Term
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Definition
nOften defined as :PUMP FAILURE
nMEDICAL EMERGENCY
nGoal of Treatment: PREVENTION
nLife-threatening condition
nHigh mortality rate: 50-80%
nEarly intervention REQUIRED to interrupt the vicious cycleà mortality risk increases as person moves thru Stage1à Stage 4
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Term
| clinical manifestations of cardiogenic shock |
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Definition
nS&S of ACUTE HEART FAILURE
nAcute SOB
nTachypnea
nHYPOXIA
nRestlessness
nChange in Mental Status/confusion
nDecreased pulse ox
nSHOCK SYNDROME
nAcute Hypotension
nTachycardia: weak/thready pulse
nCold clammy skin (hypo-perfusion)
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Term
4 stages of cardiogenic shock-what happens at each?
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Definition
nInitial Stage:
nasymptomatic
nCompensatory Stage:
nCatecholaminesà Vasoconstriction
nProgressive Stage:
nDisarrayà anaerobic metabolism & metabolic acidosis
nRefractory Stage:
nTOTAL disarrayà losing the fightà DIC & MOF
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Term
| goals of cardiogenic shock management |
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Definition
nReduce Cardiac Demand
nCorrect Underlying cause
nImprove Oxygenation
nMaintain BP
nCorrect Acidosis
nMaintain normal glucose levels
nThrombolytics
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Term
| interventions of management of cardiogenic shock |
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Definition
nAGGRESSIVE TREATMENT to Correct Underlying Causeà STOP the PROGRESSION
nCorrect underlying dysrhythmia
nCorrect hypo or hypervolemia
nReduce Cardiac demand
nImprove oxygenation
nMaintain Blood Pressure
nPharmacologic therapyà to reduce cardiac workload
nCorrect pump-failure
nAssistive devices (IABP)
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Term
| medication managment of cardiogenic shock |
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Definition
Positive Inotropics (next slide)
nVasodilators-adenosine, epi
nDiuretics
nVasopressors-fighting hypotension
nThrombolytics
nSodium Bicarbonate
nBeta-blockers
nMorphine
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Term
| positive ionotropics and cardiogenic shock |
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Definition
nGoal: increase force of myocardial contraction
nDobutamine, Epinephrine, Amrinone
nCan cause tachy-dysrhythmias
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Term
| vasodilators and cardiogenic shock |
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Definition
nGoals: reduce volume returning to heartàdecrease cardiac workload, also decrease BP (caution!!)
nNitroglycerine
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Term
| diuretics for cardiogenic shock |
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Definition
nGoal: reduce cardiac workload, reduce pre-load& afterload
nIV Lasix-drug of choice
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Term
| goal for cardiogenic shock |
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Definition
nGoal: reduce pre-load, decrease anxiety & impending doom
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Term
| other medications for cardiogenic shock |
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Definition
nSodium Bicarbonate: correct metabolic acidosis
nThrombolytics: prevent clot formation
nBeta-blockers: decrease heart rate & decrease BP
nInsulin: to maintain euglycemia (normal blood glucose levels)
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Term
| vasopressors for cardiogenic shock |
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Definition
nNOT INDICATED IN EARLY STAGES OF CARDIOGENIC SHOCK
nGoal: Increase BP & Increase cardiac Outputàpromote perfusion of heart and brain (at the expense of other organs.. i.e. kidneys)à compromised perfusion to other vital organs
nIE: Dopamine, Epinephrine, Norepinephrine
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Term
| additional nursing considerations in the mangement of cardiogenic shock |
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Definition
nIV fluids: Normal Saline or Lactated ringers: maintain intravascular volume
nSupplemental Oxygen
nIntubation may be required
nMonitoring of VS & Lab Values
nBed rest
nParenteral Nutrition
nPain & anxiety control
nEmotional support for Patient & Family
nCalm environment and reassuring approach
nDealing with possible impending death (spiritual support)
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Term
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Definition
Catheter goes into any big artery, thread down into aorta, inflated during diastole, deflated during systole
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