NotesNursing Procedures and Skills

CARDIOGENIC SHOCK (Clinical Manifestations, Assessment and Diagnostic Findings, Medical Management and Drug Treatment)

Clinical Manifestations

Cardiogenic shock produces symptoms of poor tissue perfusion.

  • Clammy skin. The patient experiences cool, clammy skin as the blood could not circulate properly to the peripheries.
  • Decreased systolic blood pressure. The systolic blood pressure decreases to 30 mmHg below baseline.
  • Tachycardia. Tachycardia occurs because the heart pumps faster than normal to compensate for the decreased output all over the body.
  • Rapid respirations. The patient experiences rapid, shallow respirations because there is not enough oxygen circulating in the body.
  • Oliguria. An output of less than 20ml/hour is indicative of oliguria.
  • Mental confusion. Insufficient oxygenated blood in the brain could gradually cause mental confusion and obtundation.
  • Cyanosis. Cyanosis occurs because there is insufficient oxygenated blood that is being distributed to all body systems.

Assessment and Diagnostic Findings

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Diagnosis of cardiogenic shock may include the following diagnostic tests:

  • Auscultation. Auscultation may detect gallop rhythm, faint heart sounds and, possibly, if the shock results from rupture of the ventricular septum or papillary muscles, a holosystolic murmur.
  • Pulmonary artery pressure (PAP). PAP monitoring may show increase in PAP, reflecting a rise in left ventricular end-diastolic pressure and increased resistance to the afterload.
  • Arterial pressure monitoring. Invasive arterial pressure monitoring may indicate hypotension due to impaired ventricular ejection.
  • ABG analysis. Arterial blood gas analysis may show metabolic acidosis and hypoxia.
  • Electrocardiography. Electrocardiography may show possible evidence of acute MI, ischemia, or ventricular aneurysm.
  • Echocardiography. Echocardiography can determine left ventricular function and reveal valvular abnormalities.
  • Enzyme levels. Enzyme levels such as lactic dehydrogenase, creatine kinase. Aspartate aminotransferase and alanine aminotransferase may confirm MI.

Medical Management

The aim of treatment is to enhance cardiovascular status by:

  • Oxygen. Oxygen is prescribed to minimize damage to muscles and organs.
  • Angioplasty and stenting. A catheter is inserted into the blocked artery to open it up.
  • Balloon pump. A balloon pump is inserted into the aorta to help blood flow and reduce workload of the heart.
  • Pain control. In a patient that experiences chest pain, IV morphine is administered for pain relief.
  • Hemodynamic monitoring. An arterial line is inserted to enable accurate and continuous monitoring of BP and provides a port from which to obtain frequent arterial blood samples.
  • Fluid therapy. Administration of fluids must be monitored closely to detect signs of fluid overload.

Drug Treatment

Drug used may include:

  • IV dopamine. Dopamine, a vasopressor, increases cardiac output, blood pressure, and renal blood flow.
  • IV dobutamine. Dobutamine is an inotropic agent that increase myocardial contractility.
  • Norepinephrine. Norepinephrine is a more potent vasoconstrictor that is taken when necessary.
  • IV nitroprusside. Nitroprusside is a vasodilator that may be used with a vasopressor to further improve cardiac output by decreasing peripheral vascular resistance and reducing preload.
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Source: Nurseslabs

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Jude Arko

Chief Editor - Nursing In Ghana | Mental Health Nurse | Photog | App Developer
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