective tissue perfusion related to reduction of blood flow, acute pain related to ischemic tissue, secondary to blockage or narrowing of coronary arteries and activity tolerance related to imbalance between oxygen supply and needs. All right. So nursing care planning and goals. So when we are caring for these patients, we want to prevent recurrence of cardiogenic shock.

We want to monitor their hemodynamic status. We want to administer medications and intravenous fluids, but remember to be monitoring those intervene. If they're getting intravenous fluids, we need to monitor for fluid overload and maintain it. Intra aortic balloon counterpulsation if they do have one of those inserted.

So our nursing interventions, we want to prevent the recurrence. So we want to identify patients at risk early and promote adequate oxygenation of the heart muscles. Decreasing cardiac workload can prevent this cardiogenic shock. We want to look at the hemodynamic status so we can have arterial lines and electrocardiogram monitoring equipment. We want to make sure the equipment is well-maintained and functioning. We want to monitor for the changes in hemodynamic cardiac and pulmonary status and laboratory values, making sure they're all documented what to be assessing. Those adventitious breath sounds changes in cardiac rhythm and other abnormal physical assessment findings should be reported immediately.

And we want to also use fluids. So IV infusions have to be observed closely because of, tissue, necrosis and slopping off can occur with vasopressin medications if they infiltrate in the tissues. So we, you want to, if a patient is on an IV with a vasopressor, you're looking for infiltration. So is the arm or wherever it, is a swollen, is it red is a painful those are all things you want to be looking for. And we also want to monitor the taken output. A patient's output is really going to help to identify their renal status. So we just want to make sure. You know that the patient is having an adequate output of the urine, but also noting their intake.

Make sure they're not holding onto water. Also we want to be maintaining that intra aortic balloon. Device. The nurse makes ongoing timing adjustments of the balloon pump to maximize its effectiveness. By synchronizing it with the cardiac cycle. We want to enhance safety and comfort. So administering of medications to relieve chest pain, preventing infection at the arterial and venous line insertion sites. We want to protect the skin and monitor respiratory and renal functions to help enhance patient comfort and safety arterial blood gases. We want to monitor values to measure oxygenation and detect acidosis from poor tissue perfusion.

And we also want to use positions. If a patient has that inter aortic balloon pump, we want to reposition them and perform passive range of motion exercises to prevent skin breakdown. But we don't want to flex the patient's ballooned leg at the hip because this may displace or fracture the catheter because remember they're going in through that femoral artery.

So just things to keep in mind. So our evaluation, we want to prevent recurrence of the cardiogenic shock. We want to monitor that hemodynamic status. We want to administer the meds and again, maintain that balloon pump. All right. So discharge and home care. We want to control hypertension. We want to teach the patients about exercise, managing stress, maintain a healthy weight and limit salt and alcohol intakes.

We also want to teach them to avoid smoking because the risk of stroke is the same for smokers. And even non-smokers after you stopped smoking, smoking is just not good for your heart health. In general, we want to maintain. Teach them to maintain a healthy weight. So losing extra pounds can be helpful in lowering cholesterol and blood pressure.

We want to promote eating a good diet that is eating less saturated, fat, and cholesterol to reduce heart disease. And we want to promote exercise daily to lower blood pressure increase high density lipoproteins so that's that good cholesterol and improve overall health. In the blood vessels and heart.

All right. So our documentation, so we want to do a baseline and subsequent findings for the individual because we want to be able to see is. Blood pressure going up. Is it going down as a heart rate, going up, going down. So you want the baseline and you want a further documentation. You want to do this again with heart and breath sounds, looking at ECG patterns, the present and strength of peripheral pulses, skin, and tissue status, renal output, and their mental status.

We also want to document respiration, rate character breath sounds frequency. Any secretions, any presence of cyanosis laboratory findings and again, mental status conditions that may interfere with the oxygen supply. We want to document any conditions contributing to fluid retention. We want to look at fluid balance.

I an O's, pulses of blood pressures. We want to document the client's pain and their description of the pain. What they describe as the acceptable level of pain. And we want to document pain med is used. And then once you give a pain medication, you also want to document their patient's response to those medications.

So did they find relief? So we want to look at baseline and current findings. Again, these are the same thing, heart and breath sounds. EKG is and

all right. And then we also want to include in our documentation, our plan of care, our teaching plan, the client's response to our interventions and actions performed. Status and deposition at discharge. Are they excited to go home? Are they hopeful? Are they scared? How were they feeling? Attainment or progress towards desired goals and any modifications made to the plan of care.

All right. So that is the information on cardiogenic shock. If you guys found this helpful, make sure to subscribe to the channel and give this video a thumbs up, and we have a lot more videos about things that you need to know in nursing school. So hope you found this helpful, and I will see you soon.

Thank you. Bye.